The Journal of hand surgery
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Multicenter Study Comparative Study
Comparison of functional outcome after volar plate fixation with 2.4-mm titanium versus 3.5-mm stainless-steel plate for extra-articular fracture of distal radius.
Open reduction and locked volar plate and screw fixation is a popular treatment method for extra-articular distal radius fractures with dorsal metaphyseal comminution. In this study, we compared the use of a titanium 2.4-mm precontoured plate with that of a stainless-steel oblique 3.5-mm T-shaped plate to test the null hypothesis that there would be no difference in wrist function or upper extremity-specific health status in the internal fixation of AO-type A3.2 distal radius fractures. ⋯ Therapeutic III.
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Although clinical outcomes of peripheral nerve injuries are often suboptimal, an adherence to well-established basic principles of evaluation and repair can optimize results of even the most complex injuries. Proper assessment of injury patterns both preoperatively and intraoperatively can guide treatment, and multiple repair techniques including strategies for overcoming both small and large gaps offer different advantages and disadvantages. New technologies and ideas address some unsolved problems, but more experience and research is necessary to elucidate fully their roles in the treatment algorithm.
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Randomized Controlled Trial
The incidence of intrinsic and extrinsic ligament injuries in scaphoid waist fractures.
To determine the incidence of associated intrinsic and extrinsic ligament injuries in patients with a nondisplaced or displaced scaphoid waist fracture. ⋯ In this study of acute scaphoid waist fractures, the overall incidence of associated ligament injuries was surprisingly high, at 34 of 41 wrists. Complete scapholunate ligament rupture was found in 10 of 41 wrists. This incidence is higher than previously reported and emphasizes the need for careful assessment of the intrinsic and extrinsic ligaments, particularly the scapholunate ligament, before deciding on treatment.
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This case series describes 4 patients with terrible triad injury of the elbow (dislocation with fractures of the radial head and coronoid) who were treated nonsurgically. Following nonsurgical treatment in this select group of patients, the elbow was well aligned, and the patients regained good elbow function. ⋯ One patient had surgery for residual stiffness, ulnar neuropathy, and a radial head deformity. We conclude that, in selected terrible triad cases, when the elbow is well aligned and the radial head and coronoid fractures are relatively small and minimally displaced after closed reduction and there is no mechanical block to motion, patients might regain good elbow function without surgery.
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Nerve growth factor (NGF), via the high-affinity receptor, tyrosine kinase A, has been widely reported as a mediator of pain caused by inflammation. A clinical trial has suggested that anti-NGF antibody is effective for pain caused by osteoarthritis of the knee. However, adverse events such as headache (8.9%), upper respiratory tract infection (7.3%), and paresthesia (6.8%) were reported. We hypothesized that inhibition of the low-affinity NGF receptor, p75 neurotrophin receptor (p75NTR), is also effective for joint pain and may reduce side effects. This study examined suppression of pain behavior and expression of pain-inducing neuropeptides such as calcitonin gene-related peptide (CGRP) and p75NTR in dorsal root ganglia neurons by a p75NTR inhibitory antibody in a rat model of wrist joint inflammatory pain. ⋯ p75NTR inhibition may be a therapeutic target for inflamed joint pain treatment with reduced adverse events.