The Journal of hand surgery
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Volar and percutaneous techniques of screw fixation for scaphoid fractures usually do not involve direct visualization of the dorsoproximal scaphoid articular surface. Intra-articular screw penetration may be overlooked if the proper fluoroscopic views are not obtained. The hypothesis of this study is that the pronated oblique fluoroscopic view of the scaphoid is the most sensitive in detecting dorsal articular screw penetration of the scaphoid when compared with other views. ⋯ This study confirms our hypothesis that the pronated oblique view is the most important fluoroscopic image to obtain when evaluating penetration of the proximal scaphoid articular surface.
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Perioperative management of systemic oral anticoagulants in patients having outpatient hand surgery.
Long-term oral anticoagulant therapy is frequently initiated in patients with elevated risk of venous or arterial thromboembolism. The most common indications for anticoagulation are chronic atrial fibrillation, mechanical heart valves, a history of venous thromboembolism, and hypercoagulable states. In the perioperative setting, these patients pose considerable challenges to physicians, who must weigh the thrombotic risks of therapy interruption against the bleeding risks of continuation. ⋯ Difficulties intrinsic to study design include a short duration of risk exposure, lack of patient uniformity, and rarity of baseline adverse events. Given the paucity of substantive evidence on which to base management decisions, physicians have long relied on clinical judgment to guide their choices. This review summarizes the available data specific to elective hand surgery and provide a general context in which evidence-based treatment decisions can be made.
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Comparative Study
Precontoured fixed-angle volar distal radius plates: a comparison of anatomic fit.
To compare distal radius volar fixed-angle plates for anatomic fit. ⋯ There was considerable variation in ideal plate location among the 7 plates tested. Total contact was minimal for all plates tested. The Synthes EA pin-subchondral bone distance was significantly greater than those of other plates tested. Joint penetration was relatively common, necessitating use of fluoroscopy and proper plate width.
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Scaphoid nonunions are a common complication of scaphoid fractures and frequently progress to degenerative arthritis. This study evaluated the effect of scaphoid nonunion on the in vivo kinematics of the radioscaphocapitate articulation. ⋯ Scaphoid nonunions have a dramatic impact on carpal kinematics, partially uncoupling the proximal and distal carpal rows. Although the results of this in vivo study differ from past in vitro studies, the increase in lunocapitate motion we identified is consistent with the current theory that the scaphoid acts as a fundamental link between the proximal and distal carpal rows.