The Journal of hand surgery
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Comparative Study
Comparison of 2 surgical approaches for volar locking plate osteosynthesis of the distal radius.
To determine whether a volar radial (Henry) exposure to the distal radius is associated with less median nerve dysfunction than a direct volar exposure of the distal radius through the carpal tunnel that has been abandoned due to median nerve problems. ⋯ Therapeutic III.
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Comparative Study
Comparison of neurotization versus nerve repair in an animal model of chronically denervated muscle.
Reinnervation of chronically denervated muscle is clinically unpredictable and poorly understood. Current operative strategies include either direct nerve repair, nerve grafting, nerve transfer, or neurotization. The goal of this study is to compare muscle recovery using microneural repair versus neurotization in a rat model of chronic denervation. ⋯ We demonstrated that neurotization is capable of reinnervating de novo end plates in chronically denervated muscle. Our data do not support the hypothesis that direct muscle neurotization is superior to nerve repair for functional restoration of chronically denervated muscle. However, as the duration of denervation increases, the difference between outcomes of the neurotization and repair group narrows, suggesting that neurotization may offer a viable surgical alternative in the setting of prolonged denervation.
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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
Diagnostic comparison of 1.5 Tesla and 3.0 Tesla preoperative MRI of the wrist in patients with ulnar-sided wrist pain.
The diagnostic sensitivity, specificity, and accuracy of 1.5 Tesla (T) and of 3.0T magnetic resonance imaging (MRI) are correlated with wrist arthroscopy findings in patients presenting with ulnar-sided wrist pain. ⋯ The sensitivity, specificity, and accuracy of 3.0T wrist MRI for the TFCC is consistently higher compared with those of 1.5T wrist MRI. The trend suggests that 3.0T wrist MRI provides improved capability for detection of TFCC injuries. Given the available sample size, however, the confidence intervals around the point estimates are wide and overlapping. Further studies are needed to confirm or refute our results of the estimated sensitivity, specificity, and accuracy parameters.
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Earlier reports have described characteristic fracture-dislocation patterns of the carpus and distal radius. Most result from a fall onto an outstretched arm, with an applied force directed in a radial-to-ulnar direction across the wrist. We present the clinical, radiographic, and arthroscopic findings noted with an unusual pattern of injury resulting from a force applied at the ulnar side of the wrist.