The Journal of hand surgery
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Randomized Controlled Trial
Long-term outcome of nonsurgically treated distal radius fractures.
To study the long-term outcome after nonsurgically treated distal radius fractures including recovery of grip strength, mobility, and radiographic parameters. ⋯ Our data indicate that a number of patients with nonsurgically treated distal radius fractures still experience some hand/wrist impairment a decade after the trauma. The severity of fracture displacement seems to influence the clinical outcome in contrast to patients' age. Recovery of grip strength is slower than that of range of motion. Elderly patients recover more slowly than young patients. Dorsal angulation was improved but remained considerable (13 degrees -18 degrees ), while final radial shortening (2-3 mm) increased from the injury status.
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Chronic scapholunate dissociation is the most common cause of symptomatic wrist instability. In an attempt to restore normal carpal mechanics and prevent wrist arthrosis, we developed and tested biomechanically the dorsal intercarpal ligament capsulodesis (DILC). Previously, we reported good early clinical results for this procedure at an average follow-up period of 25 months. Here, we report on the functional and radiographic outcomes at a longer follow-up period of a minimum of 5 years. ⋯ The DILC does not consistently prevent radiographic deterioration and the development of arthrosis in the long-term; however, the level of functionality and patient satisfaction remained relatively high in 58% of our patients, suggesting a lack of correlation between the radiographic findings and development of arthrosis and the functional outcomes and patient satisfaction. We believe that the DILC is still a reasonable option for treating flexible static scapholunate dissociation in patients without radiographic signs of arthritis presenting with wrist pain despite conservative treatment. Prevention of radiographic deterioration and arthrosis remains an unsolved problem.
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Patients with bilateral carpal tunnel syndrome (CTS) who had unilateral carpal tunnel surgery usually ask about the prognosis for the non-operated, opposite hand. In this study, we investigated the effects of unilateral carpal tunnel surgery on the clinical course of the non-operated, opposite hand in bilateral idiopathic CTS. ⋯ It seems that unilateral surgery for bilateral idiopathic CTS does not affect the clinical course of the non-operated, opposite hand. We recommend that each hand of patients with bilateral CTS be managed separately, based on their symptoms.
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To explore the course of the radial nerve in the brachium and to identify practical anatomic landmarks that can be used to avoid iatrogenic injury during humerus fracture fixation. ⋯ The radial nerve is at risk of injury with fractures of the humerus and with subsequent operative fixation in 2 areas. The first is along the posterior midshaft region for a distance of 6.3 cm +/- 1.7 centered at the distal aspect of the deltoid tuberosity. The second is along the lateral aspect of the humerus in its distal third from 10.9 cm +/- 1.5 proximal to the lateral epicondyle to the level of the proximal aspect of the metaphyseal flare. The deltoid tuberosity is a consistent and practical anatomic landmark that can be used to determine the level of the radial nerve along the posterior aspect of the humerus during operative fixation from an anterior approach.