The Journal of hand surgery
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To evaluate objective functional and radiographic outcomes after internal fixation of acute, displaced, and unstable fractures of the distal aspect of the radius in adults by using a low-profile dorsal plating system. Our hypothesis was that the low-profile dorsal plating system would allow for a reduction of extensor tendon irritation and pain and provide stable osseous fixation. ⋯ Therapeutic, Level IV.
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Many surgical procedures have been described for treating painful osteoarthritis at the carpometacarpal joint of the thumb. This article reports our clinical and radiographic results in performing suspensionplasty using the abductor pollicis longus (APL) tendon without tendon interposition after a complete trapeziectomy for patients with painful osteoarthritis in the carpometacarpal joint of the thumb. ⋯ Therapeutic, Level IV.
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To assess the biomechanical stability relative to screw length and K-wire augmentation in scaphoid fracture fixation using a flexibility testing protocol and cadaver scaphoids whose soft tissue attachments remained undisturbed. Our hypothesis was 2-fold: increasing screw length and augmenting fixation with a K-wire would improve fracture fragment stability, individually and in combination. ⋯ Under physiologically applied loading of cadaveric wrists with unstable scaphoid waist fractures the long screw provided significantly greater stability than the short screw. Although K-wire augmentation in the long-screw group did improve stability the improvements were not significant. Based in part on the biomechanical data from this study it is our recommendation that the optimally placed screw for scaphoid fracture fixation stability is a long screw positioned down the central axis of the scaphoid deep into subchondral bone.
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All perilunate fracture-dislocations combine ligament ruptures, bone avulsions, and fractures in a variety of clinical forms. The most frequent is the dorsal trans-scaphoid perilunate dislocation. In rare cases, however, these dislocations also have been associated with capitate fractures, triquetral fractures, or lunate fracture. We report a combined scaphoid and lunate fracture of the wrist that was not associated with perilunate dislocation.
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The postoperative monitoring of digit replants continues to be a challenge. Current objective methods of digit monitoring have not been adopted widely because of their complexity or lack of sensitivity. Because tissue oxygen tension correlates directly with vascular inflow, a device that tracks changes in tissue oxygenation may be useful to monitor the perfusion and viability of digits after revascularization. A clinical study was undertaken to evaluate noninvasive monitoring of tissue oxygenation using near-infrared spectroscopy in postoperative digit replantation. ⋯ Diagnostic, Level I.