The Journal of hand surgery
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Multicenter Study
Reasons why rheumatoid arthritis patients seek surgical treatment for hand deformities.
Previous studies have found that function and pain are the main factors that persuade physicians to recommend surgical reconstruction to patients with rheumatoid arthritis (RA). The factors that influence patients to choose surgical reconstruction, however, are not known fully. The purpose of this study was to determine how function, pain, and aesthetics rank in order of importance to RA patients who are considering metacarpophalangeal (MCP) joint arthroplasty for rheumatoid hand deformities. ⋯ Impaired function had the strongest association with patients choosing reconstruction and pain relief was the next most important factor. Although aesthetic consideration was less important, it may prove to be an important factor in determining patient satisfaction after surgery. Understanding which factors are associated with choosing rheumatoid hand reconstruction is an essential component of patient preoperative counseling.
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Radial head fractures are a particularly common yet challenging problem facing orthopedic surgeons today. Over the years multiple treatment modalities have been used including conservative management, open reduction and internal fixation, head excision, and radial head arthroplasty. The clinical outcome studies of metallic radial head arthroplasty systems indicate that head replacement is a reasonable option to offer patients with comminuted radial head fractures and complex elbow trauma. ⋯ A description of the stabilizing structures of the elbow as they relate to radial head fractures also is included. Surgical considerations that relate to radial head arthroplasty are detailed and encompass arthroplasty indications, surgical technique, postoperative rehabilitation, and complications. Finally the arthroplasty outcomes literature and a review of current implant options also are discussed.
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Comparative Study
Comparison of pullout button versus suture anchor for zone I flexor tendon repair.
To evaluate the clinical outcome after repair of zone I flexor tendon injuries using either the pullout button technique or suture anchors placed in the distal phalanx. ⋯ Therapeutic, Level III.
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To introduce a new technique of 1-stage reconstruction for thumb loss complicated by thumb-index web space contracture and to report its clinical effectiveness. ⋯ Therapeutic, Level IV.
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To report the results of combined nerve transfer in C5 and C6 brachial plexus avulsion injury. ⋯ Therapeutic, Level IV.