The Journal of hand surgery
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Comparative Study
Distal radius fractures: a comparison of tension band wiring versus ulnar outrigger external fixation for the management of distal radioulnar instability.
To retrospectively compare the results of immobilization of the forearm in supination with the results of tension band fixation of the ulnar styloid in 35 patients with distal radius fractures, fracture of the base of the ulnar styloid, and distal radioulnar joint instability treated with external fixation. ⋯ Our results indicate that patients in whom the ulnar styloid can be reduced and maintained in supination can be treated effectively with fixed supination outrigger external fixation. This method resulted in a statistically significant improvement in supination and a lower rate of distal radioulnar joint complications, and it required fewer secondary procedures.
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Carpal kinematics have been studied widely yet remain difficult to understand fully. The noninvasive measurement of carpal kinematics through medical imaging has become popular. Studies have shown that with radial deviation the scaphoid and lunate flex whereas the capitate moves radiodorsally relative to the lunate. This study investigated the midcarpal and radiocarpal contributions to radial and ulnar deviation of the wrist. This was accomplished through noninvasive characterization of the scaphoid, lunate, and capitate using 3-dimensional medical imaging of the wrist in radial and ulnar deviation. ⋯ Radioulnar deviation (in-plane motion) occurred mostly through the midcarpal joint, with a lesser contribution from the radiocarpal joint. The results of our study agree with previous investigations that found the scaphoid and lunate flex in radial deviation (out-of-plane motion) relative to the radius whereas the capitate extends (out-of-plane motion) relative to the scaphoid/lunate (with the converse occurring in ulnar deviation). Our study shows how these out-of-plane motions combine to produce in-plane wrist radioulnar deviation. The use of 3-dimensional visualization greatly aids in the understanding of these motions. The results of our study may be useful clinically in understanding the consequences of isolated midcarpal fusions in the treatment of wrist instability.
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To present our results in the treatment of late-presenting impaction fractures of the base of the middle phalanx treated by osteotomy with full exposure of the articular surface to restore the normal anatomy. ⋯ Favorable results have been achieved in this challenging scenario in the short- and middle-term in 9 of 10 patients. Previous surgery and moderate to severe wearing of the cartilage of the proximal phalanx head negatively affected the results.
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A compressive or conforming dressing is an important aspect of hand surgery, particularly the role of uniform pressure to the entire hand. Pediatric hand patients require special considerations with respect to appropriate postoperative dressing to maintain equal limb compression and to maintain the dressing during the postoperative period. This article describes a specific upper-limb hand dressing that can be used in the infant and young child.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized prospective study on the treatment of intra-articular distal radius fractures: open reduction and internal fixation with dorsal plating versus mini open reduction, percutaneous fixation, and external fixation.
To compare 2 methods of surgical treatment for displaced intra-articular fractures of the distal radius: open reduction and internal fixation with dorsal plating (Pi Plate; Synthes, Paoli, PA) versus mini open reduction with percutaneous K-wire and external fixation. ⋯ At midterm analysis the dorsal plate group showed a significantly higher complication rate compared with the external fixator group; therefore enrollment in the study was terminated. The dorsal plate group also showed statistically significant higher levels of pain, weaker grip strength, and longer surgical and tourniquet times. Based on these results we cannot recommend the use of dorsal plates in treating complex intra-articular fractures of the distal radius.