The Journal of hand surgery
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Thirteen injured digits in 10 patients (10 hands) with 20 potentially injured flexor tendons were preoperatively evaluated using real-time ultrasonography. The time interval between injury and ultrasonographic evaluation averaged 22 days. If a complete tendon laceration was found, the location of the proximal tendon stump was determined. ⋯ With complete tendon lacerations the location of the proximal tendon stump was accurately identified in 5 of 6 digits. There were 2 false ultrasound findings, including incorrectly identifying a 75% laceration in an intact index flexor and a complete tendon laceration in a 75% lacerated index finger flexor. Ultrasonography can help to evaluate the preoperative status of injured flexor tendons and, in cases of completely lacerated tendons, can help identify the location of the proximal tendon stump.
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Comparative Study
Kinematics of the proximal interphalangeal joint of the finger after surface replacement.
Nine fresh-frozen normal human cadaveric long fingers were used to compare the kinematics of the proximal interphalangeal joint (PIP) before and after a resurfacing metal-polyethylene prosthetic replacement (Avanta prosthesis, San Diego, CA) using the magnetic Isotrak system (Polhemus Navigational Systems, Colchester, VT). The kinematics of the PIP joint after replacement were similar to that of the normal joint. ⋯ The center of rotation after implant insertion was nearly identical to the center of rotation of the normal joint. This anatomically designed PIP prosthesis has potential to restore normal motion to the finger PIP joint while resisting physiologic out-of-plane forces such as pinch and grasp.
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Comparative Study
Comparison of ulnar shortening osteotomy and the wafer resection procedure as treatment for ulnar impaction syndrome.
A retrospective review was performed that compared the results of 2 different surgical treatments for ulnar impaction syndrome in 22 patients over a 6-year period. Ulnar shortening osteotomy and wafer distal ulna resection (wafer resection procedure) were each performed in 11 patients based on the preference of 3 individual hand surgeons. All patients presented with ulnar wrist pain and positive ulnar variance on either neutral rotation or pronated-grip x-rays and each failed conservative management. ⋯ There was 1 poor result in the wafer group that required revision to complete resection of the distal ulna. Five secondary procedures were required in the osteotomy group to remove painful hardware and union was delayed in 2 patients. Although ulnar shortening osteotomy provides effective treatment for ulnar impaction syndrome, the wafer resection procedure provides favorable pain relief and restoration of function but without the potential for nonunion or hardware removal. (J Hand Surg 2000; 25A:55-60.
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The pi plate (Synthes Ltd, Paoli, PA) was designed to fit the unique contour of the dorsal aspect of the distal radius. Complications of pi plate fixation of the dorsal distal radius have been previously reported to include both extensor tenosynovitis and delayed extensor tendon rupture. We report a case of rupture of the flexor pollicis longus tendon associated with inappropriate placement of the pi plate on the volar surface of the distal radius.
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Extensor triggering is an uncommon but recognized component of de Quervain's stenosing tenosynovitis. In a retrospective review of 827 patients with the diagnosis of de Quervain's disease over a 5-year period, 11 patients with 13 affected wrists were identified who had demonstrable triggering by both history and physical examination (prevalence of 1.3%). One wrist underwent surgical release without conservative treatment. ⋯ After an average follow-up period of 42 months (range, 5.7-94.5 months) there were no recurrences of triggering after surgical treatment. Seven of 12 wrists with triggering de Quervain's stenosing tenosynovitis failed nonoperative treatment. Triggering or locking in extension is an uncommon symptom in de Quervain's stenosing tenosynovitis and demonstrates a more recalcitrant course when treated nonoperatively.