The Journal of hand surgery
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Seven fresh cadaveric specimens were used to determine the loss of forearm rotation with varying distal radius fracture malalignment patterns. Uniplanar malunion patterns consisting of dorsal tilt, radioulnar translation, or radial shortening were simulated by creating an osteotomy at the distal end of the radius, orienting the distal fragment position using an external fixator, and maintaining the position with wedges and a T-plate. Rotation of the forearm was produced by fixing the elbow in a flexed position and applying a constant torque to the forearm using deadweights. ⋯ Dorsal tilt to 30 degrees and radial translation to 10 mm led to no significant restriction in forearm pronation or supination ranges of motion. A 5-mm ulnar translation deformity resulted in a mean 23% loss of pronation range of motion. Radial shortening of 10 mm reduced forearm pronation by 47% and supination by 29%.
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The use of pedicled flexor digitorum superficialis tendon as a tendon graft in the second stage of flexor tendon reconstruction has the advantage of employing local intrasynovial tendon graft and allowing early active range of motion. This method of staged flexor tendon reconstruction was used in 47 patients between 1983 and 1993. Thirty-three patients were evaluated 1 year or longer after the second stage of surgery. ⋯ Three patients needed graft tenolysis. Postoperative persistent flexion contractures ranging from 8 degrees to 55 degrees of the proximal interphalangeal or distal interphalangeal joints or both were present in 88% of patients. Several factors that influenced the final outcome were identified: age over 25 years, zone II injuries of Boyes grade V, and the lack of a regular postoperative rehabilitation program were associated with relatively less successful final results.
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Comparative Study
Injection versus surgery in the treatment of trigger finger.
One hundred nine trigger fingers in 102 patients were reviewed with respect to management plan and response to treatment. Thirty-four digits eventually underwent surgical release of the A1 pulley, while the other 75 digits were treated with local steroid injection only. All patients were evaluated with respect to clinical resolution of symptoms, dollar cost of treatment, and general satisfaction as measured with a post-treatment questionnaire. ⋯ Although surgical release of the A1 pulley cost our Medicare patients $250.00 more than a second injection, this additional cost may be offset by the benefit conferred through permanency of relief. Subjective data from the patient questionnaire responses also support surgery as a reasonable choice after one injection failure. The information from this study better delineates differences between injection and surgery as treatment choices and may aid the patient and physician in choosing an individually optimal care plan.
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To evaluate the efficacy of arthroscopic repair of the triangular fibrocartilage complex (TFCC) tears treated within 4 months after injury, functional outcome after repair was determined following arthroscopic repair in 24 patients. The patients' average age was 31 years (range, 22-38 years); the average follow-up period was 34 months (range, 26-48 months). All patients had wrist pain limiting their participation in work prior to surgery. ⋯ Postoperatively, there was a significant relief of pain (p < .01). Postoperative range of motion averaged 89% +/- 9% SD of the contralateral side, and grip strength averaged 85% +/- 20% SD of the contralateral side. Thirteen of the 19 patients returning to work did so in their original jobs.