The Journal of hand surgery
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A new surgical technique is described for the treatment of longstanding scaphoid nonunions with established degenerative changes and carpal malalignment. The technique is based on natural history and biomechanical studies and includes the excision of the distal scaphoid fragment and a limited arthrodesis that incorporates the proximal pole of the scaphoid, the lunate, and the capitate. Six men were treated with the procedure for symptomatic chronic scaphoid nonunions, and all limited arthrodeses fused. Pain relief was good to excellent, and range of motion averaged 50% of the contralateral side.
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A new epitendinal suture technique (cross-stitch) was used for flexor tendon repair in zone II in 46 consecutive patients with 55 injured digits. For the first 4 weeks after the operation, the digits were mobilized with a combination of active extension and passive and active flexion. Postoperative tendon excursions and gap formation were measured with intraoperatively placed metal markers. ⋯ Six months postoperatively the corresponding figures were 63 degrees and 94 degrees. Three weeks postoperatively the mean tendon excursions per 10 degrees of joint motion varied from 82% (distal interphalangeal joint motion) to 88% (proximal interphalangeal joint motion) of the maximum possible. The results indicate that the cross-stitch is a reliable suture technique that, when used in combination with a program incorporating early active and passive flexion, can produce very good results after flexor tendon repair in zone II.
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This prospective study reports on the use of the Herbert screw for fixation of fractures and nonunions of the scaphoid through a dorsal approach. In cases of delayed union and nonunion, screw fixation was combined with bone grafting. Twenty-five patients were treated in this manner, and union rates of 100% for acute fractures and 87% for delayed union and nonunion were achieved. We believe that the dorsal approach provides ready access to the scaphoid, enabling placement of the screw in the best possible position to provide fracture fixation.
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In 21 cadaver dissections the intramuscular anatomy of the musculocutaneous nerve and the relative relationship of the motor and sensory components of this nerve were evaluated. Nearly one half of the fibers entering the musculocutaneous nerve terminate in cutaneous receptors. We report five cases in which biceps reinnervation was performed by a surgical technique that minimizes the period of denervation by using motor nerves (medial pectoral nerves) very close to the biceps muscle. This technique also redirects the cutaneous portion (lateral antebrachial cutaneous nerve) of the musculocutaneous nerve into the biceps muscle to ensure that the motor fibers are not directed toward cutaneous receptors.
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Dynamic values of key vessel diameter, blood velocity, and flow rate in the upper extremity were obtained in 20 healthy volunteers by means of color flow Doppler imaging with a 7.5 MHz transducer. Recordings were made of the brachial, radial, posterior radial recurrent, ulnar, and digital arteries. Radial and ulnar vessels were evaluated at both wrist and midcarpal levels. ⋯ At the midcarpal level, flows ranged from 0.2 to 68.4 ml/min for the ulnar artery and from 0.8 to 42.9 ml/min for the radial artery. Variability between individuals was also demonstrated in artery dominance: eleven ulnar dominant, seven radial dominant, and two equal (within 25% of each other). The accuracy and ease of use of this technique in measurement of vessels are limited when vessels are less than 1.5 mm in diameter although the technique provides quantitative values to 0.5 mm.