The Journal of hand surgery
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Acute carpal tunnel syndrome that follows radial artery cannulation has been described. To determine the incidence and predisposing factors, we prospectively studied 151 patients who had perioperative radial artery cannulation. Postoperatively 9 of the 151 patients had symptoms of carpal tunnel syndrome with positive Phalen and Tinel signs on the side on which the radial artery catheter had been inserted. ⋯ The use of perioperative anticoagulation, the use of wrist-extension splints, and the duration of radial artery cannulation did not influence acute exacerbation of carpal tunnel syndrome. Patients with a prior history of carpal tunnel syndrome are at increased risk of recurrent symptoms after radial artery cannulation. We found no statistically significant relationship between traumatic cannulations and the development of symptoms of carpal tunnel syndrome.
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From 1985 to 1990, 167 patients were treated for impaired elbow flexion caused by brachial plexus injury. Surgical procedures were divided into two categories: nerve reconstruction (128 patients) and muscle or tendon transfers (39 patients). Surgery in the nerve reconstruction group included direct suturing, nerve grafting of portions of the brachial plexus responsible for elbow flexion, or nerve transfer (intercostal, phrenic, or spinal accessory nerve) to the musculocutaneous nerve. ⋯ Intercostal nerve transfer to the musculocutaneous nerve has satisfactory results. In the muscle tendon transfer group, Steindler flexorplasty resulted in upgrading muscle strength from level one to level two. Functioning free muscle transplantation had results similar to the latissimus dorsi transfer.
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Low-velocity gunshot wounds of the metacarpal: treatment by early stable fixation and bone grafting.
The results of early stable fixation of 64 metacarpal fractures due to low-velocity gunshot wounds in 49 patients were reviewed retrospectively. These reconstructive procedures were performed between 1 and 7 days after injury and involved stable internal fixation supplemented with primary iliac crest bone graft in 40 fractures with bone loss or comminution. Postoperatively, the hands were splinted with 90 degrees of metacorpophalangeal flexion while early interphalangeal motion was emphasized. ⋯ Complications included two superficial infections. There were no cases of deep infections or persistent draining wounds. Early, stable fracture fixation of these injuries achieved union, alignment, and early rehabilitation with no appreciable increase in morbidity.
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Although radial nerve palsy associated with a closed humeral shaft fracture may be managed by observation, it is our experience that an open humeral shaft fracture with radial nerve palsy requires exploration of the nerve. In a series of 14 patients with radial nerve palsy caused by an open humeral shaft fracture, 9 (64%) of the 14 patients had a radial nerve that was either lacerated or interposed between the fracture fragments. ⋯ Epineural radial nerve repair, done primarily or secondarily, provided a satisfactory return of radial nerve function. Rigid fixation of the associated fracture is the recommended treatment.