The Journal of hand surgery
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The simple, percutaneous placement of a smooth pin into the head of the proximal phalanx creates an extension block, which prevents subluxation of the middle phalanx and allows early active flexion of the proximal interphalangeal joint. Three case reports involving this new treatment are presented along with a detailed description of the technique.
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Magnetic resonance imaging (MRI) was used to determine cross-sectional areas and volumes of carpal canals and carpal canal contents in five cadaver specimens in an assessment of the reliability of MRI for establishing contents/canal ratios. Volumes of the carpal canals and their contents were accurately calculated from MRI with a previously described correction factor (0.8161) for carpal tunnel volumes and a calculated correction factor (1.078) for carpal tunnel contents volume. ⋯ Cross-sectional area contents/canal ratios were significantly higher (p = 0.0001) at the level of the distal aspect of the hook of the hamate (0.54) as compared with those at the level of the distal radial styloid (0.42) and proximal metacarpals (0.44). MRI provides an effective and reliable means of determining contents/canal ratios from both cross-sectional area and volume calculations.
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To date there have been no experimental studies specifically directed at effects of reperfusion intervals on skeletal muscle injury beneath the tourniquet. 99mTechnetium pyrophosphate (Tc 99) incorporation and correlative histology were used to assess injury 2 days after tourniquet application in muscles beneath (thigh) and distal (leg) to the cuff. Tourniquets were applied to rabbit hindlimbs for a total of either 2 or 4 hours. In the 4-hour series, tourniquet compression (either 125 mm Hg or 350 mm Hg cuff inflation pressure) was either continuous or interrupted by 10-minute reperfusion intervals after 2 hours or after every hour of cuff inflation. ⋯ With a 2-hour tourniquet time, Tc 99 uptake in the thigh was significantly decreased by reperfusion after 1 hour of cuff inflation. Previous clinical recommendations, based on serum creatine phosphokinase abnormalities after experimental tourniquet ischemia, probably reflected tourniquet compression injury. Hourly reperfusion limits skeletal muscle injury during extended periods of tourniquet use.
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Randomized Controlled Trial Clinical Trial
Exogenous hyaluronate as an adjunct in the prevention of adhesions after flexor tendon surgery: a controlled clinical trial.
Postoperative adhesions that restrict tendon gliding are a major cause of failure after tendon repair and grafting in zone II. Several experimental reports have claimed that exogenously administered sodium hyaluronate helps to prevent the formation of such adhesions. In a prospective double-blind, randomized, clinical study with open therapeutic control sodium hyaluronate or physiologic saline solution was injected into the tendon sheath after completion of tenorrhaphy or tendon grafting in 120 digits. Sodium hyaluronate had no statistically significant effect as evaluated on total active motion at follow-up.
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This study evaluates the effectiveness of continuous intravenous regional anesthesia for prolonged operations on the upper extremity. The factors evaluated include patient's sex and age, number of procedures performed, tourniquet on and off times, anesthetic doses, adjunctive drugs used, technical complications, and side effects. Seventy-two procedures were done on 34 patients. ⋯ There were two (6%) technical complications and two (6%) patients had side effects. Continuous intravenous regional anesthesia offers the prolonged anesthesia of brachial plexus block or general anesthesia and the safety, reliability, and ease of intravenous regional anesthesia. Continuous intravenous regional anesthesia should be considered an alternative choice of anesthetic method in upper extremity surgery.