The Journal of hand surgery
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Reflex sympathetic dystrophy syndrome is comprised of a variety of changes in vasomotor and trophic responsivity, as well as, stiffness, edema and severe pain. This study examined 20 patients with reflex sympathetic dystrophy syndrome who had failed to respond to a variety of techniques commonly used to treat this disorder. These patients had documented histories of reflex sympathetic dystrophy syndrome ranging from 18 to 60 months. ⋯ The results indicate that patients were able to significantly increase their initial (p less than 0.0001) and postrelaxation (p less than 0.0001) hand temperatures, as well as to significantly reduce their subjective pain ratings (p less than 0.0001). This reduction in pain was maintained at 1-year telephone follow-up, with 14 of the 20 patients returning to work by that time. This intervention was effective as a pain reduction strategy for our patients with reflex sympathetic dystrophy syndrome who had failed to benefit from other treatments.
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Twenty-four cases of nonvascularized nail bed grafting to correct nail deformities were reviewed. The highest success rate in improving the appearance of the deformed nail, 86%, was achieved when the split-thickness nail bed graft of sterile matrix was used to correct a nail deformity caused by a sterile matrix injury; the same procedure used to correct a nail deformity caused by a germinal matrix injury had a 0% success rate. Donor site morbidity occurred in 25% of split-thickness nail bed grafts and 100% of full-thickness nail bed grafts. The split-thickness nail bed graft of sterile matrix, if used in properly selected patients, will consistently improve the appearance of the deformed nail.
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Purpura fulminans is a rare disease that typically begins as a benign infectious process and subsequently progresses to severe sepsis, hypotension, purpura ecchymosis, and disseminated intravascular coagulation. We present an unusual case of an adult who was seen initially with pneumococcal sepsis that subsequently developed into purpura fulminans with major extremity involvement. A multidisciplinary approach is needed in the treatment of this often catastrophic disease.
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Twelve patients in whom radial artery infections developed after catheterization in an intensive care unit over a 2-year period were reviewed. The incidence of local infection was 0.4%. An increased risk of infection was associated with prolonged catheterization (greater than 4 days). ⋯ The five patients with infected aneurysms were treated successfully with antibiotics and surgical excision. The radial artery was reconstructed by use of a vein graft in one patient. We believe that patients not responding promptly to antibiotics or patients with infected aneurysms are best treated by surgical excision.
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An external fixator has been developed that is confined to the radius. It is lightweight, has a low profile, and its application is uncomplicated. ⋯ The radius mini-fixator has been effective in the treatment of unstable Frykman Type I and II Colles' fractures that account for 36.3% in Frykman's series. It has also been used to stabilize osteotomies of the radius for malunited Colles' fractures.