The Journal of hand surgery
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Three patients sustained burns of the hand in the operating room because of the lack of heat shields in the lights. A 54 degrees F increase in temperature in the operating field was noted when the heat shields were not in place.
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A number of adverse consequences can result in the upper limb from parenteral drug abuse. Propylhexedrine, a drug similar to amphetamine, is easily obtained and causes severe injury to the limb when injected intra-arterially. This report describes an inadvertent case of intra-arterial propylhexedrine injection into the radial artery, the natural course of which resulted in digital amputations. The cause and diagnosis of this injury is discussed, and a protocol for treatment is presented.
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A case of isolated traumatic avulsion of the tendon of extensor carpi radialis longus (ECRL) is described. Surgical repair was attempted 12 days later, but an early contracture of the muscle was encountered. ⋯ A year later the patient had residual weakness of wrist extension and hand grip. The likely cause of the early contracture of the muscle and the need for early and accurate reposition of extensor carpi radialis longus tendon are described.
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Transscaphoid fracture/dislocations treated with open reduction and Herbert screw internal fixation.
Six cases of dorsal transscaphoid perilunate fracture/dislocations and two cases of palmar transscaphoid lunate fracture/dislocations were treated by open reduction and internal fixation of the scaphoid with a Herbert screw. Supplemental Kirschner wire stabilization of the carpus was also used in the two cases of palmar transscaphoid lunate fracture/dislocation. ⋯ A clinical evaluation scoring system assessing pain, ability to function in an occupation, range of motion, grip strength, and radiographic appearance of the wrist was used. Based on this system the scoring of the six cases of dorsal transscaphoid perilunate fracture/dislocations that were treated was three excellent, one good, and one fair result, while the scoring of both palmar transscaphoid lunate fracture/dislocations showed poor results.
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Two cases of intra-articular median nerve entrapment after reduction of elbow dislocations in children are described. The diagnosis of median nerve entrapment is often delayed. A proximal median nerve deficit, limited passive elbow motion, and an associated medial epicondyle avulsion after reduction of a child's posterior elbow dislocation should alert the surgeon to the possibility of nerve entrapment. Optimal management of this problem consists of early surgical exploration and nerve release.