The Journal of hand surgery
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Case Reports
Digital Necrosis After Lidocaine and Epinephrine Injection in the Flexor Tendon Sheath Without Phentolamine Rescue.
The literature generally supports the safety of epinephrine injection in the digits, but recent case reports describe ischemic adverse events associated with the use of lidocaine and epinephrine in which phentolamine rescue was not performed. We present a case of finger necrosis and subsequent amputation in a patient after 1% lidocaine with 1:100,000 epinephrine was injected in the fat and flexor sheaths in the palm for a 3-finger trigger release. Phentolamine rescue was not performed. All surgeons who use epinephrine in the finger should be prepared to reverse vasoconstriction with phentolamine rescue if there is persistently inadequate perfusion of the fingertip.
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The forearm unit consists of the radius and ulna, a complex and interrelated set of joints (distal radioulnar joint, proximal radioulnar joint) and the soft tissue stabilizers between the 3 bones. Distally, this is represented by the triangular fibrocartilage complex at the wrist, proximally by the annular ligament at the elbow, and in the forearm by the interosseous membrane. Disruptions in any of these structures may lead to forearm instability, with consequences at each of the remaining structures.
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Traumatic nail bed injuries to the hand are a common problem for hand surgeons. Whereas the majority of those are treated with primary repair, the remainder present significant surgical challenges to address residual soft tissue defects. In this article, we present our approach to treating injuries to the fingertips utilizing single-layer bovine acellular dermal matrix grafts.
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To test the biomechanical properties of the dorsoradial capsulodesis procedure. ⋯ The DR capsulodesis procedure may improve rotational stability to the TMC joint.
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Review Meta Analysis Comparative Study
A Systematic Review and Meta-Analysis Examining the Differences Between Nonsurgical Management and Percutaneous Fixation of Minimally and Nondisplaced Scaphoid Fractures.
The optimal management of undisplaced scaphoid fractures remains controversial. A systematic review was conducted to assess the outcomes of acute, undisplaced scaphoid fractures managed with cast immobilization versus percutaneous or miniopen screw fixation in terms of time to return to work (RTW), time to union, and morbidity. ⋯ Therapeutic II.