The Journal of hand surgery
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Many modalities exist for diagnosing and treating lipofibromatous hamartoma (LFH), with no clear consensus. This is the first comprehensive study to review the existing literature on LFH of the median nerve and to suggest a systematic approach to its diagnosis and treatment. An electronic and manual search was conducted on Medline, Embase, Google Scholar, Current Contents, and Science Citation Index for original and review articles in English or French, from 1946 to November 2012. ⋯ Treatment of nerve compression symptoms and macrodactyly should be addressed separately. Carpal tunnel release is the mainstay of treatment for neuropathy, and ray or digital amputation, wedge osteotomy, middle phalangectomy with arthroplasty, and epiphysiodesis are suggested options in the management of macrodactyly. Based on our review of the literature, we propose an algorithm for the diagnosis and treatment of LFH of the median nerve with or without macrodactyly.
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Fractures of the scaphoid are the most common surgically treated carpal fracture, and early diagnosis is critical to minimize complications including osteonecrosis. If the initial radiographs after the injury are inconclusive, early magnetic resonance imaging (MRI) provides an immediate diagnosis to allow for proper management. This has been shown to be cost effective both in direct measureable costs and likely in difficult-to-measure indirect costs related to lost productivity. ⋯ MRI is the best imaging modality for assessing osteonecrosis of the proximal pole in a scaphoid nonunion. Unfortunately, the most useful imaging sequences remain controversial. My institution relies on the noncontrast T1-weighted images for the primary diagnosis of osteonecrosis with dynamic contrast enhancement used in a supplemental fashion.
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To investigate the outcomes of digital nerve repairs using processed nerve allograft for defects measuring 30 mm or less. ⋯ The data suggest that processed nerve allograft provides a safe and effective alternative for the reconstruction of peripheral digital nerve deficits measuring up to 30 mm.
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To evaluate a reconstructive method for chronic radial collateral ligament (RCL) injuries of the thumb metacarpophalangeal (MCP) joint using a combination of RCL advancement and the transfer of a half-slip of the abductor pollicis brevis tendon. ⋯ We recommend the reconstructive method of RCL advancement and transfer of a half-slip of the abductor pollicis brevis tendon to alleviate pain and improve grip and pinch strength in chronic RCL injuries of the thumb MCP joint.
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To investigate the outcomes of vascularized distal radius pedicled bone grafting secured with K-wires for scaphoid nonunions with small avascular proximal fragments. ⋯ Vascularized distal radius bone grafting and K-wire fixation can heal scaphoid nonunions with small avascular proximal fragments, although motion and grip strength remain unchanged. Healing may be related to the size of the proximal pole fragment.