The Journal of hand surgery
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Comparative Study
Analysis of the complications of palmar plating versus external fixation for fractures of the distal radius.
To evaluate whether there was a difference in complication rates in our patients treated with external fixation versus volar plating of distal radius fractures. We also looked for a difference in radiographic results; in the clinical outcomes of flexion, extension, supination, pronation, and grip strength; and in scores on the visual analog scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. ⋯ Therapeutic III.
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The cause of snapping in trigger finger is not clearly understood. The purpose of this study was to investigate the influence of stiffness of the first annular pulley on snapping in trigger finger patients with sonoelastography, a new technique for quantitative assessment of the stiffness of soft tissues. ⋯ Increased stiffness and thickening of the A1 pulley are considered to be causes for snapping in trigger finger, and corticosteroid injection can alleviate snapping by changing these 2 features.
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Scaphoid fracture nonunion remains prevalent, and it was our purpose to examine the initial care, fracture site, and patient gender and age to determine factors contributing to fracture nonunion. ⋯ The high rates of delayed presentation and incomplete evaluation and treatment suggest a strong need for better patient and doctor education on the subject of scaphoid injuries and nonunions particularly because the initial injury is, unfortunately, sometimes perceived as trivial. Nonunions do occur despite appropriate immobilization. Proximal pole fractures and fractures that show inadequate progression toward union while being treated in a cast should be considered for surgical intervention based on the high number of such cases identified in this study.
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This investigation tested the null hypothesis that psychological factors have no effect on patient satisfaction in a hand and upper limb practice. ⋯ In this study, the provider's sense that the patient was disproportionately uneasy with his or her symptoms was the only significant predictor of patient satisfaction, and this accounted for a small percentage of the variance in responses to these items. Patient satisfaction is complex, and the divide between medical advice and a patient's expectations are not easily reduced to one or more disease-specific or patient-specific factors.
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The diagnosis and management of complex regional pain syndrome is often challenging. Early diagnosis and intervention improve outcomes in most patients; however, some patients will progress regardless of intervention. Multidisciplinary management facilitates care in complex cases. ⋯ Multimodal treatment with hand therapy, sympatholytic drugs, and stress loading may be augmented with anesthesia blocks. If the dystrophic symptoms are controllable by medications and a nociceptive focus or nerve derangement is correctable, surgery is an appropriate alternative. Chronic sequelae of contracture may also be addressed surgically in patients with controllable sympathetically maintained pain.