Hand clinics
-
Surgical procedures for the treatment of ulnar nerve compression at the elbow are well described. Studies have reported clinical outcomes after decompression of the nerve without transposition and decompression with transposition. Numerous preoperative, intraoperative, and postoperative factors contribute to failure of the surgical procedures. Although the techniques available for revision decompression of the ulnar nerve at the elbow are similar to those used in the primary setting, the results after repeat surgical intervention are less predictable.
-
Diaphyseal fractures involving the radius and ulna, so called "both-bone" or "double-bone" forearm fractures are common orthopedic injuries. These injuries can result in significant loss of function if inadequately treated. ⋯ Preservation of the anatomic relationships of the proximal and distal radioulnar joints as well as the interosseous space is critical to preserving function. This article overviews the management of diaphyseal fractures of the radius and ulna in adults.
-
Carpal disorders in children are often associated with developmental abnormalities of structures surrounding the wrist. In addition, carpal ossification throughout childhood has unique influences on pediatric carpal injury. Because the immature carpus is composed of unossified cartilage, carpal abnormalities in young children are frequently undetectable on plain radiographs. Clinical suspicion of an abnormality may elicit further imaging with MRI, which can provide detailed information about cartilaginous structures.
-
Management of children's fractures requires a thorough knowledge of the developing skeleton, with recognition of the injury present and its potential course based on mechanism and anatomy, a dedication to complete and repeated clinical and radiologic examinations, and a willingness to intercede if unacceptable angulation or any rotation occurs in the course of treatment. The ability to remodel follows a well-defined course and may be anticipated within certain margins, but expectations of this ability should not be overemphasized or even contemplated outside the direction of joint motion. Growth arrest following injury, although a real concern, remains rare. Persistent stiffness, particularly at the PIP joint, occurs much more frequently than is perceived, particularly for phalangeal shaft, condylar, and neck fractures.
-
Many malunions of the finger metacarpals are mild and do not require or justify operative intervention. Early recreation of the fracture or osteotomy is more likely to be rewarded with favorable results than late operation. Rotational malunions of the metacarpals or proximal phalanges may be treated by transverse extra-articular transverse or step-cut osteotomies at or proximal to the malunion site. ⋯ Although multicenter studies have their own inherent flaws, they may represent the best future option to add a higher level of study design and validity as compared with past studies. The incorporation of subjective patient outcome instruments into future studies might also provide valuable information. Investigators should review previous reports with a goal of improving study designs and scientific methodology, confirming or contradicting past results, or adding new information.