Hand clinics
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Phalangeal fractures in children are common, and conservative treatment leads frequently to a good functional outcome. Articular or displaced fractures require early re-cognition and special attention, including surgery. In children, remodeling occurs primarily in the sagittal plane, and rotational deformities are often unacceptable.
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Metacarpal fractures in the finger rays are common injuries in children's hands. Fractures of the finger metacarpals account for 10% to 39% of all hand fractures in children,especially in the 13- to 16-year age group. ⋯ Results following appropriate care of these fractures are generally good, although complications can occur. This article reviews fractures and dislocations involving the finger metacarpals in children, provides standard treatment algorithms, and highlights potential pit-falls in their management.
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Although RSL fusion is a viable option for isolated radiocarpal arthritis, the enthusiasm for this procedure should be tempered with the reality that kinematics of the wrist is not entirely suited for independent midcarpal flexion and extension [10]. Limited wrist flexion and extension is expected following a successful RSL arthrodesis. ⋯ In a young patient with posttraumatic arthritis or rheumatoid arthritis limited to the radiocarpal joint, however, RSL arthrodesis remains a viable alternative to complete wrist arthrodesis if the midcarpal joint is normal. Internal fixation with plates and screws and distal scaphoid excision are technical alternatives to consider when an RSL arthrodesis is performed.
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Wrist arthrodesis results in a high degree of patient satisfaction and predictable pain relief in most patients. Most patients are able to return to gainful employment, many without impairment. Some patients require restrictions and employment in a less strenuous occupation. ⋯ Donor site morbidity remains a concern when the iliac crest is used. Complications include hematoma formation, infection, injury to the lateral cutaneous femoral nerve, and prolonged discomfort. Successful outcomes have been reported with the use of local autogenous cancellous bone graft from the distal radius metaphyseal region.
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Revision of the treatment rationale for combined fractures of the scaphoid and distal radius is based on evolution of treatment goals. The trend toward early recovery of hand function requires rigid fixation of both fractures before the start ofa hand therapy program. It is clear that prolonged immobilization of the scaphoid fracture jeopardizes early motion protocols for the distal radius. ⋯ This final step is accomplished by dorsal percutaneous implantation of a cannulated headless compression screw along the central scaphoid axis. Dorsal percutaneous fixation of scaphoid fractures with headless compression screws and rigid fixation of unstable distal radius fractures with a volar lock-ing plate system offer the most secure fixation. This small series suggests that the goals of early recovery of hand function can be accomplished using percutaneous/miniopen techniques for fracture reduction with rigid fixation and minimal risks.