Hand clinics
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Recognition of the pattern of an elbow fracture-dislocation allows immediate knowledge of the treatment principles, pitfalls, and prognosis of the injury. Specific techniques for each injury component increase the surgeon's ability to restore stability to the elbow. When complications are anticipated and avoided or addressed expediently, it is possible to restore elbow function in spite of the complexity of these injuries.
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Fractures of the proximal ulna present unique challenges to the surgeon because of the complexity of the elbow joint. It is important not to underestimate the potential difficulty of these cases and to give each one thorough preoperative consideration before embarking on a surgical course. The primary principles of treatment are to restore joint congruity and stability while permitting early range of motion. A logical and consistent approach, based on the fracture characteristics and concomitant injuries, should produce predictable results.
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The scaphoid proximal pole and waist fractures presented here were treated by a novel dorsal percutaneous technique with arthroscopic assistance. All fractures healed, with good final functional results and no complications. The advantages of the dorsal percutaneous approach to scaphoid fixation are: (1) the proximal-to-distal placement of the guide pin and screw allow for more precise placement along the central axis of the scaphoid, which decreases healing time and reduces risk of screw thread exposure. (2) The dorsal approach avoids injuring the vulnerable volar ligament anatomy. ⋯ The proven benefits of the percutaneous technique include decreased soft tissue trauma; arthroscopic visualization of the fracture, ensuring anatomic reduction; and stable fixation, allowing early physical rehabilitation. The theoretical benefits of the technique include decreased risk of interruption of the tenuous scaphoid blood supply. Percutaneous internal fixation of scaphoid fractures provides faster rehabilitation, earlier return to work, and quicker bony union in most patients.
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This article reviews the historical evolution of the assessment and understanding of the deformity of the nonunited and malunited scaphoid. The preoperative assessment, planning, and surgical technique for restoration of scaphoid anatomy are described. A brief presentation of our midterm and long term results obtained with interpositional wedge grafting is also discussed.
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The subsesamoid joints of the thumb are a common site of arthritis, but their small size makes diagnosis of disorders challenging. The sesamoid and subsesamoid joints may also be injured acutely with the volar plate complex during hyperextension injuries, and may sometimes produce mechanical dysfunction. Simple excision of chronically painful sesamoids provides excellent relief.