Hand clinics
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Treating patients with osteoarthritis (OA) and rheumatoid arthritis (RA) remains challenging; however, new agents offer the chance for an improved quality of life. As an alternative to traditional nonsteroidal anti-inflammatories, cyclooxygenase-2 inhibitors provide pain relief for OA and RA patients with possible fewer side effects. ⋯ Rheumatoid arthritis research has led to an improved understanding of the inflammatory cascade and an appreciation of the early tissue destruction. A new treatment philosophy has thus emerged along with the development of new biologic agents; the latter, along with combination therapy and a new disease modifying antirheumatic drug, leflunomide, have greatly expanded the chances for disease control in RA patients.
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Pediatric carpal injury is unusual. Because of its rarity and imaging difficulties, the diagnosis is often delayed. ⋯ Pin fixation provides temporary stabilization of displaced injuries without permanently compromising joint motion. In older children, intercarpal fusion may be elected for treatment of intercarpal instability.
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Successful treatments of musculoskeletal injuries in the pediatric population demand a thorough understanding of the basic anatomy and its biomechanics, and the physiology of growth and development of the immature skeleton. In addition, good treatment outcomes rely on the treating physician being an effective teacher to the young athlete and the patient's parents, coaches, and trainers. At the same time, the physician must be a good student in learning the nature of the patient's sports and each patient's athletic ability and aspirations. Most pediatric hand and wrist injuries can be treated nonoperatively with proper immobilization techniques and activity modification, but cases requiring surgical intervention must be recognized promptly to avoid long-term complications.
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This article addresses the types of metacarpal and phalangeal fractures seen in a variety of sports. Treatment options are discussed in depth based on the location, configuration, and associated soft-tissue injuries. This article provides a greater understanding of the treatment algorithm to minimize the possibility of long-term functional consequences for the athlete.
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Distal radioulnar joint injuries can occur in isolation or in association with distal radius fractures, Galeazzi fractures, Essex-Lopresti injuries, and both-bone forearm fractures. The authors have classified DRUJ/TFCC injuries into stable, partially unstable (subluxation), and unstable (dislocation) patterns based on the injured structures and clinical findings. Clinical findings and plain radiographs are usually sufficient to diagnose the lesion, but axial CT scans are pathognomonic. ⋯ In complex dislocation, reduction is not possible because there is soft tissue interposition or a significant tear. After the associated injury is dealt with, treatment for complex injuries requires exploration of the DRUJ, extraction of the interposed tissue, repair of the soft tissues, and open reduction and internal fixation of the ulnar styloid fracture (if present and displaced). The early recognition and appropriate treatment of an acute DRUJ injury are critical to avoid progression to a chronic DRUJ disorder, the treatment of which is much more difficult and much less satisfying.