Hand clinics
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Flexor tendon rehabilitation means control of the tendon healing process. It is therefore important to appreciate the physiological and biomechanical nuances of flexor tendon healing.
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This article concerns traction lesions of the brachial plexus in adults, focusing on management and recovery. Open wounds of the plexus are now treated surgically as soon as possible. The subsequent rehabilitation is the same as that for closed traction lesions of the brachial plexus in which significant recovery is expected.
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The treatment options for the soft-tissue mallet finger, in both its acute and chronic forms, continue to generate some degree of controversy. Priority always should be given to nonoperative management of these injuries. This translates into a 6- to 8-week period of uninterrupted immobilization of the DIP joint with an external splint. ⋯ In summary, mallet injuries are treated using closed, nonoperative techniques. The period of time after injury that this nonoperative treatment can be delayed and still be effective is being extended and the absolute outside time limit still is not known. When surgery is done, we prefer the simple placement of a transarticular Kirschner wire for 6 to 8 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
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Reviewing the history and etiology of extensor pollicis longus tendon rupture shows the most compelling mechanism of rupture apparently is interruption of the tendon's vascularity secondary to hemorrhage and pressure, which causes the damaged tendon to be more susceptible to rupture secondary to late ischemic necrosis and attrition. Treatment options tried have included direct repair, tendon grafting, and tendon transfer. The authors recommend the extensor indicis proprius tendon transfer as the most predictable procedure to restore the original function of the EPL. This technique can be performed reliably, requires little postoperative re-education, and has few associated complications.
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Fractures of the distal radius and scaphoid are the two most common intra-articular fractures of the wrist. For the distal radius, visual inspection and lavage, reduction of fracture fragments, and pin fixation conducted under arthroscopic control more accurately restore the smooth articular surfaces than is possible using traditional closed manipulation and ligamentotaxis. A technique for arthroscopically assisted reduction and screw fixation for fractures of the scaphoid is described using a modified Herbert screw. These techniques have the combined advantages of more accurate fracture reduction, reduced surgical trauma, and earlier mobilization of the wrist.