Hand clinics
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Case Reports
Distraction method for chronic dorsal fracture dislocation of the proximal interphalangeal joint.
The authors used gradual ligamentous distraction for closed reduction of nine irreducible dorsal fracture dislocations of the PIP joint. The volar fragment size was equal to or less than 40% in five and more than 50% in four. The average follow up was 18 months. ⋯ This allowed adequate joint flexion for concentric joint reduction. Distraction and simultaneous mobilization restored the final range of motion earlier than distraction and subsequent mobilization. The final range of motion of the PIP and DIP joints was from 12 degrees to 91 degrees and 0 to 45 degrees respectively.
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To the authors' knowledge, this is the largest study assembled of finger fractures in children. Distribution of fractures according to location within the hand (see Fig. 1), location within the phalanges themselves, and the percent of epiphyseal fractures as well as the age distribution of the patients are all similar to what has previously been presented in smaller studies. Previously unreported synchronous and double epiphyseal injuries were identified. ⋯ Finally, it is critical to recognize and properly treat the four major categories of injury that constitute a small percentage of the total but a large percentage of the complications. The condylar and subcondylar fractures must be identified by obtaining a true lateral film by whatever means necessary. If undisplaced, they need to be adequately immobilized, possibly including the entire arm of a small child, and if displaced, they almost always require internal fixation.(ABSTRACT TRUNCATED AT 400 WORDS)
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Extension block splinting (EBS) at the proximal interphalangeal joints of the fingers is a common technique for both primary treatment of reduced dorsal dislocations/fracture-dislocations at that joint and as a rehabilitation method following open reduction of such injuries. It is seldom realized that the method is a classic example of two orthopedic principles: stable arc splinting and early protected motion. As a primary treatment technique, following reduction of the dislocation, EBS is exemplary for an ideal group of cases, competitive for a marginal group of cases, and often unsatisfactory for a questionable group of cases. Demarcation between the groups is made, and the technique of EBS is reviewed.
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Review Comparative Study
Biomechanics and biology of fracture repair under external fixation.
The major factors determining the mechanical milieu of a healing fracture under external fixation, and thereby the mechanism of union, are the rigidity of the selected fixation device, the fracture configuration, the accuracy of fracture reduction, and the amount of physiologic stresses dictated by functional activity and loading. Bone healing problems encountered in fractures stabilized externally merely reflect the severity of the local soft-tissue and periosteal injury and should not be attributed to the inherent features of the fixation modality. Although some surgeons have had reservations concerning the use of external fixation for fracture treatment, based mainly on concerns of pin-tract infection and fracture nonunion, much of the clinical experience and basic science research results have proven the reverse. ⋯ This lack should provide the impetus for surgeons, bioengineers, and medical scientists to continue collaborative basic and applied research. Furthermore, by recognizing the proper cell mediators and the physical means to stimulate these cellular elements, the bone fracture healing process may be modulated, regardless of the fixation technique. The result of such effort should provide new modalities to improve fracture management.
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"Understanding Workers' Compensation Law" is a primer on workers' compensation, intended to give physicians a basic understanding of how workers' compensation systems function. With this background, it is hoped that those physicians who treat patients suffering from work-related injuries will more fully appreciate their role in the system. The article also outlines a few helpful hints to assist the physician when she or he is treating workers' compensation patients so that the physician can streamline his or her practice and involvement in this area and make interaction with all parties less burdensome.