Hand clinics
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Historical Article
The treatment of burns: an historical perspective with emphasis on the hand.
Since the use of fire became part of life, mankind has sought remedies to treat burns. The upper extremity, due to its frequency of exposure as the foremost organ in the everyday exploration of the environment and in manipulative and social interactions, is often involved. This article discusses the history of burn treatment.
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Review Case Reports
Stabilization of fractures in the hand and wrist with traumatic soft tissue and bone loss.
Open type III fractures of the hand or wrist with severe bone and soft tissue loss justify aggressive treatment to restore anatomy, assure healing, and maximize functional recovery. The techniques of modern wound excision used at initial surgery predictably result in a decompressed and surgically clean wound within a few days from injury in the vast majority of cases. ⋯ Early wound closure or coverage minimizes scar formation. Together, the early sequencing of effective wound debridement with skeletal stabilization and bone grafting and early wound closure or coverage provide the most favorable circumstances for healing and functional recovery of the seriously damaged hand and wrist.
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A classification of distal radial articular fractures is described, based on observations of consistent patterns of fracture fragmentation and displacement. The classification categorizes articular fractures into four types, with the medial complex assuming a pivotal position as the cornerstone of both the radiocarpal and distal radioulnar joints. ⋯ While the majority of unstable fractures can be successfully managed by closed methods, a substantial and increasing number require open treatment for restoration of articular congruity as well as repair of concomitant soft tissue and skeletal injuries. In all cases, precise reduction of the key medial fragments is essential to maximum recovery.
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The principles followed in treatment of epiphyseal injuries of the hand are essentially the same as those used in treating epiphyseal injuries elsewhere in the child. Special patience is required in treating the patients, and methods of immobilization must be modified appropriately for the active child. A knowledge of the mechanism of injury and potential effects on the growth potential of the digit are important in determining treatment and counseling parents on possible growth disturbance and later deformity. ⋯ Salter Type I and II fractures frequently demonstrate remarkable remodeling potential, whereas intra-articular Salter III and IV fractures often require surgical repair and may be more frequently associated with later problems of growth and post-traumatic arthritis. The physician should establish a trusting relationship with the child and his or her parents in order to provide comforting reassurance, facilitate treatment and compliance, and promote an understanding of the possible outcomes associated with injuries of the vulnerable growth plate. When these principles are followed appropriately, the long-term follow-up of these children provides for a very satisfying and rewarding experience for the physician and family.
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Malunions of the distal radius are common. Although the best treatment is prevention, symptomatic malunions can be salvaged through more careful fracture management, by corrective osteotomy or, in the presence of post-traumatic arthritis, radiocarpal arthrodesis. Dynamic midcarpal instability following radius malunion does not respond as well to ligament repair or intercarpal arthrodesis as it does to osteotomy of the radius and correction of the malunion deformity.