Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand
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Comparative Study
Reoperation for metalwork complications following the use of volar locking plates for distal radius fractures: a United Kingdom experience.
Volar locking plates are increasingly used in the management of distal radius fractures. As with any new implant, understanding the rate and type of potential metalwork related complications is important. In this study, we reviewed 114 distal radius fractures treated with volar locking plating. ⋯ In our series, 12 cases (10%) underwent further surgery for metalwork related complications mainly for screw protrusion into the radiocarpal joint following fracture collapse. Our results suggest that volar locking plates are associated with a high rate of metal work related complications requiring further surgery. Technical aspects to reduce such complications are discussed.
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Comparative Study
Locking palmar plate fixation for dorsally displaced fractures of the distal radius: a preliminary report.
We reviewed a series of 62 consecutive patients with dorsally displaced fractures of the distal radius, including 20 extra-articular and 42 intra-articular fractures. All patients were treated with palmar locking plate systems at our institution between 2002 and 2006. After a minimum follow-up time of 12 weeks, the fractures had healed with satisfactory radiographic and functional results. ⋯ In the good and fair groups, the demerit points were almost all for ulnar wrist pain. Our results suggest that palmar locking plate systems enable early functional mobilization with good reproducible radiographic and clinical outcomes. Since nine out of 62 patients had residual ulnar wrist pain at the final follow-up evaluation, further investigation of the pathogenesis of ulnar wrist pain is necessary to obtain better functional outcomes.
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Comparative Study
Prevention of flexor pollicis longus tendon rupture after volar plate fixation of distal radius fractures.
We evaluated the presence of "tendon irritation" of flexor pollicis longus (FPL) for cases of distal radius fracture treated with volar plates to prevent FPL tendon rupture. This report details cases of 24 patients. The presence of pain or a sense of incompatibility and subdermal crepitus around the wrist with an active thumb motion were defined as symptoms of FPL tendon irritation. ⋯ Four of these 12 patients underwent plate removal, and tendon injury was not detected. The results of this study indicate that FPL tendon irritation is likely to appear before tendon rupture. Therefore, FPL tendon rupture might be prevented by plate removal in patients who complained of tendon irritation.
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We present a hitherto unreported condition of a bipartite distal phalanx in a child. The condition mimics a fracture and may even lead one to suspect a non-union. ⋯ This could potentially cause injury to the growth plate with resultant growth arrest. Careful clinical and radiographic examination of both hands combined with an awareness of this condition can help avoid such problems.
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Randomized Controlled Trial Comparative Study
Proximal phalanx injection for trigger finger: randomized controlled trial.
Trigger finger is one of the most common upper extremity problems in the outpatient department. Conservative treatment is the mainstay for management of trigger digits especially steroid injection with highly satisfactory outcome and minimal complication. Conventional injection technique (CI) that approaches flexor tendon sheath over metacarpal head directly causes pain for most patients. ⋯ The P1I technique group had a significantly lower pain score than CI technique group (p < 0.001). The recurrence rate was 15% in the CI technique when compared to 25% in the P1I technique which was not significant (p = 0.685). We concluded that the P1I technique is less painful than the CI technique without any significant difference in recurrence rate between the two groups at three months follow-up.