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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Randomized Controlled Trial Clinical Trial
Retrograde tracing and electrophysiological findings of collateral sprouting after end-to-side neurorrhaphy.
The aim of this study was to seek more potent evidences of collateral sprouting for both motor and sensory nerve fibres after end-to-side neurorrhaphy using a modified double-labelling retrograde tracing method and to investigate the function of regenerated motor axons with electrophysiological evaluation. Four groups (n=4 for each group) were used: end-to-end coaptation (six months postoperatively), end-to-side coaptation (four months and six months postoperatively) and normal control. Two fluorescent tracers (true blue and diamidino yellow) were applied to the proximal ends of tibial and common peroneal nerves, respectively after four or six months of nerve coaptation. ⋯ Four months after surgery, the motor nerve conduction velocity in end-to-side coaptation was significantly slower than in the normal control. But no difference was found in the sixth month. These results suggest that end-to-side neurorrhaphy can induce the functional collateral sprouting of both motor and sensory axons in the peripheral nerve.
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Driving with an arm protruding through a window can result in limb threatening injury. A series of seven upper limb injuries sustained during motor vehicle accidents (MVAs) with a limb protruding from the vehicle window is described. The severity and complexity of these injuries are related to the ultimate functional recovery for the limb. This study serves to highlight the severity of injury and morbidity following these modalities of trauma, which although rarely fatal, carry extensive consequences and could be easily prevented with appropriate education programmes and legislation.
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This study is to assess the effectiveness and outcome of the AO titanium volar distal radius plate (Synthes) in the treatment of peri-articular volar rim fractures of the distal radius. It was conducted on 22 patients with distal radius fractures who underwent open reduction, internal fixation using the AO titanium volar distal radius plate between July 1998 and December 1999 at the Changi General Hospital. The radiographs of the patients were analysed upon fracture union and assessment of wrist function was done using Gartland and Werley criteria. ⋯ Complications were few with one wound infection, one tendon rupture and three neuropraxia of the superficial radial nerve. Wrist function was excellent in three patients, good in 12 and fair in four. The AO titanium plate with its distal buttressing ability is an effective treatment modality in patients with distal radius fractures involving the peri-articular volar rim.
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Splintage is commonly used in conjunction with pressure therapy to tackle the contracted scars, make it supple and thus minimise dysfunction. A static or dynamic splint can provide valuable therapy that goes beyond any treatment session. The patient's active participation in the splint programme can facilitate early recovery. ⋯ Different types of splints serve different functions at different stages of rehabilitation. A suitable and efficient application of splints can minimise most of the corrective surgical intervention and alleviate psychological trauma. This article attempts to highlight the clinical rationale and special considerations when applying different splintage on burns patients with upper limbs involvement.
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Case Reports
Digital nerve grafting using the terminal branch of posterior interosseous nerve: a report of three cases.
We report three cases of digital nerve grafting using the terminal branch of posterior interosseous nerve.