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
-
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.
-
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.
-
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.
-
Comparative Study
Intramedullary fixation of proximal phalangeal fractures through a volar extra-tendon sheath approach.
We present an operative technique and the results of intramedullary fixation of proximal phalangeal shaft fractures through a volar extra-tendon sheath approach. A J-shaped nail, which is a curved Kirschner wire sharply bent at the proximal end, was inserted from the palmar aspect of the proximal phalangeal base. Six fingers of the six patients (all male) were treated with this method. ⋯ All fingers attained successful fracture union and one of them had correction loss. No patient complained of pain at the final follow-up, and the average of total active motion was 223° (190° - 255°). This method may be an alternative for treatments of the proximal phalangeal shaft fractures because of its less invasive nature, although it does not offer anatomical reduction.
-
Comparative Study
Use of the volar fixed angle plate for comminuted distal radius fractures and augmentation with a hydroxyapatite bone graft substitute.
Treatment of distal radius fractures with a volar fixed angle plate achieves sufficient stabilisation and permits early physical exercise. However, secondary displacement after surgery sometimes occurs in elderly patients with a metaphyseal comminution and/or cases in which the subchondral support pegs were not placed immediately below the subchondral zone. ⋯ There were no significant differences between the two groups in terms of palmar tilt (P = 0.80) and radial inclination (P = 0.17); however, ulnar variance increased significantly in the group treated with a volar fixed angle plate without augmentation (P < 0.05). It might be useful to use a combination technique of a locking plate system and the hydroxyapatite bone graft substitute as augmentation to treat distal radius comminuted fractures in elderly patients.