Acta Orthop Belg
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Over a 7 years period (from September 1989 to April 1996), 25 patients have been treated for proximal humeral fractures using Kapandji's method of internal fixation. Twenty-one were available for evaluation. The mean follow-up was 3 years 9 months. ⋯ Complications were frequent, the most common being pin migration, but the functional results following Constant scores are very good. The technique is easy, quick, non- invasive and inexpensive. The approach is direct and avoids opening the elbow joint.
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A critical review is presented of the indications for nerve repair or transfer and for palliative operations in the management of paralytic shoulder following traumatic neurological injuries in the adult. Different situations are considered: paralytic shoulder following supraclavicular lesions of the brachial plexus, following retro- and infraclavicular lesions and following lesions to the terminal branches of the plexus (axillary, suprascapular and musculocutaneous nerves) and finally problems related to lesions of the accessory nerve and the long thoracic nerve. I. ⋯ Lesions of the axillary nerve may be seen associated with lesions of the rotator cuff. The treatment varies according to the age and condition of the patient and according to the condition of the cuff muscles and tendons: in a young patient with avulsion of the tendons from bone, cuff reinsertion is indicated; in an older patient, the cuff must be evaluated by MRI or arthroscan, and repair is indicated unless the cuff tear is not amenable to surgery or there is fatty degeneration of the muscles. Palliative surgery may be indicated in cases seen late or after failed attempts at nerve repair. (ABSTRACT
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The authors tried to evaluate the benefit of sympathetic nerve blocks with guanethidine in 32 patients with a sympathetic dystrophy syndrome who failed to respond to conventional treatment.
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Case Reports
Volar dislocation of the proximal interphalangeal joint of the finger: an indication for urgent operative treatment.
Two patients are described with persistent acute volar dislocation of the middle phalanx of a finger. Closed reduction was impossible due to intra-articular interposition of the lateral slip of the extensor mechanism, combined with a tear of a collateral ligament. It is important to recognize these injuries at an early stage and an operative treatment is required.
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The results of the treatment of 36 patients with posttraumatic reflex sympathetic dystrophy of the upper extremity with regional intravenous blocks of methylprednisolone and lidocaine are presented. The extremity is exsanguinated and a tourniquet is applied. A solution of methylprednisolone, lidocaine and heparin is injected. ⋯ Physiotherapy was applied in all patients (program of finger exercises, whirlpool therapy). Complications in 2 cases were transient superficial thrombophlebitis of the forearm; in 2 other patients the block was interrupted because of severe pain in the limb. We found this method simple, easy to perform, safe and inexpensive; the results are comparable to other established methods of the treatment i.e. sympathetic blocks or calcitonin.