European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Feb 2016
ReviewManagement algorithm for index through small finger carpometacarpal fracture dislocations.
Injuries to the carpometacarpal (CMC) joints are rare. The most common CMC fracture dislocations occur in the ring and small finger CMC joints. The aim of this study was to review the structured diagnostic procedure and different treatment options. ⋯ CMC fracture dislocations of the fourth and fifth CMC joints are uncommon and often overlooked. Primary goal of treatment is to restore normal function to the hand. Therefore, operative therapy might be the method of choice.
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Eur J Trauma Emerg Surg · Feb 2016
ReviewCurrent concepts for the treatment of acute scaphoid fractures.
Fractures of the scaphoid are common injuries, accounting for approximately 80 % of carpal fractures. Differentiation between stable and unstable fractures (Herbert classification) cannot be made with conventional X-rays, so evaluation by computed tomography should additionally be performed. Under most circumstances, minimally invasive surgery with cannulated screws is the treatment of choice. ⋯ Displaced fractures have a greater risk for nonunion and therefore should be treated operatively. Proximal pole fractures are definitely unstable, requiring treatment with screw fixation. The surgical approach depends on the location of the fracture and the preference of the surgeon.
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Fractures of the hand are frequently encountered with injuries to the phalanges and metacarpals comprising the vast majority. Fractures of the carpal bones excluding the scaphoid, however, are fairly uncommon. ⋯ Delayed diagnosis can result in inadequate fracture care, which places the wrist at risk of disabling sequelae. This review focuses on the current concepts of pathophysiology, diagnosis, and treatment of carpal fractures other than the scaphoid.
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Ruptures of ulnar-sided triangular fibrocartilaginous complex (TFCC) often occur in cases of trauma. Golden standard for diagnosis is the arthroscopy of the wrist. TFCC lesions are classified according to their location if traumatic in origin or if degenerative according to their severity. ⋯ Central TFCC tears are typically located close to the sigmoid notch of the radius and are either traumatic or degenerative in origin. While central TFCC lesions are usually treated by arthroscopic debridement using small joint punches or a bipolar high frequency system, the ulnar TFCC avulsions can also be refixed arthroscopically in different techniques.