Hand (New York, N.Y.)
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Hand (New York, N.Y.) · Mar 2009
Ultrasound-assisted percutaneous trigger finger release: is it safe?
Trigger fingers can be treated by open or percutaneous division of the A1 pulley. The open approach allows for visualization of the pulley, the tendon, and the adjacent neurovascular bundles. The percutaneous trigger finger release (PTFR) lacks an incision and is thought to lead to a quicker recovery, but the safety and efficacy of this blind procedure are often questioned. ⋯ The subsequent dissection revealed three out of 18 tendons with visible lacerations and 15 out of 18 A1 pulleys with incomplete division. We concluded that ultrasound-guided PTFR can be complicated by flexor tendon lacerations, potential injury to neurovascular bundles, and incomplete division of the A1 pulleys. While the clinical significance of these findings is unclear to us, it does raise questions regarding the safety and efficacy of percutaneous trigger finger release, even when adding ultrasound guidance.
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Hand (New York, N.Y.) · Mar 2009
Motor nerve transfers to restore extrinsic median nerve function: case report.
Active pronation is important for many activities of daily living. Loss of median nerve function including pronation is a rare sequela of humerus fracture. Tendon transfers to restore pronation are reserved for the obstetrical brachial plexus palsy patient. ⋯ Clinically evident motor function was seen at 4 months postoperatively and continued to improve for the following 18 months. The patient has 4+/5 pronator teres, 4+/5 flexor pollicis longus, and 4-/5 index finger flexor digitorum profundus function. The transfer of the extensor carpi radialis brevis branch of the radial nerve to the pronator teres and supinator branch of the radial nerve to the anterior interosseous nerve is a novel, previously unreported method to restore extrinsic median nerve function.
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Hand (New York, N.Y.) · Dec 2008
Treatment of delayed/nonunion of scaphoid waist with Synthes cannulated scaphoid screw and bone graft.
Fracture of the scaphoid bone is the most common fracture of the carpus, and frequently, diagnosis is delayed. The unique anatomy and blood supply of the scaphoid itself predisposes to delayed union or nonunion. The Synthes scaphoid screw is a cannulated headed screw, which provides superior compression compared with some other devices used to internally fix scaphoid nonunions. ⋯ Three out of four patients with persistent nonunion after surgery reported no pain and improved function. The failure rate was 75% in patients who had sustained their fracture more than 5 years previously. Our study demonstrates that delayed union of scaphoid waist fractures and scaphoid waist nonunions present for less than 5 years can be successfully treated by fracture compression and bone grafting.
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Hand (New York, N.Y.) · Jun 2008
Comparison of locked volar plating versus pinning and external fixation in the treatment of unstable intraarticular distal radius fractures.
We retrospectively compared the outcomes of open reduction and internal fixation (ORIF) with volar locking plate versus standard external fixation and percutaneous pinning in treating similar unstable distal radius fractures with a minimum 2-year follow-up. ⋯ Locked volar plating compares favorably to external fixation and pinning for amenable fracture patterns. Whereas grip and range-of-motion data were similar, DASH scores, frequency of rehabilitation, and some radiographic parameters were superior in patients treated with ORIF.
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Hand (New York, N.Y.) · Mar 2008
A2 and A4 flexor pulley biomechanical analysis: comparison among gender and digit.
Rock climbing has become increasingly more popular in the USA over the past two decades. Accordingly, with increased participation comes an increase in climbing-related injuries. Rooks et al noted that three-quarters of elite and recreational climbers will suffer upper extremity injuries, approximately 60% involving the hand or wrist and 40% divided evenly between the shoulder and elbow. ⋯ The A2 and A4 biomechanical properties of breaking load, displacement, and stiffness did not significantly differ among the index, middle, ring, and little fingers. Additionally, there was no significant difference in A2 or A4 pulley biomechanics between male and female specimens. The A2 and A4 pulleys among differing digits and genders have similar biomechanical properties in regards to maximum breaking load, displacement, and stiffness.