The Hand
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A case of volar transscaphoid perilunar dislocation of the wrist with a follow-up of six months is described. Conservative treatment resulted in union of the scaphoid without avascular necrosis. The patient had a good functional result. In volar transscaphoid dislocations a conservative approach is proposed due to the preservation of vascular supply to the scaphoid in an injury caused by hyperflexion of the wrist.
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For replantation surgery, continuous brachial plexus block was employed using supraclavicular or axillary approach. Of a total of fifty blocks, forty-seven (94%) gave adequate surgical analgesia throughout the operations. No serious complication appeared in this series. ⋯ One patient had paraesthesia in the blocked arm, but it subsided within a month. No toxic reaction was recognised in spite of high dose of anaesthetic agents. Thus continuous brachial plexus block has been ascertained to be safe, reliable, and useful for the replantation and other prolonged operations in the upper extremity.
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A simple method for achieving satisfactory regional anaesthesia for a wide range of hand surgery is presented. It entails separate attention to the two aims of regional anaesthesia, namely analgesia of the tourniquet and of the operative site. ⋯ The advantages of this method are its safety and simplicity even for the relatively untrained surgeon. It also obviates the need for brachial plexus blocks, intravenous regional or general anaesthesia with all their drawbacks.