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Management of an unusual injury of combined open fractures of the first metacarpal shaft and trapezium due to crush injury in a 21-year-old man was reported in this paper. Surgical management included irrigation, debridement, and reduction of the first metacarpal fracture followed by external fixation extending from the first metacarpal to the distal radius and primary wound closure. After 1 year...
The evaluation of chronic wrist pain can be a diagnostic dilemma. Lidocaine injections combined with corticosteroids are often used for both diagnosis and therapy. The purpose of this study was to determine if a midcarpal injection of lidocaine could serve as a diagnostic tool in patients with chronic wrist pain. Specifically, the relationship of pain relief from the injection and improvement of grip...
The reverse radial forearm fascial (RRFF) flap is widely used in soft-tissue reconstruction of the hand. The traditional RRFF flap incorporates the radial artery from the forearm and is perfused by retrograde flow through the palmar arch. In patients with an abnormal Allen test because of an incomplete palmar arch, the traditional RRFF flap is contraindicated unless a vein graft is used to reconstruct...
We are reporting our 10-year experience with 68 patients. Sixty-six flaps were of fasciocutaneous type and two were of osteofasciocutaneous type. These flaps were used for volar and dorsal traumatic hand defects, first web space reconstruction, thumb reconstruction, and repair of congenital anomalies. Sixty flaps (88.24%) had complete uneventful take-up. Four flaps developed partial necrosis, whereas...
Pain or dysfunction of the finger joints due to arthritis or traumatic injuries that fail medical management may necessitate arthroplasty or joint replacement. The goals of the finger joint implant arthroplasty are to relieve pain, to correct deformity, and to improve the function and appearance of the hand. Several prosthetic implants have been used for the replacement of the proximal interphalangeal...
Introduction Carpal tunnel syndrome (CTS) is thought to be due to compression of the median nerve in the carpal tunnel. It is known that carpal tunnel pressures are elevated in wrist postures of flexion and extension and in those patients with CTS. Classic symptoms of CTS include night waking with pain, tingling, and numbness. These classic symptoms stimulated our interest in the relationship of sleep...
An experience with transtrapezium approach for carpal tunnel release is reported. This technique seems to be successful in cases when carpal tunnel syndrome and first carpometacarpal joint osteoarthritis coexist and surgical treatment is indicated for both conditions. The transtrapezium approach to carpal tunnel release allows for complete carpal tunnel release without increasing the risk of surgical...
This article describes the concomitant presence of two anomalous forearm muscles in a 20-year-old man, discovered accidentally during an operation for a forearm injury. The first one was similar to a reverse palmaris longus muscle except for its direction to the Guyon’s canal. The second one originated from the radial antebrachial fascia, superficial to all other forearm muscles in the lower half...
Distal radius fractures are common injuries; however, identifying which factors are responsible for predicting outcomes remains an area of controversy. The purpose of this study was to define factors predictive of patient-reported pain and disability at 1 year in a prospective cohort of extra-articular distal radius fractures (n = 222). Data were collected at the initial visit and after 3, 6, and...
A retrospective chart review for the period between 1998 and 2006 was conducted to evaluate microneurolysis combined with a hypothenar fat pad flap (HTFPF) for patients at Mayo Clinic, Scottsdale, Arizona, who were being treated for recurrent carpal tunnel syndrome. After exclusion of patients with incomplete release of the transverse carpal ligament at the time of the original operation, 28 consecutive...
The purpose of this study was to evaluate the cost-effectiveness of routine wrist radiography in the evaluation of patients with a wrist ganglion. In the setting of a University-based hand surgery practice, 103 consecutive patients with a dorsal or volar wrist ganglion underwent posteroanterior, lateral, and oblique radiographs of the involved wrist. There were 24 men and 79 women with an average...
The purpose of our study was to review the clinical features and determine the results following surgical excision of a flexor tendon sheath ganglion. A retrospective analysis of 24 consecutive patients (25 ganglions) who underwent excision of a painful flexor tendon sheath ganglion by the same surgeon was performed. The patient’s medical and operative records were reviewed. Each patient was invited...
Introduction Extensor tendon irritation and attritional tendon ruptures are potentially serious complications after open reduction and internal fixation of distal radius fractures. These complications are well recognized after dorsal plating of distal radii; and these are now being reported after errant screw placement during volar fixed-angle plating. Intraoperative detection of improper screw placement...
Sharps injuries are an area of concern for healthcare workers. This article discusses clinical use of a blunt suture needle and an absorbable skin staple in upper limb operations. These devices may reduce the need for sharp needles in the surgical field during selected procedures on the upper limb.
The purpose of this study was to report the operative findings in patients who underwent a secondary operation for cubital tunnel syndrome. A chart review was performed of 100 patients who had undergone a secondary operation for cubital tunnel syndrome by one surgeon. The mean age was 48 years (standard deviation 13.5 years). The most common complaint after primary surgery was increased symptoms in...
Breast cancer now affects 1 in 8 American women and the taxane agent paclitaxel (Taxol® Bristol-Myers Squibb) is a major tool in the treatment of many such patients. Hand surgeons are therefore likely to encounter upper extremity complications related to the use of taxane therapy. We present an unusual case of a felon developing in a breast cancer patient on paclitaxel therapy with no antecedent history...
There are very few reports in the literature of using pedicled flaps to revascularize distant tissue. Here, we describe the first description of using a radial artery perforator from a reverse radial forearm flap to revascularize a digit. Complex hand trauma presents multifaceted problems for the surgeon. This is illustrated by a recent case we treated of a severe hand crush injury, in which the two...
The skeletal architecture of the DRUJ provides minimal inherent stability, as the sigmoid notch is shallow and its radius of curvature is 50% greater than that of the ulnar head [Af Ekenstam F, Hagert CG. Anatomical studies on the geometry and stability of the distal radio ulnar joint. Scand J Plast Reconstr Surg 1985;19(1):17–25]. Due to its incongruent articulation, the DRUJ relies strongly on the...
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