Injury
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Injury of the brachial plexus and peripheral nerve often result in significant upper extremity dysfunction and disability. Nerve transfers are replacing other techniques as the gold standard for brachial plexus and other proximal peripheral nerve injuries. These transfers require an intimate knowledge of nerve topography, a technically demanding Intraneural dissection and require extensive physical therapy for retraining. In this review, we present a summary of the most widely accepted nerve transfers in the upper extremity described in the current literature.
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Review Meta Analysis
Posterior tilt in nondisplaced femoral neck fractures increases the risk of reoperations after osteosynthesis. A systematic review and meta-analysis.
To conduct a systematic review on the effect of posterior tilt on reoperations, patient reported outcome measures (PROM) and functional outcome following osteosynthesis of undisplaced FNFs (uFNF). ⋯ A posterior tilt ≥20° leads to a higher risk of reoperations in uFNF. Even though the studies were of poor quality, the results suggest that we should include the measurement of posterior tilt in national guidelines.
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Review
Musculoskeletal trauma imaging in the era of novel molecular methods and artificial intelligence.
Over the past decade rapid advancements in molecular imaging (MI) and artificial intelligence (AI) have revolutionized traditional musculoskeletal radiology. Molecular imaging refers to the ability of various methods to in vivo characterize and quantify biological processes, at a molecular level. The extracted information provides the tools to understand the pathophysiology of diseases and thus to early detect, to accurately evaluate the extend and to apply and evaluate targeted treatments. ⋯ Notably, the development of deep learning algorithms has offered novel methods that enable intelligent processing of large imaging datasets in an attempt to automate decision-making in a wide variety of settings related to musculoskeletal trauma. Current applications of AI include the diagnosis of bone and soft tissue injuries, monitoring of the healing process and prediction of injuries in the professional sports setting. This review presents the current applications of novel MI techniques and methods and the emerging role of AI regarding the diagnosis and evaluation of musculoskeletal trauma.
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Extensive soft tissue loss or injury of the hand and upper extremity is a challenging reconstructive problem traditionally treated with abdominal-based pedicled flaps. Options for coverage included the groin flap based on the superficial circumflex iliac artery, the Scarpa's fascia flap based on the superficial inferior epigastric artery, and the paraumbilical perforator flap from the deep inferior epigastric artery perforators. Despite the ability to provide consistent and pliable soft tissue coverage with ease of elevation, these flaps have several disadvantages including restriction of mobility, requirement for multiple procedures, bulkiness and patient discomfort. ⋯ However several indications still remain. These include: patient and facility factors which deter microsurgery, the absence of recipient vessels after injury, prior surgical use of recipient vessels, the need to preserve major vessels for future reconstruction, and large multi-surface wounds requiring coverage. In this review we detail these indications and provide case examples for each.
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Bone distraction lengthening has been used for hand reconstruction. The healing process involved in this technique is affected by many factors. Here, the effectiveness and rates of healing of the phalanges and the metacarpals were evaluated in cases of traumatic finger amputation treated using an Ilizarov mini-fixator. ⋯ Distraction lengthening of the digits after traumatic amputation is an effective procedure for hand reconstructive surgery for either the phalanges or the metacarpals and is less invasive than other techniques. The rate of healing of the metacarpals is two times faster than that of the phalanges.