The Journal of hand surgery
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As the number of survivors of motor vehicle accidents and extreme sporting accidents increases, the number of people having to live with brachial plexus injuries increases. Although the injured limb will never return to normal, an improved understanding of the pathophysiology of nerve injury and repair, as well as advances in microsurgical techniques, have enabled the upper extremity reconstructive surgeon an opportunity to improve function in these life-altering injuries. The purpose of this review is to detail some of the current concepts of the treatment of adult brachial plexus injuries and give the reader an understanding of the nuances of the timing, available treatment options, and outcomes of treatment.
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Comparative Study
Biomechanical comparison of contemporary clavicle fixation devices.
Because recent studies have shown that malunited or nonunited clavicle fractures treated nonsurgically have poor outcomes, early fixation of certain clavicle shaft fractures using contemporary implants has become more common. Little is known about the physiologic loading of these implants. This study was designed to observe the biomechanical behavior and strength of implants used for fixation of the clavicle shaft. ⋯ Both locking and nonlocking constructs appear to provide similar rigid fixation under the tested mechanical conditions. The intramedullary pin can provide high resistance to failure loads in situations when rigidity and rotational stiffness are not required. Intramedullary pin fixation appears to be inadequate where rotational stiffness is required.
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To investigate the effects of motion following repair with a modified Kessler core suture and 5 different epitendinous suture designs on the gliding resistance, breaking strength, 2-mm gap force, and stiffness of flexor digitorum profundus tendons in a human in vitro model. ⋯ The cross-stitch, IHM, and running-locking epitendinous sutures had the best combination of higher strength and lower gliding resistance in this study. Although these findings suggest a potential for these suture types to be preferred as epitendinous sutures, these repairs should first be investigated in vivo to address their effect on tendon healing and adhesion formation.
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Randomized Controlled Trial Comparative Study
Blinded, prospective, randomized clinical trial comparing volar, dorsal, and custom thermoplastic splinting in treatment of acute mallet finger.
To compare volar, dorsal, and custom splinting techniques in acute Doyle I mallet finger injuries. ⋯ No lag difference was demonstrated between custom thermoplastic, dorsal padded aluminum splint, and volar padded aluminum splinting for Doyle I acute mallet fingers. Clinical measurement overestimates true lag in mallet injuries. Increased lag occurs after discontinuation of splinting. Increased age and complications correlate with worse radiographic lag.