The Journal of hand surgery
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Randomized Controlled Trial Comparative Study
Upper extremity spasticity in children with cerebral palsy: a randomized, double-blind, placebo-controlled study of the short-term outcomes of treatment with botulinum A toxin.
Botulinum A toxin (BoNT-A) injections are used widely to manage lower extremity spasticity in children with cerebral palsy. However, their use in the upper extremity is less well defined. This randomized, double-blind, placebo-controlled clinical trial evaluated the safety and efficacy of upper extremity intramuscular injections of BoNT-A in a cross-section of children with varying levels of function. ⋯ Children receiving BoNT-A injections demonstrated clinically meaningful short-term improvements in upper extremity function. Injections were well tolerated and safe. In contrast to other studies, study participants underwent multiple injection sessions based on their individual spasticity patterns.
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Comparative Study
Radial collateral ligament injuries of the thumb metacarpophalangeal joint: epidemiology in a military population.
The reasons for variation in the reported incidence rates between thumb metacarpophalangeal joint radial collateral ligament (RCL) and ulnar collateral ligament (UCL) injuries are unclear. Delay in diagnosis of injury to the RCL leads to greater time of patient disability. The purpose of this study was to define the demographics and presentation of patients with RCL injuries in a military health care system. ⋯ In this series, patients sustaining injuries to the RCL were younger and presented later than their counterparts with UCL instability. Close attention to subtle or frank instability presenting as pain in younger patients with axial loading injury mechanisms may allow early diagnosis and appropriate treatment of this injury.
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Review Case Reports
Iatrogenic burn caused by an operating microscope: case report.
We present a patient who experienced a burn from an operating microscope during surgery for a brachial plexus birth palsy, a literature review, and recommendations on how to avoid such injuries.
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Olecranon fractures are common injuries of the upper extremity; majority are treated surgically. A variety of fixation techniques are available to surgeons in modern practice, but there is little comparative clinical research to guide one's decision. Nonetheless, good results over all are to be expected after surgical management. This article presents a review of the current understanding and available evidence in the treatment of olecranon fractures, their relevant anatomy, fracture patterns, fixation options, and outcomes.
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We present 2 cases of a capitellum fracture with concomitant triceps avulsion fracture. Common radiologic features of these injuries include a comminuted fracture of the capitellum with extension to the lateral portion of the trochlea, absence of posterior lateral condyle comminution, and a triceps avulsion fragment that is avulsed in a posterolateral direction.