The Journal of hand surgery
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The treatment of fracture dislocations of the proximal interphalangeal joint often results in pain and stiffness. A small dynamic external finger fixator was designed to maintain the reduced position of the dislocated middle phalanx and allow early active range-of-motion exercise. ⋯ The average range of the proximal interphalangeal joint motion with this device was 88 degrees. The average follow-up period was 21 months.
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Although radial nerve palsy associated with a closed humeral shaft fracture may be managed by observation, it is our experience that an open humeral shaft fracture with radial nerve palsy requires exploration of the nerve. In a series of 14 patients with radial nerve palsy caused by an open humeral shaft fracture, 9 (64%) of the 14 patients had a radial nerve that was either lacerated or interposed between the fracture fragments. ⋯ Epineural radial nerve repair, done primarily or secondarily, provided a satisfactory return of radial nerve function. Rigid fixation of the associated fracture is the recommended treatment.
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Thirty wrists of 27 patients with ulnar impaction syndrome who underwent ulnar shortening osteotomy were retrospectively reviewed. The average follow-up was 51 months. The wrists were graded preoperatively and postoperatively according to a wrist-grading system modified from Gartland and Werley. ⋯ Twenty-four wrists were graded excellent, 4 good, 1 fair, and 1 poor after the surgery in comparison with 28 poor and 2 fair before the operative treatment. Complications were rare, with no ulnar nonunions. This long-term follow-up study revealed that distal ulnar shortening osteotomy is an excellent procedure for the treatment of ulnar impaction syndrome.
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Twenty fresh cadaver extremities were dissected to delineate and quantify the course of the superficial branch of the radial nerve. This branch bifurcated from the radial nerve at the level of the lateral humeral epicondyle in eight specimens, and in all specimens the bifurcation was no more than 2.1 cm from the lateral epicondyle. It continued distally, deep to the brachioradialis and became subcutaneous a mean of 9.0 cm proximal to the radial styloid, traversing between the tendons of the brachioradialis and extensor carpi radialis longus. ⋯ Distally, at the level of the extensor retinaculum, the closest branches to the center of the first dorsal compartment and to Lister's tubercle were mean distances of 0.4 and 1.6 cm, respectively. In the hand, the superficial branch of the radial nerve most commonly supplied branches to the thumb, the index finger, and the dorsoradial aspect of the long finger. Knowledge of the course of the superficial branch of the radial nerve will help prevent injury during operative procedures on the radial side of the hand, wrist, and forearm and will aid in its localization in treatment of traumatic injuries or performance of nerve blocks in its distribution.