Hand clinics
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The pathophysiology of true frostbite reveals that the direct injury produced during the initial freeze process has a minor contribution to the global tissue damage. However, rapid rewarming to reverse the tissue crystallization has essentially been the lone frostbite intervention for almost half a century. The major pathologic process is the progressive microvascular thrombosis following reperfusion of the ischemic limb, with the cold-damaged endothelial cells playing a central role in the outcome of these frozen tissues. Newer interventions offer the opportunity to combat this process, and this article offers a scientific approach to frostbite injuries of the upper extremities.
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Fractures of the scaphoid are a common athletic injury. In this article the indications and treatment strategy for arthroscopic management of scaphoid fractures and nonunions in athletes are reviewed. Various arthroscopic assisted and percutaneous techniques for the fixation of fractures of the scaphoid are discussed, including the volar and dorsal percutaneous approaches, and arthroscopic reduction by the Geissler technique. In general, these techniques include a small amount of wrist arthroscopy and a significant amount of fluoroscopy.
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Congenital hand surgery has advanced during the last 10 years with surgical technique improvements, the incorporation of new technologies, and an enhanced understanding of the basic pathology of upper extremity anomalies. This article reviews the literature with a survey of 70 articles from seven leading journals published in the last 12 years. The author concludes that the next decade should be even more exciting with the incorporation of an improved understanding of tissue engineering and molecular genetics into classification and treatment algorithms. Understanding the genetic pathways of normal, and therefore abnormal, development should allow improved classification schemes and intervention to prevent, modify, or remedy these birth abnormalities.
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Increasing data suggest that the traditional clinician-centered or disease-focused, biomedical approach to illness is less effective than a biopsychosocial, evidence-based, patient-centered approach to illness, particularly for chronic pain conditions. This article distinguishes patient-centered care from more traditional and outdated biomedical decision-making models; illustrates the complexity of illness behavior with a patient example; delves into the communication issues raised by this complexity, thereby demonstrating how best evidence can sometimes run counter to biases and intuition; provides a summary of evidence that patient-centered care positively affects outcomes; and explores how the shared decision-making approach along with cultivation of good communication skills can facilitate evidence-based practice.
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In the current study, a retrospective review of 56 patients with posttraumatic root avulsion brachial plexus injuries who underwent contralateral C7 transfer using the selective contralateral C7 technique is presented. The intraoperative findings of the involved brachial plexus, the surgical technique of preparation of the donor C7 nerve root, and the various neurotization procedures are reported. The surgical outcomes as well as the potential adverse effects of the procedure are analyzed. We conclude from this study that the selective contralateral C7 technique is a safe procedure that can be applied successfully for simultaneous reconstruction of several different contralateral muscle targets or for neurotization of cross chest nerve grafts for future free muscle transplantation.