Hand clinics
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Surgical procedures for the treatment of ulnar nerve compression at the elbow are well described. Studies have reported clinical outcomes after decompression of the nerve without transposition and decompression with transposition. Numerous preoperative, intraoperative, and postoperative factors contribute to failure of the surgical procedures. Although the techniques available for revision decompression of the ulnar nerve at the elbow are similar to those used in the primary setting, the results after repeat surgical intervention are less predictable.
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Diaphyseal fractures involving the radius and ulna, so called "both-bone" or "double-bone" forearm fractures are common orthopedic injuries. These injuries can result in significant loss of function if inadequately treated. ⋯ Preservation of the anatomic relationships of the proximal and distal radioulnar joints as well as the interosseous space is critical to preserving function. This article overviews the management of diaphyseal fractures of the radius and ulna in adults.
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Carpal disorders in children are often associated with developmental abnormalities of structures surrounding the wrist. In addition, carpal ossification throughout childhood has unique influences on pediatric carpal injury. Because the immature carpus is composed of unossified cartilage, carpal abnormalities in young children are frequently undetectable on plain radiographs. Clinical suspicion of an abnormality may elicit further imaging with MRI, which can provide detailed information about cartilaginous structures.
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Percutaneous K-wire fixation is still a useful technique for closed oblique phalangeal and meta-carpal fractures when an adequate closed reduction can be achieved. Lag screw fixation may be the best choice for open fixation of long oblique phalangeal and metacarpal fractures. For short oblique fractures, plating or tension band wiring is recommended. ⋯ Tension band wiring technique at the phalangeal location may reduce such complications. Overall, successful outcomes of treating phalangeal and metacarpal fractures require a clear appreciation of fracture anatomy and pattern. It is mandatory for the treating surgeon to be familiar with all the treatment techniques discussed in order to tailor a specific technique for a particular injury and patient type.
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Many malunions of the finger metacarpals are mild and do not require or justify operative intervention. Early recreation of the fracture or osteotomy is more likely to be rewarded with favorable results than late operation. Rotational malunions of the metacarpals or proximal phalanges may be treated by transverse extra-articular transverse or step-cut osteotomies at or proximal to the malunion site. ⋯ Although multicenter studies have their own inherent flaws, they may represent the best future option to add a higher level of study design and validity as compared with past studies. The incorporation of subjective patient outcome instruments into future studies might also provide valuable information. Investigators should review previous reports with a goal of improving study designs and scientific methodology, confirming or contradicting past results, or adding new information.