Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand
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Comparative Study
Scaphoid non-unions, where do they come from? The epidemiology and initial presentation of 270 scaphoid non-unions.
Scaphoid injury and subsequent non-union is a well documented and researched subject. This article gives an overview of the epidemiology and results of the patients we have treated for scaphoid non-union at a University Hospital. 283 scaphoid non-unions in 268 patients (83% men) were operated upon, 230 as a primary and 47 as a secondary. The median age at time of surgery was 27 years. ⋯ The greatest potential for the reduction of scaphoid non-union is an increased awareness amongst younger men. There is also potential for improved accuracy in the diagnosis of scaphoid fractures (better clinical tests, the use of radiographs, CTs and MRIs) in order to identify the fracture and evaluate dislocation at the initial injury. Early diagnosis and treatment of fractures and non-unions will reduce the development of degenerative wrist changes.
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Comparative Study
Outcome of unstable distal radius fractures treated with open reduction and internal fixation versus external fixation.
The objective of this study was to compare the clinical results of unstable distal radius fractures treated with ORIF with plate and screws compared to EF. Patients with unstable distal radius fractures treated with ORIF or EF from January 2005 to December 2010 were reviewed in terms of the Modified Mayo Wrist Score, range of motion, pain, grip strength, and radiologic parameters. ⋯ There were no significant differences in terms of radial and ulnar deviation, grip strength, pain and postoperative radiologic parameters (p < 0.05). Better wrist flexion, wrist extension and forearm rotation can be expected in ORIF compared to EF in the management of unstable distal radius fractures.
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A rare case of isolated traumatic hamate dislocation combined with fracture of the hamate hook is reported. Plain X-rays revealed a volar dislocation of the hamate, but computed tomography was necessary to recognise the fracture of the hamate hook. The injury was successfully treated with open reduction and internal fixation with Kirschner wires. ⋯ Cone-beam computed tomography, a novel imaging modality in hand surgery, was successfully used during follow-up. We conclude that computed tomography is essential in emergency preoperative planning in this type of uncommon injuries in order to diagnose concomitant bony lesions which can otherwise be overlooked. Alternative treatment options are discussed, and literature is reviewed.
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Comparative Study
Arthroscopic direct repair for radial tear of the triangular fibrocartilage complex.
Although various repair techniques for Palmer type 1B lesions of the triangular fibrocartilage complex (TFCC) have been introduced, arthroscopic repair techniques for Palmer type 1D lesions are still being honed. Until recently, inside-out techniques have commonly been used to repair radial tears of the TFCC. However, that technique has the disadvantages of a requirement for an extra skin incision, pain resulting from prominent subcutaneous suture knot stacks, and peripheral nerve injury. We describe an all-arthroscopic direct-repair technique using a suture hook with 2-0 polydioxanone that is relatively simple and safe and is thus a useful alternative for radial tears of the TFCC.
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Modified single-incision distal biceps tendon repair using three suture anchors: surgical technique.
Complete distal biceps tendon rupture causes a considerable loss of supination and flexion strength, and thus, surgical repair is indicated in active individuals. To reduce the risk of injury to the radial nerve in the confined space where the distal biceps inserts into the radius, several surgical methods have been reported, such as, pull out sutures, two-incision techniques, and the use of suture anchors. Here, we describe our modified single-incision distal biceps tendon repair technique using three suture anchors, which widens the bone-tendon contact surface and simplifies tensioning of the tendon attachment.