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
Intramedullary fixation of proximal phalangeal fractures through a volar extra-tendon sheath approach.
We present an operative technique and the results of intramedullary fixation of proximal phalangeal shaft fractures through a volar extra-tendon sheath approach. A J-shaped nail, which is a curved Kirschner wire sharply bent at the proximal end, was inserted from the palmar aspect of the proximal phalangeal base. Six fingers of the six patients (all male) were treated with this method. ⋯ All fingers attained successful fracture union and one of them had correction loss. No patient complained of pain at the final follow-up, and the average of total active motion was 223° (190° - 255°). This method may be an alternative for treatments of the proximal phalangeal shaft fractures because of its less invasive nature, although it does not offer anatomical reduction.
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Comparative Study
Prevention of flexor pollicis longus tendon rupture after volar plate fixation of distal radius fractures.
We evaluated the presence of "tendon irritation" of flexor pollicis longus (FPL) for cases of distal radius fracture treated with volar plates to prevent FPL tendon rupture. This report details cases of 24 patients. The presence of pain or a sense of incompatibility and subdermal crepitus around the wrist with an active thumb motion were defined as symptoms of FPL tendon irritation. ⋯ Four of these 12 patients underwent plate removal, and tendon injury was not detected. The results of this study indicate that FPL tendon irritation is likely to appear before tendon rupture. Therefore, FPL tendon rupture might be prevented by plate removal in patients who complained of tendon irritation.
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Comparative Study
Continuous peripheral nerve block in forearm for severe hand trauma.
We studied the use of a continuous peripheral nerve block (CPNB) in the distal forearm and wrist immediately after emergent surgery for severe hand trauma in 22 hands. After emergent surgery, a 2-3 cm longitudinal incision was made at the distal forearm and an 18-gauge catheter was inserted along the peripheral nerves. ⋯ There were no major complications related to the CPNB and one patient showed mild superficial infection at the insertion site that immediately recovered after catheter removal. This method provides good postoperative analgesia without loss of motor function in extrinsic hand muscles and should be considered as a postoperative pain management for severe hand trauma.
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Case Reports
Fixation of comminuted distal radius fractures with a mixture of calcium phosphate and calcium sulfate cement.
Distal radius fracture alignment and stabilization can be a surgical challenge in the face of severe comminution and bone loss. We describe a technique using a calcium phosphate/sulfate bone cement, as an adjunct to internal fixation. ⋯ Bone cement is employed for the following purposes in comminuted fractures: (1) to fill a void due to lost or crushed cancellous bone, (2) to hold larger unstable fragments while hardware is placed, and (3) to retain fragments too small to take hardware. Available bone cements, studies involving the use of bone cement for distal radius fractures, indications, and surgical technique will be reviewed.
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We present a hitherto unreported condition of a bipartite distal phalanx in a child. The condition mimics a fracture and may even lead one to suspect a non-union. ⋯ This could potentially cause injury to the growth plate with resultant growth arrest. Careful clinical and radiographic examination of both hands combined with an awareness of this condition can help avoid such problems.