摘要:

Complete thumb ulnar collateral ligament (UCL) injuries usually require primary repair. The ulnar collateral ligament is often torn from its insertion site and reattachment is difficult. Seven patients underwent repair with the Mitek bone anchor (Mitek Surgical Products, Norwood, MA) for complete ulnar collateral ligament disruptions. A Stener lesion was found in four patients. Follow-up examination was at approximately 1 year. All patients regained a stable metacarpophalangeal joint to valgus stress. X-ray films demonstrated accurate placement of the bone anchor with protraction of the metallic wings within cancellous bone. Range of motion revealed a 7% loss of metacarpophalangeal flexion-extension and a 21% loss of interphalangeal motion. Pinch strength in apposition averaged 98% and in opposition 97% of the uninvolved hand. Grip strength was 96% of the contralateral extremity.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The biomechanical properties of apex bending and torsional rigidity of 11 different titanium mini- and microplates (Leibinger and Synthes) were examined to evaluate the effects of plate design and thickness and screw size and design. Two hundred sixteen fresh-frozen human cadaveric metacarpal bones underwent a midshaft transverse osteotomy followed by application of one of the following plates: Synthes 1.5-mm and 2.0-mm five-hole linear plates; Leibinger linear 1.2-mm 5-hole, 1.7-mm 4-hole, 2.3-mm 4-hole plates; or Leibinger three-dimensional 1.2-mm 4-hole, 1.2-mm 8-hole, 1.7-mm 4-hole, 1.7-mm 8-hole, 2.3-mm 4-hole, and 2.3-mm 8-hole plates. The specimens were subjected to a three-point bending test with apex dorsal or apex volar loading or torsional loading. Analysis of variance statistical analysis revealed that increasing plate thickness and, more significantly, three-dimensional design were associated with increased rigidity.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Proximal interphalangeal joint injuries can severely affect hand function. Early, active motion is important in ensuring a good range of motion and a functional outcome. Active traction splinting is a dynamic splinting system that can be performed with either open or closed reduction of phalangeal joint fractures, especially at the proximal interphalangeal level. This system allows for continued traction on the involved joint and thereby aids in providing a dynamic force that will unload the joint throughout its arc of motion and noticeably decrease pain. Early, active therapy and the continual in-line traction enables the patient to achieve an almost full range of motion early in the course of rehabilitation. This combination contributes significantly to improve patient understanding and compliance. The benefits of the active traction system are reduction of fragments, marked decrease in pain, and early range of motion with improved patient compliance. Early, active motion facilitates improved joint nutrition, contouring, and healing. Active traction splinting for proximal interphalangeal joint injuries is a relatively simple and effective method for treating these complex injuries.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

To determine the possible beneficial effect of postoperative splint immobilization after open carpal tunnel release, we performed a prospective, randomized study comparing 2 weeks of postoperative wrist splinting versus a bulky dressing only. Forty patients with 43 carpal tunnel releases were evaluated. There were no statistically significant differences between the two groups using subjective parameters of patient satisfaction with their outcome and objective parameters of grip and lateral pinch strength, complication rates, and digital and wrist range of motion. No clinical evidence of bowstringing could be noted in either group of patients. We found no beneficial effect from postoperative splinting after open carpal tunnel release when compared to a bulky dressing alone.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

An anatomical study was performed on the ulnar nerve to determine whether branches are present in the region of the incision for open or endoscopic carpal tunnel release that may be transected or traumatized, resulting in painful neuromata or dysesthetic symptoms. Twenty-four cadaveric forearms were dissected under 3.5-loupe magnification. A palmar cutaneous branch of the ulnar nerve was found in 42% of the limbs. Branches of the nerve were found in the proximity of the incision for carpal tunnel release in 12.5%. The palmar cutaneous branch of the median nerve was present in 92% of the limbs, with 8% having a branch in proximity to the incision. These anatomical findings suggest that injury to the palmar cutaneous branch of the ulnar nerve may be responsible for the “painful scar” more often than the palmar cutaneous branch of the median nerve.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We present our investigative and clinical experience with a new vascularized nerve graft: the serratus anterior intercostal nerve graft. The serratus branch of the thoracodorsal arterial system was injected with silicone rubber injection compound in seven fresh cadavers (N = 11 injected specimens) after the composite serratus-intercostal structures were harvested. Microdissection of selected vascular territories was then performed. Our findings reconfirmed the previously described vascular connections between the thoracodorsal system and the intercostal vessels via periosteal vessels. We also newly discovered vascular anastomoses between the serratus anterior muscle and the intercostal artery running within a mesentery. This mesentery is lateral to and distinct from the serratus-periosteal-intercostal network. The nerve graft was applied clinically in the reconstruction of a complex soft-tissue, 13-cm ulnar nerve defect of the volar forearm after an electrical injury. The clinical application was successful with limb salvage and return of protective sensation at 4 months. Our clinical and investigative results support the feasibility of the serratus anterior intercostal nerve graft, a unique and versatile new vascularized nerve graft.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

This study was conducted to determine how testing of nerve repair using nerve isolation techniques compares with standard testing. Nerve isolation consisted of double-gloving, leaving the study finger free, and administering local anesthetic blocks to all other sensory contributions in the exposed digit. Ten patients with 13 single digital nerve repairs of equally severe injuries were studied at a mean of 41 months postoperatively. Standardized tests yielded an excellent result in 77% for static two-point discrimination (S2pd), 85% for moving two-point discrimination (M2pd), and 46.2% for Semmes-Weinstein monofilaments (SWMF). The same studies combined with nerve isolation yielded an excellent result in only 43% for S2pd, 43% for M2pd, and 0% for SWMF. These results indicate a statistically significant difference and the importance of crossover innervation from intact nerves in the long-term result of digital nerve repair. Nerve isolation study techniques are an important adjunct in assessing the outcome of nerve repair and are the only method of evaluating the true end result of nerve regeneration following neurorrhaphy.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The purpose of this study was to measure the relationship between severity of injury and sensibility outcome. This was done by a retrospective study of 37 digital nerve repairs in 26 patients, with a mean follow-up of 35 months. All patients underwent complete hand examination and standard nerve testing, including static and moving two-point discrimination, Semmes-Weinstein monofilaments (SWMF), object recognition, and the pick-up test. A hand injury severity scoring system based on wound characteristics, mechanism of injury, and number of structures involved was then developed. Severity grading led to three classes, and each study group was well matched. Subjectively, all patients considered their outcome as either good or excellent. Objective results are reviewed individually for each test, with the overall combined result of static and moving two-point discrimination being excellent (Higher S4) in 81% for class I, 41% for class II, and 31% for class III, all different at a statistically significant level. We concluded that the severity of injury in the hand can be graded and does have a relationship to the functional end result of digital nerve repair.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

We present a simple provocative diagnostic office test for detection of triangular fibrocartilage complex tears of the wrist. Twenty-seven patients with a working diagnosis of a triangular fibrocartilage complex tear complained of wrist pain caused by forceful use; 18 had a history of trauma. A “press test” was performed in each, requiring the seated patient to push the body weight up off a chair using the affected wrist, creating an axial ulnar load. A positive test provoked focal ulnar wrist pain replicating the discomfort that had prompted the patient to seek medical attention. Thirteen patients improved with conservative treatment. Seventeen underwent magnetic resonance imaging (showing 13 tears and 4 normal results) and two patients had arthrograms (both had tears). Fourteen patients had wrist arthroscopy; all had triangular fibrocartilage complex tears, which were debrided, with postoperative clinical improvement. As verified by arthroscopy, the press test had 100% sensitivity in preoperative tear detection compared with 79% for magnetic resonance imaging. The press test is recommended as a useful, free, noninvasive clinical test for triangular fibrocartilage complex tears of the wrist.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Fifty limited wrist fusions were performed in 47 patients including 24 scaphoid-trapezium-trapezoid, 12 capitate-lunate-triquetrum-hamate, and 13 other limited wrist fusion combinations. Fusions were performed most commonly for rotary subluxation of the scaphoid and follow-up averaged 13.6 months for the chart review and 44 months for the questionnaire. There were 10 major complications in 8 patients, most of which required secondary surgery. There were 3 partial nonunions but no complete nonunions. Two patients later underwent a total wrist fusion. There were 15 minor complications in 10 patients, most of which were managed nonoperatively. A questionnaire was returned on 28 of the 50 fusions. Pain levels decreased from a preoperative level of 8.2 to a postoperative level of 3.0 (scale of 1–10 with 10 being most severe pain ever). All but 3 patients would have the fusion again.

ISSN:0148-7043    

出版商:OVID    

年代:1995

数据来源: OVID