ISSN:1089-3393    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The elderly population is larger, healthier, and more active than ever. Osteoporosis-related fractures and their sequelae are becoming more commonplace. Successful management of these problems requires adequate internal fixation of osteoporotic bone. Fixation of osteoporotic bone has evolved from the use of cement or allograft-augmented screws to fixed-angle plates, and now to fixed-angle screws that thread into and engage solidly the hole in the plate, creating a fixed blade. Familiarity with these techniques may facilitate the care of elderly patients requiring operative fracture care.

ISSN:1089-3393    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Tissue expansion in the upper extremity is a valuable technique with expanding indications and expected outcomes. The primary indications are coverage problems after trauma, but the technique is also applicable to defects caused by treatment of hemangioma, nevi, tattoos, or hypertrophic scars as well as correction of unstable tissue or as an alternative to free tissue transfer. The advantage of expansion—specifically, match in tissue texture and retention of sensibility—may be more important in the hand and upper extremity than in other areas. The inevitable capsule that forms around the expander does provide a smooth gliding surface for tendons in the forearm and wrist. In conclusion, tissue expansion of the upper extremity offers the surgeon the ability to improve cosmesis in one location without having to sacrifice cosmesis at a second site.

ISSN:1089-3393    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

There are limited reconstructive options for segmental bone defects of the upper extremity larger than 6 cm in length, especially when associated with soft-tissue loss. Among the limited treatment options the osteoseptocutaneous fibular transplant is well established. The anatomy is reliable, the blood supply is constant, and the operative technique can be standardized. The advantage of including skin with the vascularized fibular transplant is twofold. First, the skin paddle can be used to augment the soft-tissue envelope. Second, the skin paddle serves as a monitor, providing an immediate, ongoing, and reliable method to monitor the blood flow to the graft. The osteoseptocutaneous fibular transplant proved to be an effective treatment of combined segmental bony and soft-tissue defects of the forearm and humerus.

ISSN:1089-3393    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Surgery based on an accurate determination of deforming forces, muscle weakness, and joint instability achieves reasonably predictable results in patients with cerebral palsy. Thumb deformities can be classified into those of mainly intrinsic nature, extrinsic nature, and those of a combined nature. This allows identification of which muscles are released most appropriately and which muscle function requires augmentation. Joint instability needs to be taken into consideration because tendon transfers across unstable joints will be ineffective. The various surgical procedures are outlined in the text. In 32 patients, application of these principles and techniques allowed removal of the thumb from the palm in 29 patients during fist formation. Lateral pinch was established in 26 thumbs, and functional assessment revealed improvement in one functional grade. Functional benefit may be determined by other factors beyond the control of the surgeon. Therefore, the decision to proceed to surgery may be undertaken only after detailed and repeated clinical examinations are conducted that are coordinated with the assessments of parents, caregivers, physicians, occupational and physical therapists, and social counselors.

ISSN:1089-3393    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The main goal of first carpometacarpal arthritis surgery is to relieve pain. The main disadvantage of the classic techniques (trapeziectomy, implant arthroplasty) is that they are extensive surgeries with potential complications, such as radial nerve paresthesia and synovitis. In the author's opinion, denervation of the first carpometacarpal joint is a viable option in selected cases. He describes the technique of denervation based on his previous anatomic investigations. Two incisions are needed to sever all the articular branches derived from the superficial branch of the radial nerve, the palmar cutaneous branch of the median nerve, the thenar branch of the median nerve, and the lateral antebrachial cutaneous nerve. Results comparable with trapeziectomy or first carpometacarpal joint fusion are obtained concerning pain. Complications are uncommon, except for temporary paresthesia of the radial nerve sensory branch.

ISSN:1089-3393    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The management of recalcitrant nonunion of the scaphoid can be frustrating. Recent understanding of the vascular anatomy of the distal radius has helped in the management of these problems. Vascularized bone grafting for scaphoid nonunion has improved the union rates. Consequently, familiarity with this procedure is an important tool for any surgeon who treats scaphoid nonunion. Although there are numerous publications discussing both the vascular anatomy of the distal radius and the scaphoid, little is written about the surgical technique. This study reviews the literature on scaphoid nonunion and outlines the authors' experience with this procedure.

ISSN:1089-3393    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The authors follow conservative treatment of infantile trigger thumb because of the possible anesthetic and postoperative complications. Their conservative treatment involves passive exercise of the affected thumb performed only by the mother. Eighty-six percent of our patients showed improvement, with an average treatment period of 3 years 2 months. A secondary complication, radial flexion deformity of the distal phalanx at the affected thumb, was detected in 5% of patients. This secondary deformity occurred at an average age of 3 years 11 months. The authors think surgical release should be performed if any sign of such a deformity is noted. However, because none of the patients with the complication felt this was a cosmetic problem, the authors have not experienced a case for which the patient desired surgery. Although conservative treatment tends to require a long period of time, the authors consider it to be a useful method.

ISSN:1089-3393    

出版商:OVID    

年代:2003

数据来源: OVID