1/104. Salter-Harris type III and IV epiphyseal fractures in the hand treated with tension-band wiring.We present tension-band wiring in the treatment of Salter-Harris types III and IV avulsion fractures in the hand. By placing a small-gauge wire through the insertion of the ligament into the fracture fragment, accurate reduction and stability, allowing early mobilization, are achieved, avoiding many of the pitfalls and complications of other methods of internal fixation. The technique is simple and adheres to important physiological and biomechanical principles.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
2/104. Serratus fascia "sandwich" free-tissue transfer for complex dorsal hand and wrist avulsion injuries.The serratus anterior fascia was used as a free-tissue transfer in four patients for the reconstruction of dorsal hand defects. All patients had multiple open metacarpal fractures with extensor tendon injuries. The fascia was used to "sandwich" the extensor tendons in a bed of areolar gliding tissue to avoid adhesions. The mean follow-up was 2 years. There were no complications and all flaps survived completely. All flaps were grafted with meshed split-thickness skin at the time of transfer with a 100 percent take in all cases. A good functional result was noted in all patients. This free-tissue transfer is recommended for complex injuries to the dorsum of the hand associated with soft-tissue defects.- - - - - - - - - - ranking = 1.2keywords = hand (Clic here for more details about this article) |
3/104. Transarticular fixation with the capacity for motion in fracture dislocations of the elbow.Post-traumatic stiffness of the elbow joint is a frequent result of immobilisation leading to severe disability in the use of the upper extremity. Recognition of the tendency to stiffness leads to the assumption that the strong self-healing forces of the capsule and ligament apparatus converts the initial instability of the joint after ligament disrupture, into a high-grade undirected stability following immobilisation. Directed stability as it is produced by the natural ligament apparatus of the joint on the other hand produces a guided movement of the joint in one direction. These theoretical considerations lead to the idea that the self-healing forces of the ligament apparatus under continuous guided movement of the joint will result in a stable and movable joint to allow healing of the compromised soft tissue envelope and moreover to maintain free soft tissue access without compromising the stability. For this a unilateral fixator with motion capacity was developed. The joint bridging application approaches the humerus and ulna from the lateral side. The proximal pin group is inserted into the proximal region of the humerus respecting the radial nerve. The distal pin group is implanted from the dorsal side into the middle third of the ulna. The fixator has a hinge joint. The design of the fixator clamps, bars and the hinge joint allows simple alignment with the rotational axis of the elbow. Pro- and supination of the forearm is unhindered. Flexion and extension can be permitted according to the soft tissue situation.- - - - - - - - - - ranking = 0.2keywords = hand (Clic here for more details about this article) |
4/104. Cruciate paralysis, hypothesis for injury and recovery.STUDY DESIGN: Case report and review of the literature. OBJECTIVES: Discuss a case of cruciate paralysis, a review of the literature and the hypotheses regarding the pathogenesis and recovery in spinal cord injuries that cause disproportionate weakness of the upper extremities. SETTING: Thomas Jefferson University Hospital, philadelphia, PA, USA. methods: Case report. RESULTS: A case of cruciate paralysis is presented involving a 59-year-old female who experienced a gunshot wound to the face. Initial motor exams revealed mild lower limb weakness and absent upper limb function with an upper limb modified American Spinal Injury association motor score of 0/50 (a modified impairment scale using half point muscle grades). Spinal imaging revealed fractures of the C1 anterior ring and the odontoid process, both associated with multiple bullet fragments. No spinal surgery was performed and she was placed in halo fixation. By 3 weeks she had regained enough upper limb function to manipulate large objects with her left hand and move her right hand. At that time, her upper limb asia score was 16/50. By 5 weeks, her upper limb modified asia motor score had improved to 31.5/50 and she began manipulating feeding utensils, writing legibly, and brushing her teeth with her left hand. CONCLUSIONS: In this case report we present a patient's motor and functional recovery. We also discuss the hypothesis that the acute central cord syndrome and cruciate paralysis are a likely result of similar pathologic mechanisms and that good functional outcome resulted from an initially disabling trauma.- - - - - - - - - - ranking = 0.6keywords = hand (Clic here for more details about this article) |
5/104. Acute injuries of the distal radioulnar joint.Distal radioulnar joint injuries can occur in isolation or in association with distal radius fractures, Galeazzi fractures, Essex-Lopresti injuries, and both-bone forearm fractures. The authors have classified DRUJ/TFCC injuries into stable, partially unstable (subluxation), and unstable (dislocation) patterns based on the injured structures and clinical findings. Clinical findings and plain radiographs are usually sufficient to diagnose the lesion, but axial CT scans are pathognomonic. Diagnostic arthroscopy is the next test of choice to visualize stable and partially unstable lesions. Stable injuries of the DRUJ/TFCC unresponsive to conservative measures require arthroscopic debridement of the TFCC tear, along with ulnar shortening if there is ulnar-positive variance. Partially unstable injuries, on the other hand, are treated with direct arthroscopic or open repair of the TFCC tear, once again, along with ulnar shortening if ulnar-positive variance is present. Unstable injuries include simple and complex DRUJ dislocations. A simple DRUJ dislocation is easily reducible but may be stable or unstable. In complex dislocation, reduction is not possible because there is soft tissue interposition or a significant tear. After the associated injury is dealt with, treatment for complex injuries requires exploration of the DRUJ, extraction of the interposed tissue, repair of the soft tissues, and open reduction and internal fixation of the ulnar styloid fracture (if present and displaced). The early recognition and appropriate treatment of an acute DRUJ injury are critical to avoid progression to a chronic DRUJ disorder, the treatment of which is much more difficult and much less satisfying.- - - - - - - - - - ranking = 0.2keywords = hand (Clic here for more details about this article) |
6/104. The posterior interosseous flap: a review of 81 clinical cases and 100 anatomical dissections--assessment of its indications in reconstruction of hand defects.Based on our experience of 100 cadaveric dissections and a series of 81 clinical cases, we have assessed the indications for the posterior interosseous flap in reconstruction of the hand. Large fasciocutaneous island flaps can be harvested, even when the radial or ulnar pedicles are damaged, sacrificing only vessels of secondary importance to the perfusion of the hand. Compound flaps can be dissected based on muscular, musculoperiosteal and fascioperiosteal branches. The primary indications for using this flap are dorsal hand defects up to the metacarpal joints, reconstruction of the first web space up to the interphalangeal joint of the thumb and extensive lesions on the ulnar border of the hand.- - - - - - - - - - ranking = 1.6keywords = hand (Clic here for more details about this article) |
7/104. Divergent fracture-dislocation of the second carpometacarpal joint and the three ulnar carpometacarpal joints.A case of divergent dislocation between the second metacarpal and the three ulnar metacarpals is presented. Severe edema, fragments of the trapezoid, and interposed volar ligaments prevented successful closed reduction. Open reduction enabled restoration of the carpometacarpal complex with excellent recovery of hand function.- - - - - - - - - - ranking = 0.2keywords = hand (Clic here for more details about this article) |
8/104. The role of mini-fragment screw fixation in volar dislocations of the proximal interphalangeal joint.Palmar fracture-dislocations of the proximal interphalangeal (PIP) joint are uncommon injuries, which can be associated with long-term complications if sub-optimally treated. We report two cases of palmar fracture-dislocations of the PIP joint treated by open reduction and internal fixation using a single mini-fragment screw. The long term results of hand and finger function were excellent.- - - - - - - - - - ranking = 0.2keywords = hand (Clic here for more details about this article) |
9/104. Traumatic axial dislocation of the carpus: a case report of transscaphoid pericapitate transhamate axial dislocation.Traumatic axial dislocation of the carpus in a 20-year-old man is described. This injury was accompanied by a crushing injury to the hand. The disruption pattern was different from those of previously reported cases. Despite the restoration of painless wrist motion postoperatively, grip strength remained below normal. Early accurate reduction, fixation, and range of motion (ROM) exercise are the treatment of choice in such complex injuries.- - - - - - - - - - ranking = 0.2keywords = hand (Clic here for more details about this article) |
10/104. Biomechanical failure of metacarpal fracture resorbable plate fixation.Metacarpal fractures are a relatively common hand injury that may require operative intervention to ensure adequate reduction and stabilization. The use of permanent hardware, although acceptable, may lead to complications and an increased number of surgical procedures. The use of resorbable hardware such as poly-L-lactic acid and polyglycolic acid copolymer plates and screws may circumvent some of these complications. in vitro studies have demonstrated that the biomechanical characteristics of these resorbable plates may provide the rigid fixation necessary to allow for union of metacarpal fractures in vivo. However, limited clinical data are available regarding the success of their use in this application. The authors present what they believe is the first reported case of the failure of a poly-L-lactic acid and polyglycolic acid copolymer miniplate after use in the fixation of a metacarpal shaft fracture.- - - - - - - - - - ranking = 0.2keywords = hand (Clic here for more details about this article) |
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