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Hand Clinics

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https://www.readbyqxmd.com/read/29169603/complex-trauma-management-of-the-upper-extremity
#1
EDITORIAL
Asif M Ilyas
No abstract text is available yet for this article.
February 2018: Hand Clinics
https://www.readbyqxmd.com/read/29169602/ulnar-nerve-management-with-distal-humerus-fracture-fixation-a-meta-analysis
#2
REVIEW
Jonathan W Shearin, Talia R Chapman, Andrew Miller, Asif M Ilyas
Ulnar nerve dysfunction following distal humerus fractures is a well-recognized phenomenon. There is no consensus regarding optimal handling of the ulnar nerve during surgical management of these fractures between in situ management and transposition. Using an electronic database to identify retrospective studies involving surgical fixation of distal humerus fractures yielded 46 studies, 5 trials meeting the authors' inclusion criteria, totaling 362 patients. An overall incidence of 19.3% for ulnar neuropathy was identified...
February 2018: Hand Clinics
https://www.readbyqxmd.com/read/29169601/antibiotic-management-and-operative-debridement-in-open-fractures-of-the-hand-and-upper-extremity-a-systematic-review
#3
REVIEW
William J Warrender, Christopher J Lucasti, Talia R Chapman, Asif M Ilyas
Open fractures of the hand are thought to be less susceptible to infection than other open fractures because of the increased blood supply to the area. Current evidence for all open fractures shows that antibiotic use and the extent of contamination are predictive of infection risk, but time to debridement is not. We reviewed in a systematic review the available literature on open fractures of the hand and upper extremity to determine infection rates based on the timing of debridement and antibiotic administration...
February 2018: Hand Clinics
https://www.readbyqxmd.com/read/29169600/arterial-injury-in-the-upper-extremity-evaluation-strategies-and-anticoagulation-management
#4
REVIEW
Cory Lebowitz, Jonas L Matzon
Trauma to the upper extremity can present with an associated arterial injury. After patient stabilization, thorough assessment with physical examination and various imaging modalities allows accurate diagnosis of the specific arterial injury. After diagnosis, efficient treatment is necessary to allow limb salvage. Treatment options include ligation, primary repair, graft reconstruction, endovascular repair, and amputation. The final treatment rendered is frequently dependent on injury location and mechanism...
February 2018: Hand Clinics
https://www.readbyqxmd.com/read/29169599/elbow-fractures-with-instability-evaluation-and-treatment-strategies
#5
REVIEW
Neal C Chen
The treatment goals of elbow fracture dislocations are congruent reduction of the ulnohumeral and radiocapitellar joints, stable fixation of the proximal ulna, stable fixation or arthroplasty of the radial head, and soft tissue repair. Fracture dislocations occur in patterns, and recognition of these patterns help guide surgical treatment. In patients with persistently unstable fractures after standard fixation, additional temporary joint spanning implants are useful to protect repairs.
February 2018: Hand Clinics
https://www.readbyqxmd.com/read/29169598/traumatic-wounds-of-the-upper-extremity-coverage-strategies
#6
REVIEW
Muhammad Mustehsan Bashir, Muhammad Sohail, Hussan Birkhez Shami
Soft tissue coverage of traumatic wounds of the upper extremity is often required to restore adequate function and form. An optimal coverage should be stable, durable, and able to withstand heavy demands of work, should allow free joint mobility, and should have an aesthetically acceptable appearance. Reconstructive options for coverage include autologous tissue and dermal skin substitutes. Multiple factors, including wound characteristics and complexity, general condition of the patient, and surgeon comfort and expertise, help in selection of the reconstructive technique...
February 2018: Hand Clinics
https://www.readbyqxmd.com/read/29169597/forearm-compartment-syndrome-evaluation-and-management
#7
REVIEW
Justin M Kistler, Asif M Ilyas, Joseph J Thoder
Compartment syndrome of the forearm is uncommon but can have devastating consequences. Compartment syndrome is a result of osseofascial swelling leading to decreased tissue perfusion and tissue necrosis. There are numerous causes of forearm compartment syndrome and high clinical suspicion must be maintained to avoid permanent disability. The most widely recognized symptoms include pain out of proportion and pain with passive stretch of the wrist and digits. Early diagnosis and decompressive fasciotomy are essential in the treatment of forearm compartment syndrome...
February 2018: Hand Clinics
https://www.readbyqxmd.com/read/29169596/hand-compartment-syndrome
#8
REVIEW
Aaron J Rubinstein, Irfan H Ahmed, Michael M Vosbikian
Acute hand compartment syndrome is a potentially devastating condition a hand surgeon may be called on to evaluate and treat. This pathophysiologic cascade of events that begins with an inciting event progresses to increased intracompartmental pressure, tissue necrosis, and resultant morbidity and potentially mortality. Many patients present with an altered sensorium, making the diagnosis challenging, requiring the clinician to rely on clinical findings and intracompartmental pressure measurements. The timing to definitive treatment with complete decompressive fasciotomies is critical to optimize patient outcomes...
February 2018: Hand Clinics
https://www.readbyqxmd.com/read/29169595/open-distal-radius-fractures-timing-and-strategies-for-surgical-management
#9
REVIEW
Matthew L Iorio, Carl M Harper, Tamara Rozental
Open distal radius fractures are rare injuries with few studies to guide treatment. Degree of soft tissue injury and contamination may be a primary consideration to dictate timing and operative intervention. Antibiotics should be started as early as possible and include a first-generation cephalosporin. Surgical fixation remains a matter of surgeon preference: although studies support the use of definitive internal fixation, many surgeons address contaminated injuries with external fixation. Although postoperative outcomes are similar to closed injuries for low-grade open distal radius fractures, high-grade injuries with more complex fracture patterns carry a high risk of complications, poor outcomes, and repeat surgical procedures...
February 2018: Hand Clinics
https://www.readbyqxmd.com/read/29169594/carpal-tunnel-syndrome-and-distal-radius-fractures
#10
REVIEW
David Pope, Peter Tang
Carpal tunnel syndrome (CTS) after distal radius fractures can present in 3 forms: acute, transient, and delayed. Acute CTS requires an emergent carpal tunnel release. Many patients with transient CTS after distal radius fracture do not require surgical release of the carpal tunnel once the fracture is repaired. Prophylactic carpal tunnel release in the absence of signs and symptoms of CTS after a distal radius fracture is not indicated. For patients with delayed CTS after a distal radius fracture, all possible causes of nerve compression should be considered and addressed in standard fashion...
February 2018: Hand Clinics
https://www.readbyqxmd.com/read/29169593/-damage-control-hand-surgery-evaluation-and-emergency-management-of-the-mangled-hand
#11
REVIEW
Rick Tosti, Kyle R Eberlin
Mangled hand injuries are defined as those with significant damage to multiple structures, which may be limb threatening. Historically these injuries resulted in amputation or death, but modern surgical and perioperative advances allow for complex reconstruction and the possibility of a sensate and functional limb. Evaluation begins with surveying for life-threatening injuries followed by a systematic approach to identify injured structures; management begins with preserving all parts, minimizing warm ischemia time, performing d├ębridement, and planning an operative approach to optimize the chance of a functional limb...
February 2018: Hand Clinics
https://www.readbyqxmd.com/read/29169592/distal-radius-fractures-in-a-functional-quadruped-spanning-bridge-plate-fixation-of-the-wrist
#12
REVIEW
Brian A Tinsley, Asif M Ilyas
Patients who require assistive devices with their hands for mobilization are called functional quadrupeds. These patients pose a unique challenge after they have a distal radius fracture, as their injury not only limits the wrist but also compromises ambulation. The authors propose a different treatment strategy for functional quadrupeds to improve mobilization and weight-bearing with the injured limb after a distal radius fracture. In this article, the authors define the functional quadruped and describe their technique of spanning bridge plate fixation with a retrospective review of patient outcomes...
February 2018: Hand Clinics
https://www.readbyqxmd.com/read/29169591/radial-nerve-palsy-after-humeral-shaft-fractures-the-case-for-early-exploration-and-a-new-classification-to-guide-treatment-and-prognosis
#13
REVIEW
Gerard Chang, Asif M Ilyas
Radial nerve palsies are a common complication associated with humeral shaft fractures. The authors propose classifying these injuries into 4 types based on intraoperative findings: type 1 stretch/neuropraxia, type 2 incarcerated, type 3 partial transection, and type 4 complete transection. The initial management of radial nerve palsies associated with closed fractures of the humerus remains a controversial topic, with early exploration reserved for open fractures, fractures that cannot achieve an adequate closed reduction requiring fracture repair, fractures with associated vascular injuries, and polytrauma patients...
February 2018: Hand Clinics
https://www.readbyqxmd.com/read/29169590/open-fractures-of-the-hand-review-of-pathogenesis-and-introduction-of-a-new-classification-system
#14
REVIEW
Jacob E Tulipan, Asif M Ilyas
Open fractures of the hand are a common and varied group of injuries. Although at increased risk for infection, open fractures of the hand are more resistant to infection than other open fractures. Numerous unique factors in the hand may play a role in the altered risk of postinjury infection. Current systems for the classification of open fractures fail to address the unique qualities of the hand. This article proposes a novel classification system for open fractures of the hand, taking into account the factors unique to the hand that affect its risk for developing infection after an open fracture...
February 2018: Hand Clinics
https://www.readbyqxmd.com/read/28991594/evolution-and-inspiration-from-hand-and-wrist-arthroscopy
#15
EDITORIAL
Clara Wing-Yee Wong, Pak-Cheong Ho
No abstract text is available yet for this article.
November 2017: Hand Clinics
https://www.readbyqxmd.com/read/28991593/complications-of-wrist-and-hand-arthroscopy
#16
REVIEW
Zahab S Ahsan, Jeffrey Yao
Arthroscopy of the wrist continues to evolve and advance as a valuable clinical technique in hand surgery. This article aims to address safety of wrist arthroscopy and provide an overview of the known iatrogenic complications. Ultimately, the likelihood of associated injuries during wrist arthroscopy is dependent on the surgeon's ability and understanding of the equipment. Case volume and duration of experience directly correlate with mitigating iatrogenic injury and optimizing patient outcomes.
November 2017: Hand Clinics
https://www.readbyqxmd.com/read/28991592/progress-and-role-of-finger-joint-arthroscopy
#17
REVIEW
Isato Sekiya, Masaaki Kobayashi, Hideki Okamoto, Takanobu Otsuka
This article describes the authors' experience with, and recent advancement in, the techniques that have allowed the development of many new arthroscopic procedures in the finger joints. It also describes the role and techniques of arthroscopy in small finger joints. Because the intra-articular anatomy of the first to the fifth metacarpophalangeal (MCP) joints is similar, this article discusses the hand MCP joints without distinguishing thumb from fingers.
November 2017: Hand Clinics
https://www.readbyqxmd.com/read/28991591/arthroscopic-management-of-scaphoid-trapezium-trapezoid-joint-arthritis
#18
REVIEW
Loris Pegoli, Alessandro Pozzi
Scaphoid-trapezium-trapezoid (STT) joint arthritis is a common condition consisting of pain on the radial side of the wrist and base of the thumb, swelling, and tenderness over the STT joint. Common symptoms are loss of grip strength and thumb function. There are several treatments, from symptomatic conservative treatment to surgical solutions, such as arthrodesis, arthroplasties, and prosthesis implant. The role of arthroscopy has grown and is probably the best treatment of this condition. Advantages of arthroscopic management of STT arthritis are faster recovery, better view of the joint during surgery, and possibility of creating less damage to the capsular and ligamentous structures...
November 2017: Hand Clinics
https://www.readbyqxmd.com/read/28991590/arthroscopic-management-of-thumb-carpometacarpal-joint-arthritis
#19
REVIEW
Clara Wing-Yee Wong, Pak-Cheong Ho
The thumb carpometacarpal joint (CMCJ1) is born to have good freedom of motion. However, the excellent mobility at this joint also predisposes attenuation of capsuloligamentous structures, joint incongruity, instability, and osteoarthritis. The prevalence of radiographic CMCJ1 arthritis is high. There is no single ideal surgery for all stages of CMCJ1 arthritis, and for all kinds of patients. The arthroscopic approach seems to provide a better alternative with rewarding preliminary results. It includes arthroscopic synovectomy/debridement/thermal shrinkage, arthroscopic partial trapeziectomy and suture button suspensionplasty, and arthroscopic CMCJ1 excision/suture button suspensionplasty/K-wire fixation...
November 2017: Hand Clinics
https://www.readbyqxmd.com/read/28991589/arthroscopic-management-of-bennett-fracture
#20
REVIEW
Jason Solomon, Randall W Culp
Bennett fracture is the most common fracture of the thumb. Choosing the appropriate approach to fracture fixation requires a thorough knowledge of the anatomy surrounding the first carpometacarpal joint, which is necessary to prevent injury to local sensory nerves and tendons. Although no study has shown superior outcomes compared with open reduction internal fixation and fluoroscopically guided closed reduction and percutaneous pinning, arthroscopic-assisted fixation allows for debridement of the carpometacarpal joint, direct visualization of the articular surface during reduction, and has minimal morbidity and associated complications...
November 2017: Hand Clinics
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