Abstract:
:Many malunions of the finger metacarpals are mild and do not require or justify operative intervention. Early recreation of the fracture or osteotomy is more likely to be rewarded with favorable results than late operation. Rotational malunions of the metacarpals or proximal phalanges may be treated by transverse extra-articular transverse or step-cut osteotomies at or proximal to the malunion site. Rotational malunions of the proximal phalanges as great as 200 in the index, middle, and ring fingers and 300 in the small finger may be managed by transverse extra-articular osteotomy at the adjoining metacarpal base. Angular and combined angular and rotational deformities of the metacarpal can be corrected by closing wedge osteotomy at the malunion site, with adjustment for malrotation when necessary. Angular and combined angular and rotational deformities of the proximal phalanx may be corrected by dorsal opening or lateral opening or closing wedge osteotomy, with derotation when needed. Articular malunions may be treated by osteotomy at the fracture site, a sliding osteotomy of the fracture and its proximal supporting cortex, or extra-articular osteotomy. Each approach for articular malunions has its potential risks and benefits. The true risks of articular malunion correction may not be fully known, because of the small number of cases in each presented series and the short follow-ups. Finger motion may be improved by correction of deformity alone, and may be further enhanced by tenolysis of adjacent adhesions. Capsulolysis may be helpful in instances of adjacent joint contracture. Despite improvement of finger motion in a majority of cases, some degree of remaining stiffness is common. Stiffness is almost always a residual of the original injury rather than a complication of corrective surgery, and serves to reinforce the fact that primary fracture reduction, stabilization, and rehabilitation are usually the best deterrents to malunion and consequent impairment. Much of the best available information has been gained from retrospective cohort or case study reports that may have inherent flaws in study design that limit their statistical validity and ability to detect trends. Flaws may include heterogeneity; investigator enthusiasm; and a lack of enrollment, prospective controlled randomization, blinding, confidence interval determinations, and follow-up. The statistical ability to determine trends in past reports may be compromised. Past reports provide important information and advances, but should be interpreted with some discretion. The pen may be mightier than the scalpel. In spite of encouraging reported results, phalangeal and articular osteotomies, in particular, remain daunting procedures for most hand surgeons. Prospective, controlled randomized studies maybe difficult to achieve in the clinical setting because of the time that would be necessary to secure adequate enrollments for statistical validity andthe occurrence of "dropouts" before completion of adequate follow-up. Meta-analysis is difficult because of variations in discriminators for patient selection and clinical outcomes. Although multicenter studies have their own inherent flaws, they may represent the best future option to add a higher level of study design and validity as compared with past studies. The incorporation of subjective patient outcome instruments into future studies might also provide valuable information. Investigators should review previous reports with a goal of improving study designs and scientific methodology, confirming or contradicting past results, or adding new information.
journal_name
Hand Clinjournal_title
Hand clinicsauthors
Freeland AE,Lindley SGdoi
10.1016/j.hcl.2006.03.001subject
Has Abstractpub_date
2006-08-01 00:00:00pages
341-55issue
3eissn
0749-0712issn
1558-1969pii
S0749-0712(06)00033-3journal_volume
22pub_type
杂志文章,评审相关文献
HAND CLINICS文献大全abstract::The evaluation and treatment of the stiff elbow are described, as well as the lateral, medial, anterior, and posterior approaches for release of elbow contractures. The results after surgical release in 48 patients that failed nonoperative treatment for elbow contractures in our institution are reported. A literature ...
journal_title:Hand clinics
pub_type: 杂志文章
doi:10.1016/s0749-0712(02)00005-7
更新日期:2002-02-01 00:00:00
abstract::An appreciation of the salient clinical and radiologic presentations of osteoarthritis, as well as associated tenosynovial problems (stenosing tenosynovitis and carpal tunnel syndrome), is necessary for effective diagnosis. The treatment of osteoarthritis is predicated upon an understanding of the anatomy and pathomec...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:
更新日期:1987-08-01 00:00:00
abstract::Although carpal fractures other than of the scaphoid are uncommon, vigilance in diagnosing these potentially serious fractures is paramount to early and effective treatment. Physical examination and standard plain radiographs may reveal only subtle findings. Use of special radiographic views and computed tomography ma...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:10.1016/j.hcl.2006.07.007
更新日期:2006-11-01 00:00:00
abstract::High clinical suspicion is of paramount importance in evaluating the hand or wrist for an evolving compartment syndrome. A detailed history coupled with a thorough physical examination form the basis for the diagnosis. The use of techniques to measure compartment pressures forms the objective foundation to assist in f...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:
更新日期:1998-08-01 00:00:00
abstract::A classification of distal radial articular fractures is described, based on observations of consistent patterns of fracture fragmentation and displacement. The classification categorizes articular fractures into four types, with the medial complex assuming a pivotal position as the cornerstone of both the radiocarpal...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:
更新日期:1988-08-01 00:00:00
abstract::Injuries to the proximal interphalangeal joint are extremely common. An understanding of the complex anatomy of this joint is essential for diagnosis and treatment of proximal interphalangeal joint sprains and dislocations. Lateral injuries are among the commonest injuries in the hand. These are often stable after red...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:
更新日期:1988-02-01 00:00:00
abstract::Despite continued improvement in the methods used to treat tendon injury, problems still arise. Careful attention paid to the details of surgical indications, technique, and postoperative management will prevent or reduce the effects of complications in this difficult area of hand surgery. ...
journal_title:Hand clinics
pub_type: 杂志文章
doi:
更新日期:1986-05-01 00:00:00
abstract::Since the use of fire became part of life, mankind has sought remedies to treat burns. The upper extremity, due to its frequency of exposure as the foremost organ in the everyday exploration of the environment and in manipulative and social interactions, is often involved. This article discusses the history of burn tr...
journal_title:Hand clinics
pub_type: 历史文章,杂志文章
doi:
更新日期:1990-05-01 00:00:00
abstract::This article reviews the history of total wrist arthroplasty as a treatment option for painful, nonfunctional wrists in disease states. Technologic advances in materials, wear properties, and manufacturing now account for increased implant longevity. They may also improve total wrist replacement design, survival, and ...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:10.1016/j.hcl.2012.08.015
更新日期:2012-11-01 00:00:00
abstract::The lumbrical muscles are unique in having their origin and insertion on tendons. The lumbricals assist in metacarpophalangeal joint flexion; they contribute to interphalangeal joint extension by acting as deflexors of the proximal interphalangeal joint. Anatomically, they are highly specialized in terms of their arch...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:10.1016/j.hcl.2011.09.002
更新日期:2012-02-01 00:00:00
abstract::This article reviews the assessment and management of obstetrical brachial plexus palsy. The potential role of distal nerve transfers in the treatment of infants with Erb's palsy is discussed. Current evidence for motor outcomes after traditional reconstruction via interpositional nerve grafting and extraplexal nerve ...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:10.1016/j.hcl.2015.12.006
更新日期:2016-05-01 00:00:00
abstract::There are just two variables that define the mechanical qualities of each muscle. One is its potential for generating tension, and the other is the distance through which tension can be exerted. Tension capability can be increased in a muscle by exercise. There is no way to increase potential for excursion except by r...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:
更新日期:1988-05-01 00:00:00
abstract::Experience will show that proper management during the first 3 postoperative weeks will be the major determinant for the final result in extensor tendon injuries. In the simple injury, meticulous care in properly immobilizing each joint, combined with edema control, allows the patient to begin the mobilization phase w...
journal_title:Hand clinics
pub_type: 杂志文章
doi:
更新日期:1986-02-01 00:00:00
abstract::The implementation of the wide-awake local anesthetic no tourniquet (WALANT) approach to surgical procedures in Cyprus has led to significant cost savings. In the United Kingdom, the implementation of WALANT has led to shorter waiting times for hand surgical procedures, cost savings for the National Health Service, an...
journal_title:Hand clinics
pub_type: 杂志文章
doi:10.1016/j.hcl.2018.08.007
更新日期:2019-02-01 00:00:00
abstract::Therapy for the painful upper extremity is a challenge. This article focuses on various assessment tools and techniques that are reflective of the painful status. The author reviews several research articles that discuss validating treatment options and outlines rehabilitation for the painful upper extremity as it rel...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:
更新日期:1996-11-01 00:00:00
abstract::The general indications, timing, and choice of procedure can be determined by asking and answering the following questions appropriately: 1. Has the patient achieved neurologic, emotional, and social stability? 2. What is the patient's current level of motor and sensory resources and function? The number and strength ...
journal_title:Hand clinics
pub_type: 杂志文章
doi:10.1016/s0749-0712(02)00030-6
更新日期:2002-08-01 00:00:00
abstract::Injury and musculoskeletal disorders are a major cause of death, disability, and decreased quality of life in developing countries. Thus, understanding the cost-effectiveness of orthopedic care in low- and middle-income countries may help to guide future outreach. A systematic review was conducted on the literature av...
journal_title:Hand clinics
pub_type: 杂志文章
doi:10.1016/j.hcl.2019.07.015
更新日期:2019-11-01 00:00:00
abstract::When the wrist is grasping an object, at least four mechanisms of carpal stabilization are involved-one for each carpal row (proximal and distal), one for the midcarpal joint, and one for the radiocarpal joint. These mechanisms are based on the general principle that, under load-bearing conditions, any bone tends to r...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:
更新日期:1997-02-01 00:00:00
abstract::Improvements in critical care and burn victim resuscitation have led to increased survival of burned patients. Initial resuscitation, early excision of burned tissues, prevention of burn wound sepsis, and wound coverage remain mainstays of care. Many burn wounds require complex reconstruction. This is particularly imp...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:10.1016/j.hcl.2016.12.007
更新日期:2017-05-01 00:00:00
abstract::Soft tissue reconstruction of the digit is challenging for hand surgeons because it must satisfy both functional and aesthetic requirements. A wide variety of treatment options exist. A free flap can be an alternative solution in some clinical situations. This article has 2 purposes. First, it discusses various consid...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:10.1016/j.hcl.2019.08.008
更新日期:2020-02-01 00:00:00
abstract::Many surgical techniques are available for the repair of peripheral nerve defects. Autologous nerve grafts are the gold standard for most clinical conditions. In selected cases, alternative types of reconstructions are performed to fill the nerve gap. Non-nervous autologous tissue-based conduits or synthetic ones are ...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:10.1016/j.hcl.2017.04.005
更新日期:2017-08-01 00:00:00
abstract::Until the 1920s, TOS was believed to be a vascular condition caused by compression of the subclavian artery by a congenital anomaly, either a cervical rib or tight anterior scalen muscle. Today it is regarded primarily as a neurologic condition caused by neck trauma injuring and scarring the scalene muscles. ...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0712(03)00079-9
更新日期:2004-02-01 00:00:00
abstract::Rheumatoid arthritis commonly affects the thumb. Deformity does not require surgical intervention unless pain is present or a functional deficit exists, but if bony erosion develops and surgical treatment may be compromised in the future, earlier intervention may be indicated. When the pathogenesis and pathoanatomy of...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:
更新日期:2001-05-01 00:00:00
abstract::The prevention and treatment of hand injuries in low- to middle-income countries needs to be a priority. Surgical outreach trips are a primary avenue for patients to receive interventions. Challenges include language and cultural barriers, poor infrastructure, and limitations in a patient's ability to follow-up. Strat...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:10.1016/j.hcl.2019.07.005
更新日期:2019-11-01 00:00:00
abstract::Most sports are associated with specific patterns of hand injury. In some cases, these are unavoidable due to the nature of hand involvement dictated by the rules or environment of the sport. In other cases, such injuries point out the need for better protective gear or training. ...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:
更新日期:1990-08-01 00:00:00
abstract::Release of the transverse carpal ligament is commonly performed and highly successful in the treatment of carpal tunnel syndrome; however, complications do occur and may be broadly classified as errors in diagnosis and surgical technique. Complications range from incomplete division of the transverse carpal ligament t...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:
更新日期:1994-02-01 00:00:00
abstract::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. Tre...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:10.1016/j.hcl.2017.09.009
更新日期:2018-02-01 00:00:00
abstract::Delayed finger and thumb tip reconstruction should try to optimally reconstruct perioncyhial aesthetic and functional units by replacing tissue as closely resembling the original loss as possible. Avoid thinking in terms of a "reconstructive ladder" but rather going directly to the reconstructive choice that seems mos...
journal_title:Hand clinics
pub_type: 杂志文章,评审
doi:10.1016/j.hcl.2020.09.008
更新日期:2021-02-01 00:00:00
abstract::Carpal bone fractures make up a significant proportion of injuries to the wrist. The complex bone shape and articulations make diagnosis more difficult and missed injuries more common. This article reviews carpal bone fractures excluding the scaphoid. ...
journal_title:Hand clinics
pub_type: 杂志文章
doi:10.1016/j.hcl.2009.08.014
更新日期:2010-02-01 00:00:00
abstract::In nerve entrapment syndromes in the upper extremity, the surgeon must first become a diagnostician. When the symptoms of entrapment are bilateral, diabetes mellitus and cervical arthritis are found in a significant statistical number over the general population. These diseases can result in incomplete relief of sympt...
journal_title:Hand clinics
pub_type: 杂志文章
doi:
更新日期:1986-11-01 00:00:00