1/49. Immediate autografting of bone in open fractures with bone loss of the hand: a preliminary report. case reports.Three patients with open fractures of the hand associated with bone loss were treated within four to six hours of injury by corticocancellous bone grafting and soft tissue coverage after meticulous debridement, copious irrigation of the wounds, and broad-spectrum antibiotics given intravenously. Long term follow-up was uneventful and showed that the graft had taken and healed well with early and full restoration of function and a good cosmetic result. Immediate corticocancellous bone grafting of an injured hand could be used in selected cases with well-debrided, surgically clean wounds as long as there is a rich blood supply. Adequate bone fixation, soft tissue coverage, and broad-spectrum antibiotics given intravenously will remove the risk of infection. Hand architecture is corrected while wound contracture and secondary deformity are avoided. Both patients' discomfort and hospital costs are considerably reduced.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/49. Ultrasonic assistance in the diagnosis of hand flexor tendon injuries.In contrast to routine flexor tendon injuries, flexor tendon ruptures following blunt injury or re-ruptures following repair can be difficult to diagnose. The authors investigated the efficacy of using ultrasound to assist in the diagnosis. From 1996 to 1997, 8 patients underwent evaluation of the flexor tendons using an ATL HDI-3000 ultrasound machine with a high-resolution, 5 to 9-MHz hockey stick linear probe. Dynamic evaluation was performed in real time, simulating clinical symptoms. Six patients underwent surgical exploration. Sonographic diagnosis and intraoperative findings were correlated. Ultrasound was used to diagnose 3 patients with ruptured flexor digitorum profundus tendons. Mechanisms of injury included forceful extension, penetrating injury, and delayed rupture 3 weeks after tendon repair. Subsequent surgical exploration confirmed the ruptures and location of the stumps. Five patients had intact flexor tendons by ultrasound after forceful extension, penetrating injury, phalangeal fracture, crush injury, and unknown etiology. In 3 patients who underwent surgery for tenolysis, scar release, or arthrodesis, the flexor tendons were found to be intact, as predicted by ultrasound. The authors found ultrasound to be accurate in diagnosing the integrity of flexor tendons and in localizing the ruptured ends. They conclude that ultrasound is helpful in evaluating equivocal flexor tendon injuries.- - - - - - - - - - ranking = 0.2keywords = fracture (Clic here for more details about this article) |
3/49. Physical therapy after hand injuries.The nuances of physical therapy necessary in the trauma patient are discussed. This article also discusses either the treatment of fractures via therapy or the treatment of nerve, tendon, or arterial injuries. It also describes physical therapy guidelines relevant to the patient with hand trauma and reviews communication between the physician and therapist in managing these patients. Intervention concepts are illustrated through case studies of patients with complex hand injuries.- - - - - - - - - - ranking = 0.2keywords = fracture (Clic here for more details about this article) |
4/49. 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 = 0.2keywords = fracture (Clic here for more details about this article) |
5/49. A case of old trapezoid fracture.We studied a rare case of old dorsal displacement fracture of the trapezoid. Favorable results were obtained with sugical reduction, despite the fracture being old.- - - - - - - - - - ranking = 1.2keywords = fracture (Clic here for more details about this article) |
6/49. Paediatric hand injuries caused by spiked railings.We report five cases of hand injuries caused by spiked palisade railings. One patient sustained an open fracture of the distal phalanx with a disruption of the nail bed, and two patients had digital nerve injuries. Two patients presented with the railing still impaled in the fingers, one of whom had an ischaemic digit at presentation. All patients were male, between 9 and 12 years of age, and presented in the course of 1 month. Railings of this type would appear to be a significant cause of hand injuries, which may be prevented by legislation or a change in railing design.- - - - - - - - - - ranking = 0.2keywords = fracture (Clic here for more details about this article) |
7/49. Treatment of ununited fracture of the hook of hamate by low-intensity pulsed ultrasound: a case report.A patient presented 4 months after sustaining a fracture of the hook of hamate. x-rays and computed tomography scanning of the carpal tunnel confirmed the presence of an ununited fracture. Low-intensity ultrasound was applied to the fracture site. After 4.5 months of exposure to ultrasound, union was confirmed by both x-rays and computed tomography scanning of the carpal tunnel. (J Hand Surg 2000; 25A:77-79.- - - - - - - - - - ranking = 1.4keywords = fracture (Clic here for more details about this article) |
8/49. Isolated fracture of the trapezoid.We describe a case of an isolated trapezoid fracture that was managed nonoperatively with a favorable clinical outcome. To our knowledge and based on a literature review, this is the first report of a true isolated trapezoid fracture without accompanying dislocation and without associated metacarpal, carpal, or distal radial fractures. We present our findings in this case and review the clinical presentation, diagnostic workup, and treatment of trapezoid fractures in general.- - - - - - - - - - ranking = 1.6keywords = fracture (Clic here for more details about this article) |
9/49. Hamatometacarpal fracture-dislocation: distinctive three dimensional computed tomographic appearance.We report here two fully documented cases of hamatometacarpal fracture-dislocation following trauma and treated in our hospital. In our cases, the patients suffered hamate fracture in association with metacarpal dislocation. In the first case, a dorsal oblique fracture of the hamate was associated with a dorsal dislocation of the base of the fourth metacarpal. In the second case, a dorsal oblique fracture of the hamate was not associated with a dorsal dislocation of the base of the fifth metacarpal. This diagnosis should be suspected on initial review of plain radiographs, which must include an oblique view because of diagnostic difficulty for this injury. We recommend three dimensional computed tomography (3D-CT) in any patient presenting with pain after blunt trauma to the hand to prevent in diagnosis. Open reduction and internal fixation of the fracture is indicated and relevant for displaced fracture.- - - - - - - - - - ranking = 2keywords = fracture (Clic here for more details about this article) |
10/49. Complete tooth extraction: a case report.Advanced Trauma and life Support protocol is used in trauma situations to identify life-threatening injuries, and after those are addressed, it provides a systematic approach to identify minor injuries. A 17-year-old male, who was involved in a motor vehicle accident, was treated for an open toe fracture. He also had an "avulsion injury" to his left hand and was missing a tooth. On follow-up two days later, he was found to have a tooth in his left hand after he presented with cellulitis of a hand wound. He was appropriately treated with foreign body removal, incision and drainage, and antibiotics. This case is not only presented for being unique but also to emphasize the importance of the secondary survey and serial examinations instructed by Advanced Trauma and life Support.- - - - - - - - - - ranking = 0.2keywords = fracture (Clic here for more details about this article) |
| | Next -> |