Cases reported "Wrist Injuries"

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1/468. Communicating defects of the triangular fibrocartilage complex without disruption of the triangular fibrocartilage: a report of two cases.

    Perforations or communicating defects of the triangular fibrocartilage complex have been more commonly identified after Palmer published his classification system (J hand Surg 1989;14A:594-606). To his variants of class 1B (traumatic) ulnar avulsion with or without distal ulnar fracture, a third category may be added: defects of the ulnar collateral ligament without any associated disruption of the triangular fibrocartilage. The ulnar collateral ligament can be defined as an ulnar capsular structure between the more discrete elements of the triangular fibrocartilage and the ulnar ligaments, with the defect or perforation being distal to the intact triangular fibrocartilage and exiting into the floor of the extensor carpi ulnaris sheath. We present 2 cases that illustrate the diagnosis, the use of both magnetic resonance imaging and arthrography to confirm the diagnosis, the associated dorsal ulnar cutaneous nerve pain distribution, and the open direct and retinacular flap repair. ( info)

2/468. Transverse carpal ligament disruption associated with simultaneous fractures of the trapezium, trapezial ridge, and hook of hamate: a case report.

    Traumatic disruption of the transverse carpal ligament associated with fractures of the trapezial ridge and hook of hamate is a known entity. Only one report of a coronal fracture of the trapezium has been mentioned in the literature. We report a combination of these two injury patterns. diagnosis was aided by computed tomography. Treatment involved excision of the trapezial ridge and hook of hamate fragments with lag screw fixation of the trapezial body fracture. ( info)

3/468. wrist pain with triangular fibrocartilage thickening.

    We review the case of a patient who had wrist pain with synovial proliferation due to triangular fibrocartilage (TFC) thickening, whose pain was relieved by total TFC resection. This suggested that TFC thickening should be considered in the evaluation of patients with wrist pain. ( info)

4/468. Complete avulsion of the distal posterior interosseous nerve during wrist arthroscopy: a possible cause of persistent pain after arthroscopy.

    A case of avulsion of the distal posterior interosseous nerve during wrist arthroscopy is presented. Surgeons unaware of this entity may attribute persistent middorsal wrist pain to the underlying disease rather than to iatrogenic damage to the distal posterior interosseous nerve. ( info)

5/468. upper extremity salvage using the tensor fascia lata flap: report of two cases.

    The tensor fascia lata pedicled flap was successfully used to salvage 3 severely injured upper extremities in 2 patients. Both patients had undergone 3 prior free tissue transfers without complete closure of their wounds. All 3 tensor fascia lata flaps (2 myocutaneous, 1 myofascial) survived entirely. We believe this flap offers a distinct advantage compared with the groin flap when pedicled flap coverage of the upper extremity is required. ( info)

6/468. Isolated capitate fracture diagnosed by computed tomography. Case report.

    Isolated fractures of the capitate, though rare, are probably often missed entirely. As in scaphoid fractures, repeated radiographs, tomography, or bone scanning are necessary for the diagnosis. Reviewing the literature, we found that most capitate fractures reported were transverse or combined with other carpal injuries, including the scapho-capitate fracture syndrome. Our patient presented an isolated oblique intraarticular fracture of the capitate. An old fracture of the styloid process of the ulna was seen at the primary examination. This special type of capitate fracture has not been previously described. The fracture was missed on standard radiographs, but discovered by computed tomography (CT). The different types of fractures of the capitate and their treatment are discussed. ( info)

7/468. Wire-loop fixation of volar displaced osteochondral fractures of the distal radius.

    We describe the technique of wire-loop fixation to treat 4 young men with a unique variant of Melone's type 4 articular fracture of the volar lunate facet, characterized by a displaced rotated articular fragment supported by a limited amount of subchondral bone. This is an unusual injury that threatens the integrity of both the radiocarpal and distal radioulnar joints. It is the result of a compressive force to the wrist and may require trispiral computed tomography for delineation. Open reduction and internal fixation is recommended to maintain stability and articular congruity. The displaced volar-articular fragment, however, may be relatively small; therefore, direct manipulation could lead to soft tissue stripping and osteonecrosis. We have found the technique of wire-loop fixation to be a simple, reproducible, and effective alternative method of internal fixation for these difficult fractures. Malunion, nonunion, loss of fixation, tendon rupture, infection, arthrosis, or pain caused by hardware has not occurred. Use of this technique is not recommended in patients with osteoporotic bone. ( info)

8/468. The role of emergency free flaps for hand trauma.

    Primary closure of a wound with free flap requires minimizing the risk of infection in an effort to cover vital exposed structures. Careful patient selection, radical debridement of the wound, and an experienced microsurgical team are important for the routine application of this technique. Primary reconstruction of all injured structures is an extension of this technique that enables efficient management of severe upper extremity problems in a single setting. ( info)

9/468. Irreducible Galeazzi fracture-dislocation due to an avulsion fracture of the fovea of the ulna.

    We report a rare case of Galeazzi fracture-dislocation with an irreducible distal radioulnar joint. The cause of the irreducibility was entrapment of a fragment avulsed from the fovea of the ulna. The patient was successfully treated with open reduction and internal fixation of the radius, ulnar styloid process and avulsed fracture at the fovea of the ulna. ( info)

10/468. pseudarthrosis of the capitate.

    Nonunion of an isolated fracture of the capitate is an infrequent condition. The authors present a patient who had few symptoms. Computed tomography showed more bone destruction than the standard X-ray. The nonunion healed with the use of a cancellous bone graft. ( info)
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