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Physical Examination of the Hand
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Arterial territories: An Allen test assists in deciding whether the radial or ulnar artery is responsible for the major artery supply to the hand. An Allen test (Figures 3.19 and 3.20) (Videos 3.10 and 3.11) manoeuvre is performed at the wrist level and repeated to look for the predominant blood supply. Usually, radial artery remains the predominant artery supply for the hand.
Trauma in the Elderly
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Injuries to the upper limbs are often seen in mobile patients. Eighty-five per cent of proximal humerus fractures occur in patients aged >65, with a female to male ratio of 70:30.40 Distal radius fractures are frequently associated with osteoporosis and may occur on minimal trauma. Similarly, these are more common in female patients. Treatment focuses on anatomical reduction, preservation of function and restoration of normal activities. Surgical repair may be required in grossly unstable fractures.41
Surgery of the Elbow
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Alan Salih, David Butt, Deborah Higgs
The anteromedial portal is established under direct vision and the arthroscope introduced to view the radioulnar and radiocapitellar articulations plus the annular ligament. Extending the elbow reveals more of the capitellum, and forearm rotation exposes more of the radial head. The anterolateral gutter and capsule should also be examined.
Distraction plating for bilaterally severely comminuted distal radius fracture: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Yuta Izawa, Hiroko Murakami, Tetsuya Shirakawa, Kazuo Sato, Toshiki Yoshino, Yoshihiko Tsuchida
The goal of treating distal radius fractures is to obtain a stable and movable wrist joint. Various treatment options are available, including conservative treatment, but open reduction and internal fixation are required in cases with severe instability or high disposition. The gold standard for internal fixation is volar locking plate fixation [1,2], and fragment-specific fixation is recommended when the articular surface is severely comminuted [3,4]. However, high-energy trauma may be accompanied by severe comminution and soft tissue damage, which are difficult to treat using a traditional internal fixation strategy. In such cases, external fixation is generally regarded as the next best treatment option [5,6]. External fixation spans the wrist joint continuously to maintain alignment until bone union; however, pin site infection and inconvenience owing to the fixation apparatus that the patient has to wear are common problems with this approach. Distraction plating is a method of bridging fixation from the radial shaft to the third metacarpal bone subcutaneously on the dorsal side and is used as an alternative to external fixation [7–10]. Although there is concern that the limitation of range of motion will remain due to the fixation of the wrist joint until implant removal, it has been reported that an acceptable range of motion of the wrist joint will eventually be obtained. Herein, we report a case in which distraction plating was performed for a bilateral highly comminuted distal radius fracture, with acceptable results obtained in the wrist joint’s range of motion and function.
Comparison of bone microstructures via high-resolution peripheral quantitative computed tomography in patients with different stages of chronic kidney disease before and after starting hemodialysis
Published in Renal Failure, 2022
Kiyokazu Tsuji, Mineaki Kitamura, Ko Chiba, Kumiko Muta, Kazuaki Yokota, Narihiro Okazaki, Makoto Osaki, Hiroshi Mukae, Tomoya Nishino
Bone microstructures of the distal radius and tibia of the non-dominant arm and leg were evaluated using HR-pQCT (Xtreme CT II, SCANCO Medical, Brüttisellen, Switzerland). If a patient had an arteriovenous fistula on the non-dominant arm, the evaluation was performed on the dominant arm. We used the data within three months after initiation of hemodialysis in the CKD 5 D group. The radial scan site was an area of the distal radius, 10.2 mm in width, 4% of the forearm length proximal from the hand joint. Furthermore, the tibial scan site was an area of the distal tibia, 10.2 mm in width, and 7.3% of the lower leg length proximal from the talocrural joint. The scanning conditions were as follows [29–31]: voltage, 68 kVp; tube current, 1470 μA; integration time, 4.3 ms; projection number, 900; field of view, 140 mm; matrix, 2304 × 2304; voxel size, 60.7 μm; scan length, 10.2 mm; and scanning time, 120 s. The computed tomography dose index, dose length product, and effective dose were 10.8 mGy, 11.0 mGy·cm, and 5 μSv, respectively. All images were evaluated for motion artifacts, and those with artifacts grade 3 or higher were excluded [32]. The semiautomatic algorithm was used for segmentation. For the periosteum, automatic contouring was performed with almost no manual correction. For the endosteum, however, automatic contouring was often followed by manual correction.
Most surgeons still prefer to reduce overriding distal radius fractures in children
Published in Acta Orthopaedica, 2021
Topi Laaksonen, Jani Puhakka, Jussi Kosola, Antti Stenroos, Matti Ahonen, Yrjänä Nietosvaara
In Bernthal et al. (2015) an internet-based survey on the management of pediatric distal radius fractures reveals that fewer than 10% of American surgeons recommend cast immobilization without reduction of overriding fractures as the primary treatment. Interestingly, the overriding fracture position was accepted by approximately half of the pediatric orthopedic surgeons at the 1-week follow-up. Several previous studies have recommended percutaneous pin fixation to avoid redisplacement (Gibbons et al. 1994, McLauchlan et al. 2002, Miller et al. 2005, Colaris et al. 2013). Our study results were similar to those of Bernthal et al. (2015): only a minority of surgeons would leave overriding distal radius fractures in children unreduced. Percutaneous pin fixation appears to be especially popular in the Nordic countries for no evident reason.