(See also: Work Up for Scaphoid Frx) Discussion w/ proper casting nearly 100% of tubercle & distal third frxs will heal; in addition to healing considerations, the surgeon should note the position of healing (malunion); approximately 80-90% of scaphoid frx at the waist will heal, but only 60-70% of proximal pole frxs will heal; even … Read more
Discussion (Humeral Shaft Frx ») Forces Displacing the Fracture components of a well designed cast brace include an anterior component w/ a bicipital contour and a posterior component w/ a flat mold for the triceps; velcro straps maintain adequate compression; in closed humeral shaft fractures involving the middle or proximal thirds, about 95% of patients … Read more
– Indication for Closed Treatment: – indications — These are based on “personality” of the fracture as described by Nicoll EA (1964) – he listed factors favoring union: – displacement: if the fracture fragments on are or can be opposed to 25% in a transverse fracture, casting or bracing is permissible – more than 50% initial frx … Read more
– See: Metacarpal Extra-articular Base Frx – Discussion: – relatively mobile ring and little CMC joints are more susecptible to dislocation than the immobile index and long rays; – fifth CMC is the most frequently injured; – pertinent anatomy: – ring and little metacarpals articulate w/ … Read more
Review Articles: Current Concepts: Entrapment Neuropathies of the Upper Extremities. Carpal tunnel syndrome in patients who are receiving long-term renal hemodialysis. The carpal tunnel syndrome. A study of carpal canal pressures. Spontaneous rupture of the flexor carpi radialis tendon. Deep postoperative wound infection after carpal tunnel release. Symptomatic restrictive thumb-index flexor tenosynovitis: incidence of musculotendinous … Read more
– See: Anatomy of Carpal Tunnel – TCL Incision: – transverse carpal lig is exposed, but this is generally obscured by origin of thenar & hypothenar muscles, which come to lie in opposition in midline; – palmar fascia is incised, & nerve is identified just proximal to the carpal canal; … Read more
– See: Anatomy of Carpal Tunnel – Anesthesia: – Bier Block: – proponents note that regional anesthesia allows a less rushed operation along w/ a synovectomy, if needed; – median nerve block at elbow; – w/ elbow extended brachial … Read more
– Discussion: – median nerve compression syndrome at the wrist; – most common form of nerve entrapment; – first described by Paget; – references: The First Description of Carpal Tunnel Syndrome. James Paget FRS – pathophysiology: – nerve compression may result in ischemia, focal demyelination, decrease in axonal caliber, and finally axonal loss; – ref: … Read more
– Discussion: – certain rhythms are very sensitive to cardioversion, & low energy levels are likely to bring about conversion: (e.g. A. Flutter and V. Tach); – A. Fib & V. Fib are more resistant to cardioversion & require higher energy levels; – Pre-Medication: – anticoagulants may be administered prior to the procedure; – sedation … Read more
– See: – Kinematics – Dynamic Instability – Ligaments of the Wrist – Perilunate Dislocations – Instability Patterns: – ulnar translocation: carpus shifts ulnarward (frequently seen in rheumatoid wrist); – dorsal intercalated segment instability; – present when lunate has rotated into dorsiflexion, as seen on lateral x-rays; – capitate displaces dorsal to long axis of … Read more