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Drake Nieves posted an update 6 months, 3 weeks ago
The objective of this study was to evaluate the outcome of a special interdisciplinary hand therapy program depending on the time interval between trauma and rehabilitation.
With use of self-assessed scores (Disability of the Arm, Shoulder and Hand Score , European Quality of Life 5 Dimensions ) and objective functional parameters (TAM = Total Active Motion for finger injuries, ROM = Range of Motion for wrist injuries, grip strength) the outcome of 76 patients with injuries of the fingers, wrist or a complex regional pain syndrome (CRPS) was analysed at the begin and end of an inpatient rehabilitation and at a follow-up examination after 12 to 16 weeks. The patients were divided into groups with an early (< 120 days after trauma) or late beginning of their rehabilitation.
At the follow-up examination early beginners had a significant better DASH-Score as well as a ROM. At the end of the rehabilitation program and at the time of the follow-up examination significant more patients with an early as patients with a late start of the rehabilitation were back to work. Especially patients with CRPS and finger injuries benefit from an early start of the rehabilitation.
Compared to a late start an early start of a rehabilitation program after finger and hand injuries and a CRPS leads to better functional with special benefit for patients with a CRPS.
Compared to a late start an early start of a rehabilitation program after finger and hand injuries and a CRPS leads to better functional with special benefit for patients with a CRPS.
Incorrect screw placement and penetration in screw fixation of scaphoid fractures are found in 5 to 30 %. this website Therefore, optimizing of screw placement is desirable, especially because an exact central position of the screw in the proximal fragment leads to a significant higher stability as a more peripheral position.
36 patients with an acute non-displaced scaphoid fracture were included in this randomized prospective study. 18 patients underwent navigated, the other 18 conventional percutaneous screw fixation of an acute non-displaced scaphoid fracture through a dorsal approach. Operation time and x-ray dose were measured. In both groups the position of the screw in the scaphoid was calculated on CT scans and compared with each other. Clinically, 17 patients with navigated and 11 with conventional percutaneous screw fixation with an average age of 52 resp. 43.2 years were available for follow-up examination including Krimmer- and DASH-score.
All scaphoids healed within an adequate time. Two cases of navigaior to conventional percutaneous screw fixation, neither for screw position, screw penetration nor with respect to the clinical outcome.
In this study navigated screw fixation of acute non-displaced scaphoid fractures was not superior to conventional percutaneous screw fixation, neither for screw position, screw penetration nor with respect to the clinical outcome.
Decompression of the anterior interosseous nerve can be performed in an open operative exploration or endoscopically. Using an endoscopic decompression superficial anatomical landmarks serve as reference point. The aim of the study was to determine the location of the distribution of the median nerve in relation to the elbow joint in order to facilitate preparation during endoscopic decompression.
The median nerve and the anterior interosseous nerve were dissected in 31 human specimens with regard to the elbow joint. The superficial anatomical landmark was the intercondyle line between the medial and lateral epicondyles. The distance between the origination of the anterior interosseous nerve of the median nerve was measured in relation to the intercondyle line.
The anatomical preparation was done using 62 adult cadaveric upper extremities. 11 specimens were formalin fixed and 20 specimens were fresh frozen cadaveric upper extremities. The average of the intercondyle distance was 7.2 cm ± 0.5 (min. 5.8; max. 7.8). The anterior interosseous nerve originated from the median nerve in average 39 mm ± 18 (min. 8; max. 80) distal to the intercondyle line. In 12 cases the distance was within the first 2 cm. There was only a correlation between the length of the upper arm and the nerve junction.
The anterior interosseous nerve originated from the median nerve in average 4 cm distal to the intercondyle line. Although there was a distribution under 2 cm in around 20 % of the cases. This is very important with regard to the endoscopically technique and should be considered.
The anterior interosseous nerve originated from the median nerve in average 4 cm distal to the intercondyle line. Although there was a distribution under 2 cm in around 20 % of the cases. This is very important with regard to the endoscopically technique and should be considered.
There are no data ensuring a standardized landmark-based-technique for blocking sensitive nerves of the forearm.
To identify locations were with use of good palpable bony landmarks and lines between them sensitive nerve blocks on the forearm can be done with great success.
Dissection of the superficial branch of the radial nerve (SBRN), the dorsal branch of the ulnar nerve (DBUN), the lateral, medial and dorsal antebrachial cutaneous nerve (LACN, MACN, and DACN) as well as the palmar branch of the median nerve (PBMN) was performed on five upper limbs of five different Caucasian cadavers. With respect to radius and ulnar styloid, Lister’s tubercle, and the medial and lateral epicondyle of the humerus as well as connecting lines between these bony landmarks locations were defined, where the mentioned nerves can be found and blocked.
The six nerves can be safely blocked at the following sites the SBRN 85 mm proximal to Lister’s tubercle on a line drawn between the latter and the medial humeral epicondyle; the LACN 38 mm and the dorsal one 32 mm ulnar from the lateral epicondyle; the MACN 14 mm radial to the medial epicondyle; the DBUN 27 mm proximal to the ulnar styloid in direction to the lateral epicondyle; the PBMN 45 mm proximal to the radial styloid following a line between the latter and the medial epicondyle and 21 mm ulnarwards perpendicular to this line.
Using superficial good palpable landmarks at the wrist and elbow as well as connecting lines between them the SBRN, DBUN, PBMN, LACN, MACN, and DACN can easily be located.
Using superficial good palpable landmarks at the wrist and elbow as well as connecting lines between them the SBRN, DBUN, PBMN, LACN, MACN, and DACN can easily be located.
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