journal
https://read.qxmd.com/read/37979995/when-things-don-t-heal-as-planned
#1
EDITORIAL
Erin A Miller, Jerry I Huang
No abstract text is available yet for this article.
February 2024: Hand Clinics
https://read.qxmd.com/read/37979994/management-of-ulnar-styloid-nonunions
#2
REVIEW
Maximilian A Meyer, Fraser J Leversedge
Ulnar styloid fractures commonly occur in the setting of distal radius fractures and often progress to asymptomatic nonunion. Displaced basilar ulnar styloid fractures involving the deep radioulnar ligament attachments may cause distal radioulnar joint (DRUJ) instability. A careful clinical history, physical examination, review of imaging studies, and selected diagnostic interventions are important for confirming the relationship of the ulnar styloid nonunion with ulnar-sided wrist symptoms and/or DRUJ instability...
February 2024: Hand Clinics
https://read.qxmd.com/read/37979993/role-of-three-dimensional-guides-in-management-of-forearm-and-wrist-malunions
#3
REVIEW
Geert Alexander Buijze, Andreas Verstreken, Frederik Verstreken
Although its precise added value and cost-effectiveness need to be determined, three-dimensional (3D) planning and intraoperative guidance facilitate restoration of normal anatomy. The use of 3D computer planning and patient-specific intraoperative guides leads to more accurate and reproducible correction of forearm and wrist malunion. Its value augments with increasing complexity of deformities. Combined deformities and complex intra-articular malunions of the forearm and wrist benefit the most from the use of 3D techniques...
February 2024: Hand Clinics
https://read.qxmd.com/read/37979992/managing-the-intra-articular-distal-radius-malunion
#4
REVIEW
Chelsea C Boe, Stephen A Kennedy
Intra-articular malunion of the distal radius represents a difficult clinical problem. While not all patients require treatment, corrective osteotomy may significantly improve motion, grip strength, and patient-reported outcome measures. Meticulous planning and technical precision are required with the possible need for multiple surgical approaches and both volar and dorsal implants. Arthroscopic assistance may be used to visualize the joint and articular reduction. Custom 3-dimensional planning guides are helpful in addressing complex multiplanar deformities...
February 2024: Hand Clinics
https://read.qxmd.com/read/37979991/managing-the-extra-articular-distal-radius-malunion
#5
REVIEW
Francisco Rodriguez-Fontan, Alexander Lauder
Distal radius fractures are common injuries. Satisfactory outcomes are typically achieved with appropriate nonoperative or operative treatment. A proportion of these injuries develop symptomatic malunions, which may be treated surgically with distal radius corrective osteotomy. A thorough understanding of the anatomy, biomechanics, radiographic parameters, and indications is needed to provide appropriate treatment. Factors, including surgical approach, osteotomy type, use of bone graft, fixation construct, management of associated tendon and/or nerve conditions, soft tissue contracture releases, and need for ulnar-sided procedures, should be considered...
February 2024: Hand Clinics
https://read.qxmd.com/read/37979990/distal-radius-nonunions-a-rare-entity
#6
REVIEW
Sofia Bougioukli, Kevin C Chung
Although distal radius fractures are common injuries, nonunion is extremely rare. Nonunion has been associated with increased metaphyseal comminution, concomitant distal ulna fracture, inadequate immobilization, and patient factors. Nonunion should be suspected in patients with persistent pain, limited range of motion, and worsening wrist deformity after wrist remobilization. Treatment selection depends on presence of infection, status of the radiocarpal and distal radioulnar joints, and type of prior surgical interventions...
February 2024: Hand Clinics
https://read.qxmd.com/read/37979989/pediatric-forearm-malunions
#7
REVIEW
Shea Ray, M Claire Manske
The aim of this article is to review the evaluation and management of pediatric forearm malunions. Acceptable parameters for nonoperative management of pediatric forearm fractures are reviewed, followed by clinical and imaging workups of malunions and decision-making points for treatment. The landscape of available technology for planning and execution of corrective osteotomy is discussed. Several cases of pediatric forearm malunion are presented, along with surgical and functional outcomes. Recommendations are given regarding the authors' preferred approach for management of pediatric forearm malunions...
February 2024: Hand Clinics
https://read.qxmd.com/read/37979988/forearm-nonunions-from-masquelet-to-free-vascularized-bone-grafting
#8
REVIEW
Marc J Richard, Catphuong L Vu
Forearm fractures present a unique challenge due to the anatomic relationship of the radius relative to the ulna. Associated with the complexity of the treatment for these fractures is the management of nonunion and malunion of the radius and ulna. Evaluation and management of forearm nonunions require a critical evaluation of contributing factors prior to surgical intervention. Timely and precise treatment of nonunion and malunion is necessary to restore function of the forearm.
February 2024: Hand Clinics
https://read.qxmd.com/read/37979987/vascularized-medial-femoral-condyle-flap-reconstruction-for-osseous-defects-of-the-hand-and-wrist
#9
REVIEW
James P Higgins
Vascularized bone flaps from the descending genicular artery system are versatile and effective for the use of recalcitrant nonunions from the tubular bones of the hand to the long bones of the upper extremity. Familiarity with the vascular pedicle, various techniques of harvest and inset, and skin paddle harvest and application are essential for the reconstructive surgeon.
February 2024: Hand Clinics
https://read.qxmd.com/read/37979986/metacarpal-and-phalangeal-malunions-is-it-all-about-the-rotation
#10
REVIEW
Jeremy E Raducha, Warren C Hammert
Metacarpal and phalanx fractures are common injuries that can often be managed nonoperatively with satisfactory clinical outcomes. However, loss of normal finger alignment including malrotation and severe angulation as well as intra-articular deformities can lead to functional deficits which may benefit from operative intervention. There are numerous surgical options to correct malunions and the correct choice varies based on the injury pattern, concurrent injuries/complications, and surgeon's preference. While these surgeries can be technically demanding, successful treatment can lead to good results with satisfactory deformity correction and patient function...
February 2024: Hand Clinics
https://read.qxmd.com/read/37979985/bone-graft-substitutes-what-are-my-options
#11
REVIEW
Kalpit N Shah, Robin N Kamal
We examine the range of available bone graft substitutes often used in nonunion and malunion surgery of the upper extremity. Synthetic materials such as calcium sulfate, beta-calcium phosphate ceramics, hydroxyapatite, bioactive glass, and 3D printed materials are discussed. We delve into the advantages, disadvantages, and clinical applications for each, considering factors such as biocompatibility, osteoconductivity, mechanical strength, and resorption rates. This review provides upper extremity surgeons with insights into the available array of bone graft substitutes...
February 2024: Hand Clinics
https://read.qxmd.com/read/37979984/metacarpal-and-phalangeal-nonunions
#12
REVIEW
Stefan Czerniecki, Mark Mishu, Ryan Schmucker
The majority of phalangeal and metacarpal fractures will proceed to union when appropriately treated. However, when a nonunion does occur, it can lead to significant functional impairment for patients and societal costs. Operative intervention is typically required in these cases, but the technique can vary depending on each individual patient scenario. This article provides an overview of nonunions of the metacarpals and phalanges in the hand, including incidence, risk factors, current treatment options, and postoperative care...
February 2024: Hand Clinics
https://read.qxmd.com/read/37979983/scaphoid-nonunions-local-vascularized-bone-flaps
#13
REVIEW
Justin C McCarty, Ryoko Hamaguchi, Kyle R Eberlin
If untreated, scaphoid nonunions may progress to scaphoid nonunion advanced collapse in a substantial portion of cases and may require salvage procedures. Multiple different techniques have been described to address scaphoid nonunion. Vascularized bone flaps (VBFs) are associated with faster time to union compared with nonvascularized grafts. Because these are local pedicled flaps, they do not require microsurgical anastomoses and should be within the armamentarium of all hand surgeons. Appropriately chosen local VBFs, can achieve union rates up to 90% to 100% in appropriately selected patients...
February 2024: Hand Clinics
https://read.qxmd.com/read/37979982/traditional-bone-grafting-in-scaphoid-nonunion
#14
REVIEW
Erin A Miller, Jerry I Huang
Management of scaphoid nonunion remains challenging despite modern fixation techniques. Nonvascularized bone graft may be used to achieve union in waist and proximal pole fractures with good success rates. Technical aspects, such as adequate debridement and restoration of scaphoid length, and stable fixation are critical in achieving union and functional wrist usage. Rigid fixation can be achieved with compression screws, K-wires, and plate constructs. The surgeon has a choice of various bone graft options including corticocancellous, cancellous, and strut grafts to promote healing and correct the humpback deformity...
February 2024: Hand Clinics
https://read.qxmd.com/read/37979981/principles-and-evaluation-of-bony-unions
#15
REVIEW
Tamara D Rozental, Ian T Watkins
Nonunion is a common and costly problem. Unfortunately, there is no widely agreed upon and standardized definition for nonunion. The evaluation of bony union should start with a thorough history and physical examination. The clinician should consider patient-dependent as well as patient-independent characteristics that may influence the rate of healing and evaluate the patient for physical examination findings suggestive of bony union and infection. Radiographs and clinical examination can help confirm a diagnosis of union...
February 2024: Hand Clinics
https://read.qxmd.com/read/37827616/innovation-in-upper-extremity-fracture-treatment-implementation-of-advanced-techniques-to-improve-outcomes
#16
EDITORIAL
Robin N Kamal, Lauren M Shapiro
No abstract text is available yet for this article.
November 2023: Hand Clinics
https://read.qxmd.com/read/37827615/novel-tools-to-approach-and-measure-outcomes-in-patients-with-fractures
#17
REVIEW
Edgar Garcia-Lopez, Ryan Halvorson, Lauren Shapiro
Upper extremity fractures are prevalent and pose a great burden to patients and society. In the US alone, the annual incidence of upper extremity fractures is 67.6 fractures per 10,000 persons. While the majority of patients with upper extremity fractures demonstrate satisfactory outcomes when treated appropriately (the details of which are discussed in prior articles), the importance of follow-up and outcome measurement cannot be understated. Outcome measurement allows for accountability and improvement in clinical outcomes and research...
November 2023: Hand Clinics
https://read.qxmd.com/read/37827614/strategies-for-perioperative-optimization-in-upper-extremity-fracture-care
#18
REVIEW
Thompson Zhuang, Robin N Kamal
Perioperative optimization in upper extremity fracture care must balance the need for timely treatment with the benefits of medical optimization. Care pathways directed at optimizing glycemic control, chronic anticoagulation, smoking history, nutrition, and frailty can reduce surgical risk in upper extremity fracture care. The development of multidisciplinary approaches that tie risk modification with risk stratification is needed.
November 2023: Hand Clinics
https://read.qxmd.com/read/37827613/advances-in-soft-tissue-injuries-associated-with-open-fractures
#19
REVIEW
Andrew W Hollins, Suhail K Mithani
Management of soft tissue injury is a key component in the overall treatment of upper extremity fractures. Hand surgeons must rely on their armamentarium for treating soft tissue deficits for functional outcomes. Understanding the role of fracture fixation and wound adjuncts, including negative pressure wound therapy and dermal regenerative templates, is the keys to success. In addition, detailed knowledge of local and free tissue options is essential for hand reconstruction.
November 2023: Hand Clinics
https://read.qxmd.com/read/37827612/rethinking-scaphoid-fixation
#20
REVIEW
Jill Putnam
Scaphoid fixation, whether for acute injuries or nonunion, is made challenging by the small and intra-articular nature of the most commonly fractured carpal bone. The purpose of this article is to review the techniques to simplify scaphoid fixation and to optimize healing and early return to activity.
November 2023: Hand Clinics
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