Thumb digital neuropathy caused by splinting.

Healthcare professionals are currently faced with a great variety of splints and splinting materials. Choices range from prefabricated products to custom splints made on-site from plaster, orthoplast, or fiberglass. In addition to providing immobilization to maintain a particular posture, a splint must protect important soft tissues. Patients with hand or wrist injuries often receive a prefabricated metal cock-up wrist splint in emergency departments. Complications from splints are not uncommon but are infrequently reported. We report a case in which a metal wrist cock-up splint caused compression of the thumb ulnar digital nerve. Preventive measures for such complication are included.

Effects of diabetes and steroids on fracture healing.

Fracture healing is largely controlled by local regulatory interactions among cells and tissues near the site of injury; however, many systemic hormones including insulin, the glucocorticoids, and the gonadal steroids also can influence the course of tissue repair, particularly in the case of pathologic hormone excess or deficiency. Using well-defined animal models, recent studies have established that deficiencies in insulin and estrogen impair fracture healing, but data from this type of experiment are limited. Still, the similarities between morphogenetic events in fracture healing and those found in normal bone development and remodeling suggest that testable predictions can be made concerning hormonal effects on the progress of fracture healing. One concept that has received some direct experimental support in fracture healing model studies is that systemic hormones exert pleiotropic effects on callus tissue by regulating the expression and activity of local growth factors. Further verification of this and other predicted hormone effects should increase our understanding of the fundamental mechanisms underlying fracture repair, and may aid development of means to improve fracture healing in states of altered endocrine function.