ABSTRACT
At present, fascicular nerve repairs produce almost identical results to epineurial repairs. There are still theoretical advantages to the improved alignment potentially offered by fascicular nerve repair, and fascicular technique already offers an advantage in partial nerve injuries. As fascicular capabilities improve, fascicular nerve repair may still offer the best solution for nerve recovery.
Subject(s)
Peripheral Nerves/surgery , Adolescent , Adult , Evaluation Studies as Topic , Fingers/innervation , Follow-Up Studies , Humans , Median Nerve/injuries , Median Nerve/physiopathology , Median Nerve/surgery , Neurologic Examination , Peripheral Nerve Injuries , Peripheral Nerves/physiopathology , Suture Techniques/instrumentation , Sutures , Time Factors , Ulnar Nerve/injuries , Ulnar Nerve/physiopathology , Ulnar Nerve/surgeryABSTRACT
The Boston Brace has been reserved mainly for treating scoliosis curves with an apex below T9 while the Milwaukee superstructure has been recommended as the choice of treatment for higher thoracic curves. This paper is an analysis of the preliminary result of treatment of 300 thoracic curves with an apex of T9 or higher treated with the Boston underarm brace from 1975 through 1979. Preliminary success of Boston Bracing for thoracic curves is dependent upon placement of the thoracic pad adjacent to the ribs at the apex of the convexity and a high axillary crutch on the concave side of the curve. Boston Bracing of thoracic curves appeared initially favorable at apices T9, T8, T7, and possibly T6. Higher thoracic curves are difficult to control, and should be treated with the standard Milwaukee type brace with uprights.
Subject(s)
Braces , Scoliosis/therapy , Female , Follow-Up Studies , Humans , Male , Radiography , Scoliosis/diagnostic imaging , Thoracic VertebraeABSTRACT
Bone is shortened only enough to obtain skin closure or to remove excessive local comminution. Shortening is never done solely for the purpose of obtaining vessel apposition since vascular damage may extend beyond the zone of general soft tissue involvement. Fixation should be rapidly accomplished and be reasonably stable. Techniques are described. Following bony fixation, repair of flexor tendons and then nerves is carried out. Vessel repair using vein grafts to make up defects is then accomplished followed by loose skin closure.
Subject(s)
Bone and Bones/surgery , Fingers/surgery , Replantation , Adolescent , Amputation, Traumatic/surgery , Child , Female , Humans , Male , Orthopedic Fixation Devices , Replantation/methodsABSTRACT
The results of treatment of 348 painful neuromas of sensory nerves of the hand in 172 patients were evaluated. Three hundred and sixteen were treated by simple excisional neurectomy and these results may be used for comparison with other methods. Sixty-five percent had an excellent or satisfactory result from a single such procedure. A repeated neurectomy improved the results to 78 percent. The use of silicone rubber caps as a secondary procedure over the nerve stump in 32 cases did not improve the results. A technique of funicular resection with epineurial ligation in 45 patients with neuromas achieved about the same percentage of good results as did simple excisional neurectomy. The ideal treatment is not at hand yet, but at the present time it is recommended that treatment should consist of excisional neurectomy, repeated at least one if necessary.
