We have all experienced frustration with a category of patients that we have termed “the RSD patient.” They present with a guarding of their extremity, a thick and complicated medical history, and a sense of frustration that they will never get better. However, we must all realize that what has been traditionally called RSD, or Reflex Sympathetic Dystrophy, is a very real phenomenon that deserves our attention and patience.
Fractures and Dislocations of hand/wrist/forearm/elbow/upper arm and shoulder
Poster Board Number: PE212
Location: Hall E
Moscone Convention Center
Hand & Wrist
Jorge L. Orbay, MD Miami FL
(D – Hand Innovations)
Alejandro Badia, MD Miami FL
Igor R. Indriago, MD Miami FL
Roger K. Khouri, MD Miami FL
Purpose: Metacarpal fractures are common but consensus on the best mode of treatment has not been established. For severely displaced fractures, open reduction and internal fixation with plates or screws is commonly performed. Unfortunately, extensor tendon adhesions and/or unsightly scars frequently follow this form of treatment. Flexible Intramedullary nailing of these fractures, with multiple small pins, has been described. The method is not popular because it is technically demanding. We have performed flexible Intramedullary nailing of metacarpal fractures utilizing a single, large nail and a simplified method of percutaneous insertion. Methods: We treat extra-articular metacarpal and phalangeal fractures with percutaneously inserted anterograde nails. Our method utilizes flexible nails (.062 and .045) and closed fluoroscopically assisted reduction. Metacarpal Phalangeal joint flexion block splinting is used for four weeks and the nails are routinely removed in the office after fracture healing. Results: We have collected 140 patients with metacarpal or phalangeal fractures treated with this method. We have 119 metacarpal fractures and 41 phalangeal. All fractures healed. Patients have no rotational deformities. All patients returned to previous occupation. Metacarpal fractures recovered full range of motion. Phalangeal fractures presented more serious challenge. Average total active motion for phalangeal fractures was 210°. Complications are infrequent and can be treated successfully. Conclusion and Significance: Our experience with this technique is very favorable as it avoids exposure of the fracture, dissection around the extensor mechanism and scar problems. It obtains excellent functional results and has a low complication rate.
Wednesday, February 28 10:00 AM – 7:00 PM
Thursday, March 1 through Saturday, March 3 7:30 AM – 5:00 PM
Sunday, March 4 7:30 AM – 12:30 PM
The principal exhibitor will be available from 12:00 Noon to 3:00 PM to discuss the exhibit and answer questions regarding the poster.
Cameras may be used in the Poster Exhibit area.
April 11, 2007
Author: Alejandro Badia, M.D, F.A.C.S.
For this discussion, we enlisted the moderating skills of Alan Freeland, MD, Professor Emeritus, Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, MS. Joining him in the discussion are hand surgeons Alejandro Badia, MD, FACS, Miami Hand Center, Miami, FL; Amit Gupta, MD, Department of Orthopedics, University of Louisville, Louisville, KY; and Stephen Trigg, MD, Assistant Professor in Hand Surgery and Orthopedics, Mayo Clinic, Jacksonville, FL. Providing perspective from the therapist quarter is hand therapist Maureen Hardy, PT, MS, CHT, St. Dominic Jackson Memorial Hospital, Hand Management Center, Jackson, MS.
For complete article please download pdf version at the link above.
For this discussion, we enlisted the moderating skills of Alan Freeland, MD, Professor Emeritus, Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, MS. Joining him in the discussion are hand sur- geons Alejandro Badia, MD, FACS, Miami Hand Center, Miami, FL; Amit Gupta, MD, Department of Orthopedics, University of Louisville, Louisville, KY; and Stephen Trigg, MD, Assistant Professor in Hand Surgery and Orthopedics, Mayo