Metacarpophalangeal joint motion ranged from 79% to 100% compared with the contralateral thumb. Data range was reported as minimum to maximum absolute values. In this minimally invasive technique, the surgeon makes a small cut over the back of the thumb joint and examines the area around the injury for damage. HHS Vulnerability Disclosure, Help Complication rates after RCL repair (N= 4; 22.2%) were higher than UCL repair (N= 7; 11.3%). 15 -17,19 Therefore, UCL reconstruction has become a common procedure to address UCL insufficiency in adolescent, collegiate, and professional throwers. 5. Highlight selected keywords in the article text. A postsearch criterion of exclusion included expert opinion level V evidence studies or outcomes after management of radial collateral ligament (RCL) injury of the thumb. There is no uniformly agreed on surgical indication for UCL injuries to the MP joint of the thumb. 2013;23(4):247-254. If you log out, you will be required to enter your username and password the next time you visit. Keywords: This website also contains material copyrighted by 3rd parties. eCollection 2021. The mean prevalence of postoperative ulnar neuropathy was 12.0% overall after any UCLR procedure at a mean follow-up of 3.3 years, and 0.8% of cases required reoperation to address ulnar neuropathy. Thus, the true natural history is yet unknown. There is currently no consensus on treatment of acute or chronic UCL injuries. 12. eCollection 2021 Mar. 1987;214:113120. It was hypothesized that surgical management results in equivalent outcomes for both acute and chronic UCL injury. Clin J Sport Med. Thumb dominance reported in 8 studies (168 thumbs). UCLR techniques associated with the highest rates of neuropathy were detachment of the FPM, modified Jobe fixation, and concomitant ulnar nerve transposition, although it remains unclear whether there is a causal relationship between these factors and subsequent development of postoperative ulnar neuropathy due to limitations in the current body of published literature. Methodological quality of the study was assessed using the Quality Appraisal Tool (Table 1). Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. When a broken bone fails to heal it is called a "nonunion." A "delayed union" is when a fracture takes longer than usual to heal. Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament: Early Outcomes of Suture Anchor Repair with Suture Tape Augmentation. Tommy John surgery; ulnar collateral ligament reconstruction; ulnar nerve transposition; ulnar neuropathy. For more information, please refer to our Privacy Policy. 35. This systematic review has demonstrated excellent clinical outcomes (pain, strength, motion, and stability) after surgical treatment (repair and autograft reconstruction) of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively. Continuous variable data were reported as mean SDs from the mean. Complications after this procedure may include nerve or blood vessel damage. In the event of disagreement among authors for study inclusion, the final decision was made by the senior author (HMA). The grip strength and the pinch strength were 94.3% and 92.27%,. After the nerves exit the spinal cord, they connect from the Axillary (armpit) and upper arm . PMC Am J Sports Med. Both repair and reconstruction (autograft and allograft) techniques were inclusive. Get new journal Tables of Contents sent right to your email inbox, Outcomes After Injury to the Thumb Ulnar Collateral LigamentA Systematic Review, Articles in PubMed by Julie Balch Samora, MD, PhD, Articles in Google Scholar by Julie Balch Samora, MD, PhD, Other articles in this journal by Julie Balch Samora, MD, PhD, Ulnar Collateral Ligament Injury of the Thumb Metacarpophalangeal Joint, Weight Training in Youth-Growth, Maturation, and Safety: An Evidence-Based Review, Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study, Core Stability Exercises for Low Back Pain in Athletes: A Systematic Review of the Literature, Diagnosis and Treatment of Triceps Tendon Injuries: A Review of the Literature, Privacy Policy (Updated December 15, 2022). Hand Clin. Frykman G, Johansson O. Surgical repair of rupture of the, 46. sharing sensitive information, make sure youre on a federal J Hand Surg Am. To date, no literat. official website and that any information you provide is encrypted You've successfully added to your alerts. The pathology and treatment of radial subluxation of the thumb with ulnar displacement of the head of the first metacarpal. *Glickel grading scale. 1961;43-A:541546. Dinowitz M, Trumble T, Hanel D, et al.. Failure of cast immobilization for thumb. Through a small incision along the side of the thumb joint, we will see where the ligament was torn. 37. 1993;21:800804. Accurate diagnosis of finger injuries can often be difficult, given the complicated soft-tissue anatomy of the hand and the diverse spectrum of injuries that can occur. It is the result of repetitive stretching and abduction stresses of the ulnar collateral . Mean study follow-up was 42.8 months. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 2008 Jun;36(6):1193-205. doi: 10.1177/0363546508319053. Simmons underwent surgery, also performed by Shin, to repair a torn UCL in his left thumb (like Trout, Simmons injured his non-dominant thumb). Stener B, Petersen I. Electromyographic investigation of reflex effects upon effects upon stretching the partially ruptured medial collateral ligament of the knee joint. The ulnar collateral ligament (UCL) of the thumb is commonly injured by falling onto an outstretched hand or in sports where the thumb metacarpal phalangeal joint (MP) is hyperextended or hyper-abducted. Riederer S, Nagy L, Buchler U. The original study using this tool had a mean quality score range of 25% to 96% but had more than half of the studies scoring >75%.16 Despite these study limitations, this systematic review is strong in that it analyzes the largest number of studies and subjects in the literature managed with both nonoperative and operative means for acute and chronic UCL injury. Results You will be limited for the first 6 weeks with pain, weakness, and stiffness in the hand and thumb. After application of all inclusion and exclusion criteria, 14 studies were identified for further analysis and review. The UCL is also known as the medial collateral ligament or "Tommy John Ligament". 1996;25:474477. This is the first study to compare complication rates between radial and ulnar collateral ligament injuries of the thumb. Clipboard, Search History, and several other advanced features are temporarily unavailable. Click the topic below to receive emails when new articles are available. Therefore, the purpose of this systematic review is to combine patient outcomes from multiple unique studies and analyze the results of treatment of thumb UCL injury to determine the following: The authors hypothesized that no difference exists in clinical outcomes between repair and reconstruction for acute UCL injury. Proximal interphalangeal joint injuries of the hand. Surgery has been recommended for fracture displacement, significant articular involvement, clinical instability, or fragment rotation.38 Chuter et al40 contend that surgical repair of acute UCL ruptures is the gold standard of treatment in the presence of gross instability, Stener lesions, or displaced avulsion fractures. Epub 2021 Sep 7. Abstract Objectives: Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. A secondary purpose was to compare graft choice and surgical technique for reconstruction. Post-traumatic instability of the metacarpophalangeal joint of the thumb. Descriptive statistics were calculated. Bailie DS, Benson LS, Marymont JV. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. Smith RJ. TREATMENT: Treatment consists of either a period of splintage or if completely torn,a repair of the ligament with an operation. Nonoperative treatment often failed, necessitating surgery. Various complications have been previously documented including transient and permanent neuropathies involving the ulnar, saphenous, and median palmar nerves, neuroma formation, hematoma, infection, donor site harvest tenderness, postoperative stiffness, retear of flexor-pronator muscle, and stress fracture of the ulnar bone bridge. Nonoperative treatment of acute UCL injury (with or without a Stener lesion) frequently fails, leading to chronic pain, instability, and weakness, eventually prompting surgical intervention. Concomitant ulnar nerve transposition was associated with a higher neuropathy rate (16.1%) compared with no handling of the ulnar nerve (3.9%). Sakellarides HT, DeWeese JW. Wilk KE, Arrigo CA, Dugas JR, Cain EL, Andrews JR. 8600 Rockville Pike The authors report no funding or conflicts of interest. 31. A Stener lesion is difficult to diagnose but leads to poor healing and usually indicates operative management. Patients who fail nonoperative management have persistent thumb pain, decreased pinch strength, decreased grip strength, limited activities of daily living (especially opening jars and turning keys), continued instability, and early arthrosis. government site. Ford GM, Genuario J, Kinkartz J, Githens T, Noonan T. Am J Sports Med. Mechanism of injury to the RCL of the MCP joint of the thumb is force . The ECRL bone-tendon ligamentoplasty for chronic ulnar instability of the metacarpophalangeal joint of the thumb. The LUCL is located on the lateral or outside part of the elbow. Your surgeon is the person best able to help you avoid any serious recovery problems. Ulnar Collateral Ligament Reconstruction: Anatomy, Indications, Techniques, and Outcomes. Unable to load your collection due to an error, Unable to load your delegates due to an error. A Novel Surgical Reconstruction Technique in the Management of Chronic Ulnar Collateral Ligament Tears with Volar Subluxation. Corresponding Author Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 (hisham.awan@osumc.edu). MeSH 1995;18:11611165. Leland DP, Pareek A, Therrien E, Wilbur RR, Stuart MJ, Krych AJ, Levy BA, Camp CL. Surgical Repair of Ulnar Collateral Ligament of ThumbDr. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. doi: 10.1016/j.asmr.2020.12.004. Injuries to the PIP joint remain swollen for long periods of time. 1 An injury to the ulnar collateral ligament occurs when this structure is stretched too far. These movements include opposing the thumb to each finger, thumb extension/abduction and full wrist movement. Eighty patients were included in the study [N=62 (UCL), N=18 (RCL)]. Search for Similar Articles Search performed on November 17, 2011. SYMPTOMS: The thumb may be swollen, bruised and painful. UCLR case series that contained complications data were included. A secondary purpose was to compare graft choice and surgical technique for reconstruction. No Difference in Complications Between Elbow Ulnar Collateral Ligament Reconstruction With the Docking and Modified Jobe Techniques: A Systematic Review and Meta-analysis. This includes, but not limited to, self-retrograde massage, cold therapy, and extremity elevation. 1999;24:7075. Your surgeon will discuss these options with you. 1996;25:527530. Federal government websites often end in .gov or .mil. Bostock S, Morris MA. Am J Sports Med. Weakened grip or reduced thumb range of motion may occur. Background:Thumb ulnar collateral ligament (UCL) tears are common in competitive athletes. Table 1. Positive ulnar variance is used to describe a forearm where the distal ulna is no longer in line with the distal radius, resulting in the ulnar being longer. 2021 Apr 22;9:20503121211003362. doi: 10.1177/20503121211003362. ||Injury chronicity not always defined, but we used ,3 weeks for acute injury and .3 weeks for chronic injury. Thorough literature review to define the question, Specific inclusion and exclusion criteria, Appropriate scope of psychometric properties, Sample size calculation and justification, Authors referenced specific procedures for administration, scoring, and interpretation of procedures, Valid conclusions and clinical recommendations, 96% good and excellent outcomes* with stable joint, pain relief, restored strength, and 85% motion retention, 100% good and excellent outcomes,* 85% without pain, 70% without laxity, 82% strength retention, and 79% motion retention, 100% good and excellent outcomes,* 100% without pain or instability, 89% strength retention, and 90% motion retention, 100% stability, 96% key pinch strength retention, and 106% pulp pinch strength retention, 89% without pain, 89% pinch strength retention, 93% grip strength retention, and 74% motion retention, 100% good and excellent outcomes,* 90% strength retention, and 92% motion retention, 100% stability, 100% strength retention, and 100% motion retention, Both returned to previous level of sport and function, Compared intraosseous suture anchor and early mobilization to pullout suture or button and cast immobilization, Both groups significantly improved outcomes, 9 had suture periosteal repair; 1 had pullout suture repair, 31% loss of motion at MP joint; 10% loss of motion at IP joint, Arthroscopic Stener reduction and K-wire MP immobilization, No patient had loss of motion .10 degrees, 8 ligament repairs; 1 anchor; 1 drill hole; 4 K-wire fixations of avulsion, No detectable residual UCL laxity in 10 patients, 2 had less than 15 degrees laxity, 7 pullout suture and K-wire MP immobilization; 25 periosteal soft tissue suture, Palmaris longus via bone tunnels with or without K-wire fixation MP joint, Iliac crest boneperiosteumbone with cortical screw fixation, ECRL bonetendon ligamentoplasty with 1.5-mm titanium screw and suture anchor fixation, Palmaris longus via bone tunnels with K- ire fixation MP joint, 20 excellent, 4 good, and 2 fair results*. Bennet Fracture. The UCL has as its central function maintenance of ulnar stability of the joint, which is paramount for pinch grip. J Hand Surg Br. They may even tear completely. 1992;8:713732. The site is secure. Despite 11 of these patients (34%) remaining symptomatic, 5 remaining clinically unstable, and a 25% (n = 8 patients) nonunion rate, all 32 were satisfied with their clinical outcome (mean, 3 years follow-up). Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. Chest pain, difficulty breathing, nausea, vomiting Cold fingers, or painful fingers that are not normal in color Increasing redness beginning 7 days after surgery If the UCL is completely torn, the ruptured ligament may cause a lump inside the thumb. When applicable, these parameters were compared, integrated, summated, and statistically analyzed. This article provides a review of . This damage may lead to temporary or permanent numbness or weakness. 1999;24:275282. Triangular fibrocartilage complex injury is one of the most common causes of ulnar wrist pain and can impair daily activities, such as door opening and handshaking. Comparison of results after surgical repair of acute and chronic ulnar collateral ligament injury of the thumb. If you're experiencing pain, bruising and swelling in your thumb after an accident such as a fall, be sure to contact your healthcare provider. Some broken bones do not heal even when they get the best surgical or nonsurgical treatment. The search was performed on November 17, 2011, using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.13 There were no limits placed on study publication date. Wong TC, Ip FK, Wu WC. [33,45] When repair is attempted, nonanatomical repositioning of the UCL may contribute to the loss of joint motion.[46]. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. This leads to what is know as a positive ulnar variance. Categorical variable data were reported as frequency with percentages. Axillary block anesthesia is a technique which can also provide anesthesia to the whole arm. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ). The UCL of the thumb acts as a primary restraint to valgus stress and is injured if hyperabduction and hyperextension forces are applied to the first metacarpophalangeal joint. three muscles provide deforming forces at the base of the thumb. Surgically Treated Chronically UCL-Deficient Patients Who Had Failed Previous Management, Clinical Outcomes After Primary Repair of Acute UCL Injury, Clinical Outcomes After Autograft Reconstruction for Chronic UCL Injury. When the thumb is straight, the collateral ligaments are tight and stabilize the joint against valgus force. 2005;24:217221. Epub 2014 Oct 22. The .gov means its official. Surgical treatment has been advocated for all avulsion fractures of the UCL, as the area of articular cartilage is always greater than the fragment size. In these patients, after failure of nonoperative treatment at anywhere from 1 month to more than 6 years, nearly all patients can achieve complete pain relief, normal pinch and grip strength, joint stability, and range of motion after surgical reconstruction. A broken thumb usually causes more intense pain, and your thumb may look deformed or misshapen. Although the natural history of chronically untreated UCL injury eventually leads to pain and loss of function, surgery intervened in the studies present. This tool is a 12-item instrument, with each item possibly receiving a minimum integer of 0 and a maximum integer of 2 score points. Metacarpophalangeal joint injuries of the thumb. J Hand Surg Am. Exclusion criteria were non-English studies and any study with less than 2 years mean follow-up. [19] Although most surgical undertakings result in good clinical and functional outcomes, there are postoperative complications, including stiffness and decreased range of motion (specifically, restricted flexion at the MP joint), failed reconstruction, infection, neuropraxia, continued pain, implant failure, graft failure, loosening, scarring, and arthrosis. Figure 46-2 Approach to the ulnar collateral ligament. Kaplan EB. 2022 Jun;54(2):191-196. doi: 10.5152/eurasianjmed.2022.22024. The Orthopedic Journal of Sports Medicine. Complications after surgical treatment of UCL injury are rare. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. 7. Surgical techniques and a review of 70 patients. These exercises may be directed by a physical or occupational therapist. Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. 1994;25:2123. Ulnar neuropathy was defined as any symptoms or objective sensory and/or motor deficit (s) after surgery, including resolved transient symptoms. A common complication following fracture of the distal radius is when the radius shortens. 20. Any hard force on the thumb that pulls the thumb away from the hand (called a valgus force) can cause damage to the ulnar collateral ligaments. Thumb sprain may cause bruising, tenderness, and swelling around the base of the thumb. Potentially inclusive articles were manually reviewed, discussed among the authors, and a decision was made regarding inclusion or exclusion. No study compared different graft types or fixation techniques. All techniques improved clinical outcomes, including pain, motion, strength, and stability (Table 5). Furthermore, the lack of patient-specific data precluded advanced statistical calculations, and weighted means from individual studies were the basis for comparison. Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. Muscles. Increase in Use of Medial Ulnar Collateral Ligament Repair of the Elbow: A Large Database Analysis. the thumb. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Data collected on each patient included patient demographics, imaging (x-rays and MRI), perioperative data (e.g. Only prospective studies can determine this injury course. Orthopedics. Our objective was to compare the complication rates after thumb metacarpophalangeal joint (MCP) radial collateral ligament (RCL) versus ulnar collateral ligament (UCL) repair. All but 2 were level IV evidence. There were 200 acute injuries and 93 chronic injuries. Epub 2021 Jan 18. 36. To address the purposes of this systematic review, the authors conducted a search of the following medical databases: PubMed, SPORTDiscus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central Register of Controlled Trials. The original study using this tool had a mean quality score range of 25% to 96% but had more than half of the studies scoring >75%. UCLR case series that contained complications data were included. 2021 Aug;31(8):5699-5712. doi: 10.1007/s00330-020-07666-z. Danilkowicz RM, O'Connell RS, Satalich J, O'Donnell JA, Flamant E, Vap AR. The https:// ensures that you are connecting to the No study directly compared the clinical outcome between repair and reconstruction of the thumb UCL for acute (less than 3 weeks) or chronic UCL injury. Systematic review and meta-analysis. J Hand Surg Am. Abrahamsson SO, Sollerman C, Lundborg G, et al.. Most times, they won't know until they're in the surgery if the internal brace is appropriate. Performance Orthopaedics and Sports Medicine, Wilmington, Ohio. Rao S, D'Amore T, Willier DP 3rd, Gawel R, Jack RA 2nd, Cohen SB, Ciccotti MG. Orthop J Sports Med. Metacarpophalangeal joint fusion was performed on 36.3% (4/11) of patients with RCL (N=1) and UCL (N=3) tears. The surgical approach associated with the highest rate of neuropathy was detachment of flexor pronator mass (FPM) (21.9%) versus muscle retraction (15.9%) and muscle splitting (3.9%). The range of motion of the MP joint of the thumb following operative repair of the. PLoS Med. Kozin SH, Bishop AT. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). J Bone Joint Surg Am. A systematic review of multiple medical databases was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with specific inclusion and exclusion criteria. 4 weeks after surgery: The splint can be removed for basic hand hygiene and light thumb movements (actives only). Am J Sports Med. 2012 Nov 7;94(21):2005-12. doi: 10.2106/JBJS.K.01024. Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. The fixation technique associated with the highest rate of neuropathy was the modified Jobe (16.9%) versus DANE TJ (9.1%), figure-of-8 (9.0%), interference screw (5.0%), docking technique (3.3%), hybrid suture anchor-bone tunnel (2.9%), and modified docking (2.5%). UCL injuries occur via thumb MCP hyperabduction or hyperextension ; in contrast, RCL injuries result from a forced or sudden thumb MCP adduction moment. The following clinical outcome parameters were extracted, if available, from each article identified for further review and scrutinized: pain, range of motion, key-pinch strength, stability testing, number of retears, range of motion posttreatment, prekey-pinch strength and postkey-pinch strength, and complications. Transfer bias was present in the difference of length of follow-up, despite a minimum of 2 years, and the proportion of subjects who enrolled and completed that which was actually followed up. Please enable it to take advantage of the complete set of features! A score of 0 was assigned if the item was either omitted or not performed. Part I: anatomy and diagnosis. After three to four weeks, the joint should heal enough to remove the splint and begin strengthening exercises. The rate of complications after RCL primary repair was higher than UCL repair, however not statistically significant. 4. MeSH J Bone Joint Surg Am. 25. All continuous data for independent and dependent variables were assimilated with weighted means and SDs based on the number of subjects or thumbs and the applicable means and SDs. Pain reduction was significantly improved in all subjects (P < 0.05). eCollection 2021 Nov. Yu JS, Carr JB 2nd, Thomas J, Kostas J, Wang Z, Khilnani T, Liu K, Dines JS. Complications after surgery were rare. A systematic review of ulnar collateral ligament reconstruction techniques. Non-Fusion. Hand Surg. Thus, a patient with delayed presentation of UCL injury can still achieve predictably successful outcomes, equivalent to acute repair, with autograft UCL reconstruction. Ritting et al30 assert that operative management of acute injuries is indicated when the thumb is without an endpoint to valgus stress testing. Please enter a Recipient Address and/or check the Send me a copy checkbox. ECRL, extensor carpi radialis longus; IP, interphalangeal; MRI, magnetic resonance imaging; NR, not reported. Conclusion: We sought to address a gap in the literature by comparing thumb metacarpophalangeal (MCP) joint angle measurements and biomechanical strength before complete, acute UCL tear and after . Morphometric Evaluation of Collateral Ligaments of the First Metacarpophalangeal Joint. Bethesda, MD 20894, Web Policies Subject, surgical, and study data were compared using 2-sample and 2-proportion Z-test calculators with alpha 0.05 because of the difference in sample sizes between the compared groups. 1,6,15 The mechanism of injury is a radially directed force on an extended thumb, which can occur when an athlete falls onto an abducted thumb, slides into a baseball base, or attempts to catch a ball. 2018;6(4):1-7. Comparison of Outcomes Based on Graft Type and Tunnel Configuration for Primary Ulnar Collateral Ligament Reconstruction in Professional Baseball Pitchers. PMC 2021 Apr 15;3(2):e527-e533. 10. 1 Major components of the TFCC are the articular disc (AD), meniscus homolog, radioulnar ligaments, and extensor carpi . Stretching or even a rupture of the graft is also possible. Long-term results of ligament reconstruction. Careers. If it is appropriate, then surgical consent probably happened before the surgery. Results of surgical treatment of acute and chronic grade III [corrected] tears of the radial collateral ligament of the thumb metacarpophalangeal joint. Would you like email updates of new search results? The repair is continuously vulnerable until twelve weeks after repair and could fail if overstressed by knocks or excessive gripping. Roy J, MacDermid J, Woodhouse L. Measuring shoulder function: a systematic review of four questionnaires. History. The limitations of this systematic review are reliant on the studies analyzed. may email you for journal alerts and information, but is committed No study directly compared nonoperative to operative treatment. Gamekeeper's thumb: a quantitative evaluation of acute surgical repair. No study reported the outcomes of nonoperative management of chronic UCL injury. At this stage, patients should be advised to wear your splint part-time. 22. Usually it is pulled off of the bone (proximal phalanx) on the nail side of the joint. Further detection bias existed in that not all studies used each clinical outcome (eg, Glickel grade) or radiographic measure postoperatively. There is currently no consensus on treatment of acute or chronic UCL injuries. Louis DS, Huebner JJ Jr, Hankin FM. National Library of Medicine There are some cases where the fusion is not successful and you will still have pain in . You may search for similar articles that contain these same keywords or you may Chir Main. In these cases, a new graft may be used to perform a second reconstruction. Moher D, Liberati A, Tetzlaff J, et al.. Epub 2015 Sep 22. Pichora DR, McMurtry RY, Bell MJ. 2015 Nov-Dec;7(6):511-7. doi: 10.1177/1941738115607208. 1994;23:797804. A p-value of 0.05 was considered statistically significant. HHS Vulnerability Disclosure, Help Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further surgery. Corresponding Author: Hisham M. Awan, MD, The Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Rd, Suite 3200, Columbus, OH 43212 ([emailprotected]). There were 61 studies eliminated as secondary for being in a language other than English. There were 200 acute injuries and 93 chronic injuries.
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