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Purpose: This review aimed to compare the postoperative outcomes of open reduction internal fixation (ORIF) versus excision in the surgical treatment of hook of hamate fractures. Methods: A systematic review of PubMed and EMBASE databases from 1954 to 2023 was performed using the search term "hook of hamate fracture" to identify all publications regarding the use of ORIF or excision in the treatment of hook of hamate fractures. Outcomes included a return to sport, pain, ulnar nerve dysfunction, flexor tendon dysfunction, union rate, wrist range of motion (ROM; % of contralateral hand), grip strength (% of contralateral hand), and quick disabilities of arm, shoulder, and hand scores. Results: Twenty-seven of the 705 total screened articles were included. Excision of the hook of hamate (n = 779) resulted in a shorter return to sport time (6 vs 7.8 weeks), lower rates of postoperative pain (6.1% vs 33.3%), higher rates of ulnar nerve sensory dysfunction (4.2% vs 0%), and higher rates of ulnar nerve motor dysfunction (1.5% vs 0%) relative to ORIF (n = 51). Chronic fractures had a longer return to sport time (7.2 vs 5.7 weeks) relative to nonchronic injuries. Conclusions: Both surgical procedures appear to yield acceptable outcomes in the treatment of hook of hamate fractures. However, based on the sparsity of available data, we are unable to determine a consistent difference between hook of hamate excision and ORIF. Clinical relevance: To our knowledge, no current consensus on the optimal surgical treatment for hook of hamate fractures exists. Our findings emphasize the need for a large prospective cohort study using standardized outcomes to provide strong evidence as to whether surgical excision or ORIF yields greater outcomes in the treatment of hook of hamate fractures.

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Purpose: Carpal tunnel syndrome is the most common compressive neuropathy. The diagnostic parameters currently used for the general adult population may not be valid in elderly or younger cohorts. The purpose of this study is to determine the diagnostic accuracy of nerve conduction studies (NCS) and ultrasound (US) in different age groups utilizing the 6-item Carpal tunnel syndrome (CTS) symptoms scale (CTS-6) as the reference standard. Methods: A retrospective database of patients who underwent US and NCS as part of the diagnostic work-up for suspected peripheral nerve compression was reviewed. Subjects were separated into three groups based on the median age of carpal tunnel syndrome patients (55 years of age) and two standard deviations (standard deviation 13.5 years) above and below the median. The young group was 28 years of age or less, the middle group was 29-71 years of age, and the old group was 72 years of age or greater. CTS-6 and Boston Carpal Tunnel Syndrome Questionnaire scores were recorded. Using CTS-6 as a reference standard, the sensitivity and specificity were calculated for NCS and US. Results: A total of 295 hands were included in the analysis with 23 hands in the young group and 24 hands in the old group. NCS showed 31% sensitivity and 100% specificity in the young group compared to 54% sensitivity and 90% specificity for US. NCS showed 94% sensitivity and 25% specificity in the old group compared to 81% sensitivity and 38% specificity for US. Overall accuracy for US and NCS was 66% for both tests when looking at all age groups. The accuracy in the young group was 70% for US and 61% for NCS, whereas the accuracy in the old group was 67% for US and 71% for NCS. Conclusions: US has comparable sensitivity and specificity to NCS in patients two or more standard deviations above or below the mean age for presentation of CTS. US may be more accurate in younger patients, although NCS limits the number of false positive tests. There remains a substantial amount of inaccuracy for both tests when using a validated clinical diagnostic tool (CTS-6) as the reference standard. Type of study/level of Evidence: Diagnostic IV.

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Background: The net promoter score (NPS) allows analysis of patient satisfaction and preference between treatment and/or diagnostic testing. Electrodiagnostic testing (EDX) and ultrasound (US) are commonly used diagnostic tests for carpal tunnel syndrome. Although EDX is reliable for diagnosing carpal tunnel syndrome (CTS), it can be uncomfortable and inconvenient for patients. We aimed to determine whether patients preferred US or EDX studies for the diagnosis of CTS, using the NPS. Methods: Seventy-five patients presenting to the clinic for evaluation of CTS complaints who had EDX were prospectively studied. US evaluation of the median nerve was then completed at time of evaluation. Patient satisfaction was determined by asking, "how likely are you to recommend this procedure to a friend or relative?" for both EDX and US. Patient demographics, comorbidities, CTS-6 questionnaire (CTS-6), and functionality assessed through patient-reported qDASH were also recorded. Results: Sixty-five patients were included in the study. Most patients did not have any comorbidities and were nonsmokers. The gender composition was similar, and the average age of the enrolled patients was 58. The NPS for US was significantly higher than EDX (P < 0.0001). Patients with diabetes mellitus rated their EDX experience significantly lower than those without diabetes mellitus. Conclusions: Patients are more likely to recommend US instead of EDX in the evaluation of CTS complaints. This allows for shared decision-making between the patient and provider if ordering diagnostic testing for CTS.

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Although increased cross-sectional area of the median nerve on ultrasound has been associated with carpal tunnel syndrome, there has been little research examining outlier cases with exceedingly large nerves. The purpose of this study was to identify factors associated with these "mega" nerves, and to determine whether these nerves carry with them increased severity of disease. Methods: Patients who presented to clinic with upper extremity paresthesias over a 4-year period were included in this study. Two groups were created: mega nerves (cross-sectional area >2 SD above average), and nonmega nerves. Statistical analysis was performed to compare demographics, symptom scores, and nerve conduction studies (NCS). Significant variables were then compared between patients with mega nerves and those with ultrasound positive nerves (≥10 mm2), which did not reach mega size (normal nerves were excluded). Results: The cohort included 425 median nerves with 25 mega nerves. The groups differed significantly in diabetes status, body mass index (BMI), Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale scores, and NCS results. When compared only with ultrasound positive but nonmega nerves, mega nerves were still associated with diabetes, higher BMI, and worse NCS results. Conclusions: Diabetes, BMI, NCS results, and BCTQ Symptom Severity Scale scores are associated with mega nerves. However, BCTQ scores do not differ between mega nerves and other ultrasound positive nerves. In patients with obesity or diabetes, outlier ultrasound measurements may not correlate with worsened clinical symptoms, even in the setting of more significantly altered NCS results.

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PURPOSE: A growing body of evidence supports ultrasound (US) as an alternative first-line confirmatory test for carpal tunnel syndrome (CTS). Recent studies have demonstrated a correlation of US cross-sectional area with electrodiagnostic (EDX)-determined severity; however, it is unclear whether patient sex affects the cutoff values used for determining severity. The purpose of this study was to determine if patient sex affects US graded severity when using EDX as the reference standard. METHODS: A cohort of 367 women and 46 men, aged 18-90 years, from 1 orthopedic hand surgeon's practice underwent EDX and US. Distal motor latency and distal sensory latency of the median nerve were recorded. Severity was classified using a modified Bland severity scale. The US measurements of the cross-sectional area of the median nerve at the wrist crease were acquired by a fellowship-trained hand surgeon. Separate receiver operator characteristic curve analyses of the male and female groups were performed for US cutoff values. RESULTS: The cutoff value in both the female (F) and male (M) patients was 11 mm2 for mild (area under the curve = 0.76 F; 0.78 M), 12 mm2 for moderate (area under the curve = 0.75 F; 0.73 M), and 13 mm2 for severe (area under the curve = 0.75 F; 0.71 M) CTS. The sensitivity of the cutoffs for mild, moderate, and severe CTS in the female and male groups was 49% and 56%, 44% and 50%, and 49% and 44%, respectively. The specificity of the cutoffs for mild, moderate, and severe CTS in the female and male groups was 75% and 79%, 74% and 82%, and 83% and 78%, respectively. CONCLUSIONS: Patient sex does not appear to have a significant impact on the determination of CTS severity graded using US cutoff values. Ultrasound can be used to grade the severity of CTS with a 75% to 85% specificity but low sensitivity. A cutoff value of 13 mm2 can be used to classify CTS as severe. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Assuntos

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Purpose: Thumb metacarpophalangeal collateral ligament injuries occur in 50 per 100,000 people. The most frequent rupture site locations that are often cited are the thumb ulnar collateral ligament (UCL) occurring distally from the proximal phalanx and the radial collateral ligament (RCL) occurring proximally from the metacarpal head.2,16 In this study, we report the frequency of the rupture site location of both thumb UCL and RCL injuries. Methods: A retrospective analysis of 1,004 consecutive finger collateral ligament surgeries performed at a single academic institution over 17 years was conducted. The inclusion criteria were any patient who underwent either a thumb UCL or RCL surgical repair. Patients were excluded if the rupture etiology was secondary to a laceration or a congenital or chronic deformity. Descriptive statistics were presented. Results: Three hundred forty-seven patients were included in this study, including 288 thumb UCL injuries and 59 thumb RCL injuries. The rupture site location for the thumb UCL was proximal in 5.9% (n = 17) of the cases, distal in 92.7% (n = 267), and midsubstance in 1.4% (n = 4). Fifty-three (18.4%) Stener lesions were noted. The rupture site location for the thumb RCL was proximal in 69.5% (n = 41) of the cases, distal in 25.4% (n = 15), and midsubstance in 5.1% (n = 3). Conclusions: In thumb UCL ruptures, the rupture site occurred most often at the proximal phalanx, whereas RCL injuries occurred most often at the metacarpal head. Overall, there was greater heterogeneity of RCL rupture site location frequency. Careful surgical exposure should be performed when repairing either the UCL or RCL. Further studies will determine if differences in rupture site location portend a difference in prognosis. Type of study/level of evidence: Prognostic III.

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The elbow positions the hand in a stable manner relative to the trunk while allowing flexion and extension as well as forearm rotation at varying shoulder positions. Its ability to perform this task without joint subluxation is accomplished through a combination of bony congruency, ligamentous restraint, and dynamic stabilization. This article reviews the bony and dynamic contributors to elbow stability and kinematics. Bony stability is conferred through the morphology of the humeroulnar, humeroradial, and radioulnar joints. Depending on the arm position relative to the trunk and the degree of elbow flexion, the bony contribution will vary. Dynamic elbow stabilizers confer stability through the activation of various muscles that cross the elbow. These forces help resist valgus and varus forces and may also increase bony stability by generating compressive forces. The goal of this article is to review the literature surrounding the biomechanics of bony and dynamic stabilizers of the elbow while drawing clinically relevant biomechanical observations.

Assuntos

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Purpose: The purpose of this study was to determine whether there is a difference in the change in cross-sectional area (CSA) of the median nerve in patients undergoing carpal tunnel release (CTR) based on surgical technique and whether this change is associated with changes in patient-reported outcomes evaluated using the Carpal Tunnel Syndrome Assessment Questionnaire. Methods: Individuals with carpal tunnel syndrome were evaluated with ultrasound and the CTSAQ before and 6 weeks after surgery. Patients were eligible for inclusion if they underwent either a mini-open CTR (MOCTR) or endoscopic CTR (ECTR). A single surgeon performed all surgeries. Changes in median nerve CSA, Carpal Tunnel Syndrome Assessment Questionnaire scores, and their associated surgical technique (MOCTR vs ECTR) were analyzed. Results: A total of 77 patients were enrolled, 13 of whom were lost to follow-up, which left 64 for analysis. Of those, 42 patients underwent ECTR and 22 MOCTR. Mean age was 55 years; there were 52 women and 12 men. Mean changes in CSA for endoscopic and mini-open techniques from before to 6 weeks after surgery were -1.9 mm2 (95% confidence interval [CI], -1.1 to -2.7) and +0.6 mm2 (95% CI, -1.6 to 0.4), respectively. Mean Symptom Severity Scores improved after endoscopic and mini-open release by 1.7 (95% CI, 1.4-2.1) and 1.5 (95% CI, 1.2-1.9), respectively. Mean Functional Status Scores improved after endoscopic and mini-open release by 1.2 (95% CI, 0.9-1.9) and 0.7 (95% CI, 0.03-1.3), respectively. Conclusions: Patients undergoing ECTR demonstrated decreased median nerve CSA, whereas those undergoing MOCTR demonstrated increased median nerve CSA at 6 weeks. All patients undergoing surgical intervention demonstrated improvement in both Symptom Severity Scores and Functional Status Scores after surgery. Whereas both techniques successfully improve patient outcome scores, an increase in CSA after MOCTR may be seen in the initial postoperative period, potentially contributing to a slower short-term improvement in outcome in functional scores compared with ECTR. Type of study/level of evidence: Therapeutic IV.

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Purpose: Although the literature has shown that the cross-sectional area (CSA) of the carpal tunnel on ultrasound is enlarged in patients with carpal tunnel syndrome, it does not provide information regarding whether proximal nerve pathology, such as that seen in cervical radiculopathy, increases the CSA of the median nerve. Methods: In this study, 15 patients were enrolled who had a clinical diagnosis of cervical radiculopathy but not carpal tunnel syndrome. All patients underwent electrodiagnostic studies and ultrasound measurement of the CSA of the median nerve. Results: Increased median nerve CSA was seen in 1 of 15 patients (7%). Positive findings of cervical radiculopathy were found in 7 patients (47%) by electrodiagnostic studies. Conclusions: In patients clinically diagnosed with isolated cervical radiculopathy, the vast majority have normal median nerve CSA measured on ultrasound. Type of study/level of evidence: Prognostic IV.

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Scapholunate advanced collapse (SLAC) is a frequently encountered cause of wrist arthritis. For stage 2 disease, proximal row carpectomy (PRC) is an accepted treatment for which the literature has documented satisfactory outcomes and generally low complication rates. However, we report a case of SLAC wrist treated with PRC complicated by postoperative volar dislocation of carpus, to our knowledge a complication not yet reported in the literature. The patient developed atraumatic volar carpus dislocation after a routine PRC. This was treated with subsequent return to the operating room with closed reduction and percutaneous pinning of the wrist. Adequate reduction of the carpal dislocation was achieved and maintained after removal of pins. This case shows that closed reduction and percutaneous pinning is a valid option in this rare complication.

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Purpose: To determine whether there are changes in nerve conduction studies (NCS) of the median nerve after distal radius fracture (DRF) and to determine how operative fixation through a volar approach with a locking plate contributes to nerve conduction changes. We hypothesized that a considerable percentage of patients would have electrodiagnostic evidence of median neuropathy at the wrist after fracture, but fixation with a volar locked plate would not worsen the electrodiagnostic findings. Methods: This was a prospective cohort study of 14 neurologically asymptomatic patients who underwent surgical treatment of an isolated DRF using a volar plate. All patients underwent surgery within 2 weeks of injury. On the day of surgery and at the 6-week follow-up, patients were clinically examined, Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire was completed, and patients underwent NCS using a handheld device with the unaffected limb, which was used as a comparison. Preoperative and postoperative nerve function were compared with the unaffected limb as a baseline. Results: Patients without symptoms after DRF had a 28% incidence of prolonged latencies compared with reference values for the device used. Distal sensory latencies of the median nerve were 3.64 ± 0.32 ms in the unaffected arm, 3.76 ± 0.70 ms before surgery, and 3.81 ± 0.52 ms after surgery. Distal motor latencies of the median nerve were 3.91 ± 0.59, 3.60 ± 0.68, and 3.88 ± 0.36 ms in respective arms and time points. Quick-Disabilities of the Arm, Shoulder, and Hand scores improved from 77 before surgery to 46 at 6 weeks. Conclusions: Asymptomatic patients may satisfy nerve conduction criteria for median neuropathy at the wrist after DRF; however, open reduction and treatment with a volar locked plate has no significant effect on NCS findings. Type of study/level of evidence: Prognostic II.

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Purpose: Diabetes mellitus (DM) is a well-known risk factor for carpal tunnel syndrome (CTS). However, few studies have compared differences in the cross-sectional area (CSA) of the median nerve in patients with and without DM. The purpose of this study was to compare the utility of ultrasound for the diagnosis of CTS in diabetic versus nondiabetic patients. Method: A total of 248 hands of 155 patients were evaluated: 154 hands belonged to non-DM patients with CTS, 80 to DM patients with CTS, 13 patients with DM but no CTS, and 51 patients without DM or CTS. All hands underwent ultrasonography of the median nerve at the wrist for determination of CSA; patients completed a CTS Symptom Severity Scale and Functional Status Scale for each hand. Results: Average CSA (mm2) of non-DM patients with CTS was 11.25 whereas the average in DM patients with CTS was 12.23 (P = .17). Cross-sectional area of 9.5 or greater was the most powerful predictor of CTS in patients without DM, and CSA of 10.5 or greater in patients with DM. Conclusions: Cross-sectional area of the median nerve was similar for patients with and without DM; however, cutoff values for positive diagnosis may need to be adjusted in patients with DM. Ultrasonography of the wrist is a valuable resource for diagnosing CTS in patients with and without DM. Type of study/level of evidence: Diagnostic II.

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PURPOSE: Nerve conduction studies (NCS), CTS-6, Wainner, Kamath, and Lo are diagnostic tests that are used to diagnose carpal tunnel syndrome (CTS). To our knowledge, no study has compared the sensitivity and specificity of these 5 tests with one another. The purpose of this study is to compare NCS, CTS-6, Wainner, Kamath, and Lo using clinical diagnosis by a hand fellowship-trained orthopedic surgeon as reference standard. METHODS: A hand fellowship-trained surgeon completed the CTS-6, Wainner, Kamath, and Lo diagnostic tools. Cutoff values for a positive test were based on values in the literature, if available. The NCS were performed by a certified electrodiagnostic physician according the standards of the American Association of Neuromuscular and Electrodiagnostic Medicine and were interpreted using absolute latencies, relative latencies, and combined sensory index. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were calculated for the tests using clinical diagnosis as the reference standard. RESULTS: A total of 408 wrists from 250 patients were analyzed in the study. The NCS had the highest sensitivity (94%) but also the lowest specificity (50%) of any of the diagnostic tests. Using a cutoff of 18, CTS-6 had the highest specificity (99%). The NCS had the highest area under the curve at 74%, followed closely by the Kamath at 69%. CONCLUSIONS: The NCS were traditionally felt to be a strong confirmatory test given their high specificity. However, this prospective series demonstrated that NCS had the lowest specificity of any diagnostic test. CLINICAL RELEVANCE: Consideration should be given to using alternative diagnostic tests/tools based on the results of this study.

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PURPOSE: Carpometacarpal (CMC) joint subluxations of the fifth finger are rare injuries and are notoriously difficult to diagnose due to severe swelling and overlapping of bones on radiographs. Various radiographic studies have been suggested to identify these injuries. We hypothesize that there will be no difference between various oblique radiographs for detection of a fifth finger CMC subluxation. METHODS: Using 4 cadaveric specimens, we took radiographs at various angles (0°, 30°, 45°, and 60°) with the fifth metacarpal in anatomic position, subluxated 25% and 50% dorsally. Radiology and orthopedic residents, fellows, and attending physicians viewed each image to determine whether a subluxation was present. Data were analyzed using area under the receiver operating curve, sensitivity, and specificity. RESULTS: A total of 36 responses were obtained from 9 radiologists (4 residents, 3 fellows, 2 attendings) and 27 orthopedic surgeons (16 residents, 8 fellows, 3 attendings). Radiographs taken at 60° were more sensitive and specific (Sn 85, Sp 60) than at 0° (Sn 64, Sp 33), 30° (Sn 84, Sp 47), or 45° (Sn 80, Sp 49). Area under the receiver operating curve was also higher for 60° (0.87) than 0° (0.59), 30° (0.75), and 45° (0.75). CONCLUSIONS: Sensitivity, specificity, and area under the receiver operating curve were highest for 60° radiographs. We recommend obtaining radiographs of the hand in 60° of pronation from the lateral if there is suspicion for a fifth CMC subluxation or dislocation. CLINICAL RELEVANCE: This study suggests a simple radiographic view to enhance the diagnosis of fifth CMC subluxations.

Assuntos

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PURPOSE: To determine whether there is a correlation between the cross-sectional area (CSA) of the median nerve, as measured using ultrasound, and the distal motor and/or sensory latencies as measured on nerve conduction studies. METHODS: Patients with clinical signs and symptoms of carpal tunnel syndrome were prospectively enrolled in this study. Subjects underwent ultrasound measurement of the CSA of the median nerve at the carpal tunnel inlet by a fellowship-trained hand surgeon, followed by nerve conduction studies (NCS) by a certified electrodiagnostic technician who was blinded to the results of the ultrasound examination. Pearson correlations were performed to compare CSA and NCS. RESULTS: Pearson correlation was r = 0.57 between CSA and distal motor latency and r = 0.47 between CSA and distal sensory latency. Correlation was r = 0.81 between distal motor latency and distal sensory latency. CONCLUSIONS: There is a correlation between CSA of the median nerve and NCS. Further research is necessary to determine which test correlates better with patient symptoms and function. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.

Assuntos

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BACKGROUND: Carpometacarpal arthroplasty provides well-documented pain relief with preservation of thenar function in basal joint arthritis treatment. Nevertheless, some patients continue to have pain following surgery. The authors hypothesize that unrecognized midcarpal (capitolunate) arthritis is a contributor to persistent pain after carpometacarpal arthroplasty. The prevalence of midcarpal arthritis in patients with basal joint arthritis is unknown. This article establishes the radiographic prevalence of midcarpal arthritis in patients with carpometacarpal arthritis. METHODS: Patients with basal joint arthritis were identified from a search using International Classification of Diseases, Ninth Revision code 716.94. Hand radiographs were reviewed and graded using the Eaton classification and Sodha classification for carpometacarpal arthritis. Scaphotrapeziotrapezoid arthritis and midcarpal arthritis were graded using the Sodha classification for arthritis as follows: grade 1, no or nearly no arthrosis; grade 2, definite arthrosis but not severe; and grade 3, severe arthrosis. RESULTS: Eight hundred ninety-six radiographs were reviewed. The prevalence of scaphotrapeziotrapezoid arthritis in this population was 64 percent. The prevalence of midcarpal arthritis in this population was 23.5 percent. The prevalence of midcarpal arthritis in patients with radiologic evidence of carpometacarpal arthritis was 25.4 percent. The prevalence of severe midcarpal arthritis was 7 percent. CONCLUSIONS: The prevalence of midcarpal arthritis in patients with basal joint arthritis is 24 percent. The presence of two locations of arthritis may explain persistent hand and wrist pain in this population despite carpometacarpal arthroplasty. Clinically, these data will allow hand surgeons to better educate patients with basal joint arthritis regarding the possibility of incomplete pain relief following carpometacarpal arthroplasty.

Assuntos

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PURPOSE: To compare plain radiographs and computed tomography (CT) when determining the narrowest diameter of the medullary canal of the distal phalanx. METHODS: A database review identified 48 patients (23 male, 25 female) who underwent a CT scan of the hand and plain radiographs of the same hand. Using digital imaging software, the smallest diameter of the medullary canal was measured for each finger (index, middle, ring, little) on CT and on radiographs. RESULTS: The narrowest diameter of the medullary canal was measured on the axial CT and lateral hand radiograph at the transition between the tuft and the distal phalanx shaft. The mean narrowest diameters on plain radiographs for the index, middle, ring, and little fingers were 1.4 mm, 1.4 mm, 1.4 mm, and 1.1 mm, respectively. The mean diameters on CT were 1.2 mm, 1.3 mm, 1.2 mm, and 1.0 mm, respectively. Men had larger medullary canal dimensions (1.5-1.7 mm) than women (0.8-1.2 mm). CONCLUSIONS: The differences in canal diameter measurements between plain radiograph and CT were small and likely clinically insignificant. CLINICAL RELEVANCE: Lateral radiographs can be used for preoperative planning when estimating the size of the distal phalanx intramedullary canal.

Assuntos

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PURPOSE: To describe the anatomical insertion of the flexor digitorum profundus (FDP) on the distal phalanx. METHODS: The FDP insertion to the index, middle, ring, and little fingers were dissected in 10 fresh-frozen cadavers. The FDP tendon was dissected off the volar plate, which was elevated from proximal to distal, before the distal phalanx was disarticulated. The distal phalanx was then inked and the FDP was sharply dissected from bone. The insertion length, width, and distance of the insertion from the joint were measured and the insertion surface area and centroid of the FDP insertion were calculated. RESULTS: The average insertion length and width were 6.2 mm (range, 5.1-7.0 mm) and 7.9 mm (range, 6.9-8.4 mm), respectively. The average surface area of the distal phalanx occupied by the FDP tendon, for all fingers, was 20% (range, 15%-27%). The average distance from the most proximal insertion to the joint surface was 1.2 mm (range, 0.4-2.1 mm) and the calculated centroid of the FDP insertion from the distal interphalangeal joint was 3.6 mm (range, 2.5-5.1 mm) or approximately 20% of the distal phalangeal length. CONCLUSIONS: These findings may aid anatomical attachment of the FDP tendon in the treatment of zone I injuries. CLINICAL RELEVANCE: A better understanding of the anatomy of the FDP insertion may aid proper repair positioning in the treatment of zone I injuries.

Assuntos