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Digital replantation: a functional assessment.

With the advent of microvascular anastomosis it has become technically and practically feasible to replant amputated digits. In the last 5 years the achievements in this field of surgery have shown considerable improvement. Success is initially measured in terms of survival of the amputated digits but finally in terms of function. This paper presents a functional assessment of the authors' 33 digital replantations in 20 patients. In all of these patients the period of follow-up has been longer than 2 1/2 years. An 85% survival rate for the replanted digits was obtained. Of the 17 patients who have surviving digits function in 15 was judged to be significantly improved by the procedure. These results have permitted the development of guidelines for selecting patients who will benefit most from the procedure.

Adolescent↗

Total joint arthroplasty. Introduction to the upper extremity.

Total joint replacement in the upper extremity has developed in step with that of the lower extremity. The indications for treatment, the place of total joint arthroplasty in contrast to other forms of arthroplasty, and the criteria for patient selection have recently been classified. A number of problem areas are under biomechanical and clinical study, and most investigators are proceeding cautiously. In properly selected patients, however, prosthetic replacement offers great improvement in both relief of pain and joint function, and improvement should continue. The patient and physician should recognize the limitations that are inherent in any "artificial joint" replacement. Realistic expectations would be for improvement that approaches, but rarely achieves, normal function.

Arthritis↗

Arthritic hand response to pressure gradient gloves.

Five women with osteoarthritis and 10 with rheumatoid arthritis and finger joint involvement wore a pressure gradient glove, a control glove, or no glove in a randomly assigned sequence. All were outpatients. Each patient wore the assigned glove nightly for 1 week, after which a battery of subjective and objective data, including number of tender joints, ring size, grip strength, palmar temperature, and hand function were obtained. In all, 105 separate examinaion sessions were completed over 7 visits, with each hand serving as its own control in the experimental design. The palmar skin temperature was elevated in both patient groups when either a pressure gradient or control glove was worn. In patients with rheumatoid arthritis, the only significant difference was that the pressure gradient glove reduced ring size when compared to the control glove or no glove. No differences were detected in the patients with osteoarthritis.

Arthritis, Rheumatoid↗