Stable and undisplaced phalangeal and metacarpal fractures treated with strapping or functional splinting and controlled active exercises offer from about 70 to 80% of good results. The goal of treatment of closed unstable and displaced fractures should be to achieve similar or better outcome. External fixation combines the simplicity of time-honoured fixation with K-wires and an external frame to increase rigidity. This combination was used in a prospective study of 100 consecutive patients with closed fractures of the proximal and middle phalanges and the distal three-quarters of the metacarpal bones. Good clinical results (TAM > or = 230 degrees) were obtained in 76% of isolated phalangeal fractures, in all metacarpal fractures and in 89% of multiple fractures.
Continuous sensory analgesia of brachial plexus (CSA BP) was only occasionally reported to have been used in the treatment of CRPS. In the past four years, we have treated 21 patients with a working diagnosis of CRPS. The treatment was instituted one to six months after inciting injury. All patients were admitted to hospital. In the first two days, the therapy consisted of elevation, cryotherapy, and active exercises. Five patients responded well to this initial physiotherapy (5/21). In 16 cases, no evident improvement was observed and CSA BP was introduced. At follow-up (3-36 months), the results were: 13/16 (81%) had at least good results (excellent 2, good without any sequelae 5, good with sequelae of initial injury 6, and poor 3). The results were judged as follows: excellent (completely normal hand); good (only temporary pain up to 2 on a 0-10 numeric rating scale; no signs of dysfunction of sympathetic nervous system; ROM of wrist over 50% of normal hand; ROM of fingers excellent or good; and the strength of hand grasp and key pinch over 50% of normal hand measured with dynamometer) and if any of the former criteria was missing, the result was defined as poor.
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