Bimaxillary surgery without the use of an intermediate splint to position the maxilla.
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Scald injuries to the feet are relatively common in young children. In a minority of cases, contracture formation can lead to permanent disability. We present a new technique, which provides a simple yet functional form of splintage in the treatment of the contractures.
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The treatment of hand deformity and associated dysfunction is a major focus of physical and occupational therapy for people with CP, as poor grasp and manipulation has potential to impact on many aspects of daily life. To assist therapists in analyzing patterns of movement of the wrist, finger, and thumb musculature at rest and during functional activities, five patterns of deformity commonly seen in the hypertonic hand are described. Interventions that impact on hypertonicity and associated contracture and that facilitate functional use of the hand in the presence of these deformities are discussed. The paucity of evidence from clinical trials on intervention strategies reflects in part the diversity of people with CP and the highly individual functional problems they encounter. While further research is needed on the many possible interventions and how they contribute to maximizing hand function, there is increasing evidence of the value of therapy that is directed to functional outcomes relevant to the individual.
We advise dynamic extensor splintage put on as early as possible within the first 6 weeks after the diagnosis of boutonniere deformity. This splintage runs from the dorsal aspect of the hand to the DIP joint which is left free to flex actively. This apparatus is left on for at least six weeks post injury. Sixteen patients have been treated in this way. Seven of them were monitored carefully. Only one had a bad result with DIP flexion still preserved. The others averaged a mean extension loss of 23 degrees, and no loss of extension in DIP joints. Active flexion both in PIP and DIP was perfectly preserved. The functional treatment without surgery seems to be a good technique in management of fresh rupture of the extensor mechanism in PIP joints.
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The purpose of this article was to illustrate a limited search for evidence and its application in the context of a patient with CTS. The search was by no means exhaustive, as it was performed and interpreted in less than an hour. My conclusions are not definitive because my evidence was based almost exclusively on abstracts, and many key details about the studies are unknown. I do not know how closely my specific patient matches those in a particular study. My search allowed me, however, to make an informed response to a patient with legitimate questions. Integrating the evidence with my own clinical judgment and the patient's preferences kept me from being paralyzed in decision making by a lack of sufficient data. This intentionally quick and patient-specific search for evidence could be contrasted to a more complete and comprehensive analysis of evidence. A more complete search would be indicated for areas that represent common or frequent problems for a particular clinical setting, for which basic procedural guidelines might be developed.