Evaluation of volar compartment pressures with a needle monitor, Icing and elevation of the arm with follow-up evaluation in 8 hours, Immediate EMG evaluation of the left upper extremity, Closed reduction, carpal tunnel release, and sugar tong splinting, Emergent open reduction internal fixation with carpal tunnel release. Common Hand dvida ou necessidade, entre em contato! Read the Court's full decision on FindLaw. The operative options available are percutaneous pinning, external fixation, internal fixation or a combination of these techniques. (OBQ18.216) Pins should not be inserted percutaneously due to high incidence of nerve and tendon damage and also to prevent open section defects due to eccentric drilling. Serving the Wenatchee Valley since 1983, supplying ready mix concrete, gravel and sand products. LaFontaine v. Disclaimer, National Library of Medicine Due to the large number of variables to consider and the broad spectrum of injuries, no classification is adequate. Would you like email updates of new search results? [The MEU classification system for distal radius fractures: Prognostic and therapeutic value of an independent assessment of various fracture parameters]. A 32-year-old ballet dancer sustains a distal radius fracture, and is subsequently closed reduced and casted. Usually 3.5mm Schanz screws are used for radius and 2.5 mm for metacarpals. . His radiograph is shown in Figure A. Pins are inserted by limited open technique. Figures A and B depict the closed injury radiograph of a 79-year-old right-hand-dominant woman who fell on her left wrist. Brachioradialis is step-cut in extended flexor carpi radialis approach to access the dorsal surface in complex intra-articular fractures of distal radius. Worse outcomes on the Mayo wrist score are expected without fixation, Chronic distal radioulnar joint instability can be expected to occur without fixation, Wrist function depends on the level of ulnar styloid fracture and initial displacement, Grip strength and wrist range of motion are improved with fixation, There is no adverse effect on wrist function or stability without fixation. Leads to varus malunion and gunstock deformity, Fragment is flexed volarly instead of dorsally, caused by fall on the olecranon, Treated with CRPP, more likely to require open reduction. The https:// ensures that you are connecting to the High-resolution digital photography is used to create a permanent record of these sacred First Nation sites. Immediate post-operative radiographs are seen in Figure A. Pourdana and Asghari Language Testing in Asia (2021) 11:6 Page 15 of 22 Table 7 Cross-tabulation of components in descriptive/narrative writings x TA/PA Criteria Group Teacher assessment Peer assessment Descriptive writing Organization Count 53 14 % within criteria 79.0% 20.0% Std. The reason the original Sgarbossa criteria are limited in clinical practice is the low sensitivity (i.e. In extra articular fractures, successful outcome needs restoration of certain parameters like radial length, radial inclination and palmar tilt. %%EOF Admit for acute carpal tunnel syndrome monitoring, Admit for acute open reduction/internal fixation, Place into removable soft splint and follow-up in clinic, Place into rigid splint and follow-up in clinic, Place into rigid splint and schedule for outpatient open reduction/internal fixation. Results: One hundred fifty-five patients (96 hips and 59 knees) were identified. At the time of the index operation, there was no distal radioulnar joint instability after plating of the radius. 14. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Do not sell or share my personal information, 1. Rua Dona Claudina, 365 Rio de Janeiro, RJ tel: 2138997044, UNIDADE III We've updated our privacy policy. Locking plates rigid fixation and allow eary mobilisation evn in presence of osteoporosis and bone defects. Scaphoid fracture, Benett's fracture, Rolando's fracture, Mallet's finger Management of Geriatric Distal Radius Fracture: Now and Then, Failed phalangeal and metacarpal fracture management, Approach to Soft Tissue Tumor in Upper Extremity, 6. MIER Before Standardised PA and lateral views and some times comparative views of opposite wrist are needed for accurate evaluation of these parameters. Once you create your profile, you will be able to: ST Elevation at the J-point, relative to QRS onset, is at least 1 mm AND has an amplitude at least 25% of the preceding S-wave. The first and last groups represent insufficiency fractures and the middle one represent traumatic fractures. The distal radius has metaphyseal flare and three articular surfaces: scaphoid fossa, lunate fossa and the sigmoid notch. The methodology of RAND/UCLA appr-opriateness was used to develop consensus guidance statements. (OBQ04.233) Radiographs obtained at the time of injury are shown in Figure A. Skip to main content. May need a pelvic binder in attempt to close down pelvic volume. associated ulnar fracture (more than just tip of ulnar styloid), dorsal comminution >50% (most frustrating for holding reduction), Instability factors (elderly can take alot of deformity with good outcomes), Volar ulnar corner where the lunate articulates (Die-punch fractures), Comminuted and displaced extra-articular fractures, Progressive loss of volar title and radial length following closed reduction and casting, External fixation for severe open fractures, highly comminuted fractures, medical unstable patients, Based on how many parts to the fracture there is, The more parts of a fracture the more likely there will be avascular necrosis (AVN), A part is considered separate if there is displacement of >10mm or 45degrees of angulation (this is actually quite of bit of displacement and angulation), Fracture through Anatomic neck or Surgical neck, Humeral head articular segment is not reduced with glenoid, Can include two part, three part or four part fractures, 2, 3, and 4-part fractures in younger patients (higher energy fracture mechanism, Head-splitting fractures in younger patients. Radiographs are provided in Figures A-C. Initial radial shortening >5mm . Research in both laboratory and field applications of sanitary science is the essential force underlying modi- fications and developments in the broad problem of acceptable standards. You review his operative note in which the surgeon reports having to apply a volar locking plate in a distal position to secure the difficult intra-articular fracture. (SBQ17SE.75) Hand Surg Rehabil. In intra-articular fractures in addition to the above, the articular congruity must also be restored. Yes. What is the next best step in management of this patient? Elevation of pronator quadratus with 1-2mm cuff of intermediate fibrous zone makes its repair easy. Associated ulnar fracture Unsere Bestenliste Jan/2023 - Ultimativer Test Beliebteste Modelle Beste Angebote Smtliche Vergleichssieger JETZT direkt ansehen. The patient undergoes closed reduction and splinting; however, her paresthesias worsen significantly in the next 12 hours. Displaced impaction fracture of the lunate fossa, Displaced intra-articular fracture with a fragment consisting of the volar-ulnar corner, Displaced extra-articular fracture with apex volar, Displaced extra-articular fracture with apex dorsal. Blade plates are less commonly used as the blades or tines have to be put in as predetermined by the shape and position of tines in the plate. Clinical criteria: - Limitation of motion of the lumbar spine in all three planes: anterior flexion, lateral flexion, and extension. This recommendation is not applicable to patients with Barton fractures, they should be treated by buttress plating. It identified fracture patterns that reflect specific mechanisms of injury. hbbd```b``"A$Cd`qm"o*%L@snEFg` _ Dos 6 a 12 anos: O momento imperdvel das regras! Calcs that help predict probability of a disease, Subcategory of 'Diagnosis' designed to be very sensitive, Disease is diagnosed: prognosticate to guide treatment. Fracture around stem or just below it, with a loose stem, but poor quality proximal bone stock or severely comminuted, Femoral component revision with proximal femoral allograft, Fracture occurs well below the prosthesis. But they tend to be thicker and more prominent than standard locking plates. Here are the systems that we have found are commonly discussed in fracture conference that would be good to be familiar with for your ortho trauma rotations. Lafontaine M, Delince P, Hardy D, Simons M. Acta Orthop Scand. The plate may need to removed once the fracture is healed to reduce the chance of flexor pollicis longus injury, The plate may need to removed once the fracture is healed to reduce the chance of flexor carpi radialis injury, The plate may need to removed once the fracture is healed to reduce the chance of flexor digitorum superficialis index finger injury, The patient should undergo revision fixation as soon as possible, The plate is in appropriate position and will likely never need to be removed. Patients who underwent arthrocentesis were included and the modified Kocher criteria were applied to all. Clipboard, Search History, and several other advanced features are temporarily unavailable. Short arm cast is as effective as long arm cast in maintaining distal radius fracture reduction: Results of the SLA-VER noninferiority trial. These criteria, as well as age over 60 years, were considered as gravity factors. Learn vocabulary, terms, and more with flashcards, games, and other study tools. (OBQ05.195) Bado Classification (Monteggia fractures, ulnar shaft + radial head dislocation), Fracture of proximal or middle third ulna with, Fracture of ulna metaphysis, distal to coronoid with, Thoracolumbar Injury Classification and Severity Score (TLICS for Thoracolumbar Burst Fractures), Young-Burgess Classification (Pelvic Ring Injuries), anterior and posterior sacroiliac (SI) ligaments, Letournel Classification (Acetabular Fractures), Denis Classification (Pronounced like Den-ee), Pipkin Classification (Femoral Head Fractures), Garden Classification (Elderly Femoral Neck fractures), Pauwels Classification (Young Femoral Neck Fractures based on verticality of fracture line), Vancouver Classification (Fractures Around Arthroplasty Stems), Fracture around stem or just below it, with a, Fracture around stem or just below it, with a loose stem, but, poor quality proximal bone stock or severely comminuted, Schatzker Classification (Tibial plateau fractures), ascular injury is most common in this type due to common fracture-dislocation of the knee, Non Operative indications for ankle fractures, Operative indications for ankle fractures, Gartner Classification (Supracondylar humerus fractures), Pediatric Tibial Shaft Fracture Parameters, Checklists: Admission, Pre-Op and Post-Op, 7/18/21 Newsletter: Unstable Intertrochanteric Femur Fractures, 7/4/21 Newsletter: Tibial Plateau Fractures and Vascular Injury, 6/4/21 Newsletter: Humeral Shaft Fractures Discussion. The site is secure. An ST/S ratio of 0.20 is also very high and almost as specific as a 0.25 ratio. Using the 1990 ACR classification criteria as the gold standard, the new 2010 ACR diagnostic criteria made the correct diagnosis in 83% of cases. Symphysis widening and disruption of anterior and posterior sacroiliac (SI) ligaments (SI dislocation). Open reduction and plating is indicated in those with irreducible fractures and in presence of joint incongruity. Injury 1989;20(4):208-10. There are also the Lafontaine criteria which are . There is no median nerve paresthesias. J Clin Med. It is shown that the use of base isolation in this building caused the base overturning . Pearls and pitfalls with im nailing of proximal tibia fractures, dislocations & fractures of Elbow in adults, Forearm fracture, A Wednesday child in upper extremity fracture, Tips, tricks and pitfalls of proximal femoral nailing (PFN), Overview conservative management of long bone fracture in adult, Principle management fracture forearm (shaft and distal end radius) in children. Objective: To reach consensus on the diagnostic criteria for deficiency syndrome in hypertension (YDSH) patients by a modified Delphi method. Fractures & Dislocations After ligamentotaxis , the x-ray should show 1mm widening of radiocarpal joint than midcarpal joint. The Association of Low Skeletal Muscle Mass with Complex Distal Radius Fracture. Case opinion for GA Court of Appeals ROSS v. STATE. The expression of sap1 is regulated at different stages . government site. Distal Radius Intraarticular Fracture ORIF with Dorsal Approach, Distal Radius Extra-articular Fracture ORIF with Volar Appr, Distal Radius Fracture Non-Spanning External Fixator, Distal Radius Fracture Spanning External Fixator, Type in at least one full word to see suggestions list, 7th Annual Frontiers in Upper Extremity Surgery, Nonoperative Treatment of Distal Radius Fractures - Michael Bednar, MD, Dorsal Plating of Radius Fractures - Nader Paksima, DO, MPH, Fragment Specific Fixation Distal Radius Fractures - Mark Rekant, MD, 12th Annual Orthopaedic Trauma: Pushing The Envelope. He reports having undergone open reduction and internal fixation of a distal radius fracture 1 year prior that healed uneventfully. Which of the following has evidence to support its utility in this clinical situation? (OBQ18.223) Orthop Res Rev. A good classification should categorise the fracture type and the injury severity to guide treatment. Radial styloid is reduced first followed by lunate facets. The original Ranson criteria is a scoring system that uses 11 parameters to assess the severity of acute pancreatitis. tel: 2124245384. Free access to premium services like Tuneln, Mubi and more. Patients with 3 or more factors have high chance of loss of reduction. If the lines intersect within the carpus there is no malignment if outside there is malalignment. Percutaneous pinning can be broadly classified into extrafocal and intrafocal(pinning through the fracture site). Method of reduction is by giving traction, followed by anteriorly directed pressure to correct dorsal angulation. Computed Tomography and Pathobiomechanical-Based Treatment of Volar Distal Radius Fractures. Distal radius fracture is the most common osteoporotic fracture of appendicular skeleton. We highly recommend dealing with Mandy, she is the best. Stability is determined by fracture pattern and soft tissue injuries. Ruschel modification is addition of a lateral intrafocal pin to restore radial inclination and shift. (OBQ11.273) A 45-year-old female barista from Portland fell off her skateboard and sustained a closed distal radius fracture. Kerala, India, https://learningorthopaedics.files.wordpress.com/2013/03/20130310-193744.jpg>, https://learningorthopaedics.files.wordpress.com/2013/03/20130310-193850.jpg>, https://learningorthopaedics.files.wordpress.com/2013/03/20130310-193944.jpg>, https://learningorthopaedics.files.wordpress.com/2013/03/20130310-194046.jpg>, https://learningorthopaedics.files.wordpress.com/2013/03/20130310-194135.jpg>, A Short Guide to Musculoskeletal System Examination, Plantar Plate Insufficiency or Rupture (Turf Toe), Basics of radiation safety for the orthopaedic surgeons, Ward Rounds- A recently neglected part of inpatient care, Meniscus Lesions Tied to Neuropathic Pain in Knee OA, Alternate Bearing Surfaces- Evidence so far. doi: 10.1016/j.hansur.2016.03.008. Neste perodo de pandemia provocado pelo COVID-19 nosso atendimento est sendo These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients. %PDF-1.5 % Dorsal comminution >50%, Palmar comminution, Intra-articular comminution PMID: 2592094 DOI: 10.1016/0020-1383(89)90113-7 Abstract A total of 112 consecutive cases of fractures of the distal radius managed . Carpal malalignment is assessed by the angle subtended by the longitudinal axis of capitate and radius. Click here to review the details. The patient shows you the lateral film in Figure A. A 45-year-old construction worker sustains a fall and presents with an isolated injury to his upper extremity. Also, each signature is analyzed for ink stroke, size and angles of the letters, pauses in the lines, signing materials such as type and age of paper/pen used and other important criteria. Greater troch fractures <2cm displacement Non-op with partial weight bearing, Greater troch fractures >2cm ORIF with claw/cables, Fracture around stem or just below it, with a well-fixed stem, ORIF using cerclage cables and locking plates, Fracture around stem or just below it, with a loose stem, but good proximal bone stock. A 70-year-old woman with known osteoporosis sustains a distal radius fracture of her dominant arm with some metaphyseal comminution. Due to thin cortex radially it shortens and tilts laterally after fracture which is best addressed by buttressing the lateral cortex. Which plating option provides the most appropriate treatment of this fracture? and transmitted securely. Successful non-operative treatment needs satisfactory reduction and maintenance of reduction till union. A total of 112 consecutive cases of fractures of the distal radius managed conservatively were graded according to radiological criteria using the first radiograph. Percutaneous pinning may be indicated in young patients with reduced or reducible fractures with instability. The Fontan procedure or Fontan-Kreutzer procedure is a palliative surgical procedure used in children with univentricular hearts. Initial displacement >1cm (OBQ06.136) Dorsal comminution >50%, Palmar comminution, Intra-articular comminution. In 1965, Older proposed a classification that incorporated radial shortening as variable in classification. Dorsal plating is done only rarely now due to poor soft tissue cover, tendon rupture etc. How do you counsel him about his post-operative period? It is the strongest and supports the lunar facet. A 58-year-old man underwent distal radius ORIF with a volar locking plate yesterday. Non operative minimally or non-displaced. He presents to your clinic and given his age and the fracture characteristics, he is taken for open reduction with volar locking plate fixation. Copyright 2023 Lineage Medical, Inc. All rights reserved. (OBQ08.179) A 54-year-old male falls from a ladder and sustains the fracture shown in Figure A. The modified Sgarbossa criteria replaces the absolute 5mm discordant ST elevation with a proportion (ST elevation/S-wave amplitude -0.25). (OBQ12.38) Additional Professor of Orthopaedics Orthopedist at Maharat Nakhon Ratchasima Hospital. Limited open technique utilises two 2.5 cm incisions. Normally is is about 11 mm. 10-minute Operation : Close Reduction with Percutaneous Pinning in Supracondy Minimally Invasive Surgery in Wrist Fractures. official website and that any information you provide is encrypted (SBQ17SE.70) Failure to support the lunate facet with fragment specific fixation, Use of only three bicortical screws in the intact radial shaft proximally. The modified PIOPED II criteria for the diagnosis of pulmonary embolus indicate the presence or absence of pulmonary emboli based on findings on V/Q scan (ventilation-perfusion scintigraphy). You can rate this topic again in 12 months. It is designed to fix each major fracture fragment by an implant specifically designed for that fragment. Palmar ulnar corner is called the keystone of distal radius. 2021 Jul 15;11(3):203-213. doi: 10.1055/s-0041-1731819. This article explores the relationship between Goethe's novel Wilhelm Meister's Apprenticeship and contemporary writings about natural organisms, including Goethe's own botanical studies. Operative treatment is indicated in those with irreducible fractures, fractures with predicted or proven instability and in those with bilateral fractures and polytrauma. The most important change is the modification of the rule for excessive discordance.. Extensor carpi radialis longus transfer to extensor pollicus longus, Extensor pollicis brevis transfer to extensor pollicus longus, Extensor indicis proprius transfer to extensor pollicus longus, Primary repair of extensor pollicus longus. What is the most likely etiology of her new loss of function? - History or the presence of pain at the dorso-lumbar junction or in the lumbar spine. In between the volar ligaments and pronator quadratus lies the intermediate fibrous zone. Variable angle locking plates allow an independent trajectory to be chosen for individual distal screws to match the variable geometry and surface contour of distal radius. Concordant ST depression 1 mm in V1-V3. enrolled in this study were evaluated prior to treatment. [Instability of fractures of the lower end of the radius: apropos of a series of 167 cases]. Radiographic parameters with significant associations in bivariate analysis were evaluated in multivariable models adjusted for age, sex, initial radiographic parameters, reduction status, and AO fracture type. Browse; Resources. A 65-year-old female sustains a fall onto her outstretched right hand. Similar to genetically modified organisms (GMOs) produced by classical genetic engineering, gene-edited (GE) organisms and their derived food/feed products commercialized on the European Union market fall within the scope of European Union Directive 2001/18/EC. No. hVao8+q$#*A)-C A roadblock to check sobriety and operator's permits was legal where every driver was stopped, except backed-up traffic which the officers allowed to clear for the public's protection. "Orthopaedics for non-orthopedist 3" 15 2560 . Consequently, their control in the food/feed chain by GMO enforcement laboratories is required by the competent authorities to . Caso Such patients have a superior outcome with external fixation when compared to those treated by open methods, but some series have reported unacceptably high rate of complications. A 32-year-old inebriated male falls from a mechanical bull at a bar and sustains a closed displaced intra-articular distal radius fracture. Which of the following interventions should be taken? He sustains the injury shown in Figure A. External fixation may be bridging or non-bridging. We previously identified BP1026B_I0091 as a surface attachment protein (Sap1) and an essential virulence factor, contributing to Bp pathogenesis in vitro and in vivo. Some fracture patterns, such as reverse Barton (a partial articular . Pathophysiology. You can read the details below. Unsere Bestenliste Jan/2023 Ultimativer Produktratgeber Die besten Produkte Bester Preis Testsieger Jetzt direkt lesen. UNIDADE I Anteroposterior (AP), lateral, and oblique views of the left wrist demonstrate a shear fracture of the volar aspect of the distal radius (Fig. href=https://learningorthopaedics.files.wordpress.com/2013/03/20130310-194135.jpg> Fragment specific fixation is a recent introduction. There are four radiographic parameters used to assess distal radius alignment: radial height, radial inclination, ulnar variance, and volar tilt. Upper extremity deep vein thrombosis (DVT), Lower extremity deep vein thrombosis (DVT). Following fixation, a "shuck" test is performed and shows persistent instability of the distal radioulnar joint. Stability is determined by fracture pattern and soft tissue injuries. href=https://learningorthopaedics.files.wordpress.com/2013/03/20130310-193944.jpg> Non-operative treatment is sufficient in undisplaced fractures and reducible and stable fractures. This medication is given in an effort to decrease the incidence of which of the following? (OBQ10.127) A 46-year-old woman sustains an extra-articular fracture of the distal radius and undergoes open reduction and internal fixation with a volar plate and screw construct. Symphysis widening >2.5cm. It allows placement of implants in orthogonal planes. 2022 Sep 27;4(6):315-319. doi: 10.1016/j.jhsg.2022.09.001. They must be under continual study and be modified to meet changing conditions and advances in the science of sanitation and water treatment. A 56-year-old woman sustains the closed injury depicted in Figures A-B. Huygen et al. What complication is most likely to occur in this patient? (OBQ07.8) Among the various extrafocal techniques, 2 parallel trans-styloid pins with a third wire through the dorsal-ulnar corner is the most stable. A nationwide panel of experienced clinical experts from 19 provinces was constructed. href=https://learningorthopaedics.files.wordpress.com/2013/03/20130310-193850.jpg> Once the acceptable reduction is achieved within these parameters then the next question is whether the position will remain stable till union. . CT with 3D reconstruction is useful in complex injuries. Intermediate column composed of lunate fossa and sigmoid notch is the corner stone of distal radius. : 7446890Estimated value : CAN $788,052.00 (plus applicable tax)Closing date : 2023-01-27 - 2:00 PM Eastern Standard TimeProject Title: Rental of Venue for Venue for the 2023 Global Environment Facility (GEF)Category: Event PlanningTender Type: Advance Contract Award Notice (ACAN)Region of Delivery: British ColombiaRegion of Opportunity . Four months post-injury, he presents to the office with an inability to extend his thumb. Begin typing to search, use arrow keys to navigate, use enter to select Acta Orthop Scand. 10. Volar plates fall into 4 categories: buttress plates, tine or blade plates, fixed angle locking plates and variable angle locking plates. La Fontaine (1989) criteria: Dorsal tilt >20 degrees Dorsal comminution Intra-articular fracture Associated ulnar fracture Age over 60 years 3 or more tended to collapse Treatment Options Lafontaine criteria are a predictor of instability. (OBQ12.244) METHODS: We assembled a multicenter cohort of infants 29 to 60 days of age who had cerebrospinal fluid (CSF) and blood cultures obtained. modified lafontaine criteria. tenha alguma If the volar cortex is also displaced, then the deformity should be exaggerated to disengage the fracture ends. In 1989, Lafontaine detailed five predictors for instability, namely age >60 years, dorsal angulation >20 degrees, dorsal comminution, fracture . INTRODUCTION. Recently, Steven Smith, MD from Dr. Smith's ECG Blog published a new criterion to replace the third component of the original Sgarbossa Criteria . Yes. The patient undergoes open reduction and internal fixation of the fracture. Reverse total shoulders are used when there is a high risk for AVN in more comminution such as 3 to 4 part fractures in the elderly. Walten modification of intrafocal intramedullary pins is useful in osteoporotic patients. Methods: Our study was consistent with T/CACM 1032-2017. Looks like youve clipped this slide to already. Todos os direitos reservados - Aldeia Montessori, Agende uma Radiographs show a well-fixed fracture in good alignment. MeSH Government Medical College, Kozhikode The following inclusion criteria were used: (1) presence of 3 or more instability factors as described by Lafontaine et al 6 (intra-articular, dorsal comminution, dorsal angulation > 20, associated ulna fracture, age > 60 y), (2) adequate plain radiographs of the distal radius including posteroanterior and lateral views from the date of injury, after reduction, and 1 week, 2 weeks, and 4 weeks . - Limitation of chest expansion to 1 in. Acceptable reduction range is also influenced by the physiological health of patient and functional demands of the patient. Radial inclination is the angle between a line drawn connecting the tip of styloid and the ulnar corner of radial articular surface and a line perpendicular to the long axis of radius at the level of tip of styloid. (248) 887-4747. with respect to diagnostic criteria and treatment options. Non-surgical treatment for DRF is largely dictated by Lafontaine criteria. If there are more family doctors than ever before, why cant I find one? In 1967, Frykman identified the importance of ulnar involvement and publish a classification based on involvement of radiocarpal and radioulnar joints and the ulnar styloid fracture. the patients had 'excellent' outcomes according to the modified Green O'Brien score with a mean DASH of six points at . It is well suited for young patients with reducible intra/extra-articular fractures. These criteria, as well as age over 60 years, were considered as gravity factors. (OBQ13.140) Long-term efficacy of botulinum toxin A in the treatment of various disorders over a 10 . Inability to extend the thumb interphalangeal joint.
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