Considering that pseudoarthrosis, or non-union, often occurs in patients with scaphoid fractures ... more Considering that pseudoarthrosis, or non-union, often occurs in patients with scaphoid fractures it is very important to start adequate treatment as soon as possible. On the basis of the literature, we advise immobilisation in a below-elbow cast, whereby the thumb is not immobilised and the wrist is in a slightly extended position. Despite the fact that non-dislocated fractures, at the very least, are usually consolidated within 4 weeks, we advise an immobilisation period of 6 weeks followed by clinical or radiological evaluation. If the fracture fails to consolidate, we advise prolonged immobilisation with two-weekly evaluation. There is no evidence in the literature of a positive effect of pulsed electromagnetic field therapy or pulsed low-intensity ultrasound therapy on healing of scaphoid fractures.
This chapter focuses on the current state-of-the-art, evidence-based conservative treatment of no... more This chapter focuses on the current state-of-the-art, evidence-based conservative treatment of nondisplaced and minimally displaced waist fractures of the scaphoid. On the basis of two case scenarios and an overview of the literature, a recommendation is given concerning the type of cast, comparing a below-elbow cast with an above-elbow cast, concerning the immobilization of the thumb, and concerning the position of the wrist in the cast. Furthermore, an overview of literature is given concerning the immobilization period and the use of pulsed electromagnetic field and pulsed low-intensity ultrasound therapy.
Mallet finger is a very common injury, but there is still much discussion about the best treatmen... more Mallet finger is a very common injury, but there is still much discussion about the best treatment. Mallet finger should be operated on if a fracture is larger than 1/3 of the articular surface or in volar subluxation, because otherwise the fracture may remain unstable or there may be loss of function. However, we believe that most mallet fingers can be treated conservatively. Consideration of the relevant literature from PubMed shows that nearly all cases of mallet finger can be treated conservatively with a splint, without significant differences in function, deformity or pain versus surgical treatment. Although there is no significant difference in complications between splinting and surgery, the complications of an operation may be far more serious. In spite of the current operation indication, we should be more reluctant to operate on mallet finger.
Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpop... more Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. It is an injury that rather frequently occurs in certain sports. When diagnosed incorrectly, delay in treatment can ultimately lead to chronic instability and pain. Correct knowledge of the anatomy and method of physical examination is essential when assessing a patient suspected of having skier's thumb. This article describes three different types and treatment of skier's thumb, and further describes the relevant anatomy, correct physical examination, available additional imaging and various treatments possible.
An adequate management of scaphoid fractures requires fast and reliable diagnosis. In this, prope... more An adequate management of scaphoid fractures requires fast and reliable diagnosis. In this, proper history taking and physical examination are essential. Routine scaphoid x-rays miss over 20% of all scaphoid fractures. Therefore, in patients with a clinically suspected scaphoid fracture that cannot be proven by scaphoid x-rays, further diagnostic investigation is indicated. Which supplemental diagnostic tool (bone scintigraphy, MRI, CT) is preferred remains unclear. A below-the-elbow cast without immobilisation of the thumb is an adequate treatment for stable fractures. Unstable fractures and all proximal pole fractures are candidates for open or percutaneous treatment. In addition to the type of fracture, patient-specific requirements are important in deciding which type of management is the most suitable.
Considering that pseudoarthrosis, or non-union, often occurs in patients with scaphoid fractures ... more Considering that pseudoarthrosis, or non-union, often occurs in patients with scaphoid fractures it is very important to start adequate treatment as soon as possible. On the basis of the literature, we advise immobilisation in a below-elbow cast, whereby the thumb is not immobilised and the wrist is in a slightly extended position. Despite the fact that non-dislocated fractures, at the very least, are usually consolidated within 4 weeks, we advise an immobilisation period of 6 weeks followed by clinical or radiological evaluation. If the fracture fails to consolidate, we advise prolonged immobilisation with two-weekly evaluation. There is no evidence in the literature of a positive effect of pulsed electromagnetic field therapy or pulsed low-intensity ultrasound therapy on healing of scaphoid fractures.
This chapter focuses on the current state-of-the-art, evidence-based conservative treatment of no... more This chapter focuses on the current state-of-the-art, evidence-based conservative treatment of nondisplaced and minimally displaced waist fractures of the scaphoid. On the basis of two case scenarios and an overview of the literature, a recommendation is given concerning the type of cast, comparing a below-elbow cast with an above-elbow cast, concerning the immobilization of the thumb, and concerning the position of the wrist in the cast. Furthermore, an overview of literature is given concerning the immobilization period and the use of pulsed electromagnetic field and pulsed low-intensity ultrasound therapy.
Mallet finger is a very common injury, but there is still much discussion about the best treatmen... more Mallet finger is a very common injury, but there is still much discussion about the best treatment. Mallet finger should be operated on if a fracture is larger than 1/3 of the articular surface or in volar subluxation, because otherwise the fracture may remain unstable or there may be loss of function. However, we believe that most mallet fingers can be treated conservatively. Consideration of the relevant literature from PubMed shows that nearly all cases of mallet finger can be treated conservatively with a splint, without significant differences in function, deformity or pain versus surgical treatment. Although there is no significant difference in complications between splinting and surgery, the complications of an operation may be far more serious. In spite of the current operation indication, we should be more reluctant to operate on mallet finger.
Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpop... more Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. It is an injury that rather frequently occurs in certain sports. When diagnosed incorrectly, delay in treatment can ultimately lead to chronic instability and pain. Correct knowledge of the anatomy and method of physical examination is essential when assessing a patient suspected of having skier's thumb. This article describes three different types and treatment of skier's thumb, and further describes the relevant anatomy, correct physical examination, available additional imaging and various treatments possible.
An adequate management of scaphoid fractures requires fast and reliable diagnosis. In this, prope... more An adequate management of scaphoid fractures requires fast and reliable diagnosis. In this, proper history taking and physical examination are essential. Routine scaphoid x-rays miss over 20% of all scaphoid fractures. Therefore, in patients with a clinically suspected scaphoid fracture that cannot be proven by scaphoid x-rays, further diagnostic investigation is indicated. Which supplemental diagnostic tool (bone scintigraphy, MRI, CT) is preferred remains unclear. A below-the-elbow cast without immobilisation of the thumb is an adequate treatment for stable fractures. Unstable fractures and all proximal pole fractures are candidates for open or percutaneous treatment. In addition to the type of fracture, patient-specific requirements are important in deciding which type of management is the most suitable.
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Papers by Steven Rhemrev