Displaying publications 1 - 20 of 87 in total

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  1. Ozcelik IB, Jusoh MH, Cavit A
    Tech Hand Up Extrem Surg, 2024 Mar 01;28(1):16-18.
    PMID: 37702374 DOI: 10.1097/BTH.0000000000000453
    Ulnar impaction syndrome occurs when excessive load across the ulnocarpal joints results in pathologic changes, especially over the articular surface of the ulnar head and proximal ulnar corner of the lunate. The 2 main surgical options in ulnar impaction syndrome are ulnar shortening osteotomy and wafer procedure, whether open or arthroscopically, to decompress the ulnocarpal joint load. However, all of these techniques have their shortcomings and drawbacks. The current study demonstrates a novel technique to decompress the ulnocarpal joint load: the "reverse wafer procedure" for ulnar impaction syndrome. In this surgical technique, we resected the proximal ulnar side of the lunate instead of partial resection of the thin wafer of the distal ulnar head dome in the standard wafer procedure. This technique avoids iatrogenic central tear of triangular fibrocartilage and distal radioulnar joint portal arthroscopy, which is technically demanding while preserving the distal radioulnar joint.
    Matched MeSH terms: Wrist Joint/surgery
  2. Brutus JP, Chang MC, Ahmad AA, Apard T
    Hand Surg Rehabil, 2024 Feb;43(1):101610.
    PMID: 38393765 DOI: 10.1016/j.hansur.2023.10.004
    The gold-standard for bone, ligament and joint surgery in the wrist is locoregional anesthesia in most countries. Wide-Awake Local Anesthesia No Tourniquet (WALANT) is commonly used for simple soft-tissue hand surgery procedures such as carpal tunnel or trigger finger release, and can now also be safely used in procedures such as proximal row carpectomy, scapholunate ligament repair or partial wrist fusion, to name but a few. This article describes the use of WALANT for complex surgery in the wrist. WALANT surgery offers many known benefits, such as enhanced patient safety and comfort, simplified perioperative process and avoidance of anesthesia-related risks, and also allows the surgeon to perform intraoperative testing of the repaired structures. Thus, the surgeon can tailor the rehabilitation program and shorten recovery time. We describe detailed guidelines for performing WALANT procedures safely and effectively, making it a favorable option for complex surgeries in the wrist.
    Matched MeSH terms: Wrist; Wrist Joint/surgery
  3. Ibrahim NS, Rampal S, Lee WL, Pek EW, Suhaimi A
    Cardiovasc Eng Technol, 2024 Feb;15(1):12-21.
    PMID: 37973701 DOI: 10.1007/s13239-023-00693-z
    PURPOSE: Photoplethysmography measurement of heart rate with wrist-worn trackers has been introduced in healthy individuals. However, additional consideration is necessary for patients with ischemic heart disease, and the available evidence is limited. The study aims to evaluate the validity and reliability of heart rate measures by a wrist-worn photoplethysmography (PPG) tracker compared to an electrocardiogram (ECG) during incremental treadmill exercise among patients with ischemic heart disease.

    METHODS: Fifty-one participants performed the standard incremental treadmill exercise in a controlled laboratory setting with 12-lead ECG attached to the patient's body and wearing wrist-worn PPG trackers.

    RESULTS: At each stage, the absolute percentage error of the PPG was within 10% of the standard acceptable range. Further analysis using a linear mixed model, which accounts for individual variations, revealed that PPG yielded the best performance at the baseline low-intensity exercise. As the stages progressed, heart rate validity decreased but was regained during recovery. The reliability was moderate to excellent.

    CONCLUSIONS: Low-cost trackers AMAZFIT Cor and Bip validity and reliability were within acceptable ranges, especially during low-intensity exercise among patients with ischemic heart disease recovering from cardiac procedures. Though using the tracker as part of the diagnosis tool still requires more supporting studies, it can potentially be used as a self-monitoring tool with precautions.

    Matched MeSH terms: Wrist*
  4. Chuah JP, Khoo SS, Chung TY, Jayaletchumi G
    Photobiomodul Photomed Laser Surg, 2023 Aug;41(8):402-407.
    PMID: 37506348 DOI: 10.1089/photob.2023.0018
    Background: Carpal tunnel release (CTR) is widely accepted as an effective treatment for carpal tunnel syndrome. However, the recovery is often delayed and incomplete. Photobiomodulation therapy (PBMT) produces a nonthermal effect on living tissues; it promotes healing, remodels and reduces inflammation of an injured nerve. The purpose of this study was to compare the outcome of CTR between patients who underwent postoperative PBMT and without PBMT. Materials and methods: We recruited 105 patients who had open CTR from January 2019 to January 2021. Fifty-six patients fulfilled the study criteria and were randomized into two groups: with PBMT (n = 28) and without PBMT (n = 28). Demographic and clinical data were obtained preoperatively. The PBMT group had ten 3-min sessions over 3 weeks using 808 nm, 50 mW PBMT to deliver 9 J per session to the CTR incision scar. Clinical outcomes were assessed at 1, 3, and 6 months postoperatively. Data analysis was performed with SPSS software. Results: There were significant improvements in the Functional Status Scale in the Boston Carpal Tunnel Questionnaire (p = 0.018) and pain (visual analogue scales) in the morning (p = 0.019) at 1 month postoperatively in the PBMT group compared with the non-PBMT group. Improvement of tip pinch strength at 3 months (p = 0.022) and 6 months (p = 0.024), lateral pinch strength at 1 month (p = 0.042) and 3 months (p = 0.05), and tripod pinch strength at 3 months (p = 0.005) was significantly better in the PBMT group. Thumb 2-point discrimination (2PD) at 3 months (p = 0.018) and 6 months (p = 0.016) and index finger 2PD at 3 months (p = 0.039) were also significantly improved in the PBMT group. There were no side effects of PBMT reported. Conclusions: Patients who underwent PBMT post-CTR had better outcomes. PBMT may be a valuable adjunct to post-CTR care.
    Matched MeSH terms: Wrist
  5. Azhar S, Abdullah S, Soh E
    J Hand Surg Eur Vol, 2023 Mar;48(3):279-281.
    PMID: 36691295 DOI: 10.1177/17531934221148115
    Matched MeSH terms: Wrist Joint/surgery
  6. Ajit Singh V, Jia TY, Devi Santharalinggam R, Gunasagaran J
    PLoS One, 2023;18(1):e0279210.
    PMID: 36662743 DOI: 10.1371/journal.pone.0279210
    BACKGROUND: Ulna styloid fracture occurs approximately about 55% of all distal end of radius fractures. However, the clinical and functional outcome of these fractures remains indefinite.

    RESULTS: Only 56 patients with distal radius fractures had concomitant ulna styloid fractures. The mean age was 32 years (range: 18-69; SD: ± 12.7). The majority were men. The mean time from injury was 18.7 months (range: 6-84; SD: ± 13.3). The most common was Frykman 2, followed by 6, type 8, and type 4. All were closed fractures; 60.7% were base, and 39.3% were tip fractures. 50% were treated with casting, 48.3% plating, and 1.8% external fixation. The mean period of casting was 7.67 weeks (range: 4-16; SD ± 3.1). The ulna styloid was united in 35.7%. There is no significant difference in the range of movement between those with ulna styloid union and non-union. The Ballottement test and Piano key sign was statistically insignificant between both groups. All the displacements were dorsal except in 1 case. The mean displacement of ulna styloid is 1.88mm (SD±1.08, Range: 0.20-4.60mm). The mean VAS score at rest and work is not statistically significant. The mean grip strength and functional score (DASH) are similar in both groups.

    CONCLUSION: Ulna styloid fractures do not contribute to the DRUJ instability and the status of the union of the ulna styloid and the site of the ulna styloid fracture (tip or base) did not have a bearing on the range of movement and functional status of the affected wrist. Temporary DRUJ immobilization might allow TFCC recovery.

    Matched MeSH terms: Wrist
  7. Stieger S, Graf HM, Riegler SP, Biebl S, Swami V
    Body Image, 2022 Dec;43:232-243.
    PMID: 36201860 DOI: 10.1016/j.bodyim.2022.09.009
    Social media use is consistently associated with more negative body image, but much of this literature is cross-sectional and/or lacks ecological validity. To overcome these limitations, we examined associations between everyday social media engagement and appearance satisfaction using an experience sampling method. Fifty participants from Central Europe completed a 14-day experience sampling phase in which they reported their appearance satisfaction at two random time-points each day, as well as following active engagement with social media content, using a wrist-worn wearable and a physical analogue scale (PAS; i.e., angle of a participant's forearm between flat and fully upright as a continuous response scale). Results indicated that engagement with social media content was significantly associated with lower appearance satisfaction. Additionally, we found that engagement with the content of known others was associated with significantly lower appearance satisfaction than engagement with the content of unknown others. These effects were stable even after controlling for participant demographics, active vs. passive daily social media use, and body image-related factors. These results provide evidence that everyday social media engagement is associated with lower appearance satisfaction and additionally provides preliminary support for the use of a PAS in body image research using an experience sampling method.
    Matched MeSH terms: Wrist
  8. Lee YJ, Harmony T, Jamal-Azmi IS, Gunasagaran J, Ahmad TS
    Malays Orthop J, 2021 Mar;15(1):113-118.
    PMID: 33880157 DOI: 10.5704/MOJ.2103.017
    Introduction: Bowling is an immensely popular, but scarcely researched sport associated with overuse injuries in its participants. The purpose of this study was to investigate and report on the incidence of common upper extremity complaints in elite bowling athletes.

    Materials and methods: All Malaysian national level bowlers (n=39) were evaluated via questionnaire on their upper limb symptoms. A focused, relevant clinical examination was performed on each subject to exclude de Quervain's tenosynovitis, tennis and golfer's elbow, carpal tunnel syndrome and trigger finger. The athletes were then allowed to resume bowling for two hours before completing another symptom-related questionnaire.

    Results: Pain was the predominantly observed symptom, with a predilection for the wrist, ring and middle fingers, and thumb. De Quervain's tenosynovitis was found in 53.8% (n=21) of the subjects, with 52.4% and 42.9% of them experiencing pain during and after training, respectively. Other repetitive injury-related disorders were also considerably more common than in their non-playing limb and the general population.

    Conclusion: The incidence of de Quervain's tenosynovitis was exceptionally high in this population. Further studies on sports kinematics are needed to prevent long term morbidities in these athletes.

    Matched MeSH terms: Wrist; Wrist Joint
  9. Abdul Hamid MF, Rajandiran SR, Yu-Lin AB, Sapuan J
    Int J Mycobacteriol, 2020 8 31;9(3):325-328.
    PMID: 32862171 DOI: 10.4103/ijmy.ijmy_97_20
    Tuberculosis (TB) is the most prevalent infectious disease in Southeast Asia. It causes both pulmonary and extrapulmonary diseases. TB of the wrist is rare and presents as osteomyelitis or tenosynovitis. We report a middle-aged male with carpal bone tuberculous osteomyelitis. He presented with left wrist pain initially treated as gouty arthritis. Within 2 weeks, he developed seropurulent discharge with osteomyelitic changes on imaging. He underwent debridement, and intraoperatively, there was destruction of most carpal bones. Histopathological examination revealed chronic granulomatous inflammation with abscess formation. Anti-TB medication was initiated, and he made a complete recovery with almost full range of wrist movement after 9 months of treatment. This case serves as a reminder that TB is a great mimicker, and a high index of suspicion is required to make a diagnosis of TB of the wrist. Early initiation of anti-TB is pivotal to prevent complications and deterioration of joint functions.
    Matched MeSH terms: Wrist/microbiology; Wrist/pathology
  10. Abdullah S, Ahmad AA, Lalonde D
    Plast Reconstr Surg Glob Open, 2020 Aug;8(8):e3023.
    PMID: 32983779 DOI: 10.1097/GOX.0000000000003023
    Tendon transfer for radial nerve palsy is a common procedure done under general anesthesia. We describe a surgical technique of triple tendon transfer with wide awake local anesthesia no tourniquet (WALANT). We transfer flexor carpi radialis to extensor digitorum communis, palmaris longus to extensor pollicis longus, and pronator teres to extensor carpi radialis brevis. This is commonly known as the Brand transfer. Our anesthetic or WALANT solution consists of up to 200 mL of 1:400,000 epinephrine, 0.25% lidocaine buffered with sodium bicarbonate. This technique overcomes the problem of judging the appropriate amount of transfer tension by observing awake patients actively extend their fingers, thumb, and wrist during the surgery and making adjustments before we close the wound. In our experience, there is no need of brain retraining because a patient is able to immediately use the flexor muscles to perform extension movements. WALANT is a safe and viable option for radial nerve tendon transfers.
    Matched MeSH terms: Wrist; Wrist Joint
  11. Syurahbil AH, Munajat I, Mohd EF, Hadizie D, Salim AA
    Malays Orthop J, 2020 Jul;14(2):28-38.
    PMID: 32983375 DOI: 10.5704/MOJ.2007.008
    Introduction: Redisplacement following fracture reduction is a known sequela during the casting period in children treated for distal radius fracture. Kirschner wire pinning can be alternatively used to maintain the reduction during fracture healing. This study was conducted to compare the outcomes at skeletal maturity of distal radius fractures in children treated with a cast alone or together with a Kirschner wire transfixation.

    Material and Methods: This was a retrospective study involving 57 children with metaphyseal and physeal fractures of the distal radius. There were 30 patients with metaphyseal fractures, 19 were casted, and 11 were wire transfixed. There were 27 patients with physeal fractures, 19 were treated with a cast alone, and the remaining eight underwent pinning with Kirschner wires. All were evaluated clinically, and radiologically, and their overall outcome assessed according to the scoring system, at or after skeletal maturity, at the mean follow-up of 6.5 years (3.0 to 9.0 years).

    Results: In the metaphysis group, patients treated with wire fixation had a restriction in wrist palmar flexion (p=0.04) compared with patients treated with a cast. There was no radiological difference between cast and wire fixation in the metaphysis group. In the physis group, restriction of motion was found in both dorsiflexion (p=0.04) and palmar flexion (p=0.01) in patients treated with wire fixation. There was a statistically significant difference in radial inclination (p=0.01) and dorsal tilt (p=0.03) between cast and wire fixation in physis group with a more increased radial inclination in wire fixation and a more dorsal tilt in patients treated with a cast. All patients were pain-free except one (5.3%) in the physis group who had only mild pain. Overall outcomes at skeletal maturity were excellent and good in all patients. Grip strength showed no statistical difference in all groups. Complications of wire fixation included radial physeal arrests, pin site infection and numbness.

    Conclusion: Cast and wire fixation showed excellent and good outcomes at skeletal maturity in children with previous distal radius fracture involving both metaphysis and physis. We would recommend that children who are still having at least two years of growth remaining be treated with a cast alone following a reduction unless there is a persistent unacceptable reduction warranting a wire fixation. The site of the fracture and the type of treatment have no influence on the grip strength at skeletal maturity.

    Matched MeSH terms: Wrist; Wrist Joint
  12. Wolkow AP, Rajaratnam SMW, Wilkinson V, Shee D, Baker A, Lillington T, et al.
    Sleep Health, 2020 06;6(3):366-373.
    PMID: 32340910 DOI: 10.1016/j.sleh.2020.03.005
    OBJECTIVES: This study examined the influence of a wrist-worn heart rate drowsiness detection device on heavy vehicle driver safety and sleep and its ability to predict driving events under naturalistic conditions.

    DESIGN: Prospective, non-randomized trial.

    SETTING: Naturalistic driving in Malaysia.

    PARTICIPANTS: Heavy vehicle drivers in Malaysia were assigned to the Device (n = 25) or Control condition (n = 34).

    INTERVENTION: Both conditions were monitored for driving events at work over 4-weeks in Phase 1, and 12-weeks in Phase 2. In Phase 1, the Device condition wore the device operated in the silent mode (i.e., no drowsiness alerts) to examine the accuracy of the device in predicting driving events. In Phase 2, the Device condition wore the device in the active mode to examine if drowsiness alerts from the device influenced the rate of driving events (compared to Phase 1).

    MEASUREMENTS: All participants were monitored for harsh braking and harsh acceleration driving events and self-reported sleep duration and sleepiness daily.

    RESULTS: There was a significant decrease in the rate of harsh braking events (Rate ratio = 0.48, p 

    Matched MeSH terms: Wrist
  13. Then JW, Shivdas S, Tunku Ahmad Yahaya TS, Ab Razak NI, Choo PT
    J Hand Ther, 2020 05 16;33(2):235-242.
    PMID: 32430167 DOI: 10.1016/j.jht.2020.03.029
    STUDY DESIGN: This is a two-group randomized controlled trial.

    INTRODUCTION: Finger stiffness after treatment for metacarpal fractures often occurs due to poor compliance to the conventional rehabilitation programs. Gamification has shown success in improving adherence to and effectiveness of various therapies.

    PURPOSE OF THE STUDY: The purpose of this study was to evaluate whether gamification, using cost-effective devices was comparable with conventional physiotherapy in improving hand functions and adherence to rehabilitation in metacarpal fractures.

    METHODS: A 2-group randomized controlled trial involving 19 patients was conducted. Participants were randomized to a control (conventional physiotherapy, n = 10) or interventional group (gamification, n = 9). The grips strength and composite finger range of motion were measured at the baseline and each follow-up together with Patient-Rated Wrist and Hand Evaluation scores and compliance.

    RESULTS: There were no significant differences on improvements of grip strength (means difference 24.38 vs 20.44, P = .289) and composite finger range of motion (means difference 50.50 vs 51.11, P = .886). However, the gamification group showed better results in Patient-Rated Wrist and Hand Evaluation (mean 0.44 vs 8.45, P = .038) and compliance (P 

    Matched MeSH terms: Wrist; Wrist Joint
  14. Manas A, Bajuri MY, Muhammad Nawawi RF
    Cureus, 2020 May 03;12(5):e7939.
    PMID: 32499979 DOI: 10.7759/cureus.7939
    Tuberculosis is an infection that can occur in every organ of the body, but it rarely affects the wrist joint. We report a rare case of a male patient with wrist tuberculosis with a subtle presentation. Our patient's left wrist had been swollen for four months and progressively worsened, becoming ulcerated one week prior to presentation to our center. He was asymptomatic, but a previous radiograph showed global destruction of the wrist joint. Clinical investigations, that is, polymerase chain reaction test for tuberculosis and histopathological examination, showed classic findings of tuberculosis, which lead to the initiation of anti-tuberculosis treatment.
    Matched MeSH terms: Wrist; Wrist Joint
  15. Tan K, Kwek E
    Malays Orthop J, 2020 Mar;14(1):24-27.
    PMID: 32296478 DOI: 10.5704/MOJ.2003.004
    Introduction: Orthopaedic surgeons are significantly predisposed to musculoskeletal injury, and these injuries can have negative effects on surgeon function and patient outcomes. While this phenomenon has been studied in the non-Asian population of surgeons, no study has been carried out in the local or regional Asian setting. The aim of this study was to determine the prevalence, characteristics and associations of occupational injuries in orthopaedic surgeons and residents, and to assess its functional impact.

    Materials and Methods: The Nordic Musculoskeletal Questionnaire was sent out to all orthopaedic consultants and residents at two institutions in Singapore, via an email link to an online survey. Separately, further questions on symptom description, severity and treatment were surveyed. Additional information like age, gender, height and weight were obtained as well.

    Results: A total of 87.5% respondents have at least one injury. Neck symptoms (66.1%) were the most prevalent, and back symptoms had the highest median severity score (4.5/10). The 74.1% of these injuries were reported as directly attributable to work. Age was found to be associated with an increase in the total number of anatomical areas affected (p = 0.016). A seated operating position was associated with more severe back pain (p = 0.040).

    Conclusion: There is a high prevalence of occupational injuries sustained in our population of orthopaedic surgeons. Neck symptoms, followed by back and wrist symptoms, were the predominant symptoms in our population. Targeted ergonomic interventions may be considered to prevent specific musculoskeletal injuries in our population of orthopaedic surgeons.

    Matched MeSH terms: Wrist
  16. Passiatore M, Perna A, De-Vitis R, Taccardo G
    Malays Orthop J, 2020 Mar;14(1):1-6.
    PMID: 32296475 DOI: 10.5704/MOJ.2003.001
    Introduction: Carpal tunnel syndrome is one of the most common peripheral neuropathies. Only a few studies evaluate the efficacy of "nutraceuticals" on peripheral nerves and neuropathic pain. The aim of the present investigation is to evaluate the role of Alfa-Lipoic Acid-R (ALA-R) on clinical and functional outcomes in patients affected by mild to moderate carpal tunnel syndrome.

    Material and Methods: The present investigation is a prospective randomised controlled open label study, performed at our Hand Surgery Department (Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome) from October 2018 to March 2019. The enrolled patients were divided in two groups: Group A (ALA-R 600mg once day for 60 days) and Group B (control Group, no drug administration).

    Results: 134 patients (74 F, 60 M) met the inclusion and exclusion criteria. In Group A, there was a statistically significant pain reduction compared to the control Group. Using the Boston Carpal Tunnel Questionnaire, there were no significant improvements in the other symptoms and function.

    Conclusion: ALA-R full dose administration for two months leads to positive short term results in terms of symptoms and function improvement, even if the surgical carpal tunnel release remains the treatment of choice.

    Matched MeSH terms: Wrist
  17. Samal P, Mohapatra NC, Mishra J, Mylarappa A, Das P
    Malays Orthop J, 2020 Mar;14(1):84-87.
    PMID: 32296488 DOI: 10.5704/MOJ.2003.014
    Giant cell tumour of tendon sheath is a benign soft tissue lesion most commonly found in the flexor aspect of hand and wrist. However, it is uncommon in foot and ankle and rare in bilateral achilles tendon. We report a case of 17-year-old female who presented with progressive enlargement of bilateral achilles tendon for six months. MRI findings showed that most of the tumour had intermediate to low signal intensity. Histopathology confirmed the diagnosis of giant cell tumour of tendon sheath. To help the patient regain the strength of the achilles tendon and walking abilities, a large area of tendon tumour was excised, followed by reconstruction with transfer of the peroneus brevis (PB) and posterior tibial (PT) tendon autograft. At two years follow-up, functional result was satisfactory.
    Matched MeSH terms: Wrist; Wrist Joint
  18. Mohamed Faizal Sikkandar, Shalimar Abdullah, Rajesh Singh, Parminder Singh Gill, Nur Azuatul Akmal Kamaludin, Tan Jin Aun, et al.
    MyJurnal
    Introduction: Compression of the median nerve in pregnancy is thought to be due to fluid retention within the carpal tunnel space. We aim to discover the cause of carpal tunnel syndrome (CTS) in pregnancy using high resonance ul- trasonography. Methods: This is a cross-sectional study where obstetric patients were screened for CTS and subjected to a non invasive ultrasonic imaging. Results: A total of 63 patients were seen with 25 diagnosed to have CTS (39.7%) and 38 patients had none (60.3%) based on a screening tool. Age ranged from 20-42 years old with the highest range in the 28-30 year old group (34.9%). In patients with CTS, the cross sectional area of the median nerve inside the tunnel was a mean of 0.908 cm ie larger, while non-CTS patients had a mean of 0.797 cm inside the tunnel. The transverse carpal ligament (TCL) measured a mean of 0.0988 cm in the CTS group (ie thinner) and 0.1058 cm in the non-CTS group. Median nerve mobility at equal to or less than one tendon width was 80% in pregnant women with CTS and 92.1% for those without. No fluid was present within the carpal tunnel of all patients. The results were sta- tistically not significant. Conclusion: Ultrasonographic evidence in pregnant women with CTS shows a larger median nerve, a more mobile median nerve and a less thick transverse carpal ligament. There is absence of fluid retention and synovitis ruling out extrinsic compression of the median nerve as cause of CTS in pregnancy.
    Matched MeSH terms: Wrist; Wrist Joint
  19. Lim CH, Ng BH, Teh HL
    BMJ Case Rep, 2019 Nov 21;12(11).
    PMID: 31753829 DOI: 10.1136/bcr-2019-232828
    Matched MeSH terms: Wrist Joint/physiopathology
  20. Sivasamy P, Bajuri MY, Ghani AW
    Cureus, 2019 Nov 19;11(11):e6203.
    PMID: 31890405 DOI: 10.7759/cureus.6203
    The incidence of wrist tuberculosis is rare. Clinical features and radiographs are not conclusive in the beginning, happen to delay the achievement of the diagnosis, and thus result in poor treatment. We present a case report of wrist tuberculosis that had delayed diagnosis. Hence, the initiation of antituberculous treatment was delayed, as the initial investigations were not conclusive of tuberculous infection. The patient was treated surgically multiple times before tuberculosis was diagnosed. Antituberculous chemotherapy was started for the patient for one year until she became afebrile and infective markers returned to normal. However, the patient developed left wrist stiffness due to arthrofibrosis and bony destruction of the wrist joint.
    Matched MeSH terms: Wrist; Wrist Joint
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