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Techniques in Hand & Upper Extremity Surgery

Sze-Ryn Chung, Yong Chiang Kang, Duncan Angus McGrouther
Septic arthritis of the small joints of the hand usually occurs secondary to bacterial inoculation through penetrating injury to the joint, or direct spread of infection from paronychia, felon, or pyogenic flexor tenosynovitis. Surgical treatment involves drainage and irrigation and may involve debridement if there is an open wound. We describe a method of continuous irrigation of septic joints of the hand postoperatively in the ward setting using an intravenous cannula placed within the joint and connected to an intravenous giving set with delivery of physiological fluid using a pump driver...
April 9, 2019: Techniques in Hand & Upper Extremity Surgery
Kjell Van Royen, Bert Vanmierlo, Francis Bonte, Chul K Goorens, Bart Berghs, Jean Goubau
Bennett's fractures are the most common fractures around the trapeziometacarpal joint but require specialized radiographs to be correctly diagnosed. If a fracture is missed at initial presentation, it may heal with an intra-articular gap, leading to joint incongruency and a painful trapeziometacarpal joint. We present a new technique to correct the intra-articular gap and restore joint congruency in the event of a symptomatic Bennett malunion with a gap of at least 2 mm. The joint is exposed through an anterolateral approach, and the malunion is marked with K-wires under fluoroscopic control...
March 5, 2019: Techniques in Hand & Upper Extremity Surgery
Nicholas C Smith, Brahman S Sivakumar, Dominique M Tremblay, Jonathan P Bellity, Richard D Lawson
Interosseous membrane (IOM) deficiency results in longitudinal radioulnar instability, and may result in proximal radial migration, increased radiocapitellar contact, limitations in forearm rotation, ulnocarpal instability, and ulna-sided pain. A number of reconstruction methods have been posited-however, few have been implemented in vivo. We describe a 2-bundle method of IOM reconstruction, utilizing flexor digitorum superficialis autograft. This technique has the benefits of utilizing a locally available and robust autograft with minimal donor-site morbidity, obviating the concerns associated with synthetic grafts or bone-patella tendon-bone constructs...
February 22, 2019: Techniques in Hand & Upper Extremity Surgery
Syed Suhaib Jameel, Roshin Thomas
The structures on the radial side of the wrist and thumb base can be approached by a longitudinal incision on the radial side of the wrist. However, longer longitudinal scars can be cosmetically unacceptable and can result in a scar contracture. It is preferable to curve longer incisions along the Langer's skin lines to achieve better scar characteristics. Curving the incision also enables an extensile approach and provides easy access to the thumb base, radial carpus, and radial wrist joint. We describe our approach as a "Link" between the most common approaches that surgeons are familiar with; the dorsoulnar approach to the thumb metacarpophalangeal joint for ulnar collateral ligament repair and the flexor carpi radialis approach for distal radial fracture fixation...
February 5, 2019: Techniques in Hand & Upper Extremity Surgery
Dzintars Ozols, Janis Zarins, Aigars Petersons
The first toe-to-hand transplantation was done in 1898 by Nicoladoni. It was a staged procedure and the toe flap was based on a pedicle. With advancement of optical instruments and microsurgeons' skills in 1964 the first microvascular toe-to-hand transplantation on a rhesus monkey was done. The technique's development has not stopped, many authors have modified it to achieve better outcomes for both traumatic and congenital hand defects. The most commonly used toes for transplantation are first, second, and second to third toe block...
February 1, 2019: Techniques in Hand & Upper Extremity Surgery
Justin W Walker, Gregory A Merrell, Brock D Reiter, Hill Hastings
Management of severe elbow arthritis in young or active patients presents a challenging problem. Interposition arthroplasty is a useful salvage procedure for these patients but has a significant failure rate associated with postoperative instability. Previous studies have sought to preserve the integrity of the medial elbow ligament complex to decrease postoperative instability and the need for external fixation. Our lateral epicondylar osteotomy technique preserves the native lateral elbow ligament complex...
January 29, 2019: Techniques in Hand & Upper Extremity Surgery
Abhijeet Wahegaonkar, Sahil Sanghavi, Anup Bansode, Satish Mane
Lateral epicondylitis is the most common condition affecting the elbow and is self-limiting in most cases. However, when conservative treatment fails, surgery is required for resistant cases. In this study, we describe a novel technique for the management of chronic lateral epicondylitis. The advantage of our technique is that all the 3 major components of the disease (as also all types of failure described by Morrey) are simultaneously dealt with, that is, pathology of the tendon, posterior interosseous nerve compression and intra-articular pathology are all addressed...
January 28, 2019: Techniques in Hand & Upper Extremity Surgery
Daniel J Gittings, George W Fryhofer, Michael W Hast, David R Steinberg, L Scott Levin, Benjamin L Gray
BACKGROUND: The saline load test has previously been shown to be an effective tool to diagnose traumatic arthrotomies, but no studies have assessed the test's efficacy in the wrist. The purpose of this study was to investigate the amount of fluid required during a saline load test to detect intra-articular wrist involvement of traumatic wounds with high sensitivity. METHODS: A cadaveric study was conducted using 7 thawed, fresh-frozen forequarter amputations from 7 different donors (3 male, 4 female)...
January 22, 2019: Techniques in Hand & Upper Extremity Surgery
Jae-Sung Yoo, Jong-Phil Kim, Seong-Jun Kim, Joon-Kyom Kim
We present the case of a professional golf player who gradually developed a boutonniere deformity of the thumb due to chronic repetitive injury to the thumb and was treated with reconstruction of its insertion onto the proximal phalangeal base. The athlete showed an insertion variation of the extensor pollicis brevis, where some slips attached onto the extensor hood and the other slips ran along with the extensor pollicis longus to the distal phalanx, providing no slip to the proximal phalanx. The slips inserting to the distal phalanx were transferred to the base of the proximal phalanx and sagittal band reconstruction...
January 22, 2019: Techniques in Hand & Upper Extremity Surgery
Jesse B Jupiter
No abstract text is available yet for this article.
March 2019: Techniques in Hand & Upper Extremity Surgery
Brent R DeGeorge, Alexander Y Shin
Scaphoid fractures typically occur in young, healthy males at the peak of their employment and productivity, and left untreated or inadequately treated will ultimately progress to nonunion and a "predictable" pattern of wrist arthritis and carpal collapse. Nonoperative treatment of these fractures requires prolonged cast immobilization, which can lead to wrist stiffness, loss of grip strength, muscle atrophy, and protracted loss of economic productivity. To prevent these devastating sequelae, percutaneous techniques for scaphoid fixation have been described and popularized; however, these techniques are technically demanding as optimal position of the compression screw is required to achieve bony union...
March 2019: Techniques in Hand & Upper Extremity Surgery
Nicolas Gallusser, Patrick Goetti, Beat K Moor
The surgical treatment of a displaced fracture of the clavicular shaft generally consists in an open reduction and plate fixation. The most common complications of the classic direct "transplatysma" approach are hardware related. These consist of simple hardware irritations requiring secondary plate removal but also feared wound healing problems ranging from dehiscence to superficial and deep wound infections. In the present article, we describe the so-called "platysma-flap" approach in which the platysma muscle is entirely preserved and distally raised as a flap...
March 2019: Techniques in Hand & Upper Extremity Surgery
Orlando D Sabbag, Casey M DeDeugd, Eric R Wagner, Bassem T Elhassan
The posterior aspect of the elbow is an area prone to chronic wound complications due to its prominence and the tensile forces resulting from elbow range of motion. In situations in which local wound care fails, various options for soft tissue coverage are available, including the anconeus, lateral arm, radial forearm, extensor carpi radialis longus, and flexor carpi ulnaris flaps. Each option offers unique considerations depending on the complexity and extent of the soft tissue defect. In situations in which coverage of a large defect is required, or when primary soft tissue coverage options fail, an alternative option is the brachioradialis rotational muscle flap...
March 2019: Techniques in Hand & Upper Extremity Surgery
Kenneth Pak Leung Wong, Ee Ming Chew, Arjandas Mahadev
INTRODUCTION: Many methods have been described to minimize the risk of ulnar nerve injury during the insertion of a medial pin for the percutaneous pinning of pediatric supracondylar humerus fractures (SCHF). The most recent AAOS Clinical Practice Guidelines suggests that physicians might want to avoid the use of medial-entry pins due to considerations of potential injury to the ulnar nerve. However, there are circumstances whereby a cross pin configuration is required. These include cases where there is medial wall comminution or due to the obliquity of the fracture...
January 17, 2019: Techniques in Hand & Upper Extremity Surgery
Evan P Trupia, Robert J Strauch
Management of proximal pole scaphoid nonunion remains a challenging problem. Multiple surgical techniques have been described, although no treatment has proven superior. Recent studies have questioned the need for vascularized bone grafting, even in in the setting of avascular proximal poles. We present a relatively simple technique of intramedullary autogeneous cancellous bone grafting that does not disturb the intact cortical shell of the nonunion, which has so far provided gratifying clinical results.
January 17, 2019: Techniques in Hand & Upper Extremity Surgery
Varun Puvanesarajah, Babar Shafiq, John V Ingari
Glenohumeral arthrodesis is a salvage procedure in the shoulder with few indications. However, in young patients with flail shoulder, shoulder arthrodesis is a durable, functional option. Allograft or autograft can be used to reconstruct the defect during glenohumeral arthrodesis. Autografts be vascularized or nonvascularized. The use of vascularized autograft can increase operative time and is associated with substantial donor-site morbidity. The reamer-irrigator-aspirator, a system that irrigates and aspirates reamed bone and medullary contents, including mesenchymal stem cells, isolating bone graft with little donor-site morbidity, is a potential solution...
January 11, 2019: Techniques in Hand & Upper Extremity Surgery
Vanni Strigelli, Luigi Mingarelli, Giulio Fioravanti, Gianfranco Merendi, Antonio Merolli, Francesco Fanfani, Lorenzo Rocchi
OBJECTIVES: We retrospectively reviewed 1305 open-surgery for idiopathic trigger finger performed by 4 senior hand surgeons between 2014 and 2016. MATERIAL AND METHODS: Medical records and a telephone interview made with a minimum follow-up of 1 year were used to identify the recurrent rate of triggering and other complications. RESULTS: This retrospective study let us note that 169 fingers (13%) required simultaneous release of the A1-A2 pulleys because the sectioning of the A1 pulley alone did not lead to complete free sliding of the tendons...
January 11, 2019: Techniques in Hand & Upper Extremity Surgery
Puripun Jirangkul, Surasak Jitprapaikulsarn, Thawee Songpatanaslip
In partially or completely displaced intra-articular fracture of the distal radius , achieving satisfactory reduction and maintenance of good reduction before applying the plate may be difficult. Especially to accomplish the anatomic volar tilt remains a problem. Typically, the Kapandji technique has been described to reduce and stabilize a large displaced and extra-articular fracture of the distal radius. We present the results of a prospective series using the temporary Kapandji technique for K-wire intrafocal fixation followed by rigid fixation with distal radial locking compression plate...
January 7, 2019: Techniques in Hand & Upper Extremity Surgery
Eric Wait, Joash R Suryavanshi, Brendan J MacKay
The thenar eminence of the thumb is made up of 4 intrinsic muscles: abductor pollicis brevis, opponens pollicis, flexor pollicis brevis, and the adductor pollicis (ADD). While both heads of the ADD insert on the medial base of the thumb proximal phalanx, the oblique head originates on the capitate and second and third metacarpals, and the transverse head originates on the distal half of the third metacarpal. We present the case of a 36-year-old man who was involved in a motor vehicle collision and sustained a laceration in the first webspace with 1 cm extrusion of the ADD and no neurovascular deficiencies on examination...
December 24, 2018: Techniques in Hand & Upper Extremity Surgery
Vicente Carratalá Baixauli, Francisco J Lucas García, Cristóbal Martínez Andrade, Rogelio Carratalá Baixauli, Eva Guisasola Lerma, Fernando Corella Montoya
Peripheral injuries of the triangular fibrocartilage complex can produce pain and instability of the distal radioulnar joint (DRUJ). There are several techniques for the repair or reconstruction of these injuries, which vary depending on the location, healing capacity, and viability of the tissues, as described by the classification proposed by Atzei. In irreparable chronic injuries of the triangular fibrocartilage complex in which there are no associated chondral injuries of the DRUJ or in failures in previous repair techniques, ligament reconstruction plasty with tendon grafts, either by open surgery or assisted by arthroscopy, are the treatments of choice...
December 24, 2018: Techniques in Hand & Upper Extremity Surgery
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