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Techniques in Hand & Upper Extremity Surgery

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https://www.readbyqxmd.com/read/28953168/bipedicle-flaps-for-posterior-elbow-reconstruction
#1
Kyle J Chepla, Shirley Shue, Bram R Kafuman
Chronic posterior elbow soft tissue defects often require soft tissue reconstruction because of exposure of the underlying triceps tendon and proximal ulna. Current options for soft tissue coverage require sacrifice of a local muscle or microsurgery. The purpose of this study is to evaluate patient and surgical outcomes after reconstruction of small-sized to medium-sized (<50 cm) posterior elbow defects with bipedicle advancement flaps. A retrospective chart review was performed for 3 patients who underwent posterior elbow reconstruction with bipedicle flaps...
September 25, 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28930949/the-blocking-flap-for-ulnar-nerve-instability-after-in-situ-release-technique-and-a-grading-system-of-ulnar-nerve-instability-to-guide-treatment
#2
Peter Tang
In situ ulnar nerve release has been gaining popularity as a simple, effective, and low-morbidity procedure for the treatment of cubital tunnel syndrome. One concern with the technique is how to manage the unstable ulnar nerve after release. It is unclear how much nerve subluxation will lead to problems and surprisingly there is no grading system to assess ulnar nerve instability. I propose such a grading system, as well as a new technique to stabilize the unstable ulnar nerve. The blocking flap technique consists of raising a rectangular flap off the flexor/pronator fascia and attaching it to the posterior subcutaneous flap so that it blocks the nerve from subluxation/dislocation...
September 19, 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28914668/minimally-invasive-palmaris-longus-abductorplasty-for-severe-carpal-tunnel-syndrome
#3
Sze-Ryn Chung, Robert Tze-Jin Yap, Andrew Yam Kean Tuck
Camitz abductorplasty is the most commonly used tendon transfer in patients with severe carpal tunnel syndrome with significant muscle wasting and loss of opposition. This procedure requires a long incision in the palm to harvest a strip of palmar aponeurosis to lengthen the palmaris longus tendon, allowing it to reach the abductor pollicis brevis insertion. Several complications have been attributed to this extensive dissection in the palm. We describe a minimally invasive palmaris longus abductorplasty using a strip of free flexor carpi radialis tendon graft to achieve the necessary length...
September 13, 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28902098/repair-of-the-thumb-ulnar-collateral-ligament-with-suture-tape-augmentation
#4
Anthony F De Giacomo, Steven S Shin
One of the most commonly injured structures of the thumb metacarpophalangeal (MCP) joint is the ulnar collateral ligament (UCL). An acute injury of this ligament is often amenable to primary repair. Despite the favorable outcomes of primary repair, the thumb is often restricted during initial healing of the ligament with immobilization and delayed rehabilitation. We present a novel technique to augment the repair of the UCL with suture tape to provide immediate biomechanical support and strength during the critical time of ligament healing...
September 8, 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28885384/a-new-stem-guide-and-a-tuberosity-anchoring-lasso-system-for-shoulder-hemiarthroplasty-in-the-treatment-of-complex-proximal-humerus-fractures
#5
Philippe Valenti, Davide Aliani, Charbel Maroun, Jean-David Werthel
Hemiarthroplasty implantation for proximal humerus fracture is challenging. In case of young demanding patients with functional rotator cuff, humeral head replacement is an option if open reduction internal fixation is not a viable solution. The criteria for success in terms of clinical outcomes and longevity are anatomic healing of the tuberosities and stem positioning (restoring correct height, version, and axis). The purpose of this article is to describe a technique including a new stem guide and a tuberosity anchor "lasso" system for the implantation of hemiarthroplasty in complex proximal humerus fractures...
September 6, 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28885383/application-of-a-modified-pedicled-adipofascial-lateral-arm-flap-in-the-prevention-and-treatment-of-radial-nerve-injuries
#6
Steven M Koehler, Andrew P Matson, Suhail K Mithani
The fasciocutaneous lateral arm flap is a workhorse flap in upper extremity reconstruction. However, its adipofascial variant is not widely used. The technique can be used in various clinical scenarios. The adipofascial flap can be transposed to circumferentially wrap the radial nerve with a pliable, vascularized fat and fascial envelope, mimicking the natural fatty environment of peripheral nerves. This technique has the advantage of providing a scar tissue barrier, a barrier to hardware irritation and a milieu for vascular regeneration of the nerve...
September 6, 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28777156/deep-transverse-metacarpal-ligament-reconstruction-using-suture-button-and-a1-pulley
#7
Joshua Piercey, Paul McEniery, Nicholas Green
Rupture of the deep transverse metacarpal ligament (DTML) can result in pain, impaired grip strength, and undermine functional performance of the hand. We describe the case of a patient whose right hand came into contact with a boat propeller. He sustained a complete disruption of the DTML between the second and third ray in addition to soft tissue injury and open metacarpal fractures. Although other techniques describe a reconstruction of the DTML, our technique describes an adjunctive technique that strongly augments the A1 pulley reconstruction and nullifies the requirements of palmaris longus graft...
August 3, 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28777157/has-the-contemporary-electronic-medical-record-emr-made-the-comprehensive-hand-examination-obsolete
#8
Jesse B Jupiter
No abstract text is available yet for this article.
September 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28727585/closed-continuous-irrigation-with-lidocaine-and-immediate-mobilization-for-treatment-of-pyogenic-tenosynovitis
#9
Rebecca Knackstedt, Joyce Tyler, Steven Bernard
Pyogenic flexor tenosynovitis treatment consists of either closed continuous irrigation with sterile saline or antibiotic solution, or open debridement and irrigation. These treatment approaches serve to resolve the infection, but are extremely painful and residual stiffness can be devastating to the patient. We describe herein our approach to managing pyogenic flexor tenosynovitis. To provide continuous irrigation, a butterfly catheter with needle removed is utilized with irrigation holes cut into the tubing...
September 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28708756/anatomic-reconstruction-of-distal-radioulnar-ligaments-with-tendon-graft-for-treating-distal-radioulnar-joint-instability-surgical-technique-and-outcome
#10
Daniela Meyer, Andreas Schweizer, Ladislav Nagy
Among the various reasons for chronic posttraumatic ulnar-sided wrist pain, instability of the distal radioulnar joint (DRUJ) has recently received major attention and finally achieved fundamental progress in understanding thanks to anatomic and biomechanical studies. This has resulted in more physiological and successful treatment methods compared with the historic options. One and the most dramatic surgical technique consists in the replacement of the main ligamentous stabilizer of the DRUJ, the so-called triangular fibrocartilage, with a tendon graft...
September 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28671904/a-sandwich-method-using-kapandji-intrafocal-pinning-to-facilitate-palmar-plating-of-displaced-distal-radius-fractures
#11
Hui-Kuang Huang, Yi-Chao Huang, Jung-Pan Wang, Ming-Chau Chang
The use of palmar plating in the treatment of dorsally displaced distal radius fracture is very common, and can result in a good functional outcome. We present an easy "sandwich method" to reduce the fracture and to facilitate osteosynthesis. Firstly, the dorsal Kapandji intrafocal wire was applied to achieve the reduction of the dorsally displaced fracture and provide a volar-directed force. Then the intra-articular fractures were reduced or the metaphyseal defect is stuffed with bone graft if necessary. Finally, the anatomical plate is used to buttress and push back the distal fragment to complete the osteosynthesis...
September 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28614277/the-pull-out-k-wire-anchorage-the-shepherd-s-crook-technique
#12
Daniele De Spirito, Dario Giunchi
Traditional pull-out techniques for tendon and ligament repair are still widely used in hand surgery, despite constant refinements and the development of other methods of fixation. We propose a modification of the classic technique which utilizes a K-wire as an external strut instead of the classic button. This fixation system can be usefully applied in the fixation of extensor and flexor tendons and reinsertions. It is particularly applicable in situations where a transarticular K-wire is to be used anyway, in situations of temporary joint immobilization and in other situations...
September 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28614276/wrist-arthrodesis-with-femoral-head-structural-allograft-after-failed-total-wrist-arthroplasty
#13
Louis C Grandizio, Steven Maschke
The failed total wrist arthroplasty represents a challenging reconstructive problem for the upper extremity surgeon. Bone loss, poor bone quality, and soft tissue defects all present technical challenges when considering revision procedures. Our purpose is to describe a technique for wrist arthrodesis after failed total wrist arthroplasty utilizing fresh-frozen femoral head allograft and dorsal plate fixation. We describe a simple method of allograft preparation for this procedure, as graft preparation and implantation can be time consuming and technically challenging...
September 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28614275/indocyanine-green-angiography-a-helpful-tool-for-intraoperative-assessment-of-upper-extremity-perfusion
#14
Paul A Ghareeb, Thomas M Neustein, Robert C Fang, Diane E Payne
Assessment of tissue perfusion can be a challenge for the hand surgeon. Indocyanine green (ICG) angiography has been shown to be a valuable adjunct to physical examination and clinical judgment when there is a concern for tissue perfusion. The use of this technology has risen sharply in recent years in reconstructive surgery. Applications of ICG angiography have been developed throughout the field of surgery, including breast surgery, free tissue transfer, bowel surgery, neurosurgery, and lymphatic reconstruction...
September 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28614274/corrective-osteotomy-for-symptomatic-clavicle-malunion-using-patient-specific-osteotomy-and-reduction-guides
#15
Mathias Haefeli, Matthias Schenkel, Ralf Schumacher, Karim Eid
Midshaft clavicular fractures are often treated nonoperatively with good reported clinical outcome in a majority of patients. However, malunion with shortening of the affected clavicle is not uncommon. Shortening of the clavicle has been shown to affect shoulder strength and kinematics with alteration of scapular position. Whereas the exact clinical impact of these factors is unknown, the deformity may lead to cosmetic and functional impairment as for example pain with weight-bearing on the shoulder girdle...
September 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28614273/fat-grafting-for-esthetic-correction-of-the-muscle-atrophy-secondary-to-ulnar-nerve-lesion
#16
Samuel Ribak, André L Vasconcelos, Ricardo K Oliveira
Patients with hand muscular atrophy due to damage of the ulnar nerve could be stigmatized for their appearance. Unsatisfactory results in the attempt to correct the atrophy are reported in the literature. Fat grafting is an autologous and easily obtainable graft, antigenic response is very unlikely, it does not require any special material, and the procedure has a low cost. The technique of autologous fat grafting by using fat block, to remodel the first interdigital space, is useful and safe in correcting muscle atrophy of the first interdigital space caused by the injury of the ulnar nerve...
September 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28383357/radiopaque-element-to-evaluate-adequacy-of-debridement-of-bony-lesions
#17
Nicholas Pulos, Alexander Y Shin
A technique for using an x-ray detectable radiopaque element from a surgical sponge to assess the adequacy of debridement of carpal bone cysts, Kienböck disease (lunate avascular necrosis), enchondroma of the digits, and scaphoid nonunions is described. The technique is simple to perform, inexpensive, and presents minimal additional risk to the patient. The technique has been used over the past 16 years and has enabled adequate debridement of these hand and wrist maladies by radiographically demonstrating the adequacy of the debridement to be bone grafted...
September 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28525521/what-is-surgical-grit
#18
Nicholas Pulos, Alexander Y Shin
No abstract text is available yet for this article.
June 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28448306/open-glenohumeral-joint-reduction-and-latissimus-dorsi-and-teres-major-tendon-transfers-for-infants-and-children-following-brachial-plexus-birth-palsy
#19
Joshua M Abzug, Scott H Kozin, Peter M Waters
Glenohumeral dysplasia can occur in brachial plexus birth palsy due to an imbalance of muscle forces. Most commonly this occurs in C5-C6 injuries where the shoulder external rotators are weak compared with the shoulder internal rotators. Treatment of the dysplasia with open reduction of the glenohumeral joint in combination with rebalancing the muscles can improve the development of the joint. Furthermore, the tendon transfer can improve shoulder function by decreasing the internal rotation forces about the shoulder while increasing the external rotation forces...
June 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28441305/step-by-step-technique-for-segmental-reconstruction-of-reverse-hill-sachs-lesions-using-homologous-osteochondral-allograft
#20
Hassanin Alkaduhimi, Michel P J van den Bekerom, Derek F P van Deurzen
Posterior shoulder dislocations are accompanied by high forces and can result in an anteromedial humeral head impression fracture called a reverse Hill-Sachs lesion. This reverse Hill-Sachs lesion can result in serious complications including posttraumatic osteoarthritis, posterior dislocations, osteonecrosis, persistent joint stiffness, and loss of shoulder function. Treatment is challenging and depends on the amount of bone loss. Several techniques have been reported to describe the surgical treatment of lesions larger than 20%...
June 2017: Techniques in Hand & Upper Extremity Surgery
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