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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...
November 1, 2018: Techniques in Hand & Upper Extremity Surgery
John V Ingari, Suresh K Nayar, Kenneth F Taylor
In this retrospective study, we report the preliminary results of a novel technique for volar vascularized strut grafting to treat avascular scaphoid nonunion by using the 1,2 intercompartmental supraretinacular artery through a single incision. Forty-three of 45 patients with avascular scaphoid nonunion healed at a mean of 13 weeks (range, 3 to 10 mo). Complications consisted of 1 pin tract infection that resolved with oral antibiotics and 4 cases of transient dysesthesia of the radial sensory nerve. In 4 patients with equivocal radiographs, computed tomography scans confirmed bony union...
November 1, 2018: Techniques in Hand & Upper Extremity Surgery
Justin C R Wormald, Catherine Millar, Bran Sivakumar
No abstract text is available yet for this article.
October 8, 2018: Techniques in Hand & Upper Extremity Surgery
Jill M Cancio, Peter Rhee
Arthrofibrosis is an inevitable consequence of elbow trauma that oftentimes requires surgical release to restore range of motion and function. Although the surgical procedure for elbow osteocapsular release can result in marked improvement in elbow motion, postrelease rehabilitation is paramount to maintaining and even improving the gains achieved in surgery. There are a variety of rehabilitation protocols and modalities that can be implemented that can be divided into an early versus late stage of rehabilitation after surgery...
October 8, 2018: Techniques in Hand & Upper Extremity Surgery
Erich M Gauger, Peter C Rhee
Posttraumatic elbow stiffness is common with the primary indication for contracture release being limited motion that affects functional activities which has not adequately improved after intensive therapy and rehabilitation. Preoperative evaluation focuses on the history of previous nonoperative and/or operative treatment, physical exam with particular attention paid to the status of the ulnar nerve, and imaging consisting of radiographs and computed tomography. There are multiple intrinsic and extrinsic causes of posttraumatic contracture...
October 8, 2018: Techniques in Hand & Upper Extremity Surgery
Hisao Moritomo, Sayuri Arimitsu
We developed a novel procedure to treat a triangular fibrocartilage complex (TFCC) foveal tear, namely tenodesis of the ulnotriquetrum ligament (UTL) to the fovea. We attempted to reestablish the tension of the palmar radioulnar ligament by the procedure specifically in cases with palmar radius instability relative to the ulna. We used a palmar surgical approach to expose the palmar aspect of TFCC in which the ulnocarpal ligament merges with the palmar radioulnar ligament. UTL was distally excised at a 4 mm width from the triquetrum without disrupting its ligamentous connection to the palmar radioulnar ligament proximally...
October 8, 2018: Techniques in Hand & Upper Extremity Surgery
Ryoya Shiode, Hisao Moritomo
We developed a substitution technique for a sagittal band reconstruction for subluxation of the third extensor tendon at the metacarpophalangeal joint. Through this procedure, we attempted to supply a tether between the second and third extensor digitorum communis (EDC) tendons. A half-slip of the second EDC was interlaced to the third EDC tendon at the level of the third metacarpal head with the metacarpophalangeal joint in full flexion position; this ensured that the interlace of the graft serves as a direct stabilizer against ulnar subluxation...
September 26, 2018: Techniques in Hand & Upper Extremity Surgery
Shaan S Patel, Neil Singh, Charles Clark, Jeffrey Stone, Jason Nydick
Multiple reconstruction techniques have been described for correction of boutonniere deformities including direct repair, central slip reconstruction, lateral band reconstruction, transverse retinacular ligament reconstruction, staged reconstruction, and extensor tenotomy. Each technique has been reported to have variable results with complications including capsular contracture, loss of proximal interphalangeal flexion, and residual deformity. We describe a surgical technique for central slip reconstruction using a slip of the flexor digitorum superficialis tendon through a bone tunnel...
September 10, 2018: Techniques in Hand & Upper Extremity Surgery
Ryosuke Kakinoki, Kazuhiro Ohtani, Kazuhiko Hashimoto, Hiroki Tanaka, Ryosuke Ikeguchi, Souichi Ohta, Masao Akagi
Dupuytren's pathologic tissue usually involves the palmar skin and rarely infiltrates into the dorsal skin. In this study, we hypothesized that transplantation of a vascularized cutaneous flap harvested from the dorsum of the hand to the palmar skin, under which the pathologic cord existed might be useful for blocking reformation of the pathologic cords and for decreasing the recurrence rate. After removal of the pathologic tissue under the palmar skin, we harvested 2 types of skin islands nourished by the dorsal digital arterial network including the dorsal perforating arteries arising from the palmar digital arteries...
September 2018: Techniques in Hand & Upper Extremity Surgery
Mark T Rose, Matthew P Noyes, Patrick J Denard
BACKGROUND: Distal third clavicle fractures are associated with high rates of nonunion. Acceptable healing rates have been reported; however, complications and the need for additional procedures are a concern. The purpose of this study was to evaluate the functional outcomes and healing rates of an arthroscopy-assisted technique for fixation of unstable distal third clavicle fractures. METHODS: Seven patients presenting to a single surgeon with displaced distal clavicle fractures were included...
September 2018: Techniques in Hand & Upper Extremity Surgery
Fiesky A Nunez, Peter J Evans
Restoration of longitudinal stability of the forearm continues to pose a difficult challenge for the hand surgeon, and no technique has demonstrated success above others. Longitudinal stability to the forearm is conferred by 3 structures: the radial head, which acts as a primary stabilizer, the interosseous membrane, more specifically, the central band and, the distal radioulnar ligaments which are part of the triangular fibrocartilage complex. A combination of techniques is described in this article to address chronic longitudinal instability of the forearm: (1) ulnar shortening osteotomy to restore ulnar variance, (2) pronator teres transfer was used to reconstruct the central band of the interosseous membrane, and (3) tightrope augmentation was used to prevent elongation during the healing process...
September 2018: Techniques in Hand & Upper Extremity Surgery
Jesse B Jupiter
No abstract text is available yet for this article.
September 2018: Techniques in Hand & Upper Extremity Surgery
William L Wang, Rick Tosti
We describe a novel technique in correcting distal radius fractures deformed with significant shortening or coronal plane translation in both the acute or chronic setting. The technique involves using a modified push-pull device to assist the surgeon in correcting length and/or translation of the articular block without the use additional hardware outside of the volar plate.
September 2018: Techniques in Hand & Upper Extremity Surgery
Matthew Steffes, Samantha Tayne, Feroz Osmani, Gary Edwards, Kyle MacGillis, Walter Kim, Jon E Hammarstedt, Benjamin Goldberg
Triceps tendon rupture is an uncommon yet potentially devastating injury affecting patients over a broad demographic. Surgical treatment is essential to restore upper extremity functional status, and a vast array of techniques has been implemented with different fixation devices including suture buttons, intraosseous anchors, and suture repairs. Outcomes of distal triceps tendon repair have demonstrated nearly full return of functional capacity. Complications include infection, ulnar nerve neuropathy, arthrofibrosis, flexion contracture, hardware irritation, and most commonly, repair failure...
September 2018: Techniques in Hand & Upper Extremity Surgery
Brent R DeGeorge, Nicholas Pulos, Alexander Y Shin
A simple, reproducible technique for assessing the scaphotrapeziotrapezoid joint radiographically is described. In addition to its diagnostic value, the technique is simple to perform with a minifluoroscopy unit, allowing for image-guided injections of the scaphotrapeziotrapezoid joint.
September 2018: Techniques in Hand & Upper Extremity Surgery
Todd A Rubin, Matthew J Gluck, Michael R Hausman
Essex-Lopresti Lesions are rare injuries that are often missed in the acute setting. Delayed intervention may lead to chronic wrist and elbow pain and overall poor outcomes. The literature currently supports treatments that involve shortening of the ulna to reduce the relative degree of ulnar impaction, followed by attempted reduction of the distal radioulnar joint. Although such techniques may help to temporarily reduce wrist pain secondary to ulnar impaction, they do not address the proximal migration of the radius and ipsilateral radial head dislocation at the elbow...
September 2018: Techniques in Hand & Upper Extremity Surgery
Sergi Barrera-Ochoa, David Campillo-Recio, Tryno Muñoz-Perdomo, Ignacio Esteban-Feliu, Gerardo Mendez-Sanchez, Xavier Mir-Bullo
The treatment of advanced-stage Kienböck disease (KD) remains highly controversial. Particularly important is stage IIIC KD, which includes patients with a lunate coronal fracture. The purpose of this paper was to describe a new approach to KD in patients with Lichtman stage IIIC KD, and our results using it. The procedure combines a dorsolateral biplane closing radial osteotomy and lunate fixation. A total of 11 patients from January 2002 through December 2016 with documented KD who underwent this technique were included...
September 2018: Techniques in Hand & Upper Extremity Surgery
Lorenzo Rocchi, Gianfranco Merendi, Luigi Mingarelli, Francesco Fanfani
OBJECTIVES: The aim of our study was to assess the results of antegrade percutaneous intramedullary Kirschner wire (K-wire) fixation, for the treatment of unstable displaced metacarpal fractures in a large number of cases, in order to support the usage of this mini-invasive technique in the largest variety of fractures as possible. MATERIAL AND METHODS: Every patient meeting the inclusion criteria was treated with closed reduction and antegrade intramedullary fixation with 1 or 2 K-wire from January 2013...
September 2018: Techniques in Hand & Upper Extremity Surgery
Elizabeth A Newman, Maria C Orbay, Fiesky A Nunez, Fiesky Nunez
Proximal interphalangeal (PIP) joint arthritis causes debilitating hand pain and instability leading to significant functional impairment. Arthrodesis remains the gold standard for treatment of PIP arthritis. We present a minimally invasive PIP arthrodesis that provides rigid fixation with a headless compression screw. Seven patients who presented to the senior author with PIP joint arthritis underwent PIP arthrodesis by minimally invasive technique. A 1 cm transverse incision is made over the PIP joint, incising skin, central band, and articular capsule...
June 2018: Techniques in Hand & Upper Extremity Surgery
Alexander Y Shin
No abstract text is available yet for this article.
June 2018: Techniques in Hand & Upper Extremity Surgery
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