Direct Repair of Flexor Tendons Close to Bony Insertion and Ruptured Collateral Ligaments
Lacerated flexor tendons close to bony junction are commonly repaired using a pullout suture. However, these injuries very close to the tendon-bone junction can be repaired with robust direct suture repair of the proximal tendon stump with the short residual tendon stump and any local tissues such as periosteum and joint volar plate. Subacute or chronic traumatic rupture at the midpart of the collateral ligaments can also be repaired by “refreshing” the divided ligament ends and repairing the ligament stumps to local tissues with multiple sutures often combined with tightening the elongated joint capsule. (Source: Hand Clinics)
Source: Hand Clinics - August 1, 2022 Category: Orthopaedics Authors: Jin Bo Tang Source Type: research
Mallet Finger
Mallet injuries, either tendinous or bony, are common. They are often studied together and typically treated in the same way with extension splintage for 6 to 8 weeks. Yet the evidence clearly shows there are different injuries that present in the same way. Tendinous mallet injuries present in older patients usually following a low energy injury; they are often painless. The commonly injured fingers are the middle and ring. The injuries are almost always single digit without concomitant injuries. There is an extensor lag of a mean of 310 (range 3°–590) in the patients treated in my unit. In contrast, bony mallet injur...
Source: Hand Clinics - August 1, 2022 Category: Orthopaedics Authors: Grey Giddins Source Type: research
Discussions About Obstetric Brachial Plexus Injuries
Although patients with obstetric brachial plexus injuries (OBPI) have been recognized and treated for greater than 100 years there is much that is not understood or is mis-understood. I address 6 areas for discussion: the cause of OBPI and whether it matters to nerve surgeons; the value of the Narakas grading; whether surgeons should perform primary nerve surgery, especially in patients with incomplete OBPI; the c ause and treatment of shoulder tightness; the cause and treatment of elbow contracture; and whether patients with OBPI need surgery in adulthood. (Source: Hand Clinics)
Source: Hand Clinics - August 1, 2022 Category: Orthopaedics Authors: Grey Giddins Source Type: research
The Trapezium is Not Necessary
It has long been thought that the surgical treatment of osteoarthritis of the first carpometacarpal joint must replicate the normal anatomy. Common sense argues that biomechanical stability can be achieved by a simple ball-and-socket joint obviating complicated ligament reconstructions and trapezium replacements. Our argument is presented and the conclusions are based on the results of a very large series over a long period. A simple trapezium excision arthroplasty of the base of the thumb without ligamentous reconstructions is all that needs to be done to surgically solve painful osteoarthritis of the first carpometacarpa...
Source: Hand Clinics - August 1, 2022 Category: Orthopaedics Authors: Ulrich Mennen Source Type: research
Dynamic Rather than Static Procedures in Correcting Claw Deformities Due to Ulnar Nerve Palsy
The theoretic disadvantage of dynamic tendon transfers is the perception that they are “more complex” than static procedures. The latter may provide a simple solution to claw deformity in a subset of patients; however, they completely disregard the disability associated with loss of the intrinsic musculature. Dynamic procedures reconstruct in part the deficient intrinsic forces an d are thus capable of correcting the deformity and some disabilities associated with ulnar nerve palsy. In our practice, we have consistently achieved reasonable correction of claw deformity and improvement in tendon synchrony and grip streng...
Source: Hand Clinics - August 1, 2022 Category: Orthopaedics Authors: Brian W. Starr, Kevin C. Chung Source Type: research
Our Disagreement on “Iceberg View” on the Ulnar Wrist and Clinical Implications
The diagnosis of ulnar-sided wrist symptoms concentrates on distal radioulnar joint and triquetral-hamate joint pathology. I consider this is only looking at the “tip of the iceberg” and ignoring other possible pathologies. In particular, this ignores the role of triquetrohamate and pisotriquetral pathologies. I outline our approaches to these pathologies noting the important ligamentous structures, the clinical presentations, the relevant investigations , and the surgical treatments and outcomes that I have found to be reliable. I would encourage hand surgeons to think more widely about ulnar-sided wrist symptoms, in ...
Source: Hand Clinics - August 1, 2022 Category: Orthopaedics Authors: Eduardo R. Zancolli Source Type: research
Slight Elongation of the Scaphoid and Cancellous Bone Graft Without Compression for Treatment of Scaphoid Nonunions
In treating scaphoid nonunion, we have developed a technique of bone grafting and elongation of the scaphoid stabilizing the construct with K wires without compression. Bony union was achieved in the large majority of scaphoids as demonstrated on computed tomography (CT) scans. We advocate slight lengthening of the scaphoid with bone graft and K-wire fixation without compression of the grafted bone when treating scaphoid waist nonunion. (Source: Hand Clinics)
Source: Hand Clinics - August 1, 2022 Category: Orthopaedics Authors: Igor Golubev Source Type: research
10 Hypotheses in Hand Surgery
I have put together 10 topics and labeled them as hypotheses, which outline my preferred practices. The topics relate to questionable nerve compression, double crush syndrome of nerves, motion therapy after surgery, delayed primary tendon repair, proximal pole fracture of the scaphoid, short splint, and indications for postoperative hand elevation. I found no proof whether my preferred methods are better than or inferior to alternative methods that others use. The 10 hypotheses are presented to stimulate thinking, clinical observation, or investigations and highlight several areas of research. Investigation into these hypo...
Source: Hand Clinics - August 1, 2022 Category: Orthopaedics Authors: Jin Bo Tang Source Type: research
Challenge the Current Wisdom of Hand Surgery
As clinicians and humans, we both favor tradition and embrace novelty, although not all to the same degree. We believe the “established” facts taught to us by our trainers, but also readily take on new treatments where we think they will improve the outcomes for our patients. Sometimes these “established” facts or new treatments are less proven than we realize yet we may struggle to resist their siren calls; und oubtedly there is an emotional as well as an intellectual content to our practices. (Source: Hand Clinics)
Source: Hand Clinics - August 1, 2022 Category: Orthopaedics Authors: Jin Bo Tang, Grey Giddins Tags: Preface Source Type: research
Evidence-Based, Eminence-Based, Hypothesis-Based, or Wrong Information –Based Practice?
Healthcare givers —including those in hand surgery—are commonly considered to deliver their clinical treatment to patients based on evidence, eminence, or a combination of both, in order to obtain the best possible diagnoses and treatments. Therefore, correct clinical practice is often described as evidence- or e minence-based practice. I consider that two other categories of clinical practice exist but have not drawn sufficient attention. They are hypothesis-based practice and wrong information–based practice. (Source: Hand Clinics)
Source: Hand Clinics - August 1, 2022 Category: Orthopaedics Authors: Jin Bo Tang Tags: Editorial Source Type: research
“Established” Rules or Teachings Are Less Proven than We Realize
Professor Grey Giddins wrote most of the preface of this book. I only added a few more lines in its final paragraph. I am very touched by what Professor Grey Giddins wrote, especially the lines that I quote below. I believe this deserves attention from all our colleagues. (Source: Hand Clinics)
Source: Hand Clinics - August 1, 2022 Category: Orthopaedics Authors: Jin Bo Tang Tags: Editorial Source Type: research
Challenging Current Wisdom in Hand Surgery
HAND CLINICS (Source: Hand Clinics)
Source: Hand Clinics - August 1, 2022 Category: Orthopaedics Authors: Jin Bo Tang, Grey Giddins Source Type: research
Copyright
ELSEVIER (Source: Hand Clinics)
Source: Hand Clinics - August 1, 2022 Category: Orthopaedics Source Type: research
Contributors
KEVIN C. CHUNG, MD, MS (Source: Hand Clinics)
Source: Hand Clinics - August 1, 2022 Category: Orthopaedics Source Type: research
Contents
Jin Bo Tang and Grey Giddins (Source: Hand Clinics)
Source: Hand Clinics - August 1, 2022 Category: Orthopaedics Source Type: research
