Three-step Bending Procedure For an Easy Endomedullary K-Wire Osteosynthesis of Metacarpal Neck Fractures
No abstract available (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - November 19, 2019 Category: Surgery Tags: Letter to the Editor Source Type: research

Using Tongue Depressors as a Technique to Aid Cord Localization During Collagenase Injection For Dupuytren Disease
We describe a technique to improve visualization and isolation of Dupuytren cords using a tongue depressor. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - November 19, 2019 Category: Surgery Tags: Techniques Source Type: research

Anatomic Considerations and Reconstruction of the Thumb Flexor Pulley System
Disruption to the flexor pulley system of the thumb is an infrequent but devastating injury that can lead to significant compromise in both strength and function. Acute rupture leads to pain, weakness, reduced range of motion (ROM), and potential bowstringing of the flexor tendons. Conservative treatment with a pulley ring should be considered in all patients. However, failure of conservative treatment and bowstringing of the thumb are indications for operative intervention. Reconstruction of the oblique pulley system can be performed either in situ or using a free palmaris longus graft. Care should be taken to identify th...
Source: Techniques in Hand and Upper Extremity Surgery - November 19, 2019 Category: Surgery Tags: Techniques Source Type: research

Extra-articular Corrective Osteotomy With Bone Grafting to Achieve Lengthening and Regain Alignment for Distal Radius Fracture Malunion
Surgical correction of the distal radius fracture malunion is challenging because of the 3-dimensional deformity. We propose a method by using the Kapandji intrafocal pinning in corrective osteotomy for treatment of the distal radius fracture malunion to facilitate the alignment correction while using the bone graft to restore the radial length. The surgery was started with the osteotomy from a volar approach, and the osteotomy gap was expanded gradually. Then, allobone grafting was performed to maintain the corrected radial length. We used the Kapandji intrafocal pinning dorsally to provide dorsal supporting force and rad...
Source: Techniques in Hand and Upper Extremity Surgery - November 19, 2019 Category: Surgery Tags: Techniques Source Type: research

Triquetrum Excision in Radioscapholunate Arthrodesis for Posttraumatic Radiocarpal Osteoarthritis With Ulnar Impaction Syndrome
Dependent on fracture type, concomitant carpal injuries, and operative treatment, distal radius fractures can lead to symptomatic radiocarpal osteoarthritis. In addition, radial shortening can cause ulnar impaction syndrome. Radiocarpal arthrodesis and ulnar shortening osteotomy are known and frequently applied surgical procedures for each of those pathologies. There are limited data concerning treatment options for a combined disorder. The presented technique in this article demonstrates that radioscapholunate arthrodesis with distal pole scaphoidectomy and total triquetrum excision successfully treats both symptomatic ra...
Source: Techniques in Hand and Upper Extremity Surgery - November 19, 2019 Category: Surgery Tags: Techniques Source Type: research

A Novel External Fixation Technique for Injuries of the Proximal Interphalangeal Joint
Digital external fixation is often used for the management of complex injuries involving the proximal interphalangeal joint, including pilon fractures of the middle phalanx base and unstable fracture-dislocations. Several dynamic “homemade” constructs have been described which utilize only K-wires and rubber bands and allow early range of motion within the construct. Although these constructs are inexpensive and their application is fairly straightforward, their designs pose a few potential problems when the construct is stressed during rehabilitation efforts. These designs utilize a blocking K-wire which relie...
Source: Techniques in Hand and Upper Extremity Surgery - November 19, 2019 Category: Surgery Tags: Techniques Source Type: research

Anteromedial Release for Posttraumatic Flexion-pronation Contracture of the Wrist: Surgical Technique
We describe a safe, effective, and reproducible technique to treat these patients. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - November 19, 2019 Category: Surgery Tags: Techniques Source Type: research

Steindler Flexorplasty: A Description of Current Technique and Case Series
This year marks the 100th anniversary of Dr Steindler’s original report of a proximal transfer of the flexor pronator mass to restore elbow flexion. The authors present their updated surgical technique to perform the Steindler flexorplasty. In this procedure, the flexor-pronator mass origin on the medial epicondyle is transferred proximally to the anterior humerus to restore elbow flexion. They also report a retrospective case series of patients from 2007 to 2017 who underwent a Steindler flexorplasty at their institution to restore elbow flexion. In the series, 8 of 9 patients achieved at least 90 degrees of active ...
Source: Techniques in Hand and Upper Extremity Surgery - November 19, 2019 Category: Surgery Tags: Techniques Source Type: research

Fixation of a Type 3 Flexor Digitorum Avulsion Injury
This article describes a novel technique for flexor digitorum profundus (FDP) avulsion injuries, useful for Leddy Packer type 3, 4, and 5 injuries. Multidirectional stability is achieved with combination pull-out suture, which neutralizes the deforming force of FDP, and cerclage wire, which holds the bone fragment in an anatomic position and provides interfragmentary compression. Traditional techniques such as interosseous wires, Kirschner wires, or plating risk fragment comminution and loss of reduction due to proximal pull of FDP as demonstrated in this case report of failed Kirschner-wire fixation. The technique present...
Source: Techniques in Hand and Upper Extremity Surgery - November 19, 2019 Category: Surgery Tags: Techniques Source Type: research

Combined Pedicled Vascularized and Wedge Nonvascularized Bone Graft for Treating Scaphoid Waist Nonunion With Humpback Deformity
We describe a method by using combined wedge non-VBG to correct the nonunion deformity when treating scaphoid nonunion with pedicled VBG. The wedge bone graft was harvested just proximal to the 2,3 intercompartmental supraretinacular artery VBG and was used as an inlay at the volar site to correct the humpback deformity, whereas the VBG was set at the dorsal site for bone bridging and blood supply. We also present our results of 10 patients with scaphoid fracture nonunion and humpback deformity treated with this method. Bone healing was achieved and the lateral intrascaphoid angles could be improved in all the 10 patients....
Source: Techniques in Hand and Upper Extremity Surgery - November 19, 2019 Category: Surgery Tags: Techniques Source Type: research

Arterialized Posterior Interosseous Nerve Graft for Digital Neuroma
Painful neuromas are not uncommon following nerve injury, and are especially bothersome in the hand, with severe cases resulting in significant disability. Outcomes of neuroma surgery are unpredictable regardless of technique. It is recognized that optimal soft tissue environment influences nerve healing more than the specific nerve graft technique, and it is in this context, we present a novel technique of transferring a posterior interosseous nerve graft along with vascularized synovial and fat tissue based on a branch of the posterior interosseous artery to provide healthy soft tissue for nerve healing of neuroma in con...
Source: Techniques in Hand and Upper Extremity Surgery - November 19, 2019 Category: Surgery Tags: Techniques Source Type: research

On the Shoulders of a Giant
No abstract available (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - November 19, 2019 Category: Surgery Tags: Editorial Source Type: research

Semicircumferential Detachment of the Extensor Enthesis For Surgical Treatment of Chronic Lateral Epicondylitis: A Prospective Study
About 10% of patients with lateral epicondylitis are nonresponsive to conservative treatment; as controversy persists on etiology and pathogenesis of this pathology, there is no surgical technique universally approved. The purpose of this study is to describe and evaluate the clinical outcomes of our technique consisting in a semicircumferential and partial detachment of the entire extensor apparatus enthesis. The technique was performed on 14 consecutive patients affected by painful chronic epicondylitis between January 2010 and April 2016. Two patients were lost during follow-up. At 6 months, 1 year, and 2 years after su...
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2019 Category: Surgery Tags: Techniques Source Type: research

The Anterolateral Thigh-Medial Femoral Condyle Chimeric Flow-through Flap for Posttraumatic Wrist Arthrodesis
Wrist arthrodesis in the setting of segmental bone loss can have high failure rates. Therefore, vascularized bone grafting has been advocated for select patients. Patients suffering concomitant large soft tissue loss present even greater challenge. To that end, we describe for the first time successful anterolateral thigh-medial femoral condyle chimeric flow-through flap for posttraumatic wrist arthrodesis and soft tissue coverage. This is a case report of a 19-year-old male laborer who suffered a large blast injury resulting in significant bone and soft tissue injury to the dominant right hand and wrist. After multiple de...
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2019 Category: Surgery Tags: Techniques Source Type: research

Intra-Articular Osteotomy for Symptomatic Bennett Fracture Malunion
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. A closing wedge osteotomy with excision of the malunion site is then performed to restore joint congruency. The osteotomy is fixed with 3 interfragmentary screws, and the joint is immobilized for 2 weeks before passive mobilization is initiated. Hardware can be removed between 3 and 6 months postoperatively after consolidation of ...
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2019 Category: Surgery Tags: Techniques Source Type: research

Techniques for Continuous Irrigation of Septic Joints of the Hand
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. Modifications of the technique are described for distal interphalangeal, proximal interphalangeal, and metacarpophalangeal joints and illustrated in each joint by 3 case studies. In addition to the irrigation, intravenous antibiotics were administered. All patients healed well with a full return of joint motion, no radiologic change, and a mean QuickDASH score of...
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2019 Category: Surgery Tags: Techniques Source Type: research

Glenohumeral Arthrodesis With Reamer-Irrigator-Aspirator (RIA) Bone Grafting After Traumatic Proximal Humerus Bone Loss and Flail Shoulder
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-sit...
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2019 Category: Surgery Tags: Techniques Source Type: research

Interosseous Membrane Reconstruction Utilizing Flexor Digitorum Superficialis Autograft
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. It also replicates the nonisometric nature of the native IOM. We also present long-term results of a patient who underwent IOM reconstruction utilizing this method, following a cadaveric feasibility study. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2019 Category: Surgery Tags: Techniques Source Type: research

Open Surgery for Trigger Finger Required Combined a1-a2 Pulley Release. A Retrospective Study on 1305 Case
Conclusions: Is possible to reduce the percentage of relapse triggering or PPIJF after trigger finger surgery, by performing that combined A1-A2 pulley release. Level of Evidence: Level III. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2019 Category: Surgery Tags: Techniques Source Type: research

Sliding the Medial Pin: A Safer Approach to Cross-pinning Humerus Supracondylar Fractures?
Conclusions: The sliding method is a novel technique of protecting the ulnar nerve during closed reduction percutaneous pinning of SCHF. Level of Evidence: Level IV. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2019 Category: Surgery Tags: Techniques Source Type: research

The “FraMo” System: A New Mini-Invasive Technique in the Treatment of Proximal Humerus Fractures
Fractures of the proximal humerus are relatively common injuries in adults accounting for 5% of fractures. Nowadays the most common technique used is open reduction internal fixation with LCP plates. The risks associated with open reduction internal fixation had led us to develop and apply a “hybrid” system, which is based on external fixation and closed surgery principles. This system is capable of stabilize up to 4 fragment fractures on different planes while conferring a strong enough fixation to maintain fracture reduction while allowing the patient to perform passive and active movement since the first day...
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2019 Category: Surgery Tags: Techniques Source Type: research

Time for Change
No abstract available (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2019 Category: Surgery Tags: Editorial Source Type: research

An Extensile Approach to the Radial Aspect of the Carpus: “The Link Incision”
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. The zone between these two incisions is not as frequently approached. Our incision connects these two well established incisions and we have described a step by step approach to this unfamiliar area. This “Link zone” overlies the thumb trapeziometacarpal joint, scaphotrapeziotrapezoid joint, and the radial styloid. It conta...
Source: Techniques in Hand and Upper Extremity Surgery - May 23, 2019 Category: Surgery Tags: Techniques Source Type: research

Treatment of Proximal Pole Scaphoid Fracture Nonunions With Intramedullary Cancellous Autograft and Cannulated Headless Compression Screw
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. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - May 23, 2019 Category: Surgery Tags: Techniques Source Type: research

Augmented External Fixation of Ulnar Carpometacarpal Joint Fracture Dislocations
Ulnar-sided carpometacarpal (CMC) joint fracture dislocations are relatively uncommon, frequently associated with fractures of the metacarpal base and/or hamate, and often sustained by young male individuals secondary to striking a hard object. The complexity of ulnar-sided CMC fracture dislocations necessitates careful restitution of anatomic alignment and joint congruency for mobility and stability. Miniaturization of the external fixation device has allowed application to the hand. Spanning external fixation utilizes the principles of “ligamentotaxis”—indirect reduction through distraction forces of ca...
Source: Techniques in Hand and Upper Extremity Surgery - May 23, 2019 Category: Surgery Tags: Techniques Source Type: research

Suture Anchor Repair of Avulsed Adductor Pollicis Injury, Secondary to Motor Vehicle Collision: Case Report and Technique
We report good clinical outcomes postoperative, with intact range of motion and no surgical complication at the 6-month follow-up visit. The patient has ongoing physical therapy to reduce any residual strength deficits. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - May 23, 2019 Category: Surgery Tags: Techniques Source Type: research

Novel Technique for Toe-to-Hand Transplantation: The Fourth-toe as an Alternative Option for Toe-to-Hand Transplantation for Pediatric Patients
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. Well described plantar and dorsal vascular systems for first web space vessels...
Source: Techniques in Hand and Upper Extremity Surgery - May 23, 2019 Category: Surgery Tags: Techniques Source Type: research

Reconstruction of Chronic Boutonniere Deformity of the Thumb in a Golf Player
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. As...
Source: Techniques in Hand and Upper Extremity Surgery - May 23, 2019 Category: Surgery Tags: Techniques Source Type: research

A Novel Technique for the Surgical Management of Chronic Lateral Epicondylitis
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. We prospectively reviewed 14 consecutive cases of resistant lateral epicondylitis operated with our technique at our Institute from 2008 to 2013 with a minimum 2 years follow up. We included patients between 18 and 65 years of age who in additio...
Source: Techniques in Hand and Upper Extremity Surgery - May 23, 2019 Category: Surgery Tags: Techniques Source Type: research

The FDP-FDS-FDP Dual Tendon Transfer: A Simple, Single-stage Reconstruction Technique for Chronic, Isolated Flexor Digitorum Profundus Tendon Injuries
We present a technique for single-stage reconstruction of chronic FDP lacerations, particularly in the setting of “lumbrical plus” fingers. The key features of this technique are: the FDS is detached from the middle phalanx and advanced to the distal FDP stump; and the proximal stump of the FDP is advanced to reestablish proper lumbrical tension and sewn to the FDS tendon proximally. Postoperative therapy is according to standard, well-accepted flexor tendon rehabilitation protocols. This procedure avoids the need for tendon autograft harvest, and avoids the tensioning challenges of other FDP reconstruction tec...
Source: Techniques in Hand and Upper Extremity Surgery - May 23, 2019 Category: Surgery Tags: Techniques Source Type: research

The Saline Load Test is Effective at Diagnosing Traumatic Arthrotomies of the Wrist
Conclusions: This study demonstrates the efficacy of the saline load test in detecting traumatic arthrotomies of the wrist joint with 95% sensitivity after loading 7 mL of saline. Prompt and accurate diagnosis of traumatic arthrotomies is paramount to guide management and optimize postinjury outcomes. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - May 23, 2019 Category: Surgery Tags: Techniques Source Type: research

Interposition Arthroplasty of the Elbow Utilizing a Lateral Epicondyle Osteotomy
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. Potential advantages include bone-to-bone healing of the osteotomy, decreased postoperative instability, and the dec...
Source: Techniques in Hand and Upper Extremity Surgery - May 23, 2019 Category: Surgery Tags: Techniques Source Type: research

Hand Trauma Call: A Blessing or a Curse?
No abstract available (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - May 23, 2019 Category: Surgery Tags: Editorial Source Type: research

All-Arthroscopic Triangular Fibrocartilage Complex Ligamentoplasty for Chronic DRUJ Instability
We present a completely arthroscopic reconstruction technique of the triangular fibrocartilage complex by means of tendon graft to provide stability to the DRUJ. This reconstruction technique provides a more stable reconstruction after the integration of the tendon plasty in the bone tunnels, based on the anatomic insertions of the triangular fibrocartilage in the fovea and in the corners of the dorsal and volar sigmoid notch, along with the advantages offered by arthroscopy in terms of recovery time, esthetic result, less mobility loss, and pain. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - February 21, 2019 Category: Surgery Tags: Techniques Source Type: research

Outcomes Following Temporary Kapandji Pinning Technique and Distal Radial LCP Fixation for Intra-Articular Fractures of the Displaced 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. The mean follow-up period totaled 12 months. A total of 57 patients were evaluated by radiographic and clinical review. The modified Mayo wrist score was used for postoperative patient evaluation. The clinical results on follow-up were good to excellent. Minimal joint stiffness and functional outcomes of the wrist and elbow were satisfactory. Statically significant differences were found between the preoperative and postoperative radiol...
Source: Techniques in Hand and Upper Extremity Surgery - February 21, 2019 Category: Surgery Tags: Techniques Source Type: research

Independent Locking Screws for Articular Fragment Fixation in the Elbow
We describe a technique in which small locking screws are used independently from a plate as a substitute for headless or other traditional screws. This method of fixation negates the need for countersinking the screw head, or over drilling a guide wire, and enables the use of smaller diameter screws which provide excellent purchase in very small fragments. Independent locking screws can be considered for any fracture that previously would have been amenable to cortical or headless compression screw fixation. Locking screws from several manufacturers have been used with equal success. Screws can be used in a unicortical ma...
Source: Techniques in Hand and Upper Extremity Surgery - February 21, 2019 Category: Surgery Tags: Techniques Source Type: research

Technique Tip: Platysma-flap Approach to the Clavicle
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. This modified exposure allows to co...
Source: Techniques in Hand and Upper Extremity Surgery - February 21, 2019 Category: Surgery Tags: Techniques Source Type: research

Arthroscopic Treatment of Lateral Elbow Pain Mimicking Lateral Epicondylitis: Long-term Follow-up of a Unique Surgical Protocol
Conclusions: We report promising long-term clinical and functional results of a novel arthroscopic resection of the capsulosynovial complex in lateral epicondylitis. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - February 21, 2019 Category: Surgery Tags: Techniques Source Type: research

Palmar Capsuloligamentous Plication in Dorsal Capitolunate Instability: Technique and Preliminary Results
We describe a novel technique which aims to address palmar ligamentous hyperlaxity by plication of the radioscaphocapitate, radiolunotriquetral, and arcuate ligaments, thus closing the so-called space of Poirier. This palmar technique has been used in several cases in isolated form or in conjunction with other concomitant procedures. After the floor of the carpal tunnel and thus the palmar ligaments are exposed and the weak spot meticulously verified, 2 or rarely 3 deep FibreWire pulley sutures are used for capsuloligamentous plication. Among 11 patients, 4 cases (5 operated wrists) with isolated capitolunate capsuloligame...
Source: Techniques in Hand and Upper Extremity Surgery - February 21, 2019 Category: Surgery Tags: Techniques Source Type: research

Volar Vascularized Strut Graft for Avascular Scaphoid Nonunion Using the 1,2 Intercompartmental Supraretinacular Artery
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. The 2 patients who remaine...
Source: Techniques in Hand and Upper Extremity Surgery - February 21, 2019 Category: Surgery Tags: Techniques Source Type: research

FCR Interposition Arthroplasty for Concomitant STT and CMC Arthritis
We describe a novel technique of flexor carpi radialis (FCR) tendon interposition to tackle this condition. Our common treatment for CMC arthritis is trapezium resection with ligament reconstruction and tendon interposition with half of the FCR. With this procedure, through the same exposure, the proximal part of the trapezoid is resected. An anchor is placed into the trapezoid and the sutures are passed through a remnant of the FCR. Thus the FCR is pulled in between the scaphoid and the trapezoid and secured in place. We performed this procedure in 13 hands with average follow-up of 36 months. All patients were satisfied ...
Source: Techniques in Hand and Upper Extremity Surgery - February 21, 2019 Category: Surgery Tags: Techniques Source Type: research

Volar Approach to Percutaneous Fixation of Acute Nondisplaced Fractures of the Scaphoid
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 technic...
Source: Techniques in Hand and Upper Extremity Surgery - February 21, 2019 Category: Surgery Tags: Techniques Source Type: research

Brachioradialis Flap for Soft Tissue Coverage of Posterior Elbow Wounds: Case Report and Surgical Technique
We present a review of the literature, case report, and surgical technique using the brachioradialis muscle for coverage of a large posterior elbow wound after failure of an anconeus flap. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - February 21, 2019 Category: Surgery Tags: Techniques Source Type: research

Is There More to Life Than an Evidence-based Study
No abstract available (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - February 21, 2019 Category: Surgery Tags: Editorial Source Type: research

An Eco-conscious Alternative Material for Splinting in Hand Surgery
No abstract available (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - November 20, 2018 Category: Surgery Tags: Letter to the Editor Source Type: research

Reconstruction of Traumatic Central Slip Injuries: Technique Using a Slip of Flexor Digitorum Superficialis
We describe a surgical technique for central slip reconstruction using a slip of the flexor digitorum superficialis tendon through a bone tunnel. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - November 20, 2018 Category: Surgery Tags: Techniques Source Type: research

Tether Creation Between the Second and Third Extensor Digitorum Communis for Third Extensor Tendon Subluxation at the Metacarpophalangeal Joint
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. A key advantage of our procedure is the strong and reliable interlace of the...
Source: Techniques in Hand and Upper Extremity Surgery - November 20, 2018 Category: Surgery Tags: Techniques Source Type: research

Tenodesis of the Ulnotriquetrum Ligament to the Fovea for a Triangular Fibrocartilage Complex Tear
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 prox...
Source: Techniques in Hand and Upper Extremity Surgery - November 20, 2018 Category: Surgery Tags: Techniques Source Type: research

Preparation is the Only Shortcut You Need in Surgery: A Guide to Surgical Rehearsals for Hand and Upper Extremity Transplantation
As upper extremity transplantation is becoming more accepted worldwide, the demand for a fresh tissue cadaveric training model for this procedure is increasing and necessary to assure surgical success. Surgical rehearsals can decrease operative time, improve technique, and reduce errors made on the actual day of surgery. The purpose of this article is to describe a method for surgical rehearsal of upper extremity transplantation using cadaveric specimens based on the clinical experience of an academic institution with an active transplantation program. The logistics of rehearsal setup, equipment, and modified version of pr...
Source: Techniques in Hand and Upper Extremity Surgery - November 20, 2018 Category: Surgery Tags: Techniques Source Type: research

Therapeutic Management of the Posttraumatic Stiff Elbow After Open Osteocapsular Release
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. Irrespectively, patient ownership in the rehabilitative process and effective communication betw...
Source: Techniques in Hand and Upper Extremity Surgery - November 20, 2018 Category: Surgery Tags: Beyond the Technique Source Type: research