Vascularized Ulnar Transposition and Radioulnoscapholunate Fusion With Volar Locking Plate in a Dorsal Position Following Resection of Giant Cell Tumor of the Distal Radius
We present a case of Campanacci Grade III giant cell tumor of the distal radius with pathologic fracture and cortical destruction which was treated with neoadjuvant denosumab. This facilitated en-bloc resection of the entire distal radius, including the articular surface, while minimizing tumor contamination. Reconstruction was accomplished using a vascularized ulnar transposition flap to facilitate radioulnoscapholunate fusion, which was fixated using a long-stem contralateral variable angle locking volar distal radius plate in a dorsal position. This case illustrates multidisciplinary management of a challenging reconstr...
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2020 Category: Surgery Tags: Techniques Source Type: research

Tensioning Ligament and Tendon Repairs to Bone Using a Modified Screw-post Technique
Purpose: The purpose of this study was to demonstrate how to tension tendon and ligament repairs or reconstructions to bone by using an oblique screw-post. A controlled experiment simulating this repair technique is reported, followed by 5 case examples. Methods: A wood frame model was used to test 5 initial exposed screw lengths (4, 8, 12, 16, 20 mm) and 5 screw angles [90 (perpendicular to wood plane), 75, 60, 45, 30 degrees]. A spring-based force gauge was tied to the exposed 3.5 mm cortical screw with a washer using a #2 nonabsorbable braided suture, and the screw was fully advanced. System lengths w...
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2020 Category: Surgery Tags: Techniques Source Type: research

Delta Wiring Technique to Treat Bony Mallet Finger: No Need of Transfixation Pin
The objective of this study was to determine the result of the delta wiring technique in mallet fractures with fracture fragment involving more than one-third of the distal phalanx articular surface. The authors are reporting 5 cases of mallet fractures treated with delta wiring technique with good functional and radiologic outcomes. Radiologic outcomes were evaluated on the basis of postoperative and follow-up x-rays and functional outcomes were evaluated using Crawford’s criteria. Five patients (4 males, 1 female) with a mean age of 26.8 years (range, 20 to 33 y) were included. The mean time between the inju...
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2020 Category: Surgery Tags: Techniques Source Type: research

Syringe External Fixator: An Inexpensive Static-to-Dynamic Treatment for Comminuted Intra-Articular Phalangeal Fractures
Comminuted intra-articular phalanx fractures are complicated injuries often treated with external fixation. The ideal external fixation system should be affordable, readily available, adaptable, and easy to use. The use of dynamic external fixation has advanced the care of these injuries but can be difficult to implement. The authors present a case example of a patient with a comminuted intra-articular phalangeal fracture of the left small finger treated using a syringe as a static uniplanar fixator that was converted to a dynamic fixator during postoperative recovery. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2020 Category: Surgery Tags: Techniques Source Type: research

Percutaneous Plate Osteosynthesis of Ulnar Shaft Fractures: A Surgical Technique and Case Series
Treatment of ulnar diaphyseal fractures can range broadly from nonoperative with immobilization to surgical intervention with a variety of implants or approaches. At a Level 1 trauma center, a series of ulnar shaft fractures have been treated using a percutaneous plating technique that is base beneath the extensor carpi ulnaris. This technique description illustrates relevant anatomy, important patient and injury characteristics, implant considerations, and potential outcomes and complications. The described treatment option provides an effective way of spanning comminuted fracture patterns without disrupting the surroundi...
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2020 Category: Surgery Tags: Techniques Source Type: research

A New Single Volar Approach for Both-Bone Fractures of the Forearm: The Mediolateral Windows Approach Extended
In this report, we describe the surgical anatomy, surgical approach, and complications regarding this approach. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2020 Category: Surgery Tags: Techniques Source Type: research

APL Lasso Suspensionplasty for Trapeziectomy
Base of thumb arthritis is a common pathology, with late-stage disease often treated by trapeziectomy and a form of ligament reconstruction or suspension. No therapeutic option for suspension or ligament reconstruction has proven to be superior to others, with risks inherent to all. Here, the authors describe a novel technique utilizing an accessory slip of abductor pollicis longus looped around the second metacarpal base to suspend the metacarpal and prevent subsidence after trapeziectomy. This technique aims to mitigate some of the risks seen in other methods, while providing similar biomechanical strength. Early clinica...
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2020 Category: Surgery Tags: Techniques Source Type: research

The Color of Surgery
No abstract available (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - August 27, 2020 Category: Surgery Tags: Editorial Source Type: research

The Triceps Traction Test: A Decision Tool for the Choice of Stabilizing Flap After In Situ Decompression of the Ulnar Nerve
Purpose: Recent evidence demonstrates that in situ decompression has comparable outcomes to other surgical techniques for cubital tunnel syndrome. However, this technique does not address the instability of the ulnar nerve, a common indication to transpose the ulnar nerve. Transposition of the ulnar nerve can potentially devascularize the ulnar nerve, stabilizing flaps block subluxation of the ulnar nerve and thereby negate the need for transposition. Flaps originating from the triceps and the flexor-pronator fascia could be used to stabilize the ulnar nerve. Herein, we present a novel intraoperative test, the “tri...
Source: Techniques in Hand and Upper Extremity Surgery - May 22, 2020 Category: Surgery Tags: Techniques Source Type: research

Great Occipital Nerve as Donor Nerve for Neurotization With Suprascapular Nerve in Total Braqchial Plexus Injuries: Nerve Transfer Technique
Complete brachial plexus injuries continue to be a technical and strategic challenge in surgical reconstruction to restore function and sensitivity in a paralyzed and insensitive limb. The use of donor’s nerves to perform neurotizations is limited, and, in reconstructions for preganglionic lesions, these techniques have gained prominence, even leaving comorbidities in the donor sites. The purpose of this paper is to present the great suboccipital nerve as a new donor nerve bases on our anatomic research with the transfer technique from the great occipital nerve to the suprascapular nerve. (Source: Techniques in Hand ...
Source: Techniques in Hand and Upper Extremity Surgery - May 22, 2020 Category: Surgery Tags: Techniques Source Type: research

Skin Expansion Due to the Dupuytren Cord Allows to Design Local Flaps to Facilitate Skin Closure in Severe Cases: The 3-flap: Surgical Technique and Clinical Evaluation
In the serious forms of Dupuytren disease, passive extension during surgery often results in unmasking a loss of skin substance that makes primary closure impossible. Our objective in this study was to describe and assess the therapeutic possibilities of a 3 local flaps surgical approach in serious forms of Dupuytren disease, using the lateral skin expansion because of the cord. A cadaveric study was carried out on 12 adult nonembalmed, fresh frozen hands. For each specimen, a loss of skin substance was simulated on the palmar side of the fifth finger at the level of the proximal digital flexion crease. Coverage involved a...
Source: Techniques in Hand and Upper Extremity Surgery - May 22, 2020 Category: Surgery Tags: Techniques Source Type: research

The Thenar Crease Skin Graft: A Novel Addition to “Camouflage” Grafts of the Hand
We present a novel technique of harvesting full-thickness skin grafts from the thenar crease and report the outcome of our cases. We provide further insights to adapt the technique to a variety of clinical scenarios—degloving injuries and shaving injuries of the finger including subcomplete pulp skin loss. Graft size is up to 75 mm by 10 mm, with tension-free donor site closure. We further report the operative experience, functional and esthetic outcome. The technique is fast, versatile, and provides large surface areas of good quality glabrous skin in a single-stage procedure. It will sit well in the a...
Source: Techniques in Hand and Upper Extremity Surgery - May 22, 2020 Category: Surgery Tags: Techniques Source Type: research

Modified Hemihamate Arthroplasty With Oblique Osteotomy of the Middle Phalanx Base to Reconstruct Proper Contour of the Articular Surface
Treatments of unstable dorsal fracture dislocations of the proximal interphalangeal (PIP) joint are very challenging. The authors performed modified hemihamate arthroplasty for these injuries in 13 patients (13 fingers). Our surgical technique was unique in the point that we put volarly oblique osteotomy in the coronal plane at the recipient site to create an adequate reconstruction of the volar lip of the articular surface of the middle phalanx. Affected fingers are index in 2, middle in 4, ring in 3, and little in 3, and the mean duration of follow-up was 14 months. Hemihamate arthroplasty was indicated if>30% to 50% ...
Source: Techniques in Hand and Upper Extremity Surgery - May 22, 2020 Category: Surgery Tags: Techniques Source Type: research

Single-stage Radialization and Pollicization for Radial Longitudinal Deficiency With Thumb Hypoplasia
In this study, we propose single-stage radialization and pollicization for the radial longitudinal deficiency with thumb hypoplasia. The advantages of this technique are to reduce the number of surgical operations, the amount of anesthesia required, and to reduce the cost of multiple follow-ups for patients and family. This technique is noteworthy for the following reasons: (1) use of dorsal vertical midline incision benefit radialization proximal extension for ulnar osteotomy and has less interference with pollicization incision; (2) ulnar shortening osteotomy should be done in case of difficulty in reposition carpus over...
Source: Techniques in Hand and Upper Extremity Surgery - May 22, 2020 Category: Surgery Tags: Techniques Source Type: research

Suture Suspension Arthroplasty With Trapeziectomy for Thumb Carpometacarpal Arthritis Using a Wide-awake Approach
Despite the introduction of various techniques for ligament reconstruction in the treatment of thumb carpometacarpal (CMC) arthritis, complications, including proximal migration, dorsal subluxation of the first metacarpal base, hyperextension of the thumb metacarpophalangeal joint, and impingement between the first and second metacarpal bases, have been reported. Even suture button suspensionplasty with Arthrex Mini TightRope may be unable to correct the adduction contracture deformity and does not effectively tether the trapeziometacarpal toward the base of the index metacarpal, thus potentially leaving patients with pers...
Source: Techniques in Hand and Upper Extremity Surgery - May 22, 2020 Category: Surgery Tags: Techniques Source Type: research

Small Finger Abduction Test to Evaluate the Flexor Carpi Ulnaris Tendon
We describe a simple and effective method to assess the integrity of the flexor carpi ulnaris muscle and tendon. This method is called the Small Finger Abduction Test. The study also evaluates the efficacy and practicality of the test. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - May 22, 2020 Category: Surgery Tags: Techniques Source Type: research

Chronic Reducible Scapholunate Ligament Dissociation: A Simple Surgical Technique for a Complex Injury
Conclusions: Chronic reducible SL dissociation can be treated affectively with SL chonderectomy, temporary SL stabilization, and ECRL tenodesis to scaphoid to restore radiologic anatomy without compromising strength or work status. Level of Evidence: Therapeutic type IV. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - May 22, 2020 Category: Surgery Tags: Techniques Source Type: research

Paradigm Shift
No abstract available (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - May 22, 2020 Category: Surgery Tags: Editorial Source Type: research

Index Finger Metacarpophalangeal Joint Arthrodesis With a Dorsal Locking Plate
We present our technique of performing index finger MCP arthrodesis using a dorsal locking plate. The proposed benefits of this technique include the ability to position the MCP joint in the desired degree of flexion, generation of parallel fusion surfaces with even compression across the arthrodesis site, and stable fixation. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - February 22, 2020 Category: Surgery Tags: Technique Source Type: research

Dorsal Intercarpal Ligament Preserving Arthrotomy and Capsulodesis for Scapholunate Dissociation
We report a novel technique of modified dorsal intercarpal ligament (DICL) capsulodesis for the treatment of SL dissociation. The surgical indication for this procedure is complete SL ligament tear with a reducible carpal malalignment and no secondary osteoarthritis. This procedure is indicated when the remnant of torn ligament in the dorsal SL interosseous space is available for repair. First, carpal malalignment is corrected and the scaphoid and the lunate are temporarily fixed with a transosseous screw or Kirschner wires. Using a dorsal approach, the DICL is then exposed, which originates from the triquetrum and attache...
Source: Techniques in Hand and Upper Extremity Surgery - February 22, 2020 Category: Surgery Tags: Technique Source Type: research

Radial Head Resection and Corium Interposition Arthroplasty in Skeletally Immature Patients With Isolated Posttraumatic Radial Head Arthrosis
Radiocapitellar arthrosis represents a serious sequela of pediatric elbow injuries. Although persistent pain and disability are not uncommon in such cases, treatment remains controversial. The present study aimed to review the clinical outcomes after a new surgical treatment with partial radial head resection and corium interposition arthroplasty. To date, 3 adolescent cases underwent the surgical procedure and postoperative care. Thorough clinical and radiographic follow-up was performed. The mean age at the time of surgery was 14.4 years (range, 13 to 16 y) and mean duration of follow-up was 19 months (range, 12 t...
Source: Techniques in Hand and Upper Extremity Surgery - February 22, 2020 Category: Surgery Tags: Technique Source Type: research

A Mini-Open, Dorsal Approach for Scaphoid Fracture Fixation With a Ligament Sparing Arthrotomy
There are several surgical approaches that are currently used to address nondisplaced scaphoid waist fractures, including percutaneous fixation, limited exposure fixation, and traditional open techniques through a volar or dorsal approach. Although percutaneous fixation has some theoretical advantages, it is much more difficult to achieve an accurate starting point for a headless compression screw. The purpose of this paper is to describe a simple, dorsal, mini-open approach to the scaphoid that minimizes incision size, extensor tendon dissection, capsular trauma, and vascular disruption, while still allowing for direct vi...
Source: Techniques in Hand and Upper Extremity Surgery - February 22, 2020 Category: Surgery Tags: Technique Source Type: research

The Inverted Free Functioning Gracilis Muscle Transfer For Restoration of Elbow Flexion Following Delayed Presentation or Failed Primary Nerve Reconstruction of Upper Trunk Injuries
Free functional gracilis transfer is a well-established technique for restoring active elbow flexion in brachial plexus injuries following delayed presentation or failed nerve reconstruction procedures. In cases of delayed presentation or failed nerve reconstruction following upper trunk injuries, the lower trunk intraplexal median and ulnar nerves are spared, thereby making them available to reinnervate the transferred gracilis. Therefore, we have inverted the conventional free functional gracilis orientation so as to orient the flap’s recipient nerve in closer proximity to donor median or ulnar nerve fascicles to e...
Source: Techniques in Hand and Upper Extremity Surgery - February 22, 2020 Category: Surgery Tags: Technique Source Type: research

A Reconstructive Extensor Tendon Centralization Technique for Sagittal Band Disruption
We present a surgical technique that diminishes tension of the repair with MCPJ flexion. Twenty-two EDC tendon stabilization procedures were performed between 2006 and 2017 using a tendon flap method. The selection criteria for this group of patients included completely dislocating extensor tendons with persistent complaints of pain and decrease in finger extension despite at least a 6-week conservative treatment attempt. All subjects underwent surgical treatment for tendon centralization using a distally based tendinous flap from the EDC sutured to the adjacent finger volar plate. A mathematical model was developed to ana...
Source: Techniques in Hand and Upper Extremity Surgery - February 22, 2020 Category: Surgery Tags: Technique Source Type: research

The Second Toe-to-Hand Transfer for Full-length Thumb Reconstruction in Congenital Thumb’s Grade IIIb to V Hypoplasia: MTPJ Arthrodesis Instead of Tendon Rebalansing
Congenital thumb hypoplasia is a rare deformity of the upper extremity. The classification of thumb hypoplasia was created by Blauth in 1967 (types I to V). The base of the first metacarpal bone is absent for hypoplasia types IIIb to V, therefore, toe-to-hand transplantation is not recommended. A stable first carpometacarpal joint has been considered a mandatory factor for a successful toe-to-hand transplantation. The aim of this study is to describe a new technique for thumb reconstruction with the second toe transfer and metatarsophalangeal joint (MTPJ) arthrodesis, which can provide a five-digit hand and restore thumb f...
Source: Techniques in Hand and Upper Extremity Surgery - February 22, 2020 Category: Surgery Tags: Technique Source Type: research

Failed Proximal Humerus Osteosynthesis Using Intramedullary Fibular Strut Allograft Conversion to Reverse Shoulder Arthroplasty
Comminuted proximal humerus fractures are more frequently being treated utilizing an intramedullary fibular strut allograft to assist with open reduction internal fixation. Although this technique has led to improved outcomes, avascular necrosis, rotator cuff failure, and/or prominent hardware may still occur necessitating conversion to reverse shoulder arthroplasty. The presence of an intramedullary strut allograft makes this conversion technically demanding and creates certain potential complications unique to this group. This manuscript details the conversion of a proximal humerus open reduction internal fixation with a...
Source: Techniques in Hand and Upper Extremity Surgery - February 22, 2020 Category: Surgery Tags: Technique Source Type: research

Long-Term Outcomes After Extensor Carpi Ulnaris Subsheath Reconstruction With Extensor Retinaculum
This study assessed the long-term outcomes and complications of patients that underwent operative treatment for extensor carpi ulnaris subluxation. Fifteen patients underwent extensor carpi ulnaris subsheath reconstruction at a median of 5.9 weeks nonoperative treatment interval (interquartile range: 2.4 to 13). Reconstruction consisted of using the extensor retinaculum as a sling reconstruction. We found that about 1 in 3 patients had a complication or reoperation. At a median of 8 years follow-up, many patients had some residual symptoms, but in general, most patients were satisfied. (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - February 22, 2020 Category: Surgery Tags: Technique Source Type: research

An Old Dog Learns a New Trick
No abstract available (Source: Techniques in Hand and Upper Extremity Surgery)
Source: Techniques in Hand and Upper Extremity Surgery - February 22, 2020 Category: Surgery Tags: Editorial Source Type: research

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