Excision of the Flexor Carpi Radialis Tendon Following Ligament Reconstruction Tendon Interposition for Thumb Carpometacarpal Arthroplasty: A Review of Cases and of the Literature
Thumb carpometacarpal (CMC) arthroplasty predictably improves pain and function in patients with thumb CMC osteoarthritis. One variation of this technique involves using a split half flexor carpi radialis (FCR) tendon for ligament reconstruction tendon interposition. Postoperative pain in the wrist and distal forearm overlying the remaining FCR tendon is a potential complication that may necessitate follow-up FCR tenotomy. Being aware of this potential complication and modifying surgical technique if a poor quality tendon is discovered at the time of the initial surgery may decrease the incidence of postoperative FCR pain ...
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Tips and Pearls Source Type: research
The Oxford Spherical Mill for Metaphyseal Debridement in Open Epiphyseal Reduction and Internal Fixation for Slipped Capital Femoral Epiphysis
This article describes the benefits of using the Oxford Spherical Mill from a partial knee replacement system to assist with metaphyseal debridement during open epiphyseal reduction and internal fixation for SCFE. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Tips and Pearls Source Type: research
Nice Knot New Applications in Wrist Arthroscopy
This article aims to describe the utilization of the Nice knot in wrist arthroscopy to repair the triangular fibrocartilage complex or the scapholunate ligament. We modified the techniques described by Mathoulin for these repairs. The Nice knot is a simple knot, easy to use under arthroscopy to repare the scapholunate ligament and the triangular fibrocartilage complex tears. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Tips and Pearls Source Type: research
Treatment of Endoprosthetic Knee Joint Infection in the Setting of Massive Bone Loss With Fusion of Femoral and Tibial Antibiotic Rods
This article describes a 27-year-old man who was treated 12 years prior for stage IIB osteosarcoma of the right proximal tibia with wide resection and alloprosthetic composite reconstruction. He developed chronic periprosthetic infection of the construct. Three surgical washouts and intravenous antibiotics failed to eradicate the infection, therefore 2-stage exchange arthroplasty was initiated. The first stage involved resection of all implants and allograft, and placement of a novel antibiotic-impregnated spacer. The spacer was created by locking a retrograde femoral nail and an antegrade tibial nail together at the knee ...
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
Gluteus Maximus Transfer for Irreparable Hip Abductor Tendon Tears: Technique and Clinical Outcomes
Hip abductor tears are increasingly recognized as a common source of lateral hip pain. Primary repair has generally shown excellent results. However, where repair is not possible or advanced muscle atrophy is present, few reconstructive options are available. Here we present the technique and results of a simplified method for transfer of the gluteus maximus tendon to the greater trochanter. Patients undergoing gluteus maximus tendon transfer were identified from our institution hip preservation registry. Electronic health records, imaging, and clinical examination findings were recorded for each patient and analyzed. Preo...
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
Placement of Provisional External Fixation of Pediatric Femoral Shaft Fractures Using Radiopaque Markers in the Setting of Severe Polytrauma: A Technical Report
Conclusions:
The use of radiopaque markers reproducibly aids radiologically guided placement of threaded Shanz pins during external fixation of femur fractures in polytraumatized pediatric patients undergoing damage control orthopaedics. The technique also minimizes radiation exposure, uses equipment readily available in the hospital setting, and alleviates the need to have a radiolucent bed in the pediatric intensive care unit.
Level of Evidence:
Case report. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
Adductor Tendon Repair: Case Report and Description of a Novel Approach for Improved Exposure
Groin pain is one of the most common and challenging diagnoses for a sports medicine physician. Up to 64% of groin injuries involve the adductor tendons, which can be very difficult to treat with or without surgical intervention. The purpose of this article is to report the 2-year outcomes of a patient that presented with an acute proximal adductor tendon injury and to describe a novel surgical approach. This is a case of a 36-year-old elite athlete that presented with an acute adductor longus tear. The patient was treated with surgical repair using a parainguinal approach and bioabsorbable suture anchors into the adductor...
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
Patellar Tendon Reconstruction With Achilles Tendon Allograft For Nonrepairable Patellar Tendon Rupture
Patellar tendon reconstruction in the setting of a nonrepairable patellar tendon rupture can be a technically difficult and extensive procedure. An alternative surgical technique for patellar tendon reconstruction with Achilles tendon allograft utilizes tibial tubercle interference fixation for the bone plug. This technique uses simple instrumentation and is less traumatic to the knee which may allow an easier patient recovery. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
Latissimus Dorsi Flap for Functional Reconstruction of the Deltoid: A Descriptive and Illustrated Surgical Technique Guide
Loss of deltoid function due to irreversible damage to the muscle or its innervation results in severe disability and affects the remainder of the upper extremity even if the elbow, wrist, and fingers remain functional. The pedicled latissimus dorsi flap is our preferred method for restoring shoulder motion in well-selected patients with loss of deltoid function and an at least partially functional rotator cuff. The flap’s inherent biomechanical advantages enable superior shoulder flexion and abduction compared with other local muscle transfer techniques described for this condition. Moreover, minimal donor-site morbidit...
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
A Biomechanical Evaluation of Multiple Fixation Methods for the Treatment of Low Transverse Distal Fibula Fractures Seen With Supination Adduction Ankle Injuries Using an Osteoporotic Sawbones Model
This study sought to determine the best biomechanical fixation of low transverse distal fibula fractures as seen in supination-adduction–type ankle fractures. Four different fixation methods—a one-third tubular plate with 1 distal screw, a one-third tubular plate with 2 distal screws, a 2.4-mm mini fragment T-plate, and a fibular-specific locking plate—were compared for fixation of low transverse distal fibula fractures using an osteoporotic Sawbones model. Biomechanical testing was performed to determine stiffness of the constructs as well as load to failure (survival). A one-third tubular plate with either 1 or 2 s...
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
Skull Clamp Application: A Safe, Team-based Approach and Literature Review
Outcomes in posterior cervical spine surgery are highly dependent on proper operative head and neck positioning. As with any spinal procedure, posterior cervical surgery can be associated with significant morbidity; known complications directly related to positioning include postoperative vision loss, neurological injury, and poor surgical outcome. Unsurprisingly, a variety of techniques have been developed that aim to mitigate these complications while improving overall outcomes. The aim of this article is to present a standardized technique for application of the Mayfield skull clamp focusing on a team-based approach for...
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
Two Transiliac-Transsacral Screws in a Single Sacral Level: Surgical Technique and Patient Outcomes
We describe a technical guide on how to preoperatively assess if the S1 or S2 corridor can safely accommodate 2 TI-TS screws, and how to execute the technique using intraoperative fluoroscopy. We also report our institutional experience of 20 patients who were treated with 2 TI-TS screws for both high-energy and fragility posterior pelvic ring injuries. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
“Fibula plus Ilizarov”: a Simpler Strategy Than Bone Transport for Major Bone Defects in Children
We report a modified technique of ours in 2 of our patients. One was a 10-year-old boy with 8 cm tibial defect and the other was 13-year-old boy with 7 cm femoral defect. The first stage of treatment involved radical debridement, sequestrectomy, antibiotic spacer application, stabilization with conventional external fixation, and 6 weeks of antibiotic therapy. The second stage of treatment consisted of intramedullary autologous fibular strut grafting stabilized with intramedullary K-wire supplemented with corticocancellous graft and stabilized with simple Ilizarov fixator. Patients began full weight bearing walking wit...
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
Repair of Pars Interarticularis Defect Utilizing a Pedicle and Laminar Screw Construct: A Technique Discussion and Case Series
We describe the use of the pedicle screw-lamina screw constructs using image guidance and 3-dimensional imaging in the surgical management of isthmic spondylolysis. We also present a case series of patients undergoing treatment of isthmic spondylolysis. All patients undergoing pedicle screw-laminar screw pars repair construct from 2012 to 2017 by the senior author.
Materials and Methods:
All patients undergoing pedicle screw-laminar screw pars repair by the senior author from 2012 to 2017 were included. Patients were excluded for spondylolisthesis, disc degeneration at the level of spondylolysis, advanced age (>25),...
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
Hip Resurfacing Utilizing the Direct Anterior Approach
Background:
The direct anterior approach (DAA) has been used successfully in total hip arthroplasty with many benefits including improved radiographic positioning of components, earlier ambulation, as well as decreased narcotic consumption, length of stay, dislocation rate, discharge to rehabilitation facility (vs. home) and 30-day readmission. Hip resurfacing can be a successful surgical option for the properly selected patient as it can preserve bone stock and provide excellent function including improved activity levels as compared with total hip arthroplasty. Traditionally hip resurfacing has been performed via an ...
Source: Techniques in Orthopaedics - February 24, 2021 Category: Orthopaedics Tags: Special Technical Articles Source Type: research
