Hand clinics
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This article covers new and emerging techniques in small joint arthroscopy in the hand. Recent improvement in the quality of small joint scopes and advancement in techniques have allowed for many new small joint arthroscopic procedures in the hand. ⋯ Arthroscopic treatment of pantrapezial arthrosis is reviewed. Metacarpophalangeal arthroscopy for the treatment of synovitis, arthritis, fractures, and gamekeeper injuries are discussed, as is arthroscopy of the proximal interphalangeal, pisotriquetral, fourth and fifth CMC, and distal interphalangeal joints.
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During the last two decades, increased knowledge of functional anatomy and pathophysiology of the triangular fibrocartilage complex (TFCC) have contributed to a change in surgeons' perspective toward it. The earlier concept of the TFCC as the "hammock" structure of the ulnar carpus has updated to the "iceberg" concept, whereby the much larger "submerged" part represents the foveal insertions of the TFCC and functions as the stabilizer of the distal radioulnar joint and the ulnar carpus, thus lending it greater functional importance. This article presents an algorithm of the treatment of traumatic peripheral TFCC tear based on clinical, radiological, and arthroscopic findings.
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Peripheral ulnar-sided tears of the triangular fibrocartilage complex (TFCC) are common injuries and are amenable to arthroscopic repair. This article describes an all-arthroscopic knotless technique for TFCC repair. This technique has the advantage of being all arthroscopic using 3 portals, has the ability to repair both the superficial and deep layers of the articular disk, repairs the articular disk directly back to bone, and does not require any suture knots that may irritate the surrounding soft tissues. The surgical technique is described in detail.
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Injury to the triangular fibrocartilage complex (TFCC) is a major source of ulnar-sided wrist pain that results in disability with common activities of daily living involving forearm rotation, for which operative management is indicated if conservative management fails. Past results with open repairs have been successful, but recent surgical advances have allowed the development of arthroscopic management. This article describes and reviews an all-arthroscopic technique of repair of Palmer type IB TFCC injuries with FasT-Fix suture technology (Smith and Nephew, Andover, MA, USA), which is advantageous both biomechanically and in terms of decreasing risk of morbidity.
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Review
Arthroscopic reduction and percutaneous fixation of fifth carpometacarpal fracture dislocations.
Arthroscopy of the first carpometacarpal (CMC) joint has become routine. Similar techniques can be applied to fracture dislocations involving the fifth CMC joint. This situation is one whereby arthroscopy is definitely of benefit, because the articular fracture fragment is often volar, and difficult to visualize and reduce from a dorsal approach. This article describes arthroscopic techniques for reduction and percutaneous fixation of fifth CMC fracture dislocations.