Techniques in hand & upper extremity surgery
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Tech Hand Up Extrem Surg · Jun 2009
ReviewManagement of comminuted olecranon fractures with precut K-wires and tension band wiring.
Various methods are used to treat comminuted fractures of the olecranon. The preferred method of management of fractures of the olecranon is tension band wiring over K-wires. Often, it becomes difficult to fix small articular fragments with the 2 K-wires used for tension band wiring. Since 2005, we have used the missing K-wire technique to fix the small articular fragments.
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Intraoperative distraction aids in the restoration of length, facilitates reduction, assists in maintaining rotational alignment, and provides a temporary stable platform for definitive fixation of acute fractures, malunions, and nonunions. This technique has been described at length in the lower extremity; however, there is a paucity of literature regarding its use in the upper extremity. ⋯ Intraoperative distraction may be invaluable in the treatment of displaced fractures of the upper extremity. The objective of this paper was to detail the technique of intraoperative distraction in the surgical treatment of fractures of the clavicle, humerus, radius, and ulna.
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Tech Hand Up Extrem Surg · Jun 2009
De quervain disease: Ibri technique to avoid superficial radial nerve injury.
Tenosynovitis of the first dorsal compartment of the wrist, commonly known as de Quervain disease, is most of the time amenable to conservative treatment in form of splinting and injection of steroids into the compartment. Resistant cases need surgical release of the compartment but with high incidence of incomplete release owing to tendon anomalies and damage to the superficial branch of the radial nerve (SBRN). Many techniques evolved for a period of years, techniques using longitudinal, transverse, and oblique incisions, but damage to SBRN still remains unsolved. The authors describe a technique they have been using since 2004 and, so far, operated on 17 wrists without a single incidence of damage to the SBRN.