Techniques in hand & upper extremity surgery
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Tech Hand Up Extrem Surg · Jun 2014
Anatomic foveal reconstruction of the triangular fibrocartilage complex with a tendon graft.
An acute injury to the triangular fibrocartilage complex (TFCC) with avulsion of the foveal attachment can produce distal radioulnar joint (DRUJ) instability. The avulsed TFCC is translated distally so the footprint will be bathed in synovial fluid from the DRUJ and will become covered in synovitis. If the TFCC fails to heal to the footprint, then persistent instability can occur. ⋯ DRUJ ballottement under arthroscopic vision details the direction of instability, the functional tear pattern, and unmasks concealed tears. If the reverse hook test demonstrates a functional instability between the TFCC and the radius, then a foveal reconstruction is contraindicated, and a reconstruction that stabilizes the radial and ulnar aspects of the TFCC is required. The foveal reconstruction technique has the advantage of providing a robust anatomically based reconstruction of the TFCC to the fovea, which stabilizes the DRUJ and the ulnocarpal sag.
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Tech Hand Up Extrem Surg · Jun 2014
Percutaneous fixation of first metacarpal base fractures using locked K-wires: a series of 14 cases.
The treatment of choice for first metacarpal base fractures is surgical. Open fixation is stable but causes tendinous adhesions. Percutaneous fixation is minimally invasive but is often followed by secondary displacement. ⋯ No arthritis was noted, but the follow-up was short. Our results show that the Iselin technique using locked K-wires is minimally invasive, stable, allows immediate mobilization, and K-wire removal in the office. Its indications may be extended to all fractures of the base of the first metacarpal whether articular or extra-articular.
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Tech Hand Up Extrem Surg · Jun 2014
Exposure of the retroclavicular brachial plexus by clavicle suspension for birth brachial plexus palsy.
Surgical exploration and reconstruction of the brachial plexus requires adequate exposure beyond the zone of injury. In the case of extensive lesions, some authors advocate clavicle osteotomy for an extensile approach. Such an osteotomy introduces further morbidity and may impact upon the delicate nerve reconstruction. A new simple but effective method of clavicle elevation is described that provides access to the retroclavicular brachial plexus during exploration for birth brachial plexus palsy.
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Tech Hand Up Extrem Surg · Jun 2014
A loop suture for dynamic tendon transfer in the repair of chronic or acute extensor pollicis longus ruptures.
Ruptures of extensor pollicis longus (EPL) tendon may need a tendon transfer for repair, especially in chronic ruptures. We describe a novel transfer technique using a loop-tendon suture for dynamic transfer of extensor pollicis brevis to EPL. ⋯ No complications were observed, except for mild metacarpal-phalangeal stiffness in chronic ruptures. An early rehabilitation program may be started when no other associated injuries exist.