Techniques in hand & upper extremity surgery
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Tech Hand Up Extrem Surg · Jun 2011
Clinical TrialPurse-string suture as a complementary technique with conventional flaps in repairing fingertip amputation.
The main aim of the treatment in fingertip amputations is to establish the functional and aesthetic construction of the fingertip. The aim of this study is to discuss how to use purse-string suture as a complementary technique accompanying conventional flaps repair in fingertip amputation. Fifty-four patients with fingertip amputations on the nail bed referred to our center for fingertip reconstruction. ⋯ The nail and finger contour are important for achieving a satisfying aesthetic and functional result. We believe that this new complementary technique could be an easy way for reaching this end. It is recommended that this technique be applied to all fingertip injuries to preserve the nail.
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Tech Hand Up Extrem Surg · Sep 2010
Radial column and volar plating (RCVP) for distal radius fractures with a radial styloid component or severe comminution.
Individual fracture patterns demand specific and adequate fixation. Locked volar plating has become popular in the operative fixation of distal radius fractures. ⋯ The use of locked radial column plates or Kirschner (K) wires provides additional radial column fixation and allows the surgeon to tailor the amount of fixation to the individual fracture pattern. Outlined here is the technique of combining volar plating with locked radial column plating or K-wire fixation, as well as a step-by-step outline to help achieve fracture reduction.
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Tech Hand Up Extrem Surg · Sep 2010
Scaphoid hemiresection and arthrodesis of the radiocarpal joint.
Radiocarpal arthritis is frequently the result of trauma and/or degenerative disease. The leading causes are malunited or nonunited fractures of the radius or scaphoid, radiocarpal or intercarpal dislocations or dissociations, or a form of primary osteoarthritis or inflammatory arthritis. Management focuses on reducing pain, increasing function, and preserving some degree of motion when possible. ⋯ The choice of the procedure depends on which articulation(s) are diseased and which are spared. Motion-sparing procedures require healthy articular cartilage at the site of preserved motion. This paper described scaphoid hemiresection and arthrodesis of the radiocarpal joint, the SHARC procedure.
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Tech Hand Up Extrem Surg · Jun 2010
Brachioradialis flap for coverage after elbow flexion contracture release.
Release of a chronic elbow flexion contracture such as that seen in spastic or congenital conditions may result in an anterior soft tissue defect that leaves the antecubital neurovascular structures exposed. Although the skin defect can most often be managed by local rotation or transposition flaps, protection of the deep structures requires more than a skin graft or thin flaps. ⋯ It has a robust vascular anatomy that can support a skin paddle if necessary, and there is minimal functional morbidity when it is removed. We find this technique to be a useful strategy to simplify wound closure in the antecubital fossa.
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Tech Hand Up Extrem Surg · Jun 2010
Surgical treatment of posterolateral rotatory instability of the elbow in children.
Posttraumatic instability of the elbow in children can be a very challenging problem to diagnose and treat. Posterolateral rotatory instability (PLRI) has been well described with regard to diagnosis and treatment in adults but best clinical practices are less clear for pediatric cases. ⋯ This report presents an overview of the current practice in the diagnosis and treatment of PLRI in the pediatric population. Indications for surgical treatment and step-by-step surgical instructions for both ligamentous repair and reconstruction are presented.