Techniques in hand & upper extremity surgery
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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.
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Tech Hand Up Extrem Surg · Dec 2008
ReviewArthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability.
There is still controversy regarding the value of arthroscopic suture of triangular fibrocartilage complex (TFCC) peripheral tears compared with open transosseous repair because only the latter method restores foveal insertions of TFCC in case of distal radioulnar joint (DRUJ) instability. Five classes of TFCC peripheral tears are recognized in a treatment-oriented algorithm based on arthroscopic findings, and indications to proper treatment are set accordingly. Complete repairable tears (class 2) and proximal repairable tears (class 3) are associated with DRUJ instability and require foveal reattachment of the TFCC. ⋯ This Direct Foveal portal is used to prepare the ligament and bone and to drill and insert a suture anchor loaded with a pair of sutures. Under arthroscopic vision, a suture is passed through each limb of the ligament and tied using a small knot-pusher. This arthroscopic technique restores original TFCC anatomy and adequate DRUJ stability with less morbidity and potentially accelerated rehabilitation compared with open repair.
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Tech Hand Up Extrem Surg · Sep 2008
Management of hand palsies in isolated C7 to T1 or C8, T1 root avulsions.
Thirteen patients were operated on for hand palsies in cases of C7 to T1 or C8, T1 root avulsions. Finger flexion and intrinsic function were paralyzed in all patients. Finger extension was paralyzed in 12 patients. ⋯ Motor nerve surgery is not possible in these cases. However, surgery remains a challenge and may greatly improve these patients. Therefore, we propose a new tendon transfer and sensory neurotization protocol.
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Tech Hand Up Extrem Surg · Jun 2008
Groin flap immobilization by axillary brachial plexus block anesthesia.
Pedicled groin flaps are still widely used as soft tissue coverage in hand surgery. Various methods have been described for immobilization of flaps, such as Ace wraps, plaster, and external fixators. The hands of 5 females and 12 males, totaling 17 patients, with severe injury were reconstructed with groin flaps between 2001 and 2005. ⋯ A combination of axillary brachial plexus block plus general anesthesia had advantages in the prevention of pedicle tension or torsion during the initial recovery period. Reduction of general anesthesia time and improvement of postoperative pain were also observed. Axillary brachial plexus block and general anesthesia are a preferred combination for patients undergoing groin flap operations.