Techniques in hand & upper extremity surgery
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Tech Hand Up Extrem Surg · Jun 2007
Civilian and detainee orthopaedic surgical care at an Air Force theater hospital.
This study is a retrospective analysis of the orthopaedic care rendered to Iraqi citizens, both military and civilian, and detainees in Balad, Iraq, at an Air Force theater hospital. Defining the scope of care for this patient group and emphasizing the differences in care provided for the endemic population in contrast to the rapidly air-evacuated Coalition injured combatant are the primary focus of the study. Approximately 50% of more than 1600 trauma/combat-related injury admissions to Air Force Theater Hospital in Balad, Iraq, from the period of September 2, 2005 through January 18, 2006, were Iraqi citizens and detainees. ⋯ Injured Coalition combatants received high-level damage control orthopaedic care and initial debridements, with external fixation as the single most common means of long-bone fracture stabilization. Civilians and detainees seen at Balad received the same high-level care and much, if not all, of their definitive care while at Air Force Theater Hospital. The care rendered to Iraqi citizens and detainees at an Air Force theater hospital is described, with multiple case examples that reflect a high level of definitive care offered in a war zone.
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Tech Hand Up Extrem Surg · Jun 2007
Transfer of the intercostal nerves to the nerve of the long head of the triceps to recover elbow extension in brachial plexus palsy.
Restoration of elbow flexion is the first goal in brachial plexus injuries. The current procedures using nerve grafts and nerve transfers authorize more extensive repairs, with different possible targets: shoulder, elbow extension, and hand. Elbow extension is important to stabilize the elbow without the contralateral hand and allows achieving a useful grasp. ⋯ Moreover, in case of absence or insufficient (M0 to M2 according to Medical Research Council scoring) recovery of elbow flexion strength by nerve surgery, the reinnervated triceps can be transferred. We present the technique of intercostal nerve transfer to the long head of the triceps branch to restore elbow extension in brachial plexus palsy. Results concerning 10 patients are presented.
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Tech Hand Up Extrem Surg · Mar 2007
Technique of the double nerve transfer to recover elbow flexion in C5, C6, or C5 to C7 brachial plexus palsy.
In C5, C6, or C5-to-C7 root injuries, many surgical procedures have been proposed to restore active elbow flexion. Nerve grafts or nerve transfers are the main techniques being carried out. The transfer of ulnar nerve fascicles to the biceps branch of the musculocutaneous nerve is currently proposed to restore active elbow flexion. ⋯ Therefore, the transfer of 1 fascicle of the median nerve to the brachialis branch of the musculocutaneous nerve may be proposed to improve strength of the elbow flexion. We describe the technique of this double transfer to restore elbow flexion. The results concerning 5 patients are presented.
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Tech Hand Up Extrem Surg · Mar 2007
Suture welding for arthroscopic repair of peripheral triangular fibrocartilage complex tears.
This report presents a method of arthroscopic repair of the peripheral triangular fibrocartilage tears by using ultrasonic suture welding technique, thus avoiding the need for traditional suture knots. This technique eliminates the potential causes of ulnar-sided wrist discomfort especially during the postoperative period. ⋯ At the final follow-up, the average wrist arc of motion was as follows: extension, 65 degrees; flexion, 56 degrees; supination, 80 degrees; pronation, 78 degrees; radial deviation, 12 degrees; and ulnar deviation, 25 degrees. Grip strength measured with a dynamometer (Jamar) averaged 81% of the contralateral side at the final evaluation (range, 53%-105%).
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Tech Hand Up Extrem Surg · Sep 2006
ReviewConfirmatory needle placement technique for scalene muscle block in the diagnosis of thoracic outlet syndrome.
Scalene muscle block is often performed to assist with the clinical differentiation of primary sources of pain and weakness in the upper limb when the differential diagnosis includes thoracic outlet syndrome. This presentation offers a simple clinical method to assess needle placement in the scalene muscle before an injection of local anesthetic which, if properly placed, weakens the scalene muscle and often leads to temporary relief of symptoms associated with neurovascular compression. An appropriate scalene block response provides assistance with medical decision making.