Techniques in hand & upper extremity surgery
-
Tech Hand Up Extrem Surg · Mar 2018
Interlocking K Wires Followed by Immediate Mobilization for Fractures of the Hand.
We describe a technique of interlocking Kirschner wires to improve stability after fixation of fractures of the hand. This enables immediate mobilization of the injured fingers thus reducing the need for prolonged postoperative physical therapy and consequently diminishing chances of posttraumatic stiffness. ⋯ The technique has proven to be simple, versatile, and cost-effective. Patient compliance and satisfaction has been high and results have been gratifying.
-
Tech Hand Up Extrem Surg · Dec 2017
The Blocking Flap for Ulnar Nerve Instability After In Situ Release: Technique and a Grading System of Ulnar Nerve Instability to Guide Treatment.
In situ ulnar nerve release has been gaining popularity as a simple, effective, and low-morbidity procedure for the treatment of cubital tunnel syndrome. One concern with the technique is how to manage the unstable ulnar nerve after release. ⋯ I propose such a grading system, as well as a new technique to stabilize the unstable ulnar nerve. The blocking flap technique consists of raising a rectangular flap off the flexor/pronator fascia and attaching it to the posterior subcutaneous flap so that it blocks the nerve from subluxation/dislocation.
-
Tech Hand Up Extrem Surg · Sep 2017
Anatomic Reconstruction of Distal Radioulnar Ligaments With Tendon Graft for Treating Distal Radioulnar Joint Instability: Surgical Technique and Outcome.
Among the various reasons for chronic posttraumatic ulnar-sided wrist pain, instability of the distal radioulnar joint (DRUJ) has recently received major attention and finally achieved fundamental progress in understanding thanks to anatomic and biomechanical studies. This has resulted in more physiological and successful treatment methods compared with the historic options. One and the most dramatic surgical technique consists in the replacement of the main ligamentous stabilizer of the DRUJ, the so-called triangular fibrocartilage, with a tendon graft. ⋯ There was however a loss of forearm rotation of 20 degrees in average (pronation-8 degrees; supination-12 degrees), whereas the range of motion of the wrist and grip strength remained unchanged. We did not find any influence on the result by performing simultaneous ulnar shortening osteotomy, the duration of cast immobilization or the positioning in the cast. There were no postoperative complications, 4 failed cases needed secondary procedures (2× rereconstruction, 2× Sauvé-Kapandji-operation).
-
Tech Hand Up Extrem Surg · Dec 2016
Targeted Muscle Reinnervation for Transradial Amputation: Description of Operative Technique.
Targeted muscle reinnervation (TMR) is a revolutionary surgical technique that, together with advances in upper extremity prostheses and advanced neuromuscular pattern recognition, allows intuitive and coordinated control in multiple planes of motion for shoulder disarticulation and transhumeral amputees. TMR also may provide improvement in neuroma-related pain and may represent an opportunity for sensory reinnervation as advances in prostheses and haptic feedback progress. Although most commonly utilized following shoulder disarticulation and transhumeral amputations, TMR techniques also represent an exciting opportunity for improvement in integrated prosthesis control and neuroma-related pain improvement in patients with transradial amputations. As there are no detailed descriptions of this technique in the literature to date, we provide our surgical technique for TMR in transradial amputations.