Techniques in hand & upper extremity surgery
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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.
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Tech Hand Up Extrem Surg · Mar 2014
Posterior minimally invasive plate osteosynthesis for humeral shaft fractures.
Fractures of the humeral shaft are common. Most of them can be successfully treated without surgery. In some cases, an operative intervention may offer faster and better functional results. ⋯ However, when the fracture is near the olecranon fossa, anterior approach is not possible as there is not enough space in the distal fragment to insert the amount of screws required to achieve stability. In this case, the posterior approach may be a good option for treatment. This article describes the MIPO technique through a posterior approach for the treatment of humeral shaft fractures.
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The most common site of ulnar nerve compression is within the cubital tunnel. Surgery has historically involved an open cubital tunnel release with or without transposition of the nerve. A comparative study has demonstrated that endoscopic decompression is as effective as open decompression and has the advantages of being less invasive, utilizing a smaller incision, producing less local symptoms, causing less vascular insult to the nerve, and resulting in faster recovery for the patient. ⋯ Extra portals are used to allow retractors to be inserted, the medial intermuscular septum to be excised, cautery to be used, and a tape to control the position of the nerve. In our experience this minimally invasive technique provides good early outcomes. This report details the indications, contraindications, surgical technique, and rehabilitation of the endoscopic ulnar nerve release and transposition.
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Tech Hand Up Extrem Surg · Dec 2013
Case ReportsApplication of an antibiotic intramedullary nail in the management of a large metacarpal bone defect.
Contaminated wounds and infected nonunions of the hand are not amenable to primary internal fixation and grafting. Antibiotic-impregnated cement intramedullary nails have been used in the lower extremity in the treatment of these fractures but have not been described in the hand. ⋯ We describe an alternative technique for the management of skeletal defects in a contaminated wound bed in the hand using readily available operating room equipment. The antibiotic-impregnated cement intramedullary nail can be placed temporarily until definitive internal fixation and grafting occur.