Techniques in hand & upper extremity surgery
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Tech Hand Up Extrem Surg · Jun 2013
Treatment of intra-articular distal radius fractures by the volar intrafocal Kapandji method: a case series.
At present, the most common treatment for intra-articular fractures with a volar fragment is open reduction and internal fixation with a volar locking plate. This manuscript describes and evaluates the safety and efficacy of a modified Kapandji technique with insertion of a volar Kirschner wire for osteosynthesis of intra-articular distal radius fractures with a volar fragment. Four patients treated with the "volar Kapandji technique" completed follow-up of at least 12 (12 to 54) months. ⋯ The mean loss of flexion was 13.7 (0 to 30) degrees, the mean loss of extension was 10 (0 to 30) degrees, the mean loss of supination was 0 degrees, and the mean loss of pronation was 10 (0 to 20) degrees. There was no loss in dorsal angulation, radial inclination, or radial length compared with the other hand. No early or late complications were recorded.
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Tech Hand Up Extrem Surg · Jun 2013
2,3 intercompartmental supraretinacular artery pedicled vascularized bone graft for scaphoid nonunions.
Scaphoid nonunion is a complex problem that may continue to exist despite conventional methods of bone grafting and internal fixation. Vascularized bone grafting has been proposed as a treatment option for scaphoid nonunions with or without avascular necrosis of the proximal pole. Zaidemberg and colleagues first introduced the dorsal distal radius graft that has gained considerable popularity in the past 2 decades. ⋯ The use of rigid internal fixation with screws also permitted early wrist range of motion and shorter periods of immobilization. In this article, we describe our surgical technique of harvesting the 2,3 intercompartmental supraretinacular artery pedicled vascularized bone graft. The anatomy, indications, contraindications, and complications of treatment are also detailed.
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A groin flap is an axial-patterned cutaneous flap based on the superficial circumflex iliac arteriovenous system, which can provide soft-tissue coverage to defects on any aspect of the hand and the distal two thirds of the forearm. One of the presumed disadvantages of the pedicled groin flap is the discomfort experienced by the patient during the time required before flap division. ⋯ This technique avoids a lengthy flap and tubing, increases the patients comfort, and also makes the division and inset of the flap easier. As described, we have found this method simple and easy to duplicate.
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Carpal tunnel syndrome is a common peripheral nerve disease, often requiring surgical intervention. After the first description of endoscopic carpal tunnel release 20 years ago, several endoscopic techniques have been described. ⋯ We developed a new guiding cannula with raised borders, which will prevent accidental injury to the median nerve. A single-portal anterograde technique, to release the transverse carpal ligament, is described with the use of this new guiding device.
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Tech Hand Up Extrem Surg · Mar 2013
Treatment of middle-third clavicle fractures using anterior plating with a dynamic compression plate (DCP).
Significantly displaced midshaft clavicle fractures can be managed operatively to restore anatomy and allow early mobilization. Several techniques have described using precontoured anatomically designed plates placed on the superior surface of the bone or reconstruction plates contoured by the surgeon placed either superiorly or anteriorly. We describe the use of the dynamic compression plate placed anteriorly on the clavicle in treating these fractures and discuss the relative advantages of this technique. We have a case series of 8 patients over a 2-year period, who were followed up and all went on to successful fracture union.