Techniques in hand & upper extremity surgery
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Tech Hand Up Extrem Surg · Sep 2012
Nail hooks and elastic bands external dynamic traction for fractures of the proximal interphalangeal joint.
Intra-articular fractures of the proximal interphalangeal joint remain a treatment challenge for hand specialists. The purpose of this investigation was to review the results of 12 patients, 6 men and 6 women (average age, 21 y), who were treated using the nail hooks and elastic bands external dynamic traction technique for their intra-articular proximal interphalangeal joint fractures. Of the total 12 fractures, 6 involved the proximal phalanx and 6 involved the middle phalanx. ⋯ All patients were able to return to their preinjury level of functioning. Nail hooks and elastic bands external dynamic traction provides an effective treatment for intra-articular proximal interphalangeal joint fractures. It is an inexpensive, easily applied, nonoperative method of treatment.
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Tech Hand Up Extrem Surg · Sep 2012
Arthroscopic "cuff-sparing" percutaneous (CUSP) technique for posterior instability repair in the beach-chair position.
Arthroscopic posterior labral repair and capsular shift procedures are technically difficult in the beach-chair position as compared with the lateral decubitus position. Optimal visualization in the beach-chair position, and anchor placement in the posterior glenoid rim, necessitate various lateral trans-cuff portals, and these may result in damage to the rotator cuff tendons. ⋯ Technical variants of the procedure include: (1) a "CUSP shift" technique (combined labral repair and capsular shift); (2) a "CUSP-stitch" technique (isolated labral repair without a capsular shift); and (3) a "posterior labroplasty" technique for reconstruction of deficient posterior labral tissue. Technical tips to avoid neurological injury, and a detailed rehabilitation protocol are presented.
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Tech Hand Up Extrem Surg · Mar 2012
Orthogonal biplanar fluoroscopy-guided percutaneous fixation of a coracoid base fracture associated with acromioclavicular joint dislocation.
Coracoid process fractures that involve the coracoid base (inferior pillar) without a concomitant rupture of the coracoclavicular ligaments can destabilize the acromioclavicular joint with its subsequent dislocation; prophylactic or therapeutic operative treatment involving open reduction and internal fixation has been traditionally recommended. This report presents a new technique of percutaneous reduction and stabilization of the coracoid fracture with indirect acromioclavicular joint reduction under fluoroscopic guidance; biplanar visualization of coracoid process anatomy is obtained using 2 specific radiographic/fluoroscopic-beam angulations (Bhatia views), and this permits a guided placement of screws for controlled reduction of this dual injury. The technique is based on the author's original work on coracoid process anatomy and development of radiographic views for orthogonal visualization of coracoid pillars in their entirety. Technical tips to facilitate percutaneous fracture fixation and to avoid potential complications are discussed.
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Tech Hand Up Extrem Surg · Dec 2011
Open reduction and internal fixation for dorsal fracture dislocations of the proximal interphalangeal joint using a miniplate.
Various operative techniques have been described for unstable dorsal fracture dislocations of the proximal interphalangeal (PIP) joint with articular involvement. However, this injury still remains a therapeutic challenge for hand surgeons because no single technique guarantees successful outcomes. We performed a novel procedure using a low-profile miniplate, which allows for anatomic reduction, rigid internal fixation, and early finger joint motion. ⋯ Two patients had restricted active distal interphalangeal joint flexion owing to tendon adhesion resulting from the use of a relatively long plate in the first few cases of this series. No major complications were reported for the other 16 patients. We describe the surgical technique, indications, complications, and postoperative management for this technique.
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Tech Hand Up Extrem Surg · Sep 2011
Experience with distal finger replantation: a 20-year retrospective study from a major trauma center.
More than 40 years has passed since the first successfu0l replantation and thousands of fingers have been salvaged. We present our experience with distal finger replantation during 20 years of surgery. From 1990 to 2010, 420 replantations were performed; 64 of 420 cases were distal finger replantations. We discuss the indications, techniques, and outcomes of these difficult cases. ⋯ Our 20-year experience with distal finger replantation showed a success rate of 87%. On account of cultural beliefs amputation is not tolerated well in Eastern cultures. Thus, a high rate of single finger replantations is seen. The success rate is similar to that of the literature and cosmetic results are far superior to replantation in other zones.