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Transfer of Motor Fascicle From the Ulnar Nerve to the Axillary Nerve by Posterior Access. New Approach. 通过后方入路将运动筋膜从尺神经转移到腋神经。新方法。
Techniques in Hand and Upper Extremity Surgery Pub Date : 2024-09-01 DOI: 10.1097/BTH.0000000000000483
Luis Carlos Diaz, Enrique Vergara-Amador
{"title":"Transfer of Motor Fascicle From the Ulnar Nerve to the Axillary Nerve by Posterior Access. New Approach.","authors":"Luis Carlos Diaz, Enrique Vergara-Amador","doi":"10.1097/BTH.0000000000000483","DOIUrl":"10.1097/BTH.0000000000000483","url":null,"abstract":"<p><strong>Abstract: </strong>We describe a new technique of transferring the motor branch ulnar nerve (UN) to the axillary nerve (AN) by posterior approach. Three patients with C5, C6, and C7 brachial plexus injury were operated. By supraclavicular approach, the spinal accessory was transferred to the suprascapular nerve. By posterior approach in the arm, the AN was identified within the quadrilateral space, and the UN was identified medially with intrafascicular dissection of a motor fascicle, which is lifted to 4 cm in length and transferred to AN. By medial approach, a motor branch from the median nerve is transferred to the biceps nerve. At a follow-up minimum of 10 months, the maximum abduction was 160 and the minimum 90 degrees. This technique, neurotization of the AN with fascicles of the UN, spinal accessory to suprascapular nerve, and median nerve branch to biceps nerve are indicated in C5-C7 avulsion when there is no radial nerve available.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"171-176"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Combined Wrist Extensor Tenodesis and Tendon Transfers for Severe Spastic Flexed Wrist Deformity: Surgical Technique and Case Series. 针对严重痉挛性屈腕畸形的联合腕伸肌腱腱鞘切除术和肌腱转移术：手术技术和病例系列。
Techniques in Hand and Upper Extremity Surgery Pub Date : 2024-09-01 DOI: 10.1097/BTH.0000000000000479
Paula A Pino, Christopher S Crowe, Kitty Y Wu, Peter C Rhee
{"title":"Combined Wrist Extensor Tenodesis and Tendon Transfers for Severe Spastic Flexed Wrist Deformity: Surgical Technique and Case Series.","authors":"Paula A Pino, Christopher S Crowe, Kitty Y Wu, Peter C Rhee","doi":"10.1097/BTH.0000000000000479","DOIUrl":"10.1097/BTH.0000000000000479","url":null,"abstract":"<p><p>Spastic wrist flexion deformities both limit the functional use of the hand for grasp and pinch producing a stigmatizing appearance. Tendon transfers and total wrist arthrodesis are treatment options for this condition depending on the patient's characteristics, the latter the most commonly used in patients with severe wrist flexion deformities. Tendon transfers alone in this scenario have the tendency for recurrent deformity due to tenorrhaphy failure or soft tissue creep and resultant loss of tension. Total wrist arthrodesis is a more invasive procedure, which can have hardware or fusion problems and that is irreversible. We propose a novel technique that incorporates a distally based wrist extensor tendon slip and suture tape tenodesis to the distal radius. The rationale of this technique is to act as a protective, internal splint to prevent recurrent deformity after primary or revision tendon transfer for moderate to severe spastic flexed wrist deformities, avoiding the need to perform a total wrist arthrodesis.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"154-159"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Posterior Interosseous Artery Adipofascial Flap for the Management of Distal Radioulnar Joint Osteoarthritis. 骨间后动脉脂肪筋膜瓣治疗桡骨远端关节骨关节炎
Techniques in Hand and Upper Extremity Surgery Pub Date : 2024-09-01 DOI: 10.1097/BTH.0000000000000486
Aleksandar Lovic, Javier Pérez-Rodríguez, Pedro Bolado-Gutiérrez
{"title":"Posterior Interosseous Artery Adipofascial Flap for the Management of Distal Radioulnar Joint Osteoarthritis.","authors":"Aleksandar Lovic, Javier Pérez-Rodríguez, Pedro Bolado-Gutiérrez","doi":"10.1097/BTH.0000000000000486","DOIUrl":"10.1097/BTH.0000000000000486","url":null,"abstract":"<p><strong>Level of evidence: </strong>Level IV-therapeutic.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"177-181"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Flexor Pollicis Longus Reconstruction After Rupture Following Distal Radius Fixation With Volar Locking Plate: A Technique Guide. 用桡骨远端锁定钢板固定桡骨断裂后的屈肌重建：技术指南。
Techniques in Hand and Upper Extremity Surgery Pub Date : 2024-09-01 DOI: 10.1097/BTH.0000000000000474
Arakua Welbeck, Charles A Goldfarb, Ryan P Calfee, Christopher J Dy
{"title":"Flexor Pollicis Longus Reconstruction After Rupture Following Distal Radius Fixation With Volar Locking Plate: A Technique Guide.","authors":"Arakua Welbeck, Charles A Goldfarb, Ryan P Calfee, Christopher J Dy","doi":"10.1097/BTH.0000000000000474","DOIUrl":"10.1097/BTH.0000000000000474","url":null,"abstract":"<p><p>Flexor pollicis longus rupture is an uncommon but potentially debilitating complication after volar locking plate fixation of distal radius fractures, occurring secondary to tendon attrition against the implant. This nature of tendon injury typically precludes primary repair. This paper will illustrate 2 reconstruction techniques, an interpositional tendon graft and a tendon transfer, that have been utilized successfully by the authors.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"124-128"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140185952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Revision of Failed Nonanatomic Extensor Retinacular Stabilization of the Unstable ECU Tendon: Surgical Technique and Case Series. 对不稳定 ECU 肌腱的非解剖性伸肌腱网状结构稳定失败进行翻修：手术技术和病例系列。
Techniques in Hand and Upper Extremity Surgery Pub Date : 2024-06-01 DOI: 10.1097/BTH.0000000000000467
Stuart W Jones, Fiona C Campbell, Douglas A Campbell
{"title":"Revision of Failed Nonanatomic Extensor Retinacular Stabilization of the Unstable ECU Tendon: Surgical Technique and Case Series.","authors":"Stuart W Jones, Fiona C Campbell, Douglas A Campbell","doi":"10.1097/BTH.0000000000000467","DOIUrl":"10.1097/BTH.0000000000000467","url":null,"abstract":"<p><p>Nonanatomic surgical stabilization of the unstable extensor carpi ulnaris (ECU) tendon (where the subluxing tendon is re-routed away from the bony groove in the distal ulna) utilizes a flap of extensor retinaculum to create a new retaining sheath that will stabilize the tendon during forearm rotation movements. When this surgery fails, the extensor retinaculum tissue does not regenerate with sufficient structural strength to be used again. Previously, a different approach has then been needed for revision surgery, often using more complex surgical techniques with a substantially greater impact on recovery. We describe a highly reliable yet simple method of using local soft tissue to adequately restabilize the subluxing ECU tendon in cases where an extensor retinacular flap has already been used. We report the results of this technique in 4 patients, all of whom returned to jobs/hobbies where ECU instability was a considerable functional risk.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"67-73"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138805351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ligament Sparing Elbow Hemiarthroplasty: A Novel Technique for the Management of Distal Humeral Fractures. 保留韧带的肘关节半关节成形术：治疗肱骨远端骨折的新技术。
Techniques in Hand and Upper Extremity Surgery Pub Date : 2024-06-01 DOI: 10.1097/BTH.0000000000000469
Joseph Saleh, Ethan D Patterson, Corinne Aillerie, Patrick Tohmé, Neil J White
{"title":"Ligament Sparing Elbow Hemiarthroplasty: A Novel Technique for the Management of Distal Humeral Fractures.","authors":"Joseph Saleh, Ethan D Patterson, Corinne Aillerie, Patrick Tohmé, Neil J White","doi":"10.1097/BTH.0000000000000469","DOIUrl":"10.1097/BTH.0000000000000469","url":null,"abstract":"<p><p>Intra-articular distal humerus fractures present various challenges with a wide array of treatment options. Open reduction internal fixation remains the treatment of choice. In older patient populations with poor bone quality and short-end segment fractures with articular comminution, open reduction internal fixation, however, may bring on unsurmountable technical challenges. Total elbow arthroplasty and elbow hemiarthroplasty (EHA) may offer superior functional outcomes in these cases. During EHA for fractures, the medial and lateral columns are reconstructed with the collateral ligaments to restore elbow stability. We hypothesize that in coronal sheer fracture patterns where the columns are intact, maintaining the native collateral ligaments and columns will provide both an anatomic and stable elbow joint. We introduce the ligament sparing EHA technique for unreconstructible coronal shear fractures. We describe this novel technique and compare our postoperative outcomes in 2 patients who underwent this surgery to those described in the literature. The postoperative Disabilities of the Arm, Shoulder, and Hand scores for the 2 patients were 13.8 and 10.3, respectively. The Mayo Elbow Performance Score for the 2 patients were 80 and 85, respectively. The operative arm presented a grip strength of 82% and 89% when compared with the contralateral arm, for the patients respectively. The range of motion varied between 78% and 100% of the contralateral arm for both patients. Although our results are promising and the ligament sparing EHA technique may be a more anatomic option in certain fracture patterns, further research with larger cohorts and multiple surgeons is needed to reinforce our results.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"92-95"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140176933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Surgical Technique: Brachioradialis to Extensor Carpi Radialis Longus and Brevis Nerve Transfers for Tetraplegia. 手术技术：治疗四肢瘫痪的肱肌至桡侧伸肌和肱拇趾神经转移术。
Techniques in Hand and Upper Extremity Surgery Pub Date : 2024-06-01 DOI: 10.1097/BTH.0000000000000471
Chao Long Azad, Nicholas A Orlando, Allan J Belzberg, Sami H Tuffaha
{"title":"Surgical Technique: Brachioradialis to Extensor Carpi Radialis Longus and Brevis Nerve Transfers for Tetraplegia.","authors":"Chao Long Azad, Nicholas A Orlando, Allan J Belzberg, Sami H Tuffaha","doi":"10.1097/BTH.0000000000000471","DOIUrl":"10.1097/BTH.0000000000000471","url":null,"abstract":"<p><p>Improving upper extremity function in high cervical spinal cord injury (SCI) patients with tetraplegia is a challenging task owing to the limited expendable donor muscles and nerves that are available. Restoring active wrist extension for these patients is critical because it allows for tenodesis grasp. This is classically achieved with brachioradialis (BR) to extensor carpi radialis brevis (ECRB) tendon transfer, but outcomes are suboptimal because BR excursion is insufficient and its origin proximal to the elbow further limits the functionality of the tendon transfer, particularly in the absence of elbow extension. As an alternative approach to restore wrist extension in patients with ICSHT group 1 SCI, we present the first clinical report of the BR to extensor carpi radialis longus (ECRL) and BR to ECRB nerve transfers.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"88-91"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139973909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Greco-Nice-Lag: Lag Screw and Double Nice Knot Fixation for Spiral Proximal Phalanx Fractures-Connecting the Shoulder to the Finger. Greco-Nice-Lag: Lag螺钉和双Nice结固定治疗螺旋形近端指骨骨折-连接肩膀和手指。
Techniques in Hand and Upper Extremity Surgery Pub Date : 2024-06-01 DOI: 10.1097/BTH.0000000000000462
Victor E Greco, Ethan Wiesler
{"title":"The Greco-Nice-Lag: Lag Screw and Double Nice Knot Fixation for Spiral Proximal Phalanx Fractures-Connecting the Shoulder to the Finger.","authors":"Victor E Greco, Ethan Wiesler","doi":"10.1097/BTH.0000000000000462","DOIUrl":"10.1097/BTH.0000000000000462","url":null,"abstract":"<p><p>A colorful array of fixation options exists for the management of operative long oblique or spiral proximal phalanx fractures. These include lag screws, intramedullary devices, Kirschner wires, dorsal or lateral plating, and cerclage wiring. The \"Nice double-suture knot,\" described by Boileau and colleagues, is a sliding, self-stabilizing knot initially created for tuberosity fixation in the shoulder. Nice knot cerclage has been described in shoulder arthroplasty, as well as for comminuted patella fractures. Here we describe a technique utilizing a single lag screw with 2 Nice knot cerclage sutures for the treatment of a spiral proximal phalanx fracture in a 65-year-old active smoker with osteopenia.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"110-114"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138291916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Graftless Syndactyly Release. 无嫁接畸形释放。
Techniques in Hand and Upper Extremity Surgery Pub Date : 2024-06-01 DOI: 10.1097/BTH.0000000000000472
Jia Choong, Michalis Hadjiandreou, Pauline McGee, Wee Leon Lam
{"title":"Graftless Syndactyly Release.","authors":"Jia Choong, Michalis Hadjiandreou, Pauline McGee, Wee Leon Lam","doi":"10.1097/BTH.0000000000000472","DOIUrl":"10.1097/BTH.0000000000000472","url":null,"abstract":"<p><p>Syndactyly release aims to address skin deficits by resurfacing web spaces and sides of digits to allow independent digital motion while minimizing the risk of web creep and scar contractures. Conventional methods include the use of a dorsal and interdigitating flaps with full-thickness skin grafts. More recently, there have been several descriptions of \"graftless\" syndactyly release without skin grafts, thus avoiding a further (usually distant) donor site. However, the indications of when and when not to use these techniques remain unclear. In addition, the inevitable scarring from extra recruitment of local adjacent skin is perhaps underemphasized. In this article, we revisit the trilobed flap technique which serves to balance the amount of skin needed for resurfacing digits while minimizing local donor site scarring. The geometry and nuances of the flap inset are illustrated in detail to guide those embarking on this technique. The trilobed syndactyly release technique is a reproducible, safe, and reliable method for the release of simple syndactyly.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":"28 2","pages":"51-59"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Artificial Intelligence: Understanding Current Limitations and Future Potentials. 人工智能：了解当前的局限和未来的潜力。
Techniques in Hand and Upper Extremity Surgery Pub Date : 2024-06-01 DOI: 10.1097/BTH.0000000000000482
Alexander Y Shin
{"title":"Artificial Intelligence: Understanding Current Limitations and Future Potentials.","authors":"Alexander Y Shin","doi":"10.1097/BTH.0000000000000482","DOIUrl":"10.1097/BTH.0000000000000482","url":null,"abstract":"","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":"28 2","pages":"49-50"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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