Techniques in Hand and Upper Extremity Surgery最新文献

{"title":"360-degree Arthroscopic Management of Scaphoid Pseudarthrosis: Description of Technique and Indications.","authors":"Ricardo Kaempf de Oliveira, João Pedro Brunelli, Márcio Aita, Pedro J Delgado","doi":"10.1097/BTH.0000000000000448","DOIUrl":"10.1097/BTH.0000000000000448","url":null,"abstract":"<p><p>Nonunion remains one of the main complications of scaphoid fractures, with no consensus being reached as to the best surgical technique for scaphoid pseudoarthrosis. Thus, different types of procedures for bone stability and biological stimulus for consolidation have been described. The use of arthroscopy for scaphoid pseudoarthrosis has advantages as it allows for treating associated injuries, preserving wrist proprioception by minimizing damage to the joint capsule and ligaments and not deteriorating the already fragile scaphoid vasculature, leading to a quick recovery. Arthroscopy was initially indicated for stable scaphoid pseudoarthroses, being used in all patterns of this condition, including unstable ones and those with flexion collapse. However, most scientific articles describe the use of arthroscopy only through the dorsal portals, creating technical difficulty in complete debridement of the site of pseudarthrosis and in placing bone graft. This study describes the 360-degree technique, which standardizes arthroscopy in scaphoid pseudoarthrosis treatment, allowing, with the use of dorsal, volar, and radial portals, direct approach to the entire circumference of the nonunion site, facilitating the debridement of the injury site, the correction of the scaphoid deformity, and the placement of a graft directly on the site of the defect, mainly in its volar region after correction of the flexion deformity. The 360-degree technique aims to help and standardize the arthroscopic procedure for scaphoid pseudarthrosis, creating a routine with defined surgery stages. Additional portals allow complete access to the entire nonunion site and better positioning of the bone graft under direct view.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"230-238"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9911360","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}

{"title":"Innovative Approach to Unicondylar Proximal Phalangeal Fracture Fixation: Combining Antegrade Intramedullary Pinning With Flexion Proximal Interphalangeal Joint Transfixation.","authors":"Hsueh-Min Kuo, Hui-Kuang Huang, Cheng-Yu Yin, Yi-Chao Huang, Jung-Pan Wang","doi":"10.1097/BTH.0000000000000449","DOIUrl":"10.1097/BTH.0000000000000449","url":null,"abstract":"<p><p>Various surgical techniques have been described for the fixation of displaced unicondylar fractures of the proximal phalanx, with K-wire and interfragmentary screws being the most commonly used. Although open reduction with joint exposure can provide direct visualization and allow for anatomic reduction, its potential drawbacks, such as joint stiffness and loss of range of motion, are of significant concern. We introduced a novel fixation technique for displaced unicondylar fractures of the proximal phalanx using antegrade intramedullary pinning and transfixation of the proximal interphalangeal joint, which is simple, effective, and does not require open reduction.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"249-252"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9929904","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}

{"title":"Flexor Pollicis Tendon Reconstruction With Allograft Tendon After Rupture: Technique and Case Series.","authors":"Sarah H Townsley, Alexander Y Shin","doi":"10.1097/BTH.0000000000000439","DOIUrl":"10.1097/BTH.0000000000000439","url":null,"abstract":"<p><p>Division or rupture of the flexor pollicis longus (FPL) tendon can occur secondary to direct injury, laceration, or attritional rupture. Attritional rupture is particularly common in the setting volar plate fixation of a distal radius fracture. FPL tendon discontinuity can be restored through either primary repair or reconstruction. Primary repair can be challenging if not done within the first few days after injury secondary to contraction of the FPL muscle with retraction of the proximal tendon. Repair in this environment can lead to tension across the repair site as well as necessary flexion of the interphalangeal joint to accommodate primary repair. In the setting of attritional rupture, the proximal and distal ends are typically not viable for direct repair. We present our preferred technique for restoration of the FPL tendon, which is reconstruction with an allograft tendon.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"225-229"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9929552","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}

{"title":"A Medial Approach That Provides Ample Exposure of the Coronoid for Fracture Management.","authors":"Jorge L Orbay, John J Heifner, Robert R L Gray, Francisco Rubio, Nathan A Hoekzema, Deana M Mercer","doi":"10.1097/BTH.0000000000000444","DOIUrl":"10.1097/BTH.0000000000000444","url":null,"abstract":"<p><p>We describe a medial approach to the coronoid where the flexor-pronator mass is released from its humeral origin by creating a proximally based tendinous flap. This technique facilitates access to the coronoid, preservation of the medial collateral ligament origin, and repair of the flexor-pronator mass. This approach has utility for all coronoid fracture variations but especially the O'Driscoll anteromedial subtype 3, which includes fractures of the sublime tubercle, the anteromedial facet, and the coronoid tip.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"214-219"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10651265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The \"Standing Peanut\" Scaphoid View: A Semi-supinated Radiographic View for Intraoperative Evaluation of Screw Placement in Scaphoid Waist Fractures.","authors":"A Luke Shiver, Doyle R Wallace, Joshua D Dolan, Keri L Jones, S Mark Fulcher","doi":"10.1097/BTH.0000000000000447","DOIUrl":"10.1097/BTH.0000000000000447","url":null,"abstract":"<p><p>Scaphoid waist fractures are the most common fracture of the scaphoid. Operative management is indicated with unstable fractures and often for nondisplaced waist fractures to decrease time to union and return to work/sport. Screw placement within the central axis of the scaphoid is paramount and correlates with outcomes. Assessment of intrascaphoid screw placement is classically done via intraoperative fluoroscopy. An additional fluoroscopic view is presented to assist in confirming implant positioning. Along with the standard anterioposterior, lateral, pronated oblique, and \"scaphoid\" view we obtain a \"standing peanut\" view for assessment of central screw placement. This view also allows for further evaluation of center/center positioning and better assessment of fixation crossing the fracture into the proximal pole. The \"standing peanut\" view is best obtained in a sequential manner beginning with the forearm in neutral rotation. First, the forearm is then supinated 30 degrees; next, the wrist is placed at 45 degrees of ulnar deviation. Then finally, 10 degrees of wrist extension. We utilize this additional intraoperative view in conjunction with the standard fluoroscopic views for assessing and ensuring center-center implant positioning, particularly within the proximal pole. When ensuring center-center positioning, we prefer this view as an adjunct view to the standard fluoroscopic views intraoperatively. It provides a beneficial view of the proximal pole delineating the number of screw threads that have obtained proximal pole purchase. We have found it particularly useful in the setting of scaphoid waist fracture nonunion with the classic 'humpback' deformity after correction with volar interposition grafting. Standard radiographic views may be misinterpreted regarding implant positioning if there remains any residual flexion. The view requires little in the way of training to obtain once appreciated and exposes the patient to minimal additional radiation.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"204-209"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9929905","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}

{"title":"Trick of the Scrub Nurse: Using the Fringe of a Glove as a Vessel Loop.","authors":"Saskia J H Brinkmann, Julia van Houten, Marco J P F Ritt","doi":"10.1097/BTH.0000000000000445","DOIUrl":"10.1097/BTH.0000000000000445","url":null,"abstract":"","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"253-254"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9910775","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}

{"title":"Arthrex Mini Tightrope Fixation for Chronic Distal Radioulnar Joint Instability.","authors":"Dan Hayward, Tyler Kastner, Justin Harder, Gracie Baum, Cameron Cox, Brendan J MacKay","doi":"10.1097/BTH.0000000000000446","DOIUrl":"10.1097/BTH.0000000000000446","url":null,"abstract":"<p><p>Chronic distal radioulnar joint (DRUJ) instability is a complex clinical condition that is difficult to treat. Currently, there is no gold standard treatment. We present a novel technique using Arthrex Mini Tightrope for DRUJ stabilization. In this case series, a 1.6 mm K-wire was passed transversely through the distal ulna and radius. The Mini Tightrope was inserted into the end of the K-wire and pulled through the bone tunnels. Appropriate tension was achieved to stabilize the joint according to individual laxity comparable to the contralateral side. Five patients (3 males and 2 females) comprised this pilot series, with a mean age of 27.1 years. All sustained a traumatic injury at an average of 12.4 months before surgery (range: 5 to 32 mo). In addition, 3 patients had central triangular fibrocartilage complex tears treated with arthroscopy at the time of Mini Tightrope placement. While one patient was lost to follow-up after 7 weeks postoperative due to incarceration, 4 patients demonstrated coronal and sagittal stability in the context of DRUJ motion and a satisfactory range of motion. The mean time for the return to work for the two patients who were laborers or normal activity postoperatively was 5.2 weeks (range: 1 to 16.4 wk). Unrestricted activity was generally allowed 8 weeks postoperatively but varied by patient. The same 4 patients underwent hardware removal at an average of 31 weeks (range: 15 to 44 wk). Although this is only a pilot series, this suggests that temporary Mini Tightrope stabilization of the DRUJ may be a viable solution while upholding the benefits of minimally invasive surgery.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"243-248"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10651277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9870106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Simple Surgical Technique for Arthroscopic Repair of Traumatic Radial-Side Peripheral TFCC Tear.","authors":"Babak Shojaie, Nagham Bazzi, Hossein Saremi","doi":"10.1097/BTH.0000000000000438","DOIUrl":"10.1097/BTH.0000000000000438","url":null,"abstract":"<p><p>Conventionally, The Triangular Fibrocartilage Complex (TFCC) surgical procedures are complex in nature with open explorations and long hospital stays not to mention the added costs and the psychological stress for both the surgeon and the patient. Nowadays, surgical procedures are looked at in a different scope with the rapid progress of arthroscopic technology and equipment. To elaborate, here we introduce a simple surgical technique for arthroscopic repair of traumatic radial - side peripheral TFCC tear. In spite of the various surgical techniques found in the literature, we just used a k-wire and a couple of needles in order to repair Radial-sided peripheral TFCC tear. the simplicity of the current technique, adequate satisfaction and eliminating the use of a targeting device, is what sets this apart. For emphasis, this technique is less time consuming and is cost-effective with satisfactory result.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"200-203"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9551930","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}

{"title":"Treatment of Fourth and Fifth Carpometacarpal Fracture-Dislocations in Punching Injuries With Motion-Sparing Hamate Fixation Spring Plates: \"Rabbit Ears\" Plating.","authors":"Shelby R Smith, Elizabeth Santucci, Paul M Lamberti","doi":"10.1097/BTH.0000000000000443","DOIUrl":"10.1097/BTH.0000000000000443","url":null,"abstract":"<p><p>Punching injuries to the hand are frequent and can result in fourth and fifth carpometacarpal (CMC) fracture-dislocations. Fourth and fifth CMC fracture-dislocations are unstable, and dorsal metacarpal dislocations are most common. Operative management for maintaining reduction of the unstable fracture-dislocation was closed reduction and percutaneous pinning; however, in delayed fractures, open reduction is necessary. We report on a plating technique used for acute and delayed, unstable fourth and/or fifth CMC fracture-dislocations. This method of plating is novel and allows for physiological motion at the CMC joint through a dorsal buttressing mechanism while maintaining joint reduction. The range of motion begins within the first week postoperatively, and full composite fist formation and digital extension occur 4 to 6 weeks postoperatively. This novel technique affords an alternative effective surgical treatment option with excellent outcomes for patients presenting with fourth and fifth CMC fracture-dislocations up to 12 weeks following the injury.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"239-242"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9823337","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}

{"title":"A Novel Method of Spinal Accessory Nerve Banking Using Silicone Catheter for Functioning Free Muscle Transfer.","authors":"Mithun Pai G, Anil K Bhat, Ashwath M Acharya","doi":"10.1097/BTH.0000000000000441","DOIUrl":"10.1097/BTH.0000000000000441","url":null,"abstract":"<p><p>In secondary brachial plexus reconstruction, exploring an area that has already been operated on is challenging and time-consuming for a surgeon, especially in centers with a single-team approach. Due to their inertness and lack of adverse effects, silicone Foley catheters were used successfully during the reconstruction of flexor tendons. Based on the concept, we have achieved an acceptable functional outcome by banking the spinal accessory nerve in a silicon catheter for gracilis reanimation, which permits smooth dissection, maintains the length, and shortens the operating time for subsequent reconstruction. Level of Evidence: Level V.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":"210-213"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9683842","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}