Jose Couceiro, Manuel R Sanchez-Crespo, Higinio Ayala, Fernando Del Canto, Guillermo Menendez, Marta Fernandez-Sampedro
{"title":"One-stage Distal Interphalangeal Joint Fusion With External Fixator for the Treatment of Septic Joint Arthritis.","authors":"Jose Couceiro, Manuel R Sanchez-Crespo, Higinio Ayala, Fernando Del Canto, Guillermo Menendez, Marta Fernandez-Sampedro","doi":"10.1097/BTH.0000000000000361","DOIUrl":"https://doi.org/10.1097/BTH.0000000000000361","url":null,"abstract":"<p><p>Septic joint arthritis in the small joints of the hand can be caused by penetrating trauma, ruptured ganglion cysts, or open joint dislocations, among others. The use of external fixation for the treatment of this condition has been reported in the past as a means of temporary joint distraction, or for secondary fusion procedures. In the present article, the authors describe a surgical technique involving the use of a low-cost external fixator for the primary arthrodesis of infected distal interphalangeal joints of the hand. The external fixator is fabricated with simple materials, threaded Kirshner wires, bone cement, and an insulin syringe, which the authors have used to fuse the distal interphalangeal joint primarily when destroyed by septic arthritis.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":"26 2","pages":"78-83"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10477972","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}
Sailesh V Tummala, Kade S McQuivey, Nathaniel B Hinckley, Krista A Goulding, Kevin J Renfree
{"title":"Proximal Humeral Replacement With Osteoarticular Allograft Prosthetic Composite in Failed Revision Total Elbow Arthroplasty With Marked Bone Loss.","authors":"Sailesh V Tummala, Kade S McQuivey, Nathaniel B Hinckley, Krista A Goulding, Kevin J Renfree","doi":"10.1097/BTH.0000000000000369","DOIUrl":"https://doi.org/10.1097/BTH.0000000000000369","url":null,"abstract":"Total elbow arthroplasty (TEA) procedures are becoming more prevalent with an associated increase in revision procedures. Revision TEA in the setting of marked bone loss poses a challenge for the treating surgeon. We present a viable surgical option for patients with extensive proximal humeral bone loss treated with proximal humerus osteoarticular allograft prosthetic composites prepared with intact rotator cuff, pectoralis, and deltoid soft tissue attachments along with a rehabilitative protocol and follow up. Revision techniques involving the use of strut allografts and allograft prosthetic composites have previously been described in the distal humerus, but none to our knowledge have been published regarding composite allograft replacement of the proximal humerus in in combination with a TEA.","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":"26 2","pages":"114-121"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10122403","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}
Kristen MacDonald, Juliana Larocerie-Salgado, Shrikant Chinchalkar
{"title":"Alternative Noninvasive Treatment of Unstable Extra-articular Proximal and Middle Phalangeal Fractures: A Static Linear Traction Orthosis Design.","authors":"Kristen MacDonald, Juliana Larocerie-Salgado, Shrikant Chinchalkar","doi":"10.1097/BTH.0000000000000368","DOIUrl":"https://doi.org/10.1097/BTH.0000000000000368","url":null,"abstract":"Extra-articular unstable proximal and middle phalanx fractures are typically managed with surgical means with common complications of tendon tethering, stiffness, and secondary hand dysfunction. As a result, alternative conservative measures are being explored. The use of static linear traction through the application of an orthosis allows for fracture reduction and anatomic healing, with successful range of motion outcomes.","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":"26 2","pages":"110-113"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10123982","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":"The Gift of Complications.","authors":"Katherine M Hinchcliff, Alexander Y Shin","doi":"10.1097/BTH.0000000000000392","DOIUrl":"https://doi.org/10.1097/BTH.0000000000000392","url":null,"abstract":"","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":"26 2","pages":"69-70"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10124013","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}
Luis G Rosifini Alves Rezende, Filipe J Shimaoka, Luiz G Mandarano-Filho, Nilton Mazzer
{"title":"Corrective Fifth Metacarpal Neck Osteotomy and Intramedullary Screw Fixation Technique: Technique and Case Report.","authors":"Luis G Rosifini Alves Rezende, Filipe J Shimaoka, Luiz G Mandarano-Filho, Nilton Mazzer","doi":"10.1097/BTH.0000000000000363","DOIUrl":"https://doi.org/10.1097/BTH.0000000000000363","url":null,"abstract":"<p><p>Malunion of metacarpal fractures can result in severe functional and esthetic impairment to the patient, thus requiring surgical correction. Traditionally, the fixation methods most commonly used for these fractures are the Kirschner wires or the plates and screws. However, one of the options for the fixation of metacarpal fractures is intramedullary fixation with a headless screw. This minimally invasive method can also be used for corrective metacarpal osteotomies. It has the advantages of being a minimally invasive technique and allowing the early range of motion. This minimally invasive method can also be used to stabilize the corrective metacarpal osteotomies for malunion. This case report presents a minimally invasive technique for corrective dorsal metacarpal osteotomy and fixation with a headless intramedullary screw. This alternative fixation method has the advantage of low damage to soft tissues and good functional outcomes.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":"26 2","pages":"84-88"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10477977","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":"The Nottingham Palmar Plate Arthroplasty for Metacarpophalangeal Joint Noninflammatory Arthritis.","authors":"Ryan W Trickett, John A Oni","doi":"10.1097/BTH.0000000000000370","DOIUrl":"https://doi.org/10.1097/BTH.0000000000000370","url":null,"abstract":"<p><p>Palmar (volar) plate interposition arthroplasty for osteoarthritis (OA) of the metacarpophalangeal (MCP) joints of the fingers is a well-established technique. Its use has diminished since its initial description and introduction because of poor results in patients with inflammatory arthropathy and a difficult surgical technique. We report the surgical technique and mid-term results of the novel Nottingham interposition arthroplasty for noninflammatory MCP joint OA. A dual dorsal and palmar incision is utilized to maximize the harvest of interposition substance. The surgical technique is described and illustrated in full. Prospective data concerning pain, range of movement and function are reported. The results of 12 arthroplasties in 9 patients are reported. At a median follow-up of 76.1 months the median arc of movement was 44 degrees, favoring an improvement in flexion. The median visual analog score for pain was 0, with all but 1 patient reporting no pain at all. Range of movement has been further improved with a progressively less restrictive rehabilitation regimen giving a median arc of 70 degrees in the more recent patients. Compared with modern implant arthroplasty techniques, the Nottingham Palmar Plate Arthroplasty has demonstrated favorable results in terms of range of movement and most importantly resolution of pain. We consider it to be a viable option in the first line management of MCP joint OA.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":"26 2","pages":"122-126"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10122402","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}
Juliana Larocerie-Salgado, Shrikant Chinchalkar, Douglas C Ross, Joshua Gillis, Christopher D Doherty, Thomas A Miller
{"title":"Rehabilitation Following Nerve Transfer Surgery.","authors":"Juliana Larocerie-Salgado, Shrikant Chinchalkar, Douglas C Ross, Joshua Gillis, Christopher D Doherty, Thomas A Miller","doi":"10.1097/BTH.0000000000000359","DOIUrl":"https://doi.org/10.1097/BTH.0000000000000359","url":null,"abstract":"<p><p>Nerve transfer surgery is an important new addition to the treatment paradigm following nerve trauma. The following rehabilitation plan has been developed over the past 15 years, in an interdisciplinary, tertiary peripheral nerve program at the \"Roth|McFarlane Hand and Upper Limb Centre.\" This center evaluates more than 400 patients with complex nerve injuries annually and has been routinely using nerve transfers since 2005. The described rehabilitation program includes input from patients, therapists, physiatrists, and surgeons and has evolved based on experience and updated science. The plan is comprised of phases which are practical, reproducible and will serve as a framework to allow other peripheral nerve programs to adapt and improve the \"Roth|McFarlane Hand and Upper Limb Centre\" paradigm to enhance patient outcomes.</p>","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":"26 2","pages":"71-77"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10123978","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":"Single-stage Congenital Polysyndactyly Release: Outcomes and Long-term Followup","authors":"S. Nazerani, Tina Nazerani, M. Keramati","doi":"10.1097/BTH.0000000000000399","DOIUrl":"https://doi.org/10.1097/BTH.0000000000000399","url":null,"abstract":"The current surgical strategy for syndactyly is multistage operations in which every other web is released, leaving adjacent webs unoperated for the next stage to avoid a presumed possible digital vascular compromise. In this series, we present our experience with single-stage multiple syndactylies release. A total of 7 patients, including 2 patients with bilateral hand involvement, were included. Dorsal and volar triangular flaps were created for commissure reconstruction, and zigzag manner volar and dorsal incisions were made to release the webbed fingers. Sterile thermoplastic splints were molded directly over the skin grafts without any dressing or tie-over. Following the surgical operation, minimal flexion contracture was seen in three patients that needed future correction procedures. Cosmesis and functional outcome were acceptable. This study shows that the release of all webs in 1 setting can be accomplished by no vascular compromise, and there is no need for a preoperative vascular imaging study.","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":"26 1","pages":"276 - 281"},"PeriodicalIF":0.0,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48908338","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":"Loop Anchor Tension Band Fixation for Olecranon Fractures and Chevron Olecranon Osteotomy.","authors":"W. Ho, Shu-Hsin Yao, Chun-Ho Chen","doi":"10.1097/BTH.0000000000000394","DOIUrl":"https://doi.org/10.1097/BTH.0000000000000394","url":null,"abstract":"Although tension band wiring is effective for treating olecranon fractures, it is associated with a high reoperation rate because of hardware-related problems. The loop anchor tension band technique is a novel modification of the Arbeitsgemeinschaft für Osteosynthesefragen (AO)-modified tension band wiring technique. This technique is suitable for treating olecranon fractures without severe comminution and olecranon osteotomy. In the current case series, 2 intramedullary 1.25-mm Kirschner wires (K wires) were inserted as temporary fixation into the ulnar shaft from the olecranon after anatomical reduction. The proximal end of each K-wire was bent into a loop shape and advanced deep into the triceps tendon. A transverse hole was drilled distal to the fracture site, and a 1.0-mm metal wire was passed through the bone tunnel and the loops. The wire was tightened to form a figure-of-eight tension band construct. In total, 10 patients with a mean age of 49 (range: 19 to 85) years were included in this pilot series. The mean and minimum follow-up periods were 13.9 and 12 months, respectively. All fractures achieved favorable union, both radiographically and clinically. The mean QuickDASH score was 15.4 (range: 13.6 to 18.2) and the mean Mayo elbow performance score was 94 (range: 85 to 100). None of the patients experienced K-wire migration. The loop anchor tension band technique is a simple, cost effective modification of conventional tension band wiring and exhibited no implant migration in a pilot series.","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49462334","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 Combined Revision Surgical Technique for Failed Operative Lateral Epicondylitis With Concomitant Radial Tunnel Syndrome","authors":"William P Stults, Zachary C. Hanson, G. Lourie","doi":"10.1097/BTH.0000000000000398","DOIUrl":"https://doi.org/10.1097/BTH.0000000000000398","url":null,"abstract":"Lateral epicondylitis afflicts a large percentage of the population with most recovering through conservative treatment. The 5% to 10% of patients who undergo operative intervention are met with mixed results. Those that fail to improve often demonstrate a complex presentation of inadequate debridement of the “angiofibroblastic tissue,” missed concomitant radial tunnel syndrome, and iatrogenic residual devascularized tissue resulting from the index procedure. To address all 3 of these causes of failure, the authors have developed a revision procedure that includes repeat debridement of residual tendinosis, decompression of the posterior interosseous nerve, and a vascularized anconeus muscle flap to help cushion soft tissue defects and promote a healthier environment for healing. Performed initially in part in 20 patients, this combined procedure has developed into our recommended treatment for these challenging patients.","PeriodicalId":39303,"journal":{"name":"Techniques in Hand and Upper Extremity Surgery","volume":"26 1","pages":"271 - 275"},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48045240","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}