{"title":"Partial Hand Amputation: Digital and Transmetacarpal Amputation","authors":"Nicholas Munaretto, Bryan J. Loeffler","doi":"10.1016/j.oto.2023.101059","DOIUrl":"https://doi.org/10.1016/j.oto.2023.101059","url":null,"abstract":"<div><p>Partial hand amputations are very common in the United States. Amputations distal to the wrist account for the majority of all traumatic amputations of the upper extremity. These amputations lead to functional limitations, decreased quality of life, and disability. Treatment options include replantation or revision amputation.</p></div>","PeriodicalId":45242,"journal":{"name":"Operative Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71769722","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":"Considerations and Surgical Techniques in Upper Extremity Amputation: An Introduction","authors":"Omri B. Ayalon","doi":"10.1016/j.oto.2023.101055","DOIUrl":"https://doi.org/10.1016/j.oto.2023.101055","url":null,"abstract":"","PeriodicalId":45242,"journal":{"name":"Operative Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71769726","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":"Prosthesis Options and Management in Upper Extremity Amputation","authors":"Christopher Fink , Yoni Diamond","doi":"10.1016/j.oto.2023.101061","DOIUrl":"https://doi.org/10.1016/j.oto.2023.101061","url":null,"abstract":"<div><p>Amputation surgery is a life-altering experience, profoundly impacting an individual's ability to perform daily tasks and engage in their chosen activities. Upper extremity prostheses have advanced remarkably, offering diverse solutions to restore functionality and enhance the quality of life for amputees. This article provides a comprehensive examination of the various types of upper extremity prostheses available today, highlighting their unique features, advantages, and limitations. This article categorizes upper extremity prostheses into three main types: body-powered prostheses, myoelectric prostheses, and advanced prosthetic technologies. Passive prostheses are generally designed to replicate the appearance of the missing limb. Body-powered prostheses rely on cables and harnesses for control, offering affordability and durability. Myoelectric prostheses employ electromyography (EMG) signals from residual muscles for intuitive and precise control. Advanced prosthetic technologies, including neural interfaces and 3D printing, are pushing the boundaries of what is possible in terms of functionality and customization. This article aims to serve as a valuable resource for upper extremity surgeons to help guide options and even optimize surgical plans to allow individuals to maximize the use of upper extremity prostheses.</p></div>","PeriodicalId":45242,"journal":{"name":"Operative Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71769720","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":"Pain Management in Limb Loss","authors":"Paulinder Rai","doi":"10.1016/j.oto.2023.101060","DOIUrl":"https://doi.org/10.1016/j.oto.2023.101060","url":null,"abstract":"<div><p>This article serves as a guide to approaching pain management related to limb loss. The following points may serve as a framework by which to address common pain experiences of patients prior to and following amputation. The guidelines provided will allow surgeons and clinicians to better understand the varieties of pain associated with limb loss and assist in devising treatment plans for pain related to amputation.</p></div>","PeriodicalId":45242,"journal":{"name":"Operative Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71769721","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":"Contributors (pick up from previous issue w/updates)","authors":"","doi":"10.1053/S1048-6666(23)00054-X","DOIUrl":"https://doi.org/10.1053/S1048-6666(23)00054-X","url":null,"abstract":"","PeriodicalId":45242,"journal":{"name":"Operative Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71769727","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":"Shoulder Level Amputation: Forequarter and Brachial Plexus-Level Amputation","authors":"Megan R. Donnelly , Jacques H. Hacquebord","doi":"10.1016/j.oto.2023.101056","DOIUrl":"https://doi.org/10.1016/j.oto.2023.101056","url":null,"abstract":"<div><p>Shoulder-level amputations, including forequarter amputation<span><span> and shoulder disarticulation<span><span>, are very uncommon but can be incredibly devastating. Unlike other levels of upper extremity amputation, these procedures are indicated based on etiology, namely trauma, tumor, or infection. Depending on the emergent need for the procedure and if time allows, physical examination and advanced imaging modalities can be utilized for perioperative planning. Most likely, however, there will be a significant need for revision surgeries, such as targeted </span>muscle reinnervation (TMR), following index amputation. These surgeries can dramatically improve a patient's </span></span>quality of life<span>, by allowing them to function through a myoelectric prosthesis<span> or to enable them to live without the burden of phantom limb<span> or neuroma pain.</span></span></span></span></p></div>","PeriodicalId":45242,"journal":{"name":"Operative Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71769725","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":"Therapy and Rehabilitation in Maximizing Upper Extremity Amputation","authors":"Elaine Crerar","doi":"10.1016/j.oto.2023.101062","DOIUrl":"https://doi.org/10.1016/j.oto.2023.101062","url":null,"abstract":"<div><p>The loss of a limb is a life-altering event that profoundly affects an individual's capacity to engage in their daily routines. Therapy can play a vital role in maximizing their participation and overall independence. The rehabilitation process begins with a comprehensive evaluation of the patient's current functional level and should also include a detailed report of their occupational profile.</p></div>","PeriodicalId":45242,"journal":{"name":"Operative Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71769838","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":"Transradial Amputation and Wrist Disarticulation","authors":"Ian Chow, Raymond Glenn Gaston","doi":"10.1016/j.oto.2023.101058","DOIUrl":"https://doi.org/10.1016/j.oto.2023.101058","url":null,"abstract":"<div><p><span>Transradial amputations represent the most common level of amputation in the upper extremity proximal to the fingers. While patients following forearm-level amputations have a high rate of phantom limb pain<span> and utilization of neuropathic medications, they are also the most likely upper extremity amputees to utilize a prosthesis and remain in the work-force. The advent and evolution of active nerve management strategies such as targeted </span></span>muscle reinnervation<span><span> (TMR) and regenerative peripheral nerve<span> interfaces (RPNI) have revolutionized amputation surgery. Initially developed to facilitate prosthetic control, TMR and by extension, RPNI have been shown to significantly mitigate neuroma<span> pain and phantom limb pain. The use of these techniques should be considered in most patients undergoing major limb amputation. The continuous development of improved prosthetic technologies has led to a refinement of paradigms for amputation throughout the body, and forearm-level amputation is no different. In this chapter, we will outline the conceptual framework for TMR/RPNI, discuss its role in forearm-level amputations, review pearls and pitfalls for the surgeon performing these procedures, and outline our algorithm and approach in performing transradial amputation and wrist </span></span></span>disarticulation.</span></p></div>","PeriodicalId":45242,"journal":{"name":"Operative Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71769723","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}
Christopher G. Larsen , Martin Griffis , Natalie Tanner , Liana J. Tedesco , Omri B. Ayalon
{"title":"Optimizing Transhumeral Amputations","authors":"Christopher G. Larsen , Martin Griffis , Natalie Tanner , Liana J. Tedesco , Omri B. Ayalon","doi":"10.1016/j.oto.2023.101057","DOIUrl":"https://doi.org/10.1016/j.oto.2023.101057","url":null,"abstract":"<div><p><span><span><span><span>Transhumeral amputations have historically been plagued by high rates of neuroma formation, </span>neuropathic pain<span><span>, poor prosthetic fitting<span>, and low prosthesis use rates. Recent advances in adjunct surgical techniques are promising for excellent reconstructive and functional outcomes for these patients. A surgical approach addressing all aspects of the residual extremity, including bone, soft tissues, and nerves, will result in superior outcomes and fewer complications. Humeral osteotomy techniques shorten the residual extremity to create a lever arm, which improves prosthetic fit and functionality. Use of myodesis and myoplasty provides a stable soft tissue envelope around the residual bone ends to minimize tissue redundancy. Nerve interface procedures, such as targeted </span></span>muscle reinnervation (TMR) and regenerative </span></span>peripheral nerve<span> interface (RPNI), reduce the likelihood of neuroma formation and rates of phantom limb pain while increasing the number of electromyographic signals that can be detected by a </span></span>myoelectric prosthesis<span>. Osseointegration<span>, a promising new bone-anchored prosthesis technology, may further improve functional outcomes for transhumeral amputees. A multidisciplinary team, including orthopedic surgeons, mental health professionals, occupational therapists, and physical therapists, can improve patient </span></span></span>quality of life and functional outcome postoperatively.</p></div>","PeriodicalId":45242,"journal":{"name":"Operative Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71769724","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":"Table of Contents (pick up from previous issue w/updates)","authors":"","doi":"10.1053/S1048-6666(23)00053-8","DOIUrl":"https://doi.org/10.1053/S1048-6666(23)00053-8","url":null,"abstract":"","PeriodicalId":45242,"journal":{"name":"Operative Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71769839","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}
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