Fractional Lengthening of Forearm Flexor Tendons: A Cadaveric Biomechanical Analysis.

Purpose: Multiple procedures have been described for wrist and finger flexion contractures and spasticity. Fractional lengthening of forearm flexor tendons involves making parallel transverse tenotomies at the musculotendinous junction to elongate the muscle. Currently, there is limited literature to define the biomechanical consequences of this lengthening technique.

Biomechanical Analysis of Headless Compression Screw Versus Tension Band Wiring for Proximal Interphalangeal Joint Arthrodesis.

Purpose: Proximal interphalangeal (PIP) joint arthrodesis is a procedure employed to address arthritis, instability, and deformity. Multiple fixation methods are available to maintain stability across the arthrodesis interval, including headless compression screws (HCSs), tension band wiring (TBW), plating, and Kirschner wire constructs. The purpose of this study was to compare the biomechanical properties of the HCS and TBW techniques.

Use of Biologic Agents in Extremity Reconstruction.

Skin and soft tissue defects of the lower extremity present a unique challenge for the reconstructive surgeon. Successful repair of the lower extremity relies not only on strong anatomical knowledge and surgical expertise, but also on careful consideration of the numerous preoperative factors and indications that may alter the patient's response to operative management. While many of these injuries result from burns, avulsive trauma, diabetes, or vascular insufficiencies, a significant portion can be associated with resection of neoplastic pathologies.

Rodeo Thumb: To Replant or Not.

Background: This study investigated patient-reported outcomes after surgical treatment of rodeo thumb amputation to guide clinical decision-making.

Methods: A retrospective review was performed for rodeo thumb amputations from 2009 to 2019. Patient-reported outcomes were collected and compared by injury level, age, and treatment.

Arthroscopic Ganglionectomy in the Pediatric Population.

Background: Arthroscopic dorsal wrist ganglionectomy is an established alternative to open excision in the adult population. The purpose of this study was to retrospectively compare outcomes of arthroscopic and open dorsal wrist ganglionectomy in the pediatric population.

Methods: All patients who underwent arthroscopic or open dorsal wrist ganglionectomy at a single pediatric institution between 2011 and 2014 were retrospectively evaluated by chart review and telephone interview.

Comparison of Fracture Location and Extent of Comminution in Isolated Scaphoid Fractures Versus Transscaphoid Fracture-Dislocations.

Isolated scaphoid fractures (ISFs) are common, whereas transscaphoid fracture-dislocations (TSFDs) are not. Scaphoid fracture location and the extent of comminution are factors that affect treatment and outcome. The purpose of this study is to compare the radiographic characteristics of ISFs with TSFDs associated with greater arc injury.

Oral Antibiotics Are Effective for the Treatment of Hand Osteomyelitis in Children.

Acute osteomyelitis of the hand is common in the pediatric population. Treatment with intravenous antibiotics is expensive and is associated with catheter-site infection and thrombosis. The purpose of this study is to investigate the efficacy of managing osteomyelitis of the hand in children with oral antibiotics.

Brachial Artery Aneurysm in a 7-Month-Old Infant: Case Report and Literature Review.

Congenital upper extremity aneurysms are very rare and can be challenging to diagnose and treat. Although they can present as an isolated finding, they are often associated with other systemic conditions. We present a rare case of brachial artery aneurysm in a 7-month-old boy.

Accuracy of Visual Estimates of Partial Flexor Tendon Lacerations.

Purpose: To determine whether hand surgeons could accurately and consistently estimate the size of partial flexor tendon lacerations.

Materials And Methods: Thirty-two partial flexor tendon lacerations were made in the flexor digitorum profundus tendons of a fresh-frozen cadaveric hand. Four hand surgeons and 5 residents estimated the size of the lacerations.

Reconstruction of scaphoid non-union and total scaphoid avascular necrosis in a pediatric patient: a case report.

Background: The medial femoral condyle vascularized bone graft has grown in popularity for treating recalcitrant fracture non-unions and has become particularly useful in treating scaphoid non-union with avascular necrosis of the proximal pole. The medial femoral condyle is an excellent source of dense, well-vascularized bone and results in minimal donor site morbidity.

Methods: We describe an unusual case of chronic scaphoid non-union and total scaphoid avascular necrosis in a skeletally immature patient.

Practical Management of Metacarpal Fractures.

Learning Objectives: After studying this article, the participant should be able to: 1. Understand the indications for metacarpal fixation. 2.

Salvage Operations for Wrist Ligament Injuries with Secondary Arthrosis.

Wrist ligamentous injuries can be challenging to treat successfully. In some cases the ligament repair or reconstruction fails, resulting in instability and progressive degenerative changes. In other cases the original injury is missed, and the patient presents for the first time with established wrist arthritis.

Management of complications with flap procedures and replantation.

Replantation and flap procedures employ microvascular techniques to salvage or reconstruct a severely damaged limb or digit. The most devastating complications include complete or partial flap loss, or replantation failure due to vascular complications. Often, these complications can be prevented by appropriate patient selection, careful surgical planning, meticulous technique, and proper postoperative management.

An Association between Carpal Tunnel Syndrome and Migraine Headaches-National Health Interview Survey, 2010.

Background: Migraine headaches have not historically been considered a compression neuropathy. Recent studies suggest that some migraines are successfully treated by targeted peripheral nerve decompression. Other compression neuropathies have previously been associated with one another.

The effect of barbed suture tendon repair on work of flexion.

Purpose: To compare the work of flexion, ultimate strength, and gap resistance of a conventional 4-strand tendon repair to a knotless barbed-suture 4-strand tendon repair.

Methods: Tendon repairs were performed on 16 cadaver flexor digitorum profundus tendons using either a 4-strand double Kessler repair or a similar but knotless 4-strand repair with a unidirectional barbed suture. Work of flexion, gap resistance during cyclical loading, and ultimate strength of both techniques were determined and their means compared.

Methicillin-resistant Staphylococcus aureus infection in the hand.

Background: Methicillin-resistant Staphylococcus aureus has become an increasingly common cause of skin and soft-issue infections. The purpose of this study was to review and summarize the most recent literature on methicillin-resistant S. aureus infections of the hand.

Complications related to harvest of the proximal end of the fibula: a systematic review.

Background: The fibula is a common source of bone graft used in skeletal reconstruction. Although in most cases only the diaphysis of the fibula is used, there are clinical scenarios in which the proximal end of the fibula and fibular head are harvested for use in articular reconstruction. The purpose of this systematic review is to determine the incidence of knee instability and peroneal nerve motor dysfunction associated with removal of the proximal end of the fibula and fibular head.

Advances in the healing of flexor tendon injuries.

The intrasynovial flexor tendons of the hand are critical for normal hand function. Injury to these tendons can result in absent finger flexion, and a subsequent loss of overall hand function. The surgical techniques used to repair these tendons have improved in the past few decades, as have the postoperative rehabilitation protocols.

Biomechanical analysis of knotless flexor tendon repair using large-diameter unidirection barbed suture.

Purpose: In traditional flexor tendon repairs, suture knots can be sites of weakness, impair tendon healing, stimulate an inflammatory response, and increase the bulk of the tendon repair. Because of this, there has been an increased interest in knotless flexor tendon repair using barbed suture. Since knots are not required, it may be possible to increase the strength of the tendon repair by using a large-diameter barbed suture.

Tenodesis for restoration of distal interphalangeal joint flexion in unrepairable flexor digitorum profundus injuries.

Purpose: To describe in a cadaveric model a tenodesis procedure for restoring distal interphalangeal joint flexion in patients with unrepairable isolated flexor digitorum profundus (FDP) injuries.

Methods: In 16 fresh-frozen cadaveric fingers, the FDP tendon was transected 1 cm proximal to its insertion to simulate an isolated zone I laceration. The injury was reconstructed using a palmaris longus tendon graft to create a mechanical linkage between the interphalangeal joints, which restored coordinated interphalangeal joint flexion.

Selection of appropriate treatment options for hand fractures.

Selecting the appropriate treatment method for hand fractures is challenging due to the wide spectrum of presentation and the enormous array of surgical and nonoperative treatment options. Unfortunately, the scientific evidence to help guide decision making is not of high quality. Because of this, the surgeon must rely on a few basic principles to guide treatment.

Soft-tissue coverage of the hand: a case-based approach.

Adequate soft-tissue coverage of the hand is paramount to achieve optimal aesthetic and functional results in patients with complex hand defects. In this article, the authors present four illustrative clinical cases and discuss potential reconstructive modalities. For each scenario, two surgical options are discussed: one established and one nontraditional method of reconstruction.

The association between glomus tumors and neurofibromatosis.

Purpose: To determine whether an epidemiologic association exists between glomus tumors and neurofibromatosis.

Methods: Using a pathology database, we established a study cohort consisting of all patients who had undergone excision of a glomus tumor of the hand between 1995 and 2010. We created a control cohort by randomly selecting 200 patients who had undergone excision of a ganglion cyst over the same period.

Wrist surgery: management of chronic scapholunate and lunotriquetral ligament injuries.

Learning Objectives: After reading this article, the participant should be able to: 1. Recognize the clinical features of chronic scapholunate and lunotriquetral ligament injuries and their long-term sequelae. 2.