Dorsal capsular-based vascularized distal radius graft for proximal pole scaphoid nonunion with avascular necrosis.

Background: Scaphoid nonunion involving the proximal pole with the presence of avascular necrosis is difficult to reconstruct. We aimed to determine the efficacy of surgical treatment of proximal pole scaphoid nonunion with avascular necrosis using a dorsal capsular-based vascularized distal radius graft.

Methods: Between 2000 and 2018, 64 patients with established proximal pole scaphoid nonunion with avascular necrosis were treated using a dorsal capsular-based vascularized distal radius graft.

Scapholunate Ligament Injury: Management Strategies From Occult Injury to Arthritis.

This chapter will explore scapholunate ligament injuries with a focus on injury recognition, diagnosis, the natural history, and options for treatment. Treatment is based upon injury factors, patient factors, and surgeon preference. The classification systems in common use will be discussed, and treatment options will be explored, including nonsurgical, arthroscopic, repair, reconstruction, pain relieving measures, and salvage procedures.

Intraoperative Subluxation of the Ulnar Nerve: Use of a Triceps Sling Reconstruction Technique.

Purpose: To determine whether the triceps sling reconstruction technique is a safe and effective treatment of intraoperative ulnar nerve subluxation after in situ decompression.

Methods: Twelve patients who underwent a triceps sling reconstruction for intraoperative ulnar nerve subluxation after in situ release were retrospectively reviewed. The triceps sling technique consists of harvesting a small, distally based strip of triceps tendon and suturing the proximal end of the strip to the posterior aspect of the released Osborne ligament.

Treatment for proximal pole scaphoid nonunion with capsular-based vascularized distal radius graft.

Purpose: We retrospectively reviewed the results of 89 patients with proximal pole scaphoid nonunion, 58 with avascular necrosis, treated with a capsular-based vascularized distal radius graft.

Methods: Seventy-one male and eighteen female patients with symptomatic nonunion at the proximal pole of the scaphoid were included in this study. No patient had a humpback deformity.

Revision of the Failed Thumb Carpometacarpal Arthroplasty.

Purpose: To evaluate the outcome of revision surgery for failed thumb carpometacarpal (CMC) arthroplasty.

Methods: We retrospectively analyzed 32 patients with failed thumb CMC arthroplasty. The primary reason for revision was pain caused by metacarpal subsidence.

Cheilectomy for Treatment of Symptomatic Distal Interphalangeal Joint Osteoarthritis: A Review of 78 Patients.

Purpose: To determine whether open cheilectomy and debridement of the distal interphalangeal (DIP) joint is a safe and effective alternative to joint arthrodesis for the treatment of symptomatic osteoarthritis.

Methods: Seventy-eight patients with symptomatic DIP joint osteoarthritis and with a minimum follow-up of 24 months were retrospectively reviewed. Preoperative radiographs were graded.

Cubital Tunnel Syndrome.

Cubital tunnel syndrome is the most common cause of symptomatic ulnar neuropathy. The unique anatomic course of the ulnar nerve around the elbow makes it particularly vulnerable at a location far from its terminal destination. The natural progression of cubital tunnel syndrome allows patients who have mild symptoms to be adequately treated nonsurgically.

Step-Cut Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome.

Introduction: The step-cut ulnar shortening osteotomy for the treatment of ulnar impaction syndrome is a safe, reliable, and less expensive technique that uses a 7-hole 3.5-mm standard neutralization plate and a lag screw for fixation, thus avoiding the need for the special instrumentation that other ulnar shortening techniques require.

Step 1 Preoperative Planning: Perform a physical examination and obtain imaging studies to identify all associated abnormalities.

Long-Term Outcome of Step-Cut Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome.

Background: Extra-articular ulnar shortening osteotomy is a common procedure for the surgical treatment of ulnar impaction syndrome. Several techniques for this osteotomy have been developed to avoid the morbidity associated with a standard transverse osteotomy. However, these techniques require special instrumentation and are expensive.

Median nerve biodegradable wrapping : Clinical outcome of 10 patients.

Nerve wrap protectors are bioabsorbable synthetic materials made of collagen or extracellular matrix that provide a non-constricting encasement for injured peripheral nerves. They are designed to be used as an interface between the nerve and the surrounding tissue. After hydrated, they transform into a soft, pliable, nonfriable, easy to handle porous conduit.

Distal biceps tendon history, updates, and controversies: from the closed American Shoulder and Elbow Surgeons meeting-2015.

Understanding of the distal biceps anatomy, mechanics, and biology during the last 75 years has greatly improved the physician's ability to advise and to treat patients with ruptured distal tendons. The goal of this paper is to review the past and current advances on complete distal biceps ruptures as well as controversies and future directions that were discussed and debated during the closed American Shoulder and Elbow Surgeons meeting in 2015.

Release of the stiff elbow with mini-open technique.

Background: Currently, there are many techniques used in the surgical release of elbow contracture, but no single technique has gained widespread acceptance. The purpose of this study was to report the outcomes of a lateral-column approach combined with a mini-open triceps-splitting technique for elbow contracture release.

Methods: Thirty-six patients with a mean age of 39 years were included in the study.

Preliminary results of recurrent cubital tunnel syndrome treated with neurolysis and porcine extracellular matrix nerve wrap.

Purpose: To evaluate the clinical results of revision neurolysis and wrapping with porcine extracellular matrix (AxoGuard Nerve Protector, AxoGen Inc., Alachua, FL) for cubital tunnel syndrome after one previous surgical decompression.

Methods: Twelve patients with recurrent cubital tunnel syndrome were treated with decompression, porcine extracellular matrix nerve wrap, and minimal medial epicondylectomy (if not previously performed).

Treatment recommendations for carpal tunnel syndrome and peripheral nerve repair.

Although open and endoscopic techniques for carpal tunnel release can provide excellent results, neither technique has demonstrated clinical superiority. A permanent nerve injury remains the most devastating complication regardless of the technique used. Symptoms in carpal tunnel syndrome recur in up to 30% of patients, usually secondary to scarring of the median nerve.

Human dermal allograft for massive rotator cuff tears.

Previously published studies reported variable results using various suture techniques and reconstruction options for massive rotator cuff tears. Therefore, the current authors retrospectively studied 21 consecutive patients/shoulders with massive rotator cuff tears treated from January 2005 to October 2011 with a human dermal allograft through a mini-open approach. Mean patient age was 58 years (range, 33-72 years).

Terrible triad injuries of the elbow: does the coronoid always need to be fixed?

Background: The "terrible triad" of the elbow is a complex injury that can lead to pain, stiffness, and posttraumatic arthritis if not appropriately treated. The primary goal of surgery for these injuries is to restore stability of the joint sufficient to permit early motion. Although most reports recommend repair and/or replacement of all coronoid and radial head fractures when possible, a recent cadaveric study demonstrated that type II coronoid fractures are stable unless the radial head is removed and not replaced.

Resection interposition arthroplasty for failed distal ulna resections.

The major complications of distal ulna resection, the Darrach procedure, are radioulnar impingement and instability. High failure rates have been reported despite published modifications of the Darrach procedure. Several surgical techniques have been developed to treat this difficult problem and to mitigate the symptoms associated with painful convergence and impingement.

Tendon allograft interposition for failed distal ulnar resection: 2- to 14-year follow-up.

Purpose: To evaluate the mid- to long-term outcome of distal radioulnar interposition arthroplasty using an Achilles allograft for salvage of painful instability after distal ulnar resection.

Methods: Twenty-six patients with an average age of 43 years were treated with Achilles tendon allograft interposition for failed distal ulnar resection. The average follow-up period was 79 months (range, 25-174 mo).

Human dermal allograft interposition for the reconstruction of massive irreparable rotator cuff tears.

This retrospective study sought to determine the effectiveness of the acellular human dermal allograft as a bridging device for reconstruction of massive irreparable rotator cuff tears (RCTs). Fourteen patients with an average age of 54.6 years underwent open reconstruction for massive irreparable RCTs.

Elbow arthritis: current concepts.

Elbow arthritis is a debilitating condition manifesting as a painful, stiff elbow. The purpose of this article is to provide an update and analyze current management, treatment options, and outcomes of treatment for elbow arthritis. This article focuses on recent developments in the treatment for elbow arthritis.

Triceps brachii distal tendon reattachment with a double-row technique.

Case reports and small series have reported variable results regarding the treatment of choice for patients with triceps brachii tendon ruptures. Early surgical repair has been recommended for acute complete ruptures of the triceps brachii distal tendon to prevent late functional disability. However, controversy exists regarding the optimum surgical technique of reattachment.

The contracted elbow: is ulnar nerve release necessary?

Background: Prophylactic release of the ulnar nerve in patients undergoing capsular release for severe elbow contractures has been recommended, although there are limited data to support this recommendation. Our hypothesis was that more severely limited preoperative flexion and extension would be associated with a higher incidence of postoperative ulnar nerve symptoms in patients undergoing capsular release.

Materials And Methods: We conducted a retrospective review of 164 consecutive patients who underwent open or arthroscopic elbow capsular release for stiffness between 2003 and 2010.

Supplemental graft fixation for distal radius vascularized bone graft.

Vascularized bone grafts from the distal radius have been used successfully for the treatment of scaphoid nonunions. Typically, the harvested graft is secured into the scaphoid with a press-fit technique. This type of fixation may lead to graft extrusion in the early postoperative period, and thus to treatment failure.