Ultrasound-guided percutaneous release of the ulnar nerve at the elbow.

Introduction: Surgical treatment of ulnar tunnel syndrome is controversial, with no consensus on the ideal procedure. Nevertheless, in-situ decompression seems to provide faster recovery with less morbidity than neurolysis-transposition. The aim of this retrospective study was to validate a new percutaneous technique using ultrasonography.

Lacertus syndrome: recent advances.

Lacertus syndrome consists in proximal median nerve entrapment with median nerve compression at the lacertus fibrosus, causing hand weakness and fatigue, forearm pain and occasional numbness. Recent advances emphasized the importance of clinical examination, due to limitations in electromyographic diagnosis and delayed diagnosis. The Hagert clinical triad, lacertus notch sign, lacertus antagonist test and taping help accurate diagnosis.

Description of WALANT technique in open bone and ligament wrist surgery.

The gold-standard for bone, ligament and joint surgery in the wrist is locoregional anesthesia in most countries. Wide-Awake Local Anesthesia No Tourniquet (WALANT) is commonly used for simple soft-tissue hand surgery procedures such as carpal tunnel or trigger finger release, and can now also be safely used in procedures such as proximal row carpectomy, scapholunate ligament repair or partial wrist fusion, to name but a few. This article describes the use of WALANT for complex surgery in the wrist.

Relevance of a Simulation Model to Microvascular Surgery for Military Surgical Residents.

Introduction: Microsurgical training is an asset for deployed military orthopaedic surgeons who frequently treat hand or nerve injuries in the field. The objective of this study was to evaluate a microvascular surgery simulation model intended to prepare residents prior to their enrolment in conventional microsurgery degree training.

Methods: An experimental study was conducted to evaluate technical progress and satisfaction of military surgical residents using a model based on Japanese noodles with four tests of increasing difficulty.

Proximal tibiofibular joint (PTFJ) dislocation due to Ehlers-Danlos syndrome: posterolateral open-wedge high tibial osteotomy combined with medial closed-wedge distal femoral osteotomy can correct the severe valgus deformity with a markedly increased tibial posterior slope.

Ehlers-Danlos syndrome (EDS) causes joint hypermobility and joint dislocation. Since there are no reports of proximal tibiofibular joint (PTFJ) dislocation caused by EDS, little is known about the long-term course of this disease. A woman in her 40s presented with a posterolaterally depressed tibial condyle and severe valgus deformity caused by a long-standing PTFJ dislocation due to EDS.

Wrist Hemiarthroplasty of Irreparable Distal Radius Fracture under Wide-Awake Local Anesthetic and No Tourniquet.

Distal radius fractures (DRF) are common in elderly patients and the incidence continues to increase with the aging of the population. For irreparable fractures in the elderly, treatment with a reduction cast leads to unreliable results and frequent complications when treated with an anterior plate. Recent studies on hemiarthroplasty for elderly complex wrist fractures have resulted in good clinical and radiologic outcomes, as well as high satisfaction rates.

Physeal Distal Radial Fracture with Entrapment of the Tendons of Extensor Pollicis Longus and Extensor Digitorum Communis to Index Finger.

We report the entrapment of the extensor tendons following a growth plate fracture of the distal radius in a teenager. It is difficult to detect tendon entrapment at the fracture site immediately after the injury and diagnosis is typically made after fracture union when patients present with an inability to extend the thumb/reduced digital movement. A careful examination of our patient demonstrated some loss of digital motion and the plain radiographs, and computed tomographic scan showed incomplete reduction suggesting tendon entrapment.

En Masse Excision and Curettage for Periarticular Gouty Tophi of the Hands.

Background: Despite increasing disease prevalence, there remains a paucity of data examining surgical treatments for gouty tophi. This article assesses en masse excision and curettage of articular tophi involving the hands and shows that carefully planned and precisely executed surgery can consistently alleviate pain, preserve function, and enhance the aesthetics of afflicted hands.

Methods: A retrospective review was conducted of all consecutive patients who underwent surgical excision of tophaceous deposits from the upper extremity.

In vitro evaluation of a synthetic (Biobrane®) and a biopolymer (Epicite) wound dressing with primary human juvenile and adult fibroblasts after different colonization strategies.

Background: The three-dimensional [3D] wound dressings Biobrane® and Epicite are used in the wound management. Fibroblasts are important for successful deep wound healing. The direct effect of Biobrane® and Epicite on human fibroblasts, particularly of juvenile individuals, remains unclear.

Anatomical 3 Ligaments Reconstruction for Symptomatic Thumb Carpometacarpal Joint Instability.

Thumb carpometacarpal (CMC) joint instability is thought to be a debilitating disorder and, if left untreated, develops joint persistent synovitis and osteoarthritis. In this study, we report a novel surgical technique reconstructing the anterior oblique ligament, the dorsoradial ligament, and the intermetacarpal ligament simultaneously using both the transverse carpal ligament, and the palmaris longus tendon. Six patients with a mean age of 44 years showing no osteoarthritic changes by the radiographical examination underwent our anatomical three ligaments reconstruction for persistent painful thumb CMC joint instability.

Trapeziectomy, Partial Trapezoidectomy, and Abductor Pollicis Longus Dual Loop Ligament Reconstruction for Advanced Basal Joint Arthritis: Long-Term Outcome of 150 Cases.

Background: Although hand surgeons usually concur that arthroplasty is indicated for disabling basal joint arthritis, controversy persists regarding the preferred surgical methods. This article describes a novel technique of trapezial excisional arthroplasty with partial trapezoidectomy and abductor pollicis longus (APL) dual ligament reconstruction, and reports the long-term results of 150 cases. Based on this experience, we hypothesize that this technique is a reliably effective and durable surgical option for basal joint arthritis.

Treatment of upper extremity nerve defects by direct suturing in high elbow or wrist flexion.

Purpose: To evaluate functional outcomes after direct suturing of upper extremity nerve defects in high elbow or wrist flexion.

Methods: A retrospective review was conducted in patients treated for median, ulnar, or radial nerve defects between 2011 and 2019. Inclusion criteria were a defect > 1 cm and a minimal follow-up period of 1 year.

A Case of an Elderly Patient With Rubber Band Syndrome.

Rubber band syndrome is a relatively rare disease in which a rubber band around a limb becomes embedded under the skin, resulting in tissue damage. Most reported cases are in children, and its occurrence in adults is considered extremely rare We present a case of a 71-year-old patient with cognitive impairment, in whom a rubber band around the wrist became embedded under the skin. The examination of the distinctive circumferential scar, ultrasonography, x-ray, and magnetic resonance imaging led to the diagnosis of rubber band syndrome.

Mast cell presence in tendon sheaths of trigger fingers: implications on pathogenesis and clinical presentation.

Trigger finger is a common hand disorder; however, its pathogenesis remains unknown. In this study, we aimed to investigate mast cells, fibroblast activators that synthesize collagen, in the tendon sheaths of trigger fingers. We investigated the presence of mast cells and their association with changes in the collagen content of the tendon sheath and clinical data.

Ballistic peripheral nerve injuries: basic concepts, controversies, and proposal for a management strategy.

Ballistic injuries to peripheral nerves are devastating injuries frequently encountered in modern conflicts and civilian trauma centers. Such injuries often produce lifelong morbidity, mainly in the form of function loss and chronic pain. However, their surgical management still poses significant challenges concerning indication, timing, and type of repair, particularly when they are part of high-energy multi-tissue injuries.

Simple surgical technique for minimizing the risk of extensor pollicis longus rupture following volar plate fixation of distal radial fracture: A case report.

Introduction And Importance: Extensor pollicis longus (EPL) tendon injury is a major complication in distal radial fracture repair. The risk factors for EPL tendon injury are prominent dorsal screws, direct intraoperative damage through drilling, and/or dorsal roof fragments. Herein, we introduce a simple technique to minimize the risk of EPL tendon rupture after volar plate fixation of distal radial fracture.

Rib osteochondral graft for scaphoid proximal pole reconstruction.

Background: An irreparable scaphoid proximal pole is challenging to treat because of the fragment size and limited blood supply. Salvage surgery, such as partial wrist fusion or proximal row carpectomy, may be performed but is not ideal for young patients. There are few reports of proximal scaphoid reconstruction using rib osteochondral grafts.

Wartime upper-extremity injuries in the Sahelian strip: Experience from a French Forward Surgical Team deployed in Mali.

This study aimed to analyze upper-extremity combat-related injuries (CRIs) and non-combat-related injuries (NCRIs) treated in the French Forward Surgical Team currently deployed in Gao, Mali. A retrospective study was conducted using the French Military Health Service OpEX surgical database from February 2013 to March 2020. All patients operated on for upper-extremity injury were included: 224 patients, with a mean age of 28.