Further developments in the twisted-toe technique for isolated thumb reconstruction: our method of choice.

Background: Posttraumatic loss of the thumb is devastating. Toe-to-hand transfer is considered the criterion standard of reconstruction but is associated with donor-site issues. The twisted-toe technique uses parts from the great toe and the second toe, which allows for almost anatomical restoration of the donor foot.

In vivo length changes of wrist ligaments at full wrist extension.

The aim of this study was to investigate the length changes of carpal ligaments when loaded in full extension in vivo. We obtained computed tomography scans of the right wrists in three positions for six volunteers: neutral; 75° extension; and 75° extension with a further 10° of radial deviation. Nine ligaments were measured and analysed with computer modelling.

Effect of local corticosteroid injection of the hand and wrist on blood glucose in patients with diabetes mellitus.

Locally administered corticosteroids are a common therapy in many hand and wrist disorders. Corticosteroids pose a theoretical risk to patients with diabetes mellitus by potentially raising blood glucose to hyperglycemic levels. Although oral corticosteroids are known to have an effect on blood glucose control, limited data exist on extra-articular administration.

Use of pedicled latissimus dorsi myocutaneous flap to reconstruct the upper limb with large soft tissue defects.

Objective: To report the technique of reconstruction of large skin and soft tissue defects in the upper extremity using pedicled latissimus dorsi myocu-taneous flaps.

Methods: Six patients with large skin and soft tissue defects were included in this report. There were 5 trauma patients and the rest one needed to receive plastic surgery for his extremity scar.

Immediate passive motion versus immobilization after endoscopic supraspinatus tendon repair: a prospective randomized study.

Introduction: Rehabilitation programs after rotator cuff repair should allow recovery of shoulder function without preventing tendon healing. The aim of this randomized prospective study was to compare the clinical results after two types of postoperative management: immediate passive motion versus immobilization.

Patients And Methods: We followed 100 patients, mean age 55 years old, who underwent arthroscopic repair of a non-retracted supraspinatus tear.

Scapholunate interosseous ligament disruption in professional basketball players: treatment by direct repair and dorsal ligamentoplasty.

In the authors' experience scapholunate interosseous ligament (SLIL) disruption with resultant scapholunate dissociation (SLD) is the most frequent disabling carpal injury among professional basketball players. Prompt diagnosis, precision surgical repair, and intensive sport-specific rehabilitation are requisites for optimal recovery. This article reports the techniques and results of a consistent surgical protocol comprising accurate carpal reduction, direct SLIL repair, and dorsal intercarpal ligament augmentation for 25 professional basketball players with disabling SLD.

Surgical exposures of the radius and ulna.

The forearm contains many muscles, nerves, and vascular structures that change position on forearm rotation. Exposure of the radial shaft is best achieved with the Henry (volar) or Thompson (dorsal) approach. The volar flexor carpi radialis approaches are used increasingly for exposure of the distal radius.

The Canaletto®™ implant for reconstructing transverse carpal ligament in carpal tunnel surgery. Surgical technique and cohort prospective study about 400 Canaletto cases versus 400 cases with open carpal tunnel surgery.

The techniques used for carpal tunnel release are open surgery, endoscopy and retinaculum repair. Postoperative outcome, however, is often altered by pain, weakness, insufficient sensory or motor recovery and recurrences. We propose, since March 2001, a new surgical technique based on the reconstruction of the flexor retinaculum using the Canaletto®™ implant.

Strength of tendon repair decreases in the presence of an intact A2 pulley: biomechanical study in a chicken model.

Purpose: Pulleys have an important role in digital flexion, but little is known about how the strength of a tendon repair is affected by a major pulley. We evaluated the difference in strengths of flexor tendon repairs in the pulley area when the pulley was intact or divided in a chicken tendon injury model.

Methods: In each of 100 long toes of 50 Leghorn chickens, a complete, transverse laceration of the flexor digitorum profundus tendon was made in the region of the A2 pulley and was repaired surgically.

Disabling hand injuries in boxing: boxer's knuckle and traumatic carpal boss.

This article describes the treatment of the two most debilitating hand-related boxing injuries: boxer's knuckle and traumatic carpal boss. Recognition of the normal anatomy as well as the predictable pathology facilitates an accurate diagnosis and precision surgery. For boxer's knuckle, direct repair of the disrupted extensor hood, without the need for tendon augmentation, has been consistently employed; for traumatic carpal boss, arthrodesis of the destabilized carpometacarpal joints has been the preferred method of treatment.

Defining a safe zone of dissection during the extensor digitorum communis splitting approach to the proximal radius and forearm: an anatomic study.

Purpose: The extensor digitorum communis (EDC) splitting approach is a direct lateral approach that can provide greater visualization of the proximal radius than the posterolateral approach to the elbow. The purposes of this study were to identify the anatomic relationships of the posterior interosseous nerve (PIN) during the EDC splitting approach to the proximal radius and to determine its safe zone.

Methods: A fellowship-trained attending hand surgeon performed the EDC splitting approach on 15 cadaveric arms, exposing the EDC origin from the lateral epicondyle and dissecting distally to expose the supinator muscle.

Percutaneous pinning of distal radius fractures: an anatomic study demonstrating the proximity of K-wires to structures at risk.

Purpose: Closed reduction and percutaneous pinning is a reliable technique for treating 2- and 3-part distal radius fractures. There are currently no data that demonstrate the proximity of at-risk nerves and tendons during percutaneous placement of 5 commonly used K-wires. Whereas the previous literature notes the risk of superficial radial nerve injury with K-wire insertion into the radial styloid, the current study provides specific distances, not only to the superficial radial nerve (SRN) but also to the tendons of the first through fifth extensor compartments during K-wire insertion.

Comparison of needle position proximity to the median nerve in 2 carpal tunnel injection methods: a cadaveric study.

Purpose: Steroid injections are commonly performed by hand surgeons for relief of symptoms associated with carpal tunnel syndrome. The purpose of this study is to examine the relationship of the needle to the median nerve within the carpal tunnel and to the palmar cutaneous branch, using 2 injection techniques.

Methods: Simulated carpal tunnel injections were performed on 15 cadaveric arms using 2 methods.

The ethics of expediency.

Socioeconomic pressures on medicine have redefined traditional relationships between physicians and patients, researchers and regulatory bodies, and consultants and device companies. Physicians are disheartened that the public perception of medicine, reinforced by the media, is often negative. Ethical lapses are frequently the focus of criticism.

Comparison of ligament reconstruction tendon interposition and trapeziometacarpal interposition arthroplasty for basal joint arthritis.

This study compared patients with basal joint arthritis who underwent either ligament reconstruction tendon interposition (LRTI) or trapeziometacarpal interposition arthroplasty (TMIA). Twenty-two consecutive LRTI and 22 TMIA procedures were compared. Arthritis was graded using the staging system of Eaton.

Use of nerve conduction studies and the pressure-specified sensory device in the diagnosis of carpal tunnel syndrome.

Sixty-nine patients with signs of carpal tunnel syndrome (CTS) underwent nerve conduction studies (NCS) and testing with the Pressure-Specified Sensory Device (PSSD). A total of 102 tests were performed (28 bilateral). Twenty patients underwent a carpal tunnel release and were retested after 4 to 6 months.

[One-stage toenail lengthening: a report of 9 cases].

Objective: To summarize clinical application of one-stage toenail lengthening in free second toe transfer for reconstruction of the thumb (finger).

Methods: Nine patients (male 7, female 2) underwent thumb (finger) reconstruction with second toe transfer were treated by one-stage toenail lengthening technique. Eight were the thumb and 1 was the index finger.

Long-term outcomes of closed reduction and percutaneous pinning for the treatment of distal radius fractures.

Purpose: The purpose of this study was to review the long-term outcomes of patients with distal radius fractures treated with closed reduction and percutaneous pinning.

Methods: We retrospectively reviewed 54 patients with 55 AO type A2, A3, C1, or C2 distal radius fractures treated with closed reduction and percutaneous pinning. The average age of the patients was 57 years.

Digital oedema, adhesion formation and resistance to digital motion after primary flexor tendon repair.

The development of digital oedema, adhesion formation, and resistance to digital motion at days 0, 3, 5, 7, 9 and 14 after primary flexor tendon repairs using 102 long toes of 51 Leghorn chickens was studied. Oedema presented as tissue swelling from days 3 to 7, which peaked at day 3. After day 7, oedema was manifest as hardening of subcutaneous tissue.

Nonvascularized autogenous bone graft for extensive phalangeal bone loss: case report.

A 47-year-old man, a fine woodworker, sustained extensive phalangeal and soft tissue loss of his dominant left long and index fingers in a table saw injury. We report the long-term clinical and radiographic outcomes of the patient following reconstruction with corticocancellous iliac crest bone grafts. Rarely described in recent literature, we believe that primary nonvascularized autogenous bone grafting for phalangeal reconstruction is a worthwhile alternative to amputation when the soft tissue envelope is satisfactory.

Wrist arthroscopy: current concepts.

Wrist arthroscopy has steadily grown from a mostly diagnostic tool to a valuable adjunctive procedure in the treatment of myriad wrist disorders. The number of conditions that are amenable to arthroscopic treatment continues to grow. A detailed knowledge of the topographical and intracarpal anatomy, however, is essential to minimize complications and maximize the benefits.

Radial portal tendon harvest and interposition in arthroscopic treatment of thumb basilar joint osteoarthritis.

This study describes an arthroscopic technique that uses the same radial arthroscopic access portal to harvest and to interpose tendon material into the trapeziometacarpal joint in the treatment of Eaton-Littler stage 2 and 3 osteoarthritis of the trapeziometacarpal joint. Clinical application of this technique has resolved pain and preserved motion at the trapeziometacarpal joint in this study experience.

The incidence of dorsal radiocarpal ligament tears in patients having diagnostic wrist arthroscopy for wrist pain.

Purpose: The goal of this study was to examine the incidence of dorsal radiocarpal ligament (DRCL) tears in patients having diagnostic arthroscopy for chronic wrist pain.

Methods: A chart review was performed of 64 patients who had diagnostic wrist arthroscopy for chronic wrist pain that was refractory to conservative measures. For each case, interosseous ligament instability/tears were graded according to the Geissler classification.