Evidence-Based Approach to Timing of Nerve Surgery: A Review.

Events causing acute stress to the health care system, such as the COVID-19 pandemic, place clinical decisions under increased scrutiny. The priority and timing of surgical procedures are critically evaluated under these conditions, yet the optimal timing of procedures is a key consideration in any clinical setting. There is currently no single article consolidating a large body of current evidence on timing of nerve surgery.

Palmar Radiocarpal Artery Vascularized Bone Graft for the Unstable Humpbacked Scaphoid Nonunion With an Avascular Proximal Pole.

Purpose: The most challenging scaphoid nonunion is the unstable nonunion with humpbacked collapse coupled with an avascular proximal pole. Dorsal distal radius pedicled vascularized bone grafts (VBGs) are contraindicated in cases of humpback deformity. The free medial femoral condyle VBG is an excellent option but it is an extensive microsurgical procedure with lengthy operative times and dual-limb incisions.

Benign bony and soft tissue tumors of the hand.

It is important to be familiar with the wide variety of benign tumors that may present in everyday hand surgery practice. The treatment of many of these tumors in the hand is based on studies with small numbers of patients or the treatment of similar lesions elsewhere in the body. The purpose of this review is to summarize the recent literature relevant to benign bony and soft tissue tumors in the hand.

Endobutton repair of distal biceps tendon ruptures.

Anatomic reconstruction is now recognized as the optimal treatment for distal biceps ruptures to maximize functional upper extremity potential. Reconstruction minimizes the loss of flexion and supination strength and endurance that is associated with neglected or untreated ruptures. A single-incision, anterior approach for reconstruction of distal ruptures is facilitated by the use of a titanium button that is anchored to the end of the tendon and then engaged on the posterior proximal radius.

Arthroscopic treatment of lateral epicondylitis.

Lateral epicondylitis refractory to conservative care can be effectively treated by arthroscopic release of the extensor carpi radialis brevis origin. Advantages to the technique include the ability to address other intra-articular sources of pain (capsular tears, radiocapitellar plica, etc.), a potentially faster return to work and sports, and a smaller incision.

Salvage procedures for the distal end of the ulna: there is no magic.

Resection of the distal end of the ulna is not a benign procedure; nor is it a panacean surgical treatment of disorders at the distal radioulnar and ulnocarpal joints. Over the past 96 years, since Darrach first described his classic procedure, many authors have warned surgeons of the consequences of the Darrach resection. For salvaging the persistently painful distal forearm after Darrach resection, researchers have recommended a spectrum of possible surgical options.

Reconstruction of the distal ulna: instability, impaction, impingement, and arthrosis.

A number of afflictions may affect the distal radioulnar joint that can lead to severe pain, disuse, dysfunction, and disability. The disorders that affect this small anatomic region are complex, have multifactorial etiologies, and can sometimes present difficult diagnostic and treatment options. This article presents an overview of recent developments in the diagnosis and treatment of a variety of conditions that affect the joint and surrounding bone and soft tissues.

Use of fluoroscopy in determining screw overshoot in the dorsal distal radius: a cadaveric study.

Purpose: To determine the ability of standard fluoroscopic imaging to assess whether screws placed from volar to dorsal during distal radius plating have penetrated the dorsal cortex of the radius.

Methods: Hard-copy digital images of cadaveric distal radii with screws of different lengths penetrating the dorsal cortex of the radius were shown to practitioners. The group included attending hand surgeons and hand fellows in training at multiple institutions.

Carpal growth and function after pediatric transcarpal hand replant: case report.

This case discusses the technique, postoperative course, and functional outcomes 5 years after an amputation between the cartilaginous anlages of the growing carpus in a 7-year-old boy. The lunate remained attached to the arm, whereas the scaphoid and the remainder of the carpus were contained within the amputated part. After 5 years, the patient had 94% growth compared to the other side, a Minnesota dexterity test in the 75th percentile, 0/10 pain, near-normal sensation, grip strength 17% of the other side, and lateral pinch 79% of the other side.

Technique for percutaneous fixation of displaced and nondisplaced acute scaphoid fractures and select nonunions.

Percutaneous surgical intervention for scaphoid fractures and some nonunions is increasingly common. There is a considerable learning curve for these procedures. Here we review basic and advanced techniques for volar and dorsal fixation of acute nondisplaced and displaced fractures as well as nonunions with minimal resorption and no humpback deformity.

Achilles allograft interposition for failed Darrach distal ulna resections.

Many treatment options exist for the symptomatic patient with a failed Darrach distal ulna resection. Tendon transfers, osteoplasties, soft tissue interpositions, and combinations have been used to mitigate the symptoms of impingement. Recently, implant arthroplasty of the distal ulna has become a favorable option for treating the patient with a symptomatic distal ulna resection.

PIP Fracture/Dislocation Treatment Technique: Use of a Hemi-Hamate Resurfacing Arthroplasty.

The nature of injury following a PIP fracture dislocation is determined by the direction of force transmission and the position of the joint at the time of impact. Dorsal dislocations with palmar lip fractures are the most frequently encountered and can be classified based on stability. The degree of stability is directly determined by the amount of middle phalangeal palmar lip involvement; the larger the palmar lip fracture, the more unstable the joint becomes.

Minimally constrained elbow implant arthroplasty: the discovery elbow system.

The Discovery Elbow System (Biomet Orthopedics, Warsaw, Ind) is the latest generation of elbow replacement systems. Its minimally constrained design provides more closely matching articular surfaces, avoids use of a true hinge, and anatomically reproduces the axis of elbow motion. Improved instruments facilitate its implantation.

Vascularized bone graft for scaphoid nonunions.

Scaphoid fracture nonunion remains a challenging problem that may persist despite traditional methods of bone grafting and internal fixation. The alteration of wrist mechanics created by nonunion as well as the development of avascular necrosis leads to degenerative change of the radiocarpal joint accompanied by loss of motion and pain. The use of a vascularized bone graft has the theoretical benefit of increased blood flow that exceeds that of nonvascularized grafts.

Total elbow replacement for distal humerus fractures and traumatic deformity: results and complications of semiconstrained implants and design rationale for the Discovery Elbow System.

Recent advances in elbow replacement design have further extended its usefulness as an expedient reconstructive method for restoring elbow function following trauma. This is particularly true in elderly patients, for whom treatment is complicated by the frequent presence of osteoporosis, severe comminution with small condylar fracture fragments, and diminished bone-healing capacity. This article addresses the role of elbow replacement for fracture, traumatic deformity, post-traumatic arthritis, and instability.

EndoButton-assisted repair of distal biceps tendon ruptures.

This report represents a multifactorial investigation of a new technique in which a titanium EndoButton was used for repair of distal biceps tendon ruptures. Cadaveric cases were used to demonstrate the anatomic efficacy and safety of the procedure. Biomechanical testing was done to compare the fixation strength of traditional techniques with the EndoButton repair.

Wide excision of the distal ulna: biomechanical testing of a salvage procedure.

Purpose: To study changes in the relationship of the distal radius and ulna after progressive resection of the distal ulna.

Method: Six-degree-of-freedom motion sensors were used to determine relative motion and a displacement transducer was used to determine strain changes in the interosseous membrane (IOM). These were applied in cadaveric specimens loaded to simulate wrist motion and axial compressive forces.

Examination of patients for carpal tunnel syndrome sensibility, provocative, and motor testing.

The value of a test for carpal tunnel syndrome (CTS) depends on the purpose of performing the test. When screening a large population with a low prevalence for CTS, a test with a high sensitivity is needed so that no possible case goes undetected. However, in order to establish a diagnosis, a more specific test is required.

Resistance to activated protein C and digital thrombosis.

Resistance to activated protein C is a newly described genetic coagulation disorder previously only reported in patients with venous thromboembolism or central arterial embolism (cerebral or coronary). We report this defect in association with digital artery thrombosis and describe the pathophysiology of this disorder.

Treatment of ectopic ossification about the elbow.

The surgical treatment of elbow ectopic ossification associated with elbow stiffness has progressed significantly in the past decade. Although previous reports describe inconsistent results and high complication rates, numerous recent reports document not only good results, but also lower complication rates. The current study outlines the authors' treatment of patients with ectopic bone about the elbow.

Cubital tunnel syndrome: anterior transposition as a logical approach to complete nerve decompression.

In it's native position, deep to Osborne's ligament, within the retrocondylar groove of the elbow, the ulnar nerve courses with a significant lever distance posterior to the elbow axis of rotation. In this position, flexion of the elbow places longitudinal traction and local compression forces on the nerve. This biomechanical consideration, as well as variations in anatomy, may potentially contribute to a decrease in the nerve's microcirculation and partial pressure of oxygen, leading to cubital tunnel syndrome.

Occult scapholunate ganglion: a cause of dorsal radial wrist pain.

There are multiple causes for chronic dorsal wrist pain over the scapholunate ligament, including occult dorsal carpal ganglion cyst, scaphoid impaction syndrome, dorsal carpal capsulitis, distal posterior interosseous nerve syndrome, and dynamic scapholunate ligament instability. Patients with such pain often have normal x-rays. A retrospective study of 21 patients undergoing surgical exploration for chronic dorsal radial wrist pain who had no palpable cyst and normal x-rays revealed that 18 of the patients had occult scapholunate ganglion cysts or myxomatous degeneration within the scapholunate ligament.