Techniques in hand & upper extremity surgery
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Tech Hand Up Extrem Surg · Dec 2013
Case ReportsApplication of an antibiotic intramedullary nail in the management of a large metacarpal bone defect.
Contaminated wounds and infected nonunions of the hand are not amenable to primary internal fixation and grafting. Antibiotic-impregnated cement intramedullary nails have been used in the lower extremity in the treatment of these fractures but have not been described in the hand. ⋯ We describe an alternative technique for the management of skeletal defects in a contaminated wound bed in the hand using readily available operating room equipment. The antibiotic-impregnated cement intramedullary nail can be placed temporarily until definitive internal fixation and grafting occur.
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Tech Hand Up Extrem Surg · Dec 2013
Immunosuppression and monitoring of rejection in hand transplantation.
Advances in vascularized composite allotransplantation over the last decade have achieved significant milestones in basic science and translational research, as well as clinically with highly encouraging functional and immunologic outcomes. However, certain immunologic challenges remain. ⋯ Furthermore, the profound side effect profile of the life-long, high-dose, multidrug immunosuppression regimen that is necessary to maintain a viable graft alters the risk to benefit ratio of this non-life-saving procedure. Therefore, there must be a concerted effort in the scientific community to develop novel protocols to either minimize immunosuppression or to induce tolerance to the allograft to promote the widespread application of this life-changing procedure.
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Olecranon bursitis is a common clinical problem. It is often managed conservatively because of the high rates of wound complications with the conventional open surgical technique. ⋯ We describe an extrabursal endoscopic technique where the bursa is not entered but excised in its entirety under endoscopic vision. A satisfactory view is obtained with less morbidity than the open method, while still avoiding a wound over the sensitive point of the olecranon.
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Tech Hand Up Extrem Surg · Sep 2013
T.A.C.' pin fixation for basal ulnar styloid fractures associated with distal radius fractures.
Distal radius fractures often accompany ulnar styloid fractures. As basal ulnar styloid fractures sometimes result in symptomatic nonunion causing distal radioulnar joint instability, surgical intervention should be considered as a method of treatment. However, conventional methods of internal fixation for ulnar styloid involving tension band wiring and pinning often causes irritation of hardware, and required further surgery. ⋯ T. A. C.' pin fixation for basal ulnar styloid is a useful method and rarely requires further surgery compared with conventional methods.
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Tech Hand Up Extrem Surg · Jun 2013
Radioscapholunate arthrodesis using low-profile dorsal pi plate.
Radioscapholunate arthrodesis is a desirable method to treat isolated radiolunate arthritis or ulnar translocation of the carpal bones. An intact midcarpal joint is a prerequisite for functional range of motion. Previously, high rates of nonunion were observed with these procedures, as rigid fixation was difficult to obtain with simple Kirschner wires and screws. ⋯ Rectangular retinacular flaps were used under and over the extensor tendons. We performed these arthrodeses in patients with lunate fossa arthritis after a distal radius fracture, and with ulnar translocation of the carpus. We have observed excellent clinical results with about 50% of wrist motion preserved and no cases of nonunion or delayed union.