Open Surgical Excision of Dorsal Wrist Ganglia: Puncturing the Dome Reduces Surgery Time.

Background: The following study is retrospective and compared the operative time and complications using two techniques of surgical resection of primary dorsal wrist ganglia in adults. Methods: Surgery was performed by the senior author (M.M.A.) through a transverse skin incision. The dome of the ganglion is dissected in both techniques. In the first technique (group A patients, n = 20 patients), dissection is continued to the base of the ganglion to reach the stalk near the scapho-lunate ligament. The stalk is transected and cauterized near the ligament. This surgical technique has been practiced by the senior author for 25 years. Over the last 5 years, the author has modified the technique (group B patients, n = 20 patients) by puncturing the dome of the ganglion following dome dissection. About two-thirds of the content of the ganglion is removed, and a mosquito is then used to close the puncture site. Dissection of the base of the ganglion to the stalk becomes easier and quicker, and the stalk is transected and cauterized near the scapho-lunate ligament. Results: There was one recurrence in each group. Other complications were not seen in either group. The mean operative time (SD) was 30.75 (SD = 2.98) minutes for group A; and 20.75 (SD = 2.25) minutes for group B. An independent-samples t test was used to compare the operative time of both groups, which showed the difference was statistically significant (P < 0.001). Conclusions: Our study showed that intentionally puncturing the dome of the ganglion makes the dissection of the base quicker, without increasing the risk of complications.

Ulnar Ray Deficiency: A New Classification and a Unique Case Report.

Ulnar ray deficiency is a rare congenital upper limb defect. We report on a unique case with hand-on-flank deformity on the one side and limb truncation on the contralateral side. The standard of care for the hand-on-flank deformity is to do humerus osteotomy to reposition the hand anteriorly. However, the right limb truncation in our patient made the senior author decide not to do the osteotomy. Final assessment showed that the posterior hand position enabled the patient to reach the ano-genital areas, the pocket, and the mouth. It was concluded that in case of hand-on-flank deformity in one limb and limb truncation of the contralateral limb, osteotomies to bring the hand anteriorly are not advised.

Mid-Term Results of Partial Trapeziectomy and Simple FCR Tendon Graft Interposition in a Selected Group of Patients with Thumb Carpometacarpal Joint Arthritis.

Introduction There are several surgical options for the treatment of osteoarthritis of the first carpometacarpal joint (CMCJ1). We introduce our technique of partial trapeziectomy and flexor carpi radialis (FCR) tendon graft interposition in a selected group of patients with CMCJ1. Objective The main purpose of this article is to investigate the mid-term results of our technique. Patients and Methods This is a retrospective study of 24 patients with CMCJ1 arthritis (23 females and 1 male with a mean age of 68 years) who were treated with partial trapeziectomy and simple FCR tendon graft interposition. Patient selection for this procedure was based on two prerequisites: the absence of scaphotrapezial arthritis and the absence of severe ligament laxity or severe subluxation of the CMCJ1. All patients had a mean follow-up of 6 years. Pre- and postoperative standard assessments were done. Results There were no postoperative complications and a zero-revision rate. All parameters significantly improved after surgery ( p < 0.05). All patients were "very satisfied" with the outcome. Conclusion The procedure of partial trapeziectomy and FCR tendon graft interposition can give an excellent mid-term outcome with a zero-revision rate if utilized in a selected group of patients with CMCJ1 arthritis.

A modified technique of two-staged extensor tendon reconstruction in zones 6-8 in a patient with absent palmaris/plantaris tendons: A case report.

INTRODUCTION: The indications for two-staged extensor tendon reconstruction are rare and only 14 previously reported cases were found in the literature. In these cases, silicone rods are inserted in the first stage. Few months later, the palmaris longus / plantaris tendon grafts are usually used to replace the silicone rods. CASE REPORT: we encountered a patient with major defects of the extensor tendons of all fingers extending from the proximal one third of zone 6 to zone 8. The patient had no palmaris or plantaris tendons. We utilized a modified technique of reconstruction using the split flexor carpi radialis as the tendon graft and the flexor carpi ulnaris as the motor tendon. At final follow-up, there was full active extension of the fingers. However, there was limitation of wrist flexion because of the harvesting of both wrist flexors. DISCUSSION: We describe a modified technique of two-staged extensor tendon reconstruction which may be used in patients with absent palmaris/ plantaris tendons. CONCLUSION: In patients with absent palmaris/ plantaris tendons and major defects of the extensor tendons of all fingers, the use of split flexor carpi radialis is an adequate alternative for reconstruction and gives a good functional outcome.