ABSTRACT
We report an unusual clinical presentation and surgical treatment of a Galeazzi-equivalent fracture in which initial closed treatment failed. This case was unique and challenging secondary to the formation of a neoulna volar to an unreduced periosteal sleeve injury, resulting in a bifid radiographic appearance.
Subject(s)
Fracture Dislocation/surgery , Fracture Fixation, Internal/methods , Fractures, Malunited/surgery , Ulna Fractures/surgery , Adolescent , Fracture Dislocation/diagnostic imaging , Fractures, Malunited/diagnostic imaging , Humans , Male , Orthotic Devices , Osteotomy , Tomography, X-Ray Computed , Ulna Fractures/diagnostic imagingABSTRACT
Video recordings of surgical procedures are an excellent tool for presentations, analyzing self-performance, illustrating publications, and educating surgeons and patients. Recording the surgeon's perspective with high-resolution video in the operating room or clinic has become readily available and advances in software improve the ease of editing these videos. A GoPro HERO 4 Silver or Black was mounted on a head strap and worn over the surgical scrub cap, above the loupes of the operating surgeon. Five live surgical cases were recorded with the camera. The videos were uploaded to a computer and subsequently edited with iMovie or the GoPro software. The optimal settings for both the Silver and Black editions, when operating room lights are used, were determined to be a narrow view, 1080p, 60 frames per second (fps), spot meter on, protune on with auto white balance, exposure compensation at -0.5, and without a polarizing lens. When the operating room lights were not used, it was determined that the standard settings for a GoPro camera were ideal for positioning and editing (4K, 15 frames per second, spot meter and protune off). The GoPro HERO 4 provides high-quality, the surgeon perspective, and a cost-effective video recording of upper extremity surgical procedures. Challenges include finding the optimal settings for each surgical procedure and the length of recording due to battery life limitations.
Subject(s)
Hand/surgery , Monitoring, Intraoperative/methods , Orthopedic Procedures/methods , Upper Extremity/surgery , Video Recording/instrumentation , Equipment Design , Female , Humans , Male , Monitoring, Intraoperative/instrumentation , Sampling Studies , Sensitivity and Specificity , Video Recording/methodsABSTRACT
Flexor tendon repairs continue to improve thanks to advancements in suture material and technique. The role of barbed sutures in flexor tendon repairs has been previously investigated, but with the advent of a new material, interest in their use has been rekindled. We hypothesized that the use of modern barbed sutures will have comparable maximum tensile strength and 2-mm gapping strength to that of conventional sutures, allowing their use to theoretically decrease adhesions and tissue damage in flexor tendon repairs. Flexor tendon repairs were performed on a cadaver model using either 3-0 Ethibond (Ethicon, Inc, Somerville, New Jersey) (Kessler repair) or 2-0 Quill sutures (Angiotech, Vancouver, British Columbia, Canada ) (Kessler-Bunnell repair) and were biomechanically tested. The mode of failure for the Ethibond sutures was suture pullout 2 times and knot failure 18 of 20 times, while the Quill sutures failed entirely by pullout. Maximum load to failure was 34.7+/-5.4 N and 29.6+/-3.6 N for Ethibond and Quill, respectively. This was found to be statistically significant (P=.001). Tensile load at 2-mm gapping was 22.8+/-6.3 N and 22.2+/-4.0 N for Ethibond and Quill, respectively. No statistical significance was found (P=.723). This study helps substantiate the possible role of modern barbed sutures in flexor tendon repair. Additional biomechanical studies will need to be performed to further assess the use of barbed sutures in flexor tendon repair.
Subject(s)
Equipment Failure Analysis , Plastic Surgery Procedures/instrumentation , Sutures , Tendon Injuries/surgery , Tendons/surgery , Cadaver , Humans , Materials Testing , Polyethylene Terephthalates , Polypropylenes , Random Allocation , Plastic Surgery Procedures/methods , Stress, Mechanical , Tensile StrengthABSTRACT
The effect of an extended flexor carpi radialis approach on the blood supply of the radius was examined in six (3 paired) fresh frozen cadaver limbs after injection with India ink and clearing using a modified Spalteholz technique. An extended flexor carpi radialis approach to the distal radius was made in the left limb in each of the three-paired limbs. The right limb served as a nonoperative control. Following perfusion of the arterial vasculature of each limb with India ink, serial transverse sections were cut and the intraosseous blood supply evaluated using a modified Spalteholz technique. Both controls and surgical specimens demonstrated complete cortical penetration from endosteal vessels in the proximal and midsections of the radius. In the distal radius, surgical specimens demonstrated reduced perfusion volarly, however there continued to be perfusion of ink through intact dorsal and ulnar metaphyseal perforating arteries. Persistent vascular perfusion to the distal radius remains through intact endosteal vessels and metaphyseal perforators of extensive surgical soft-tissue stripping.
