A simple blind tenolysis for flexor carpi radialis tendinopathy.

BACKGROUND: Flexor carpi radialis (FCR) tendinopathy is an entity with a chronic form (repetitiveness of work) and an acute form (acute overstretching of the wrist). Confirmation of this syndrome can be established by injection of a small amount of a local anesthetic in the sheet of the FCR at this tender point. Complete relieve of the symptoms after injection confirms the existence of a tendinopathy of the FCR. Whereas rest and/or local application of steroids do not have a persistent effect on the short term outcome, a tenolysis could be performed. Before performing a tenolysis underlying causes should be excluded or treated. METHODS: In this article a simple and save technique is described, using a small Beaver knife to open the osteofibrous tunnel of the flexor carpi radialis tendon, without opening the carpal tunnel. RESULTS: Relieve of complaints could be reached up to almost two third of all cases. CONCLUSION: In cases in which non-operative treatment is not effective regarding FCR tendinopathy, a simple blind technique by opening the osteofibrous tunnel could be successful.

Endoscopic carpal tunnel release: a new single-portal device.

Carpal tunnel syndrome is a common peripheral nerve disease, often requiring surgical intervention. After the first description of endoscopic carpal tunnel release 20 years ago, several endoscopic techniques have been described. The endoscopic procedure seems to have a better outcome in terms of time to return to work. A feared complication of endoscopic carpal tunnel release is injury to the median nerve or branches of the median nerve. We developed a new guiding cannula with raised borders, which will prevent accidental injury to the median nerve. A single-portal anterograde technique, to release the transverse carpal ligament, is described with the use of this new guiding device.

Digital nerve injuries: a review of predictors of sensory recovery after microsurgical digital nerve repair.

BACKGROUND: Optimal surgical management of digital nerve lesions remains uncertain despite the publication of numerous studies. The purposes of this review were primarily to analyze whether there is a superior surgical technique for digital nerve repair and secondarily to statistically verify the variables to be predictors of sensory recovery. METHODS: A literature search was performed using PubMed including citation from MEDLINE. Studies were included if they involved patients with digital nerve lacerations in whom end-to-end neurorrhaphy, nerve grafts, conduits, or end-to-side neurorrhaphy were performed. Further, the sensory outcome had to be assessed according to the modified American Society for Surgery of the Hand guidelines to stratify for two-point discrimination in millimeters. The variables age, follow-up, delay in repair, type of trauma, and gap length were extracted. The association between each predictor and response was assessed using a linear mixed model and corrected for heterogeneity between studies. Significance was considered present at p ≤ 0.05. RESULTS: Of the 34 articles found, 14 articles were included giving appropriate individual data for 191 nerves. There was no statistically significant difference in outcome between operation techniques. Age and follow-up were verified predictors of sensory recovery. CONCLUSION: In this review, the type of operation for digital nerve repair does not influence sensory outcome. However, we verified outcome to be influenced by the patient's age and the follow-up period. To add more scientific evidence to our results, larger cohort prospective studies need to be done with better detailed description of data.

One century of Kirschner wires and Kirschner wire insertion techniques: a historical review.

A century ago, in 1909, Martin Kirschner (1879-1942) introduced a smooth pin, presently known as the Kirschner wire (K-wire). The K-wire was initially used for skeletal traction and is now currently used for many different goals. The development of the K-wire and its insertion devices were mainly influenced by the change in operative goals and by the introduction of antibiotics. The first versions of the Kirschner wire were hammered through a predrilled hole into the bone, but later on drilling became the standard technique of insertion. Drilling is considered a simple way of implanting, with many advantages, such as percutaneous and atraumatic insertion. However, this technique also has its disadvantages like temperature elevation, resulting in osteonecrosis and heat-related complications. Despite these complications the K-wire is now standard for the treatment of hand fractures, worldwide.

Hammering K-wires is superior to drilling with irrigation.

Cooling during drilling Kirschner wires is not always effective in preventing thermal related damage. In this study, we used a human in vitro model and compared temperature elevation, insertion time, and extraction force between three Kirschner wire insertion methods-drilling with and without irrigation and pneumatic hammering. Forty five Kirschner wires were inserted into 15 fresh human cadaver metacarpals. All three insertion methods were applied in each metacarpal. Drilling without irrigation resulted in a temperature elevation of 67.25 +/- 5.4 degrees C with significantly lower values for drilling with irrigation (4.15 +/- 0.6 degrees C) and pneumatic hammering (31.52 +/- 3.4 degrees C). The insertion time for pneumatic hammering (47.63 +/- 8.8 s) was significantly lower compared to drilling without irrigation (263.16 +/- 36.5 s) and drilling with irrigation (196.10 +/- 28.5 s). Extraction forces after drilling without irrigation, drilling with irrigation, and pneumatic hammering were 39.85 +/- 4.1 N, 57.81 +/- 6.5 N, and 62.23 +/- 6.7 N, respectively. Pneumatic hammering is superior to drilling without irrigation, especially when irrigation is not possible.

Drilling K-wires, what about the osteocytes? An experimental study in rabbits.

INTRODUCTION: The function of osteocytes regarding osteonecrosis has been underestimated for a long time. Recently it has been suggested that apoptosis of osteocytes results in strong osteoclastic bone resorption. Death of osteocytes due to drilling may therefore increase the risk of K-wire loosening. The purposes of our in vivo study were to assess the minimal drill time needed to notice disappearance of osteocytes and to measure the distance of the empty osteocyte lacunae surrounding the drill tract in relation with the insertion time, directly and 4 weeks after drilling Kirschner (K-) wires into the femur and tibia of rabbits. MATERIALS AND METHODS: Trocar tipped K-wires (70 mm length and 0.6 mm thickness) were drilled into the femur and tibia of 14 New Zealand white rabbits [mean body weight 2.81 kg (2.66-3.09 kg)]. Six rabbits were terminated following surgery (t = 0) and eight rabbits were terminated 4 weeks (t = 4) after surgery. Following termination, hematoxylin and eosin stained sections were cut from femur and tibia until the drill hole was visible. The sections were evaluated under a light microscope for the presence or absence of osteocytes in osteocyte lacunae surrounding the drill holes. RESULTS: All osteocyte lacunae were empty around the K-wires in 50 and 87% of the cases, directly and 4 weeks after the surgery, respectively. The osteocytes disappeared especially beyond a drilling time of 37 s (P = 0.011) and 27 s (P = 0.008) at t = 0 and t = 4, respectively. Furthermore, a significantly positive correlation was seen between the distances of the empty osteocyte lacunae surrounding the drill holes in relation with time at t = 0 (P = 0.008) and t = 4 (P = 0.000). CONCLUSION: Although only drilling without cooling was studied, short drilling times may prevent the disappearance of osteocytes in case cooling is not used in clinical practice as is the case in percutaneous K-wire insertion.