Early active short arc motion following central slip repair.

Open repairs of the central slip have traditionally been treated with 4 to 6 weeks of immobilization, followed by therapy to restore motion. Although rehabilitative efforts were usually directed at avoiding extension lag, loss of flexion was also commonly encountered. Early active short arc motion produces improved range of motion with shorter treatment time compared with static immobilization of the repaired central slip. The technique is straightforward but its success depends on attention to the details of splinting and exercise, and the patient's active cooperation and compliance.

Tendon disorders of the hand and wrist.

The terminology used to describe most common tendon disorders in the hand and wrist suggests that they are inflammatory in nature, although current evidence indicates that mechanical and degenerative factors are more important. Corticosteroid injections provide relief in 60% or more of cases; however, the duration of their effectiveness remains uncertain. Surgical release of the stenotic pulley or sheath is curative in well over 90% of cases; complications of surgery are rare, and relief is long-lasting. Enlightened management of these common problems demands evidence-based guidelines defining indications for surgery that will maximize outcomes and minimize costs.

Division of the brachioradialis muscle: a modification of the current technique in endoscopic radial artery harvesting.

BACKGROUND: Utilization of the radial artery as a conduit for coronary artery bypass grafting has increased significantly over the past 8 years. Concurrently, minimally invasive surgical techniques have been increasingly applied resulting in improved aesthetics, less pain, and decreased morbidity and length of hospital stay. Endoscopic radial artery harvesting (ERAH) has been shown to be of benefit to patients undergoing coronary artery bypass grafting. The brachioradialis is a recognized limitation in ERAH. To date, the standard operative techniques for ERAH have included maintaining the integrity of the brachioradialis muscle. Objective. The aim of this study was to assess the effect of dividing the medial border of the brachioradialis muscle during ERAH. METHODS: We performed ERAH on 9 cadaveric arms using standard endoscopic vein harvesting equipment (30-degree/5-mm endoscope, subcutaneous retractor, and pig-tail vessel dissector) and ultrasonic harmonic coagulating shears. In 5 cadaveric arms, the medial aspect of the brachioradialis muscle was preserved during the dissection. In 4 arms, the medial border of the brachioradialis muscle was divided. All 9 harvests were timed and compared. At the completion of the endoscopic dissection, all 9 arms were opened and examined for neurovascular injury. RESULTS: In cadaveric arms, modifying the current ERAH technique by dividing the medial border of the brachioradialis muscle resulted in a visible increase in tunnel size. In the group where the brachioradialis muscle was divided, a statistically significant reduction in harvest time of 32% was observed (P = .02). Post-harvest examination revealed no gross neurovascular injury; specifically, no injuries to the superficial branches of the radial nerve or the lateral antebrachial cutaneous nerves were identified. CONCLUSION: Division of the medial border of the brachioradialis muscle during endoscopic radial artery harvesting appears to be a safe technique modification that subjectively improves working space and vision of vital structures, facilitating ease of the procedure. Objectively, division of the medial border of the brachioradialis muscle resulted in a statistically significant reduction in harvest time in cadaveric arms when compared with the current technique of ERAH. A clinical pilot study to verify the efficacy and safety of this technique modification is warranted.

Combined internal and external fixation of distal radius fractures.

Combined internal and external fixation of distal radius fractures is used most commonly to treat injuries with joint surface or metaphyseal comminution. External fixation aids reduction intraoperatively and facilitates arthroscopic, per-cutaneous, or open manipulation of the fracture. Internal fixation maintains precise reduction of critical anatomy, principally the contour and orientation of the articular surface. Postoperatively the fixator functions as a neutralization device, preventing fracture collapse and decreasing the biomechanical demands on the internal fixation hardware. The combined technique exploits the benefits of both forms of fixation, allowing each to be used to full advantage in the treatment of complex distal radius fractures.

Bone graft substitutes.

A better understanding of the biology of fracture healing and an increasing awareness of the limitations and potential complications of autogenous bone graft harvest have combined to foster a burgeoning interest in the development of bone graft substitutes. A few of these materials have been available for more than a decade, and many more should become available in the near future. The characteristics of the ideal bone graft substitute may vary considerably depending on the intended site of application and the clinical setting in which it is used. Knowledge of the available alternatives is a necessary prerequisite to informed decision making.

Surgical alternatives for elbow arthritis in the young adult.

Most surgeons agree that total elbow arthroplasty is best avoided or deferred in patients younger than 60 years of age, although, at times, there may be no reasonable alternative. Other reconstructive options are available that may provide years of useful function, even if they are sometimes considered a surgical bridge to allow the patient to achieve the age at which implant arthroplasty would be appropriate. The patient and surgeon must have a clear understanding of the expectations and limitations of any proposed procedure. The key to success in reconstructive elbow surgery is the choice of the option that best addresses the articular pathology and the needs and desires of the specific patient.