First Metatarsophalangeal Joint Arthrodesis Using Memory Staples: Clinical and Functional Results.

Background. We present clinical and functional results of first metatarsophalangeal joint (MTPJ) arthrodesis using Memory staples. Methods. This retrospective observational study reviewed MTPJ arthrodesis with Memory staples from 2012 to 2016. Results. The mean age of 50 patients (55 feet) was 63 years (range 41-77 years). Forty-one feet were in women. Indication was hallux rigidus (n = 49) and hallux valgus (n = 6). The overall union rate was 98.2% (n = 54 of 55), including delayed healing in 3 (5.5%). The average time to union was 12 weeks. At a mean follow-up of 38 months (range 12-73 months), the mean Foot and Ankle Ability Measure score (47 out of 55, 86% response rate) was 87% (interquartile range 78%-100%). Complications included partial laceration of extensor hallucis longus (n = 1), wound infection (n = 4), wound-related (n = 2), lesser metatarsalgia (n = 3), cock up deformity (n = 1), and pain (n = 3). Conclusions. The high union rate, good patient satisfaction scores, and low rate of complications support our use of Memory staples.Levels of Evidence: Therapeutic, Level IV.

Intra-articular Myxoma Arising from the Scapholunate Ligament: A Rare Cause of Dorsal Wrist Swelling.

The differential diagnosis of a dorsal wrist swelling includes ganglion, lipoma, cutaneous tumors, and benign peripheral nerve sheath tumors, with ganglions being the most common. We present the case of a myxoma arising from the dorsal scapholunate ligament mimicking a dorsal wrist ganglion. Volar wrist joint myxomas have been previously reported, but this is the first report of a myxoma arising from the dorsal side of the wrist joint.

An Extensile Approach to the Radial Aspect of the Carpus: "The Link Incision".

The structures on the radial side of the wrist and thumb base can be approached by a longitudinal incision on the radial side of the wrist. However, longer longitudinal scars can be cosmetically unacceptable and can result in a scar contracture. It is preferable to curve longer incisions along the Langer's skin lines to achieve better scar characteristics. Curving the incision also enables an extensile approach and provides easy access to the thumb base, radial carpus, and radial wrist joint. We describe our approach as a "Link" between the most common approaches that surgeons are familiar with; the dorsoulnar approach to the thumb metacarpophalangeal joint for ulnar collateral ligament repair and the flexor carpi radialis approach for distal radial fracture fixation. The zone between these two incisions is not as frequently approached. Our incision connects these two well established incisions and we have described a step by step approach to this unfamiliar area. This "Link zone" overlies the thumb trapeziometacarpal joint, scaphotrapeziotrapezoid joint, and the radial styloid. It contains superficial branches of the radial nerve, first extensor compartment tendons, and the deep branch of radial artery in the anatomic snuff box. The "Link incision" is an extensile approach in both the proximal and distal directions.

"The Serpentine Zone": A Surgeon's Guide to the Surface Anatomy of the Digital Neurovascular Spiral in Dupuytren's Contracture.

The anatomy of the cords that form in Dupuytren's disease is complicated and a spiral cord is the most challenging variant to address. It displaces the neurovascular bundle toward or beyond the midline and closer to the skin. This article illustrates the surface anatomy of the neurovascular spiral to help surgeons identify this zone of danger that the authors term "the serpentine zone." Careful dissection in this zone will help avoid iatrogenic digital neurovascular injury.

"Hills, Plains, and Valleys": A Topographical Concept in the Treatment of Dupuytren's Contracture With Needle Aponeurotomy.

Needle aponeurotomy is emerging as a preferred choice of treatment for patients with Dupuytren's contracture keen on a quick, minimally invasive procedure that enables a rapid return of hand function. This article describes a unique topographical concept in the treatment of Dupuytren's contracture with needle aponeurotomy. This concept guides portal placement in a planned manner to achieve better correction and avoid potential complications.

A Simple Dressing Technique Following Dermofasciectomy and Full Thickness Skin Grafting of the Fingers in the Treatment of Severe Dupuytren's Contracture.

Dupuytren's disease with severe finger contractures and recurrent contractures following previous surgery often have extensive skin involvement. In these severe cases, excision of the diseased chord along with the involved skin is a good option to reduce the risk of recurrance. The resulting skin defect can be covered with a full thickness skin graft (FTSG) or a cross finger flap. Cross finger flaps have donor finger morbidity and hence a full thickness graft is usually preferred. The FTSG extending to the midlateral margins on both sides of the finger reduces the risk of joint contracture due to graft shrinkage. Once the FTSG is sutured in place, the standard practice is to compress and secure the graft to its recipient bed with a tie-over dressing and this can be time consuming. We present a simple dressing technique to secure the FTSG without the need for a tie-over dressing.

An unusual presentation of a popliteal arteriovenous fistula after primary total knee arthroplasty.

Iatrogenic popliteal arteriovenous fistula after total knee arthroplasty is extremely rare (Int Surg. 1998 Jul-Sep;83(3):198-201). We report this complication in a 78-year-old female patient 3 years after total knee arthroplasty. She presented with symptoms of persistent swelling and recurrent cellulitis of the operated leg. A fistula was detected between the popliteal artery and vein by vascular duplex scan and confirmed by peripheral arteriography. This was successfully treated by resection of the fistula and direct repair of the artery and vein.

A simple external fixator for complex finger fractures.

Complex fractures of phalangeal bones in the hand are difficult to treat. External fixation is an effective method of treatment particularly when internal fixation is not possible due to comminution and associated soft tissue injury. A variety of commercial fixators are available for the treatment of hand fractures. However, these fixators are costly and need a sufficient degree of expertise and familiarity for their use. We describe a very simple fixator which is stable, lightweight and can be easily constructed with materials readily available in most trauma theatres.