Category Archives: Content

PUBLISHED: Subcutaneous Ulnar Nerve Transposition

Subcutaneous Ulnar Nerve Transposition
Rothman Institute at Thomas Jefferson University

Jasmine Phun
Sidney Kimmel Medical College

Asif M. Ilyas, MD, MBA, FACS
Rothman Institute at Thomas Jefferson University

In this case, Dr. Ilyas at the Rothman Institute performs a subcutaneous anterior transposition on a patient with cubital tunnel syndrome. The patient’s ulnar nerve subluxed upon elbow flexion and extension upon physical examination, which was a primary indication for choosing this surgical approach over other techniques.

This procedure not only decompresses the affected nerve but also transposes the nerve anterior to the medial epicondyle so as to relieve strain on the nerve upon the full range of motion of the elbow.

Preprint Release: Recipient Kidney Transplant from a Living Donor

Recipient Kidney Transplant from a Living Donor
Massachusetts General Hospital

Maggie L. Westfal, MD, MPH
General Surgery Resident
Massachusetts General Hospital

Nahel Elias, MD, FACS
Transplant Surgery Department
Massachusetts General Hospital

The patient in this case is a 56-year-old female with a past medical history of type I diabetes mellitus, hypertension, hypothyroidism, hyperlipidemia, and end stage renal disease secondary to diabetic and hypertensive nephropathies. In this video, Dr. Nahel Elias performs the recipient side of a living related kidney transplant from the patient’s sister.

PUBLISHED: Jersey Finger Repair

Jersey Finger Repair
Rothman Institute at Thomas Jefferson University

Rachel M. Drummey, MSc
University of Central Florida College of Medicine

Asif M. Ilyas, MD, MBA, FACS
Rothman Institute at Thomas Jefferson University

Jersey finger refers to an avulsion of the flexor digitorum profundus (FDP) at its insertion on the distal phalanx, the weakest point of the tendon. The injury frequently occurs during contact sports while grabbing the jersey of an opposing player as the player pulls or runs away. Surgical repair is the definitive treatment for all cases of complete rupture of the FDP tendon.

In this video article, Dr. Ilyas at the Rothman Institute demonstrates the suture anchor technique to repair a jersey finger. This approach was selected in place of the more traditional pull-out button technique for potentially stronger repair, no presence of external fixation devices, avoidance of button-related complications, and ease of rehabilitation.

PUBLISHED: Bilateral Posterior Retroperitoneoscopic Adrenalectomy with Cortical Sparing on Right Side

Bilateral Posterior Retroperitoneoscopic Adrenalectomy with Cortical Sparing on Right Side
Yale School of Medicine

Taylor C Brown, MD, MHS
Yale School of Medicine

Tobias Carling, MD, PhD, FACS
Yale School of Medicine

Cortical-sparing adrenalectomy allows for the resection of adrenal tumors while preserving unaffected adrenal tissue to prevent adrenal insufficiency. This is especially important in patients with bilateral adrenal tumors, typically pheochromocytomas.

Posterior retroperitoneoscopic adrenalectomy (PRA) allows for a minimally invasive approach to adrenal gland resection compared with the more traditional laparoscopic transabdominal adrenalectomy and open approaches. This approach is ideal to address patients with bilateral disease and was used in this case of a 31-year-old female patient presenting with bilateral pheochromocytomas in the setting of multiple endocrine neoplasia 2A syndrome and coexisting medullary thyroid carcinoma of the right thyroid lobe. A close review of her imaging demonstrated normal-appearing adrenal cortex tissue on the right side that allowed for cortical-sparing adrenalectomy on that side.

PREPRINT RELEASE: AIRWAY TECHNIQUES AND EQUIPMENT

Airway Techniques and Equipment
UChicago Medicine

Dany Accilien, MD
Emergency Medicine Resident
The University of Chicago Pritzker School of Medicine

Dexter C. Graves, MD
Emergency Medicine Resident
The University of Chicago Pritzker School of Medicine

Nicholas Ludmer, MD
Assistant Professor of Emergency Medicine
The University of Chicago Pritzker School of Medicine

Stephen Estime, MD
Assistant Professor of Anesthesiology and Critical Care
The University of Chicago Pritzker School of Medicine

Abdullah Hasan Pratt, MD
Assistant Professor of Emergency Medicine
The University of Chicago Pritzker School of Medicine

In this video, Dr. Pratt goes over airway management techniques in trauma resuscitation. It outlines the preparation and equipment used in patients with impending airway failure that require manual or mechanical ventilation. Also discussed are the innovative airway towers used in the University of Chicago emergency room as well as the general approach to airway management. The different types of laryngoscopy, assist devices, and cricothyroidotomy surgical airway procedures are also presented.

PUBLISHED: Extended Focused Assessment with Sonography for Trauma (EFAST) Exam

Extended Focused Assessment with Sonography for Trauma (EFAST) Exam
UChicago Medicine

Daven Patel, MD, MPH
Resident Physician
Emergency Medicine

Kristin Lewis, MD, MA
Resident Physician
Emergency Medicine

Allyson Peterson, MD
Resident Physician
Emergency Medicine

Nadim Michael Hafez, MD
Assistant Professor of Medicine
Emergency Medicine

This video covers information related to the FAST exam, which evaluates the pericardial, hepatorenal, splenorenal, and suprapubic regions for free fluid in a trauma patient as well as the extended version, which includes an additional evaluation of the pleural spaces for a pneumothorax. It goes through probe selection, probe placement and image acquisition, image optimization, and pitfalls and pearls for the subxiphoid/subcostal, right upper quadrant, left upper quadrant, suprapubic, and pleural views.

PUBLISHED: Subtalar Arthrodesis for Post-Traumatic Subtalar Arthritis

Subtalar Arthrodesis for Post-Traumatic Subtalar Arthritis
Massachusetts General Hospital

Christopher W. DiGiovanni, MD
Chief of the Foot & Ankle Service
Vice Chair for Academic Affairs
Massachusetts General Hospital

Subtalar arthrodesis is currently the mainstay treatment option for the management of recalcitrant subtalar arthrosis.

The patient in this case is a 45-year-old male who developed post-traumatic arthritis of the subtalar joint 14 years following a work-related injury in which he sustained a comminuted, joint-depression type calcaneal fracture after a 10-foot fall from a ladder. Seven years after the initial injury, imaging prompted by progressive hindfoot pain during weight-bearing or following activity revealed progressive degeneration of the subtalar joint, for which he was treated with orthoses, corticosteroid injections, and arthroscopic debridement. After exhausting both conservative and minimally invasive treatment measures at 14 years post-injury, he finally elected to undergo subtalar arthrodesis.

This video article details the methods and techniques involved in subtalar arthrodesis. After an Ollier approach was used to expose the subtalar joint, the arthritic cartilage was removed and the subchondral plate was perforated. Finally, an autogenous bone graft was harvested from the proximal tibia and inserted into the joint space, and compression was achieved by two lag screws.

PREPRINT RELEASE: Ureteroscopy, Laser Lithotripsy, and Stent Replacement for an Obstructing Left Proximal Ureteral Stone with Forniceal Rupture

Ureteroscopy, Laser Lithotripsy, and Stent Replacement for an Obstructing Left Proximal Ureteral Stone with Forniceal Rupture

Ryan A. Hankins, MD
Assistant Professor of Urology
Specialty Director of Urology
MedStar Georgetown University Hospital

The patient in this case is a 76-year-old male who was admitted to the ER two weeks prior and was found to have an obstructing, 1-cm left proximal ureteral stone with a forniceal rupture. A left ureteral stent was placed, and he was started on antibiotics. In this video, Dr. Ryan Hankins at MedStar Georgetown University Hospital performs definitive management of the stone with a left ureteroscopy, laser lithotripsy, and stent replacement.

PREPRINT RELEASE: Endoscopic Stapedectomy

Endoscopic Stapedectomy
Bascom Palmer Eye Institute

C. Scott Brown, MD
Neurotology & Lateral Skull Base Surgery Fellow
University of Miami Miller School of Medicine

Michael E. Hoffer, MD
Professor of Otolaryngology and Neurological Surgery
University of Miami Miller School of Medicine

Endoscopic ear surgery can improve visualization of critical structures. In this video, Dr. Scott Brown performs an endoscopic stapedectomy for the treatment of conductive hearing loss. He explains his technique and the advantages afforded by adoption of the endoscope in ear surgery.

PREPRINT RELEASE: Temporal Bone Dissection (Cadaver)

Temporal Bone Dissection (Cadaver)
Cranial Access, Neuroanatomy, and ENT Surgery (CANES) Lab

C. Scott Brown, MD
Neurotology & Lateral Skull Base Surgery Fellow
University of Miami Miller School of Medicine

Cadaveric dissections of the temporal bone are a critical part of learning otologic surgery in residency. Dr. Scott Brown, neurotology fellow at the University of Miami, performs a step-by-step dissection of the temporal bone. He outlines key anatomical structures and describes safe and efficient techniques for these procedures.