Tag Archives: Orthopaedics

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.

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.

PUBLISHED: Carpal Tunnel Release (Cadaver)

Carpal Tunnel Release (Cadaver)

Asif M. Ilyas, MD
Professor of Orthopaedic Surgery
Program Director of Hand Surgery
Rothman Institute, Thomas Jefferson University

Carpal tunnel syndrome (CTS) is the most common peripheral compression neuropathy and results in symptoms of numbness and paresthesia in the thumb, index finger, middle finger, and half of the ring finger. When CTS symptoms progress and can no longer be managed with nonoperative measures, carpal tunnel release (CTR) surgery is indicated.

In this case, Dr. Asif Ilyas at the Rothman Institute performs CTR surgery on a cadaveric arm via the mini-open CTR technique. A 2-cm longitudinal incision was placed directly over the carpal tunnel, the transverse carpal ligament was exposed and then released, and the wound was closed. Patients are typically sent home with instructions to use their hand immediately postoperatively, while avoiding strenuous use until the incision has healed. Splinting and therapy are not required postoperatively.


PUBLISHED: Less Invasive Stabilization System (LISS) for Distal Femur Fracture Repair

Less Invasive Stabilization System (LISS) for Distal Femur Fracture Repair
Brigham and Women’s Hospital

Michael J. Weaver, MD
Associate Orthopaedic Surgeon, Brigham and Women’s Hospital
Assistant Professor of Orthopedic Surgery, Harvard Medical School
Brigham and Women’s Hospital

The patient in this case is an 81-year-old male with dementia who sustained an unwitnessed fall that resulted in a displaced intra-articular distal femur fracture. Here, Dr. Weaver at Brigham and Women’s Hospital repairs the fracture by performing an open reduction and internal fixation with a LISS plate. An anterolateral approach was used to visualize the joint surface and obtain an anatomic reduction of the articular surface, and a percutaneously-placed lateral lock plate was used to bridge the area of comminution while restoring length, alignment, and rotation to hopefully allow for biologic fixation that permits the bone to heal well.

PREPRINT RELEASE: Flexor Digitorum Superficialis to Flexor Digitorum Profundus (STP) Transfer, Adductor Release, and Z-Plasty for a Pediatric, Stroke-Induced Left Hand Spastic Contracture


Flexor Digitorum Superficialis to Flexor Digitorum Profundus (STP) Transfer, Adductor Release, and Z-Plasty for a Pediatric, Stroke-Induced Left Hand Spastic Contracture
Hospital Leonardo Martinez, Honduras

Sudhir B. Rao, MD
Big Rapids Orthopaedics

Mark N. Perlmutter, MS, MD, FICS, FAANOS
Carolina Regional Orthopaedics

The patient in this case is a 15-year-old female who had a stroke several years ago and now has a left hand spastic contracture. Here, Dr. Rao and Dr. Perlmutter perform an STP transfer, an adductor release, and a Z-plasty to lengthen the flexor tendons of the hand and repair her thumb-in-palm deformity. This case was performed during a surgical mission to Honduras with the World Surgical Foundation.

PREPRINT RELEASE: Bone Graft for Non-Union of Right Thumb Proximal Phalanx Fracture


Bone Graft for Non-Union of Right Thumb Proximal Phalanx Fracture
Hospital Leonardo Martinez, Honduras

Sudhir B. Rao, MD
Big Rapids Orthopaedics

Mark N. Perlmutter, MS, MD, FICS, FAANOS
Carolina Regional Orthopaedics

The patient in this case is an 11-year-old female who fractured the thumb of her dominant hand 1 year ago and now has a well-established non-union of the head of the proximal phalanx of her right thumb. Here, Dr. Rao and Dr. Perlmutter repair the fracture by harvesting a bone graft from the patient’s iliac crest and transplanting it into the fracture site. This case was performed during a surgical mission in Honduras with the World Surgical Foundation.

PREPRINT RELEASE: Bilateral Syndactyly Release of Third and Fourth Fingers


Bilateral Syndactyly Release of Third and Fourth Fingers
Hospital Leonardo Martinez, Honduras

Sudhir B. Rao, MD
Big Rapids Orthopaedics

Mark N. Perlmutter, MS, MD, FICS, FAANOS
Carolina Regional Orthopaedics

The patient in this case is a 1-year-old female with complex syndactyly of the right hand and simple syndactyly of the left hand. Here, Dr. Rao and Dr. Perlmutter release both sides, with the right side involving a full-thickness skin graft taken from the patient’s groin crease. This case was filmed during a surgical mission with the World Surgical Foundation in Honduras.