Category Archives: Hand Surgery

Hand Surgery, Orthopedics, Print Release

PUBLISHED: Arthrodesis of the Distal Interphalangeal (DIP) Joint of the Right Ring Finger for Arthritis

Arthrodesis of the Distal Interphalangeal (DIP) Joint of the Right Ring Finger for Arthritis
Lasya P. Rangavajjula, BS1; Amir R. Kachooei, MD, PhD2; Asif M. Ilyas, MD, MBA, FACS1,2
1Sidney Kimmel Medical College at Thomas Jefferson University
2Rothman Institute at Thomas Jefferson University

Osteoarthritis commonly impacts the finger distal interphalangeal (DIP) joints. The prevalence of DIP joint arthritis is high, with more than 60% of individuals older than 60 having DIP joint arthritis.

Operative treatment for arthritis of the DIP joint is indicated for pain, deformity, dysfunction, and instability in patients who are recalcitrant to conservative measures. Arthrodesis, or the fusion, of the DIP joint is a widely accepted surgical treatment for DIP joint arthritis.

Several surgical techniques have been historically described, with headless compression screw (HCS) fixation being a particularly common technique because of its advantages, including reliable compression, rigid fixation, lack of prominence, and no need for removal. This video demonstrates arthrodesis using HCS for arthritis in the right ring finger DIP joint.

Hand Surgery, Orthopedic Trauma, Orthopedics, Print Release

PUBLISHED: Triceps Repair for Acute Triceps Tendon Rupture

Triceps Repair for Acute Triceps Tendon Rupture
Gregory Schneider, BS¹; Asif M. Ilyas, MD, MBA, FACS¹’²
¹Sidney Kimmel Medical College at Thomas Jefferson University
²Rothman Institute at Thomas Jefferson University

The patient in this case suffered an acute triceps tendon rupture and opted for surgical repair to restore function. His physical exam findings of tenderness at the olecranon and weakness against resistance during elbow extension, combined with plain film imaging revealing a positive fleck sign representing an avulsion the triceps tendon off of the olecranon, gave the diagnosis of acute triceps tendon rupture.

The patient underwent surgical repair under general anesthesia in lateral decubitus position with a sterile tourniquet applied for hemostasis. The treatment goal was re-approximating the distal triceps tendon to the olecranon in order to restore elbow extension strength and upper extremity function. The surgical technique demonstrated in this video is the suture bridge technique.

Fundamentals, Hand Surgery, Orthopedics, Print Release

PUBLISHED: Ulnar Nerve Transposition (Cadaver)

Ulnar Nerve Transposition (Cadaver)
Irene Kalbian; Asif M. Ilyas, MD, MBA, FACS
Rothman Institute

Ulnar nerve transposition is a surgical procedure performed to treat ulnar nerve compression of the elbow, also known as cubital tunnel syndrome. This procedure is utilized after both non-operative management and in situ decompression fails, or if these procedures are deemed inappropriate based on patient pathology or ulnar nerve instability.

Transposition of the ulnar nerve involves not only decompression of the nerve but also its anterior repositioning to reduce compression and irritation while maintaining nerve integrity. This video demonstrates, on a cadaver arm, the operative technique for performing an ulnar nerve transposition using either a subcutaneous or a submuscular technique.

Hand Surgery, Orthopedics, Print Release

PUBLISHED: Lateral Epicondylitis Debridement

Lateral Epicondylitis Debridement
Keenan R. Sobol, BS¹; Asif M. Ilyas, MD, MBA, FACS¹²
¹Sidney Kimmel Medical College at Thomas Jefferson University
²Rothman Institute at Thomas Jefferson University

Lateral epicondylitis (LE), commonly referred to as “tennis elbow,” is a common condition of the extensor tendons of the forearm that can lead to pain along the lateral epicondyle with radiation into the forearm, decreased grip strength, and difficulty lifting objects. When LE symptoms progress and can no longer be managed with non-operative measures, LE debridement may be indicated.

The approach presented here is an open debridement of the extensor carpi radialis brevis (ECRB) tendon origin. A 3–4-cm longitudinal incision was placed longitudinally over the lateral epicondyle, radial head, and capitellum. The ECRB was exposed then debrided, the lateral epicondyle was decorticated, the lateral collateral ligament was repaired, the wound was closed in layers, and a soft dressing and splint were placed.

Hand Surgery, Orthopedics, Print Release

PUBLISHED: De Quervain’s Release (Cadaver)

 

De Quervain’s Release (Cadaver)

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

Irene Kalbianr
Rothman Institute at Thomas Jefferson University

De Quervain’s release is a surgical procedure performed to curatively treat stenosing extensor tenosynovitis of the first extensor compartment of the wrist after nonoperative management fails. This procedure involves surgical release of the first dorsal compartment with care taken to fully release the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons from their respective sheaths, while protecting the radial sensory nerve, in order to decompress the extensor tendons. This video outlines the operative technique used by Dr. Asif Ilyas at the Rothman Institute for performing a De Quervain’s release on a cadaveric wrist.

 

Hand Surgery, Orthopedic Trauma, Orthopedics, Print Release

PUBLISHED: Flexor Tendon Repair for a Zone 2 FDP Tendon Laceration

 

Flexor Tendon Repair for a Zone 2 FDP Tendon Laceration

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

Chaim Miller
Sidney Kimmel Medical College at Thomas Jefferson University

In this case, Dr. Asif Ilyas at the Rothman Institute presents a zone 2 flexor tendon repair with a 4-0 Ethibond suture with a modified Kessler stitch that resulted in an 8-core strand repair. The procedure was done under wide awake local anesthesia no tourniquet (WALANT) protocol, which among other strengths allows the surgeon to test the repair and set postrehabilitation expectations for the patient.

 

Hand Surgery, Orthopedics, Print Release

PUBLISHED: Scaphoid Open Reduction and Internal Fixation Through Dorsal Approach

Scaphoid Open Reduction and Internal Fixation Through Dorsal Approach

M. Grant Liska, BS
University of Central Florida College of Medicine

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

Dr. Asif Ilyas at the Rothman Institute presents the case of a proximal pole scaphoid fracture repaired with ORIF via a dorsal approach. After dissection through the joint capsule and exposure of the base of the scaphoid, a headless compression screw is placed anterograde in line with the thumb in all planes. This procedure provides increased stability and improved rate of the union in correlation with the accuracy of intraoperative reduction, leading to improved outcomes for surgical candidates over more conservative approaches.

Hand Surgery, Orthopedics, Print Release

PUBLISHED: Distal Radius Open Reduction and Internal Fixation

Distal Radius Open Reduction and Internal Fixation

Bradley Richey, MSc
Rothman Institute

Asif M. Ilyas, MD, MBA, FACS
Rothman Institute

In this case, Dr. Asif Ilyas at the Rothman Institute presents the case of an adult female presenting with a dorsally displaced and angulated fracture of the distal radius after a fall on the outstretched hand. The fracture was treated by open reduction and internal fixation with a volar locking plate, and the natural history, preoperative care, intraoperative technique, and postoperative considerations of distal radial fractures are outlined.

Hand Surgery, Orthopedics, Print Release

PUBlished: Trigger Finger Release (Cadaver)

Trigger Finger Release (Cadaver)
Rothman Institute

Asif Ilyas, MD, FACS
Orthopaedic Surgeon

Vivian Xu

Stenosing flexor tenosynovitis of the digital flexor tendon sheath, also known as trigger finger, occurs when there is a size mismatch between the flexor tendon and the surrounding retinacular pulley system at the first annular (A1) pulley. When the flexor tendon thickens or becomes inflamed, its ability to properly glide through the flexor tendon sheath becomes impaired. Thus, the tendon catches as the finger is flexed and extended. Conservative management includes activity modification, splinting, short-term NSAIDs, corticosteroid injection, and other adjuvant therapies. In this video, Dr. Asif Ilyas at the Rothman Institute demonstrates a surgical approach to the treatment of trigger finger via the open A1 pulley release procedure on a cadaver.

Hand Surgery, Print Release

PUBLISHED: Thumb Ulnar Collateral Ligament Tear Repair

Thumb Ulnar Collateral Ligament Tear Repair
Rothman Institute at Thomas Jefferson University

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

Alexander D. Selsky, BS
Lake Erie College of Osteopathic Medicine

The patient in this case was a 35-year-old male who presented to the clinic with pain of the right thumb but no numbness after a fall onto an outstretched hand that resulted in a forced hyperabduction of the thumb. There was mild weakness with thumb adduction due to significant pain, but there was no evidence of median or radial nerve injury, and the radial pulses were intact. A palpable mass was identified along the medial side of the MCP, suggestive of a Stener’s lesion, and he was ultimately found to have a complete UCL tear of the right thumb.

Here, Dr. Asif Ilyas at the Rothman Institute performs a repair of the UCL with the use of a 3-0 suture anchor placed in the anatomical footprint and a temporary 0.045 K-wire placed across the MCP joint for reinforcement.

Preview of the case: https://www.youtube.com/watch?v=JxdoYtjgZBE&ab_channel=JOMI-JournalofMedicalInsight