Ganglion cysts (GCs) are common benign soft tissue tumors that when presenting near the nail bed of digits, are specifically termed digital mucous cysts (DMCs). The surgical excision of GCs near the nail bed requires precise technique and a thorough understanding of the anatomical relationships to prevent recurrence and minimize complications. This case report describes the surgical management of a GC located on the distal phalanx of the middle finger near the nail bed. The procedure demonstrates several key principles that are essential for successful outcomes, including the necessity of complete cyst excision to prevent recurrence, the importance of careful dissection near the germinal matrix to prevent permanent nail deformity, the value of a bloodless surgical field in maintaining precise visualization, and the significance of proper wound closure technique in ensuring optimal aesthetic and functional outcomes.
This video provides detailed step-by-step instruction for performing first dorsal compartment release in De Quervain’s tenosynovitis, with particular emphasis on anatomical landmarks, proper tissue handling, and identification of important neurovascular structures. The surgical release of the first extensor compartment for De Quervain’s tenosynovitis is a well-established procedure with consistently favorable outcomes when proper surgical technique is employed. When performed with attention to these technical details, the procedure provides reliable relief of symptoms with a low complication rate.
This surgical technique video would be particularly valuable for orthopaedic and hand surgery residents, as well as practicing surgeons who seek to refine their approach to first extensor compartment release. The detailed demonstration of nerve identification and the management of anatomical variations, especially the emphasis on finding accessory compartments, provides crucial technical aspects which help surgeons avoid complications and improve patient outcomes.
The surgical management of posterior calcaneal osteophytes is a complex procedure that requires detailed surgical technique and precise anatomical understanding. Fluoroscopy serves as a real-time guidance tool, aiding in the visualization of the osteophyte during its removal. Specialized surgical instruments, primarily a sharp osteotome are utilized for initial bone removal, followed by a rongeur to refine and smooth any remaining sharp edges. This meticulous approach ensures the complete removal of the problematic bony proliferation while maintaining the surrounding tissue’s structural integrity. This surgical demonstration offers important educational value for multiple medical professionals involved in orthopaedic and musculoskeletal care. Orthopaedic surgeons, particularly those specializing in foot and ankle surgery, will find the detailed procedural technique useful for understanding nuanced surgical approaches to posterior calcaneal osteophytes. Orthopaedic residents and surgical trainees can benefit from the step-by-step demonstration of complex surgical techniques.
This article presents a case of diffuse large B-cell lymphoma (DLBCL) with skeletal involvement in a geriatric male. Initially presenting with left hip pain, the patient was diagnosed with DLBCL affecting the left acetabulum. Subsequent treatment with systemic and radiation therapy resulted in radiation osteitis, osteoarthritis, and acetabular collapse, necessitating surgical intervention.
The treatment plan involved total hip arthroplasty (THA) with photodynamic intramedullary nails (PDNs) for pelvic stabilization, augmented with tantalum augments for enhanced support. PDNs provided structural stability while minimizing interference with future oncological interventions. The surgical procedure comprised meticulous insertion of PDNs and placement of tantalum augments, achieving optimal stability and alignment of the acetabular component.
This case underscores the strategic use of PDNs and tantalum augments in for treating major acetabular defects in patients with complex pathologies who require THA for pelvic stabilization. These techniques provide advantages in postoperative radiographic disease monitoring and precision in radiation therapy planning. The multidisciplinary approach emphasizes the importance of carefully selecting the appropriate implants to optimize outcomes in orthopaedic oncology.
Diagnostic Hip Arthroscopy Jason P. Den Haese Jr., DO1; Scott D. Martin, MD2 1Oklahoma State University Medical Center 2Brigham and Women’s/Mass General Health Care Center
Diagnostic hip arthroscopy is a minimally-invasive surgical technique used to accurately provide intraoperative information and potentially treat certain intra-articular (such as labral tears, chondral defects, and femoroacetabular impingement) and extra-articular (such as capsular tears, ischiofemoral impingement, and pediatric deformities) hip pathologies. The use of this procedure in the United States is becoming more common; annual rates are increasing by as much as 365% since 2004. Within this rapid increase of utilization, the three most common procedures being performed with diagnostic hip arthroscopy are labral repair, femoroplasty, and acetabuloplasty.
In this case, a young female athlete is being assessed for left anterior hip pain recalcitrant to nonoperative management. The patient was placed in a supine position with an anterolateral portal and modified anterior portal being placed into the left hip. A puncture capsulorrhaphy was performed to examine the labrum, femoral head, and transverse ligament. Then, the medial structures and peripheral compartment were visualized. Throughout the procedure, the only treatable hip pathology identified was labral fraying consistent with a minor labral tear. It was determined that the fraying was not significant enough to require surgical repair, so labral debridement was chosen. Other areas of labral fraying and fatty degeneration were identified, but they were not significant enough to be treated intraoperatively. The procedure was completed with no complications.
Tibial plafond or pilon fractures account for 5 to 10% of all lower extremity fractures and are associated with high energy trauma. These fractures have a high rate of non-union, mal-union, and wound healing issues due to weak metaphyseal bone, a lack of robust soft tissue coverage, and complex intra-articular extension. This manuscript and video demonstrates a tibial pilon fracture managed acutely with a hybrid fixation approach combining internal fixation with external fixation.
Intramedullary Nail for Open Tibial Fracture Caleb P. Gottlich, MD, MS1; Michael J. Weaver, MD2 1Department of Orthopedic Surgery, Texas Tech University Health Science Center 2Brigham and Women’s Hospital
This article describes the stabilization of an open tibia shaft fracture using an intramedullary nail. After copious irrigation and debridement of the fracture site, a transpatellar tendon split is used to expose the nail entry point. This is followed by fracture reduction, sequential reaming, and nail insertion and locking. Finally, the technique for proximal tibia traction pin insertion is demonstrated on the contralateral tibia.
Pelvic Osteotomies for Cloacal Exstrophy Jeffrey Gray1; Purushottam Gholve, MD, MBMS, MRCS2 1Sidney Kimmel Medical College, Thomas Jefferson University 2Tufts Medical Center
Cloacal exstrophy is part of a wide-ranging spectrum of rare congenital abnormalities resulting from the same embryological defect. Conditions include bladder exstrophy, epispadias, cloacal exstrophy, omphalocele, and more. Mortality due to complications with cloacal exstrophy was historically significant as it is among the most severe of these abnormalities. However, advancements in reconstructive surgery have improved the survival of patients. Pelvic osteotomy is typically indicated in cloacal exstrophy as it normally presents with widely separated pubic bones that require approximation as part of abdominal wall closure.
Distal humeral fractures are injuries worldwide with operative fixation being the preferred method of treatment. Ulnar neuropathy is one of the possible complications of surgery, and may require an additional surgery to achieve symptom resolution. In this video, Dr. Agarwal-Harding manages a patient who was previously treated with open reduction and internal fixation of a distal humerus fracture, but his recovery was complicated by ulnar neuropathy. He performs an ulnar neurolysis, hardware removal from the medial column of the distal humerus, and anterior transposition of the ulnar nerve with an adipofascial flap. Surgical considerations, including rationale and treatment options, are discussed.
Diagnostic shoulder arthroscopy or arthroscopic shoulder stabilization procedures can be performed with the patient in the beach chair or lateral decubitus (LD) position. Patient positioning may be dictated by surgeon preference or the specific intended procedure; however, LD setup has been found to result in lower rates of recurrent instability in cases of anterior arthroscopic stabilization procedures. The lateral and axial traction provided by the LD setup allows for lower suture anchor placement on the anterior-inferior aspect of the glenoid, as the surgeon has increased visualization and working room within the glenohumeral joint.
Prior to placing the patient in the LD position, meticulous care must be taken to properly position the beanbag device and set up the lateral traction device. Next, a coordinated team approach should be used to roll the patient into the LD position and to ensure that all bony prominences are adequately padded. The shoulder is then placed in 40° of abduction, 20° of forward flexion, with 10–15 pounds of balanced traction. Finally, the shoulder is prepped and draped in the usual sterile fashion and the surgeon is then able to proceed with the necessary arthroscopic procedure.
