Category Archives: Orthopedic Trauma

Hand Surgery, Orthopedic Trauma, Orthopedics, Print Release

PUBLISHED: Thumb Extensor Tendon Laceration Repair

Thumb Extensor Tendon Laceration Repair
Evan Bloom1; Amir R. Kachooei, MD, PhD2; Asif M. Ilyas, MD, MBA, FACS1,2
1 Sidney Kimmel Medical College at Thomas Jefferson University
2 Rothman Institute at Thomas Jefferson University

This case consists of repairing an extensor tendon laceration of a thumb. Extensor tendon lacerations are one of the most common soft tissue injuries of the hand. Surgical repair of the tendon was offered, and the operation was performed using wide-awake local anesthesia no tourniquet (WALANT) technique.

Intraoperatively, a complete laceration of the extensor tendon was confirmed repaired using a modified Kessler technique and reinforced with an epitendinous repair. Before closure, the patient tested competency of the repair with confirmation of restoration with the active extension to ensure proper function. The patient was placed in a reverse thumb spica splint following wound closure.

Postoperatively, the patient was immobilized in full thumb extension for approximately two weeks and then converted to a removable splint and prescribed supervised hand therapy for a total recovery of 8–12 weeks.

Hand Surgery, Orthopedic Trauma, Orthopedics, Print Release

PUBLISHED: Biceps Tenodesis for Distal Biceps Tendon Repair

Biceps Tenodesis for Distal Biceps Tendon Repair
Harish S. Appiakannan, 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

Distal biceps tendon ruptures can result in loss of supination and elbow flexion strength, for which surgical repair is often indicated to restore preinjury level of functionality. The distal biceps tendon can be repaired via single- or double-incision techniques using several associated implants, including endobuttons, suture anchors, or interference screws.

Here is the case of a middle-aged male presenting with an acute distal biceps tendon rupture. The tendon was repaired via a single-incision technique using an endobutton and an interference screw.

General Surgery, Orthopedic Trauma, Orthopedics, Print Release, Trauma

PUBLISHED: Ankle-Brachial Index, CT Angiography, and Proximal Tibial Traction for Gunshot Femoral Fracture

Ankle-Brachial Index, CT Angiography, and Proximal Tibial Traction for Gunshot Femoral Fracture
Johnathan R. Kent, MD; James Jeffries, MD; Andrew Straszewski, MD; Kenneth L. Wilson, MD
University of Chicago Medicine

This video demonstrates an algorithm for evaluating suspected vascular injury secondary to penetrating extremity trauma on a 42-year-old man who sustained a gunshot wound to his left lower extremity. Descriptions of how to perform an arterial-brachial index (ABI) and arterial-pulse index (API) are reviewed, along with criteria to determine if a CT angiography is indicated. Relevant imaging is reviewed with a radiology resident with descriptions of how to systematically assess the scans for injury. Lastly, a tibial traction pin is placed as a temporizing measure for long bone fractures to prevent shortening and to help with pain management.

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.

Orthopedic Trauma, Print Release

PUBLISHED: Open Reduction and Internal Fixation of a Trimalleolar Ankle Fracture

Open Reduction and Internal Fixation of a Trimalleolar Ankle Fracture
Michael J. Weaver, MD
Brigham and Women’s Hospital

The goal of ankle fracture management is to restore a stable and congruent joint. Operative management is recommended for most displaced fractures, fractures with dislocations, and open fractures.

This video article walks through the surgical management of a 23-year-old male who sustained a trimalleolar ankle fracture with concomitant dislocation and syndesmotic injury following a motor vehicle collision. Dr. Weaver discusses the surgical landmarks and approaches to the ankle, the methods of fixing the malleoli and the syndesmosis, and common concerns that arise during the surgical management of ankle fractures.

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.

 

Announcement, Content, Orthopedic Trauma, Orthopedics, Print Release

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.

General Surgery, Orthopedic Trauma, Orthopedics, Preprint Release, Trauma

PREPRINT RELEASE: Ankle-Brachial Index, CT Angiography, and Proximal Tibial Traction for GSW Femoral Fracture

Ankle-Brachial Index, CT Angiography, and Proximal Tibial Traction for GSW Femoral Fracture
UChicago Medicine

Jack Kent, MD
Resident Physician
General Surgery

James Jeffries, MD
Resident Physician
Radiology

Andrew Straszewski, MD
Resident Physician
Orthopaedics

Kenneth Wilson, MD, FACS
Associate Professor of Surgery

In another trauma case with UChicago Medicine, Drs. Kent, Jeffries, Straszewski, and Wilson evaluate and treat a patient with a gunshot wound and femoral fracture. An ABI was obtained, CT angiography was evaluated, and proximal tibial traction was performed for pain management.

Orthopedic Trauma, Preprint Release

PREPRINT RELEASE: Closed Cephalomedullary Nailing of a Diaphyseal Femur Fracture on a Fracture Table

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0121-feature-imageClosed Cephalomedullary Nailing of a Diaphyseal Femur Fracture on a Fracture Table
Michael J. Weaver MD
Clinical Instructor, Harvard Medical School Dept. of Orthopaedic Surgery, Brigham and Women’s Hospital

Dr. Weaver treats a periprosthetic femur fracture with the patient positioned supine on a fracture table using a cephalomedullary nail. The fracture table provides adequate traction to assist in reduction of the fracture.
Orthopedic Trauma, Orthopedics, Preprint Release

PREPRINT RELEASE: Open Reduction and Internal Fixation of a Diaphyseal Humeral Fracture

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feature photoOpen Reduction and Internal Fixation of a Diaphyseal Humeral Fracture
Michael Weaver MD
Clinical Instructor, Harvard Medical School Dept. of Orthopaedic Surgery, Brigham and Women’s Hospital

Dr. Weaver treats a periprosthetic humeral spiral fracture using contoured plating. The posterolateral approach helps prevent dissection of the triceps for adequate exposure of the fracture.