Ankle injuries are common, occurring most often among young males and older females. The ankle joint is crucial for stability and gait, making these injuries a significant source of disability.
Ankle injuries are usually treated operatively when there is loss of joint congruity and stability, and in this video, Dr. Agarwal-Harding takes us through the operative fixation of a bimalleolar ankle fracture. He talks about understanding why operative intervention is recommended, techniques involved, and other considerations.
Bilateral Syndactyly Release of Third and Fourth Fingers Sudhir B. Rao, MD1; Mark N. Perlmutter, MS, MD, FICS, FAANOS2; Arya S. Rao3; Grant Darner4 1Big Rapids Orthopaedics 2Carolina Regional Orthopaedics 3Columbia University 4Duke University School of Medicine
Amniotic band syndrome, or constriction ring syndrome, happens when a developing fetus gets tangled in the fibrous bands of the amniotic sac. Sometimes, fingers and toes can become trapped in these fibrous bands, with results ranging from amputation of the digits, to fusion of the fingers or toes, termed syndactyly. Syndactyly is amongst the most frequent congenital hand anomaly and is termed simple when the digits are connected by soft tissue only, and complex when one or more phalanges are fused. In complicated syndactyly, there are additional bony elements in between the digits making it challenging if not impossible to separate safely.
The patient in this case is a 1-year-old male with complex syndactyly of the left hand and simple syndactyly of the right hand. Here, both sides are released, with the left 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.
This video article demonstrate surgical correction of a severe hand deformity in a teenage girl with spastic hemiplegia. This patient has a non-functioning hand due to severe spasticity. Correction of the deformity is indicated primarily to facilitate hygiene and improve the position of the fingers. In some patients with volitional control, a certain degree of prehension may be achieved. The basic principles of deformity correction include differential sectioning of sublimis and profundus tendons followed by repair in a lengthened position. The first web contracture is released by muscular release and a skin Z-plasty.
Shoulder Arthroscopy (Cadaver) Patrick Vavken, MD1; Sabah Ali2 1Smith and Nephew Endoscopy Laboratory 2University of Central Florida College of Medicine
Shoulder arthroscopy is one of the most common procedures performed in orthopaedic surgery. It can be utilized to identify various pathologies including rotator cuff tears, degenerative arthritis, subacromial impingement, and proximal humeral fractures. With continued advancement in arthroscopy, patients benefit from smaller incisions, reduced risk of postoperative complications, and faster recovery compared to open surgery.
Shoulder arthroscopy is performed either in the lateral decubitus position or in the beach chair position (BCP) as seen in this video. The BCP provides greater benefits such as decreased neovascularization during portal placement, fewer cases of neuropathies, and reduced surgical time. In addition to position, there are various portals used in shoulder arthroscopy, with the posterior portal being the most common and used in this video. Complication rates from shoulder arthroscopy are low but include shoulder stiffness, iatrogenic tendon injury, and vascular injury. Therefore, proper patient selection, patient positioning, and appropriate portal selection are essential for successful shoulder arthroscopy. This article discusses shoulder arthroscopy and demonstrates the technique on a cadaver shoulder.
This article present the case of a female patient in her early 20’s who was seen for follow up after 5 months of rehabilitation following surgical procedures to address instability in both the medial and lateral sides of her right ankle. This patient reported achieving an excellent outcome, and her subjective sense of significant improvement after rehabilitation was aligned with her physical exam and radiographic evaluation. This case documents the improvements made by the patient during the rehabilitation process and outlines essential steps to be performed by the practitioner in the clinical examination and radiographic follow up after surgery for ankle instability.
This is the case of a 31-year-old female with a history of juvenile rheumatoid arthritis and uveitis who presented with a leg-length discrepancy and low back pain refractory to conservative management. She underwent a shortening osteotomy on her left femur around an intramedullary nail that went on to nonunion.
She underwent exchange nailing with a magnetic intramedullary nailing with autologous bone graft harvest from her affected femoral reamings. The magnetic intramedullary nail was extended 2 cm prior to insertion, and then implanted in the usual fashion with immediate compression in the operating room. Postoperatively the patient underwent a compressive program using the magnetic nail and went on to heal her osteotomy site.
Minor lower extremity amputations typically involve either toe or ray resections. The first ray is an essential component in the normal anatomy and biomechanics of the foot. By definition, the first ray consists of the hallux and the first metatarsal. The surgical procedure discussed in this educational video is a left first toe ray amputation on a cadaver. Toe amputation is a significant predictor of future limb loss. Ray amputation appears to be preferred over finger amputation in selected cases. However, the literature does not provide precise indications on when to consider a ray over a toe amputation. The choice is therefore left to the operating surgeon, based on their clinical expertise and the patient’s conditions and expectations, taking into account the underlying pathology.
Deltoid Ligament Repair William B. Hogan1; Eric M. Bluman, MD, PhD2 1Warren Alpert Medical School of Brown University 2Brigham and Women’s Hospital
Injury to the medial deltoid ligament complex is rare as it is the strongest of the ankle ligaments. However, damage to this structure can occur, often in association with an avulsion fracture of the medial malleolus due to the ligamentous strength of the complex. Deltoid ligament repair remains a primary option for patients with severe acute injuries, or patients with chronic instability who have failed conservative measures.
Repair of the medial ankle ligaments provides improved stability with reduced risk of recurrent sprains and potential damage to local cartilage. This article presents a case of a young woman with concomitant medial and lateral ankle instability who successfully underwent deltoid ligament repair for her medial ligament injury.
Diaphyseal tibial fractures are common injuries that are most often treated with intramedullary nailing. However, certain patient factors may necessitate alternative treatment strategies such as open reduction internal fixation (ORIF) with plates and screws. Presence of a total knee arthroplasty (TKA) in the injured extremity is one such factor. TKA is a common operation that is only increasing in popularity, and management of tibia fractures distal to TKA may be a frequently encountered clinical scenario.
This video presents a technique for ORIF of a distal diaphyseal tibia fracture distal to a TKA that precludes intramedullary nail fixation. The fracture is fixed with lag screws and secured with an anatomically-contoured distal tibia locking-compression plate (LCP) in neutralization mode.
This case presents a patient with a pathologic subtrochanteric femur fracture secondary to an undiagnosed primary lung adenocarcinoma. The fracture, occurring in the context of persistent atraumatic thigh and knee pain, prompted swift identification of its pathological nature in the Emergency Department. The treatment plan involved open reduction and internal fixation utilizing a carbon fiber nail, considering the immediate need for stabilization and underlying oncologic factors.
This article highlights the strategic use of carbon fiber implants in managing pathologic fractures, offering advantages in postoperative imaging, disease monitoring, and precision in radiation therapy planning. The multidisciplinary approach underscores the importance of considering implant selection nuances, especially in metastatic bone disease, to optimize outcomes.
