In this video, the authors describe and demonstrate a surgical technique for the treatment of an unstable nonunion of a proximal phalangeal fracture of the thumb.
The video describes the surgical exposure, preparation of the nonunion site, harvesting of autogenous iliac corticocancellous bone graft, bone grafting of the defect, and stabilization with K-wire fixation.
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.
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.
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.
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.
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.
Sagittal band rupture leads to subluxation of the EDC tendon at the MCP joint. The common presentation involves pain and swelling at the MCP joint, visualization of extensor tendon subluxation during flexion, and inability to actively extend the MCP joint from a flexed position.
The treatment for chronic rupture, as in this case, involves surgical repair followed by six weeks in a relative motion splint, in which the injured MCP joint is placed in greater extension relative to adjacent joints. The video here demonstrates direct repair of a chronic degenerative sagittal band rupture of the right ring finger.
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.
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.
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.