Tag Archives: Ortho

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.

Orthopedics, Print Release

PUBLISHED: Repair of a Chronic Degenerative Sagittal Band Rupture of the Right Ring Finger

Repair of a Chronic Degenerative Sagittal Band Rupture of the Right Ring Finger
Jasmine Wang, BS¹; Asif M. Ilyas, MD, MBA, FACS¹’²
¹Sidney Kimmel Medical College at Thomas Jefferson University
²Rothman Institute at Thomas Jefferson University

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.

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.

Orthopedics, Print Release

PUBLISHED: Mako Robotic-Arm Assisted Total Knee Arthroplasty

Mako Robotic-Arm Assisted Total Knee Arthroplasty
Jeffrey S. Zarin, MD; Gustavo Barrazueta, MD
Tufts Medical Center

Total knee arthroplasty (TKA) has been around for decades and serves as a very successful procedure to alleviate pain and restore function in a knee with advanced degenerative joint disease. Over the years, there have been many advancements in surgical technique and even more so in implant design. One such technological breakthrough in TKA is the use of robotic-arm assistance for enhanced preoperative planning and intraoperative guidance with dynamic joint balancing and bone preparation.

In this video article, Dr. Zarin demonstrates the operative technique he uses in performing a posterior stabilizing TKA in a varus deformity degenerative knee using Mako robotic-arm assistance.

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.

Orthopedics, Print Release

PUBLISHED: Subtalar Arthrodesis for Post-Traumatic Subtalar Arthritis

Subtalar Arthrodesis for Post-Traumatic Subtalar Arthritis
Massachusetts General Hospital

Christopher W. DiGiovanni, MD
Chief of the Foot & Ankle Service
Vice Chair for Academic Affairs
Massachusetts General Hospital

Subtalar arthrodesis is currently the mainstay treatment option for the management of recalcitrant subtalar arthrosis.

The patient in this case is a 45-year-old male who developed post-traumatic arthritis of the subtalar joint 14 years following a work-related injury in which he sustained a comminuted, joint-depression type calcaneal fracture after a 10-foot fall from a ladder. Seven years after the initial injury, imaging prompted by progressive hindfoot pain during weight-bearing or following activity revealed progressive degeneration of the subtalar joint, for which he was treated with orthoses, corticosteroid injections, and arthroscopic debridement. After exhausting both conservative and minimally invasive treatment measures at 14 years post-injury, he finally elected to undergo subtalar arthrodesis.

This video article details the methods and techniques involved in subtalar arthrodesis. After an Ollier approach was used to expose the subtalar joint, the arthritic cartilage was removed and the subchondral plate was perforated. Finally, an autogenous bone graft was harvested from the proximal tibia and inserted into the joint space, and compression was achieved by two lag screws.

Fundamentals, Hand Surgery, Orthopedics, Print Release

PUBLISHED: Cubital Tunnel Release (Cadaver)

Cubital Tunnel Release

Asif M. Ilyas, MD
Professor of Orthopaedic Surgery
Program Director of Hand Surgery
Rothman Institute, Thomas Jefferson University

Cubital tunnel syndrome is a condition that affects the ulnar nerve as it crosses the medial elbow through the retrocondylar groove. It is the second most common compressive neuropathy, causing tingling and numbness in the ring and small fingers. In advanced cases of symptomatic cubital tunnel syndrome, weakness, altered dexterity, and atrophy of the intrinsic muscles of the hand may develop. Cubital tunnel syndrome can be treated with either a cubital tunnel release or an ulnar transposition. In this case, the former is demonstrated on a cadaveric arm using the mini-open technique.

Fundamentals, Hand Surgery, Orthopedics, Print Release

PUBLISHED: Carpal Tunnel Release (Cadaver)

Carpal Tunnel Release (Cadaver)

Asif M. Ilyas, MD
Professor of Orthopaedic Surgery
Program Director of Hand Surgery
Rothman Institute, Thomas Jefferson University

Carpal tunnel syndrome (CTS) is the most common peripheral compression neuropathy and results in symptoms of numbness and paresthesia in the thumb, index finger, middle finger, and half of the ring finger. When CTS symptoms progress and can no longer be managed with nonoperative measures, carpal tunnel release (CTR) surgery is indicated.

In this case, Dr. Asif Ilyas at the Rothman Institute performs CTR surgery on a cadaveric arm via the mini-open CTR technique. A 2-cm longitudinal incision was placed directly over the carpal tunnel, the transverse carpal ligament was exposed and then released, and the wound was closed. Patients are typically sent home with instructions to use their hand immediately postoperatively, while avoiding strenuous use until the incision has healed. Splinting and therapy are not required postoperatively.