Tag Archives: Orthopaedics

PUBLISHED: De Quervain’s Release (Cadaver)

 

De Quervain’s Release (Cadaver)

Asif M. Ilyas, MD, FACS
Rothman Institute at Thomas Jefferson University

Irene Kalbianr
Rothman Institute at Thomas Jefferson University

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.

 

PUBlished: Trigger Finger Release (Cadaver)

Trigger Finger Release (Cadaver)
Rothman Institute

Asif Ilyas, MD, FACS
Orthopaedic Surgeon

Vivian Xu

Stenosing flexor tenosynovitis of the digital flexor tendon sheath, also known as trigger finger, occurs when there is a size mismatch between the flexor tendon and the surrounding retinacular pulley system at the first annular (A1) pulley. When the flexor tendon thickens or becomes inflamed, its ability to properly glide through the flexor tendon sheath becomes impaired. Thus, the tendon catches as the finger is flexed and extended. Conservative management includes activity modification, splinting, short-term NSAIDs, corticosteroid injection, and other adjuvant therapies. In this video, Dr. Asif Ilyas at the Rothman Institute demonstrates a surgical approach to the treatment of trigger finger via the open A1 pulley release procedure on a cadaver.

PUBLISHED: Thumb Ulnar Collateral Ligament Tear Repair

Thumb Ulnar Collateral Ligament Tear Repair
Rothman Institute at Thomas Jefferson University

Asif M. Ilyas, MD, MBA, FACS
Rothman Institute at Thomas Jefferson University

Alexander D. Selsky, BS
Lake Erie College of Osteopathic Medicine

The patient in this case was a 35-year-old male who presented to the clinic with pain of the right thumb but no numbness after a fall onto an outstretched hand that resulted in a forced hyperabduction of the thumb. There was mild weakness with thumb adduction due to significant pain, but there was no evidence of median or radial nerve injury, and the radial pulses were intact. A palpable mass was identified along the medial side of the MCP, suggestive of a Stener’s lesion, and he was ultimately found to have a complete UCL tear of the right thumb.

Here, Dr. Asif Ilyas at the Rothman Institute performs a repair of the UCL with the use of a 3-0 suture anchor placed in the anatomical footprint and a temporary 0.045 K-wire placed across the MCP joint for reinforcement.

Preview of the case: https://www.youtube.com/watch?v=JxdoYtjgZBE&ab_channel=JOMI-JournalofMedicalInsight

PUBLISHED: Subcutaneous Ulnar Nerve Transposition

Subcutaneous Ulnar Nerve Transposition
Rothman Institute at Thomas Jefferson University

Jasmine Phun
Sidney Kimmel Medical College

Asif M. Ilyas, MD, MBA, FACS
Rothman Institute at Thomas Jefferson University

In this case, Dr. Ilyas at the Rothman Institute performs a subcutaneous anterior transposition on a patient with cubital tunnel syndrome. The patient’s ulnar nerve subluxed upon elbow flexion and extension upon physical examination, which was a primary indication for choosing this surgical approach over other techniques.

This procedure not only decompresses the affected nerve but also transposes the nerve anterior to the medial epicondyle so as to relieve strain on the nerve upon the full range of motion of the elbow.

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.

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.


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.