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  • 1
    Online Resource
    Online Resource
    Prevalence and Clinical Manifestations of the Anconeus Epitrochlearis and Cubital Tunnel Syndrome
    Elsevier BV ; 2017
    In:  The Journal of Hand Surgery Vol. 42, No. 9 ( 2017-09), p. S9-S10
    Details
    In: The Journal of Hand Surgery, Elsevier BV, Vol. 42, No. 9 ( 2017-09), p. S9-S10
    Type of Medium: Online Resource
    ISSN: 0363-5023
    URL: Article
    DOI: 10.1016/j.jhsa.2017.06.032
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2017
    detail.hit.zdb_id: 2023397-8
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  • 2
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    Online Resource
    Fingertip Injury and Management
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  JBJS Essential Surgical Techniques Vol. 9, No. 3 ( 2019-09-11), p. e30-
    Details
    In: JBJS Essential Surgical Techniques, Ovid Technologies (Wolters Kluwer Health), Vol. 9, No. 3 ( 2019-09-11), p. e30-
    Abstract: Fingertip injuries are common and can be difficult to manage because of unique anatomical considerations. Optimal treatment minimizes residual pain while preserving the function, length, and sensation of the affected digit. Several types of fingertip injury, including sharp or crush injuries, partial or complete amputations, and those involving the nail plate or nail bed, can occur. Depending on the type of injury, location within the fingertip, degree of soft-tissue loss, and involvement of perionychium, the most effective management may be one of several options. Knowledge of local and regional anatomy is paramount in selecting and performing the procedure that provides the best outcome. To address the array of possible fingertip injuries, we demonstrate several treatment options including (1) local flap reconstruction, (2) regional flap reconstruction, (3) revision or completion amputation, (4) nail bed repair, (5) acellular dermal regeneration templating, and (6) replantation. Outcomes are generally favorable but can be affected by injury and patient characteristics. The most common complications include nail deformity, cold intolerance, and painful neuroma formation.
    Type of Medium: Online Resource
    ISSN: 2160-2204
    URL: Article
    DOI: 10.2106/JBJS.ST.19.00008
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2747088-X
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  • 3
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    Online Resource
    Digital Nerve Management and Neuroma Prevention in Hand Amputations
    SAGE Publications ; 2023
    In:  HAND Vol. 18, No. 5 ( 2023-07), p. 838-844
    Details
    In: HAND, SAGE Publications, Vol. 18, No. 5 ( 2023-07), p. 838-844
    Abstract: Hand and digit amputations represent a relatively common injury affecting an active patient population. Neuroma formation following amputation at the level of the digital nerve can cause significant disability and lead to revision surgery. One method for managing digital nerves in primary and revision partial hand amputations is to perform interdigital end-to-end nerve coaptations to prevent neuroma formation. Methods: All patients with an amputation at the level of the common or proper digital nerves that had appropriate follow-up at our institution from 2010 to 2020 were included. Common or proper digital nerves were managed with either traction neurectomy or digital end-to-end neurorrhaphy. The primary outcome was the development of a neuroma. Secondary outcomes included revision surgery, complications, and visual analog pain scores. Results: A total of 289 nerves in 54 patients underwent hand or digital amputation in the study period. Thirteen hands with 78 nerves (27%) underwent direct end-to-end coaptation with a postoperative neuroma incidence of 12.8% compared with 22.7% in the 211 nerves that did not have a coaptation performed. Significantly fewer patients reported persistent pain if an end-to-end coaptation was performed (0% vs. 11.8%, P 〈 .01). The prevalence of depression and workers compensation status was significantly higher in in patients with symptomatic neuromas than in patients without symptomatic neuromas ( P 〈 .01). Conclusions: Digital nerve end-to-end neurorrhaphy is a method for neuroma prevention in partial hand amputations that results in decreased residual hand pain without increase complications. Depression and worker’s compensations status were significantly associated with symptomatic neuroma formation.
    Type of Medium: Online Resource
    ISSN: 1558-9447 , 1558-9455
    URL: Article
    DOI: 10.1177/15589447211065074
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2316440-2
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  • 4
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    Online Resource
    Radiographic Evaluation of the Tibial Intramedullary Nail Entry Point
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of the American Academy of Orthopaedic Surgeons Vol. 28, No. 18 ( 2020-09-15), p. e810-e814
    Details
    In: Journal of the American Academy of Orthopaedic Surgeons, Ovid Technologies (Wolters Kluwer Health), Vol. 28, No. 18 ( 2020-09-15), p. e810-e814
    Abstract: Tibia fractures are common injuries that can often be effectively treated with intramedullary nail (IMN) fixation. The ideal starting point for IMN reaming and nail placement is well described and regarded as a crucial aspect in the technique. The purpose of this study is to determine the accuracy and precision with which the starting point is established and if this is maintained after nail insertion during fracture fixation. Methods: Fifty consecutive tibia fractures treated by IMN fixation sized 9 to 13 mm through an infrapatellar or medial parapatellar approach and 50 treated with a suprapatellar approach were evaluated. The starting point for reaming and IMN placement was measured using intraoperative fluoroscopy. Postoperative radiographs were used to determine the center of the IMN after placement. The distance between the measured points and the ideal starting point was measured. Results: Deviation from the ideal entry point on intraoperative fluoroscopy averaged 4.6 ± 4.0 mm medially, 2.9 ± 3.7 mm anteriorly, and 2.7 ± 3.3 mm distally. In 30% of cases, the final IMN position varied from the entry point by greater than one SD in the coronal or sagittal plane. No difference between approaches was appreciated. Discussion: Although the ideal starting point for tibial IMN fixation is known, this is frequently not the starting point accepted in practice. Final position of the IMN is independent of IMN size or approach and is not markedly different than the obtained starting point. Level of Evidence: Therapeutic level III
    Type of Medium: Online Resource
    ISSN: 1067-151X , 1940-5480
    URL: Article
    DOI: 10.5435/JAAOS-D-19-00557
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 5
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    Online Resource
    Course of the Femoral Artery in the Mid- and Distal Thigh and Implications for Medial Approaches to the Distal Femur: A CT Angiography Study
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Journal of the American Academy of Orthopaedic Surgeons Vol. 27, No. 14 ( 2019-07-15), p. e659-e663
    Details
    In: Journal of the American Academy of Orthopaedic Surgeons, Ovid Technologies (Wolters Kluwer Health), Vol. 27, No. 14 ( 2019-07-15), p. e659-e663
    Abstract: Unfamiliarity with the location of the femoral artery in the medial thigh has tempered surgeons' enthusiasm for medial approaches to the distal femur. The purpose of this study was to define the relationship of the femoral artery to the mid- and distal femur to assist in safely approaching the femur for fracture care. Methods: Fifteen patients undergoing CT with angiography (CTA) of the lower extremity (CTA) were evaluated. From three-dimensional CTA images, the distance of the artery at the anterior border, midsagittal line, and posterior border of the femur from the distal femur at both the adductor tubercle and medial femoral condyle was measured. Results: The average distances of the adductor tubercle to the femoral artery were 23.2 cm (±3.3), 18.8 cm (±3.4), and 14.3 cm (±4.1) at the level of the anterior border, midsagittal line, and posterior border of the femur, respectively. The descending genicular artery (DGA) originated 10.8 cm (±1.3) proximal to the adductor tubercle. Discussion: A wide safe zone exists in the medial distal femur. The artery crosses the midsagittal axis of the medial femur an average of 18.8 cm proximal to the adductor tubercle.
    Type of Medium: Online Resource
    ISSN: 1067-151X , 1940-5480
    URL: Article
    DOI: 10.5435/JAAOS-D-17-00700
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 6
    Online Resource
    Online Resource
    Prevalence and Clinical Manifestations of the Anconeus Epitrochlearis and Cubital Tunnel Syndrome
    SAGE Publications ; 2020
    In:  HAND Vol. 15, No. 1 ( 2020-01), p. 69-74
    Details
    In: HAND, SAGE Publications, Vol. 15, No. 1 ( 2020-01), p. 69-74
    Abstract: Background: The true prevalence of the anconeus epitrochlearis (AE) and the natural history of cubital tunnel syndrome associated with this anomalous muscle are unknown. The purpose of this study was to evaluate the prevalence of AE and to characterize the preoperative and postoperative features of cubital tunnel syndrome caused by compression from an AE. Methods: All elbow magnetic resonance imaging (MRI) scans and all patients undergoing cubital tunnel surgery during a 20-year period were identified and retrospectively reviewed for the presence of an AE. All patients with an AE identified intra-operatively were matched to patients with no AE identified at surgery based on age, sex, concomitant procedures, and year of surgery. Preoperative and postoperative physical exam findings, electrodiagnostic study results, time to improvement, and reoperations were compared between the groups. Results: A total of 199 patients had an elbow MRI, and 27 (13.6%) patients were noted to have an AE present. Average time to improvement after surgical release was 23.0 days for patients with an AE and 33.2 days for patients with no AE. Twenty-seven patients with an AE noted improvement at the first postoperative visit (68%) compared to 15 patients without an AE (33%). No patients with an AE underwent reoperation for recurrent symptoms (0%) compared with four patients (10%) without an AE. Conclusions: The prevalence of AE in our study is 13.6%. These patients experience quicker and more reliable symptom improvement after surgical release than those without the anomalous muscle.
    Type of Medium: Online Resource
    ISSN: 1558-9447 , 1558-9455
    URL: Article
    DOI: 10.1177/1558944718789412
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2316440-2
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