A 50-year-old woman sustains an open both bone forearm fracture seen in Figure A and undergoes the treatment seen in Figure B. During surgery the posterior interosseous nerve was transected and primary repair was attempted. One year following surgery the patient continues to have no posterior interosseous nerve function. Which of the following treatments will best restore function?
Sural nerve grafting to the posterior interosseus nerve
Wrist fusion with transfer of the flexor carpi ulnaris to the finger extensors
Transfer of the flexor carpi radialis to extensor digitorum and the palmaris longus to the extensor pollicis longus
Transfer of the pronator teres to the wrist extensors and the palmaris longus to the finger extensors
Transfer of the flexor carpi ulnaris to the wrist extensors and the palmaris longus to the extensor pollicis longus
There are many options for high radial nerve palsy. This transfer is a modified Jones/Tsuge/Boyd:1. Pronator teres to ECRB2. Flexor carpi radialis to the finger extensors [extensor digitorum communis (EDC)]3. Palmaris longus to extensor pollicis longusIf only PIN involved (i.e. not high radial nerve), then only have to do 1 and 2.
Video showing Elson's test for Boutonniere deformity
Flexor tendons of the fingers within Zone 2 receive their primary nutritional supply from:
Diffusion from the synovial sheath
In your notes, you mention that, "it is the more important source proximal to the MCP joint." Might want to clarify or update that since Zone 2 is for the most part distal to the MCP joint.
A 35-year-old woman reports wrist pain after a fall onto an outstretched hand. On exam, she has focal tenderness over the wrist snuffbox. A radiograph and CT image are shown in Figures A and B. What is the proper treatment of her injury?
Rest, ice, elevation
Removable splint for comfort
Thumb spica cast
Open reduction, internal fixation
Vascularized bone grafting
SNAC (Scaphoid Nonunion Advanced Collapse)
Might be better to have the word "least" in capital letters.
All of the following factors are favorable for digit survival after replantation surgery EXCEPT?
Sharply amputated digit
Crushed amputated digit
Warm ischemia time of 8 hours
Patient age of 10 years
Miller Review 2017: Operative sequence of replantationBone stabilization, usually with shorteningExtensor tendon repairFlexor tendon(s) repairArterial reanastomosisVenous reanastomosisNerve repairSkin approximation (loose)AAOS Review 2017: BoneExtensor Tendons One artery anastomosis to restore circulation Venous Anastomoses Flexor Tendons Secondary Artery Anastomosis Nerve repairs Fasciotomy and skin closure (usually with skin grafting)
You are seeing a 24-year-old male in the emergency room after he was involved in a knife fight. He has severed the common digital nerve to the index finger on his dominant hand, with an 8mm gap between nerve ends. In counseling him about repair, which of the following options is as good as autologous nerve grafting?
Glycolide trimethylene carbonate conduit
Primary end-to-end repair
Polyglycolic acid conduit
According to the last referenced evidence from Dr. Kakar, the correct answer should be polyglycolic acid conduit. Either that or further evidence needs to be presented or the question modified to fit the referenced material.
Non-united Proximal Pole Scaphoid Fracture in a 20M (C2776)
20 / M - Neglected trauma to right wrist 15 months ago.
How would you manage this patient?
Thanks for posting this case, I think this tiny proximal pole piece is avascular, sclerotic and not amenable for fixation. Excision is a good option but u have to check the integrity of scapholunate ligament.This screw should be taken out as soon as possible as it is a mechanical block to any wrist movements.U could have used K wire if headless screws are not available!!
Release of ulnar deep motor branch in Guyon's canal and carpal tunnel release
Demonstrates ulnar nerve being decompressed in the wrist through Guyon's canal and in the hand in addition to carpal tunnel release.
Thank you Susan
primary excision of proximal pole could be more beneficial for less pain and arthritic changes .
Intrinsic Minus Hand (Claw Hand)
I believe the second illustration has the FDP and FDS labeled incorrectly. Thanks,Brandon
Vascularized Bone graft based on volar carpal artery and fixed by 2 mm cortical screw as Herbert screw not available,This is was the result after 6 months after operation . what is your openion ???
The patient sustains the injury seen in Figure A from a gunshot injury. The physical exam is notable for lack of sensation in his fourth and fifth digits as well as a positive Froment's sign. Which of the following factors has not been shown to be a significant prognostic indicator of functional recovery following nerve repair?
Duration to time of repair
Length of repair
Postoperative physical rehabilitation
Type of autograft used
I have a question specifically when asking about what type of autograft used --- It would seem that it's important to match the size of the autografts used and hence different nerves are used for different locations where the lacerations occur. There is even a section above the makes reference to the specific donors recommended depending on the area of the intended nerve repair. The way I'm reading this answer -- which could be wrong -- would be to say the specific area that's repaired would be independent of the size of the donor nerve used -- for example you'd have the same result with a digital nerve repair using sural nerve graft as you would a MABC.
Peripheral Nerves Injury & Repair
I'm a little confused here, and I hope you can help me out:Surgical indication is type III injury; surgical technique is epineurial repair.In Sunderland type III and IV injury, epineurium is still intact.What are we repairing? (Or are Sunderland types III and IV only diagnosed retrospectively and the first step is resection of neuroma?)
A 10-year-old boy presents with a painless mass on the dorsal aspect of his wrist that has been present for 3 weeks. A clinical image is shown in Figure A. T1 and T2 magnetic resonance images are shown in Figure B and C, respectively. On your exam, the mass transilluminates and Allen test reveals patent radial and ulnar arteries. What is the most appropriate next step in management?
Referral to a orthopaedic oncologist
Surgical excision with wide margins
Autologus bone marrow aspirate injection
Injection of N-Butyl-Cyanoacrylate
Thanks for discussion below! If 70% of ganglia are dorsal, but there were only 2/14 (14%) dorsal ganglia in the paper, would it be safer to say that this paper has questionable validity? (Or are the proportions that much different in children?)
A collegiate baseball player injures his left small finger sliding into third base. He complains of pain and swelling. The finger is ecchymotic, swollen throughout, and painful with attempted range of motion of the PIP joint. No sensory or vascular deficits are present. A radiograph is provided in Figure A. Which of the following interventions will provide the best outcome?
Buddy taping the small finger to the ring finger
Immobilization of the MCP in flexion and the PIP and DIP in extension with a custom splint
Open reduction internal fixation
PIP joint arthrodesis
See: J Hand Surg Eur Vol. 2015 Jan;40(1):51-8. doi: 10.1177/1753193413508514. Epub 2013 Oct 14.Condylar fractures of the proximal and middle phalanges.Shewring DJ, Miller AC, Ghandour A.
J Hand Surg Am. 2004 Mar;29(2):264-72.