Dimitris G. Vardakas

RECURRENT COMPRESSIVE NEUROPATHY OF THE MEDIAN NERVE AT THE WRIST: TREATMENT WITH AUTOGENOUS SAPHENOUS VEIN WRAPPING

Recurrence of symptoms occurs in a significant number of patients after surgical decompression for carpal tunnel syndrome, and its management is both challenging and difficult. Fifteen patients with recurrent carpal tunnel syndrome were treated with a vein wrapping technique using the autologous saphenous vein. A total of 48 operations had been performed on these patients before wrapping the median nerve with a saphenous vein graft. At a mean follow-up of 43 months all patients reported significant pain relief and improvement in their sensory disturbances. Two-point discrimination and the findings of nerve conduction studies also improved.

An Allograft Salvage Technique for Failure of the Darrach Procedure: A Report of Four Cases

We report on four patients with failed resections of the distal ulna causing instability and impingement, who were treated with a tendon allograft to stabilize and buffer the ulnar stump. In three of the four patients the outcome was excellent. We believe that this new technique holds promise as an alternative salvage procedure for the failed Darrach resection.

Evaluating and treating the stiff elbow

The evaluation and treatment of the stiff elbow are described, as well as the lateral, medial, anterior, and posterior approaches for release of elbow contractures. The results after surgical release in 48 patients that failed nonoperative treatment for elbow contractures in our institution are reported. A literature review is provided.

The Compass Elbow Hinge: Indications and Initial Results

The Compass Elbow Hinge uses Illizarov’s methods of fixation to externally hold the elbow reduced and allow both passive and active motion. Eleven patients with degenerative disease, contracture or instability were treated with the Compass Elbow Hinge and were retrospectively evaluated at an average follow-up of 29 months (range: 18–62 months). One was lost to follow-up. Patients with degenerative changes underwent fascia lata interposition while those treated for contractures underwent anterior and posterior capsular release with or without fascia lata interposition. Those with elbow instability underwent ligament reconstruction. The device was removed after 6 weeks and seven of the 11 patients were satisfied with the outcome of the operation. Stability could not be achieved in two patients with coronoid fractures that were not reconstructed. One patient did not tolerate the device and requested its removal with subsequent subluxation. We conclude that patient selection and compliance are key elements in achieving a satisfactory outcome with the device.

Minimal medial epicondylectomy and decompression for cubital tunnel syndrome

Sixty-four patients (66 elbows) treated for refractory cubital tunnel syndrome had minimal medial epicondylectomy and in situ decompression to minimize the potential disadvantages of classic medial epicondylectomy. After a mean followup of 27 months results were excellent in 27 patients (44%), good in 23 patients (35%), fair in 10 patients (15%), and poor in four patients (6%). No ulnar nerve palsy, ulnar nerve subluxation, or medial elbow instability were seen. The main complaint of patients regarding the procedure was tenderness at the osteotomy site. The results show that minimal medial epicondylectomy and in situ decompression of the ulnar nerve is a safe and effective method to treat patients with cubital tunnel syndrome. This procedure minimizes the disadvantage of medial instability and recurrent symptoms attributable to nerve trauma after a classic medial epicondylectomy.

Ulnar Nerve Surgery

Summary: Cubital tunnel syndrome is a relatively common entity among compression neuropathies of the upper extremities. Different techniques to treat failure of conservative treatment have been described in the literature. These procedures are based on decompressing of the nerve alone or in combination with placement in a new physiologic bed. In this paper, we review the surgical options for treatment of the cubital tunnel syndrome.