Marwan A. Wehbé

Tendon graft donor sites

Each of 480 extremities from 120 cadavers was dissected. Particular attention was given to potential donors for tendon grafts. Both the palmaris longus and the extensor digiti minimi had an average length of 16 cm and an average width of 3 mm. The extensor indicis tendon averaged 13 cm in length and 3 mm in width. The plantaris and second toe extensors averaged 35 cm in length and 2 to 2.5 mm in width. None of these measurements correlated well with age, sex, or hand or foot size. There was, however, a high correlation between right- and left-side measurements in each specimen, in spite of some degree of anatomic variation for all the tendons studied. The palmaris longus was missing in 25% of the upper extremities, and the plantaris in 19% of the lower extremities dissected.

Computed tomography diagnosis of distal radioulnar subluxation

Eight patients with suspected diagnosis of distal radioulnar joint (DRUJ) subluxation underwent computed tomographic (CT) scans of the wrist. Five underwent surgery and had DRUJ subluxation or dislocation; CT scans revealed subluxation in four. Three CT criteria for the evaluation of DRUJ subluxation are discussed and compared in this manuscript.

Ulnar shortening using the AO small distractor

Twenty-four patients (24 wrists) with ulnar impaction syndrome underwent ulnar shortening osteotomy. They were reviewed retrospectively to evaluate a technique using the AO small distractor and 2.7-mm dynamic compression plate. A transverse osteotomy using an external compression device and compression plating was performed in all cases. The average follow-up time was 32 months. Clinical and radiographic union occurred at an average of 9.7 weeks. There were no nonunions. This study demonstrates that ulnar transverse shortening osteotomy with external compression and plating is a simple and effective method of ulnar shortening, and that highly precise and complex instrumentation is not essential.

Conservative treatment for thoracic outlet syndrome

Conservative treatment of thoracic outlet syndrome consists initially of pain control and medicinal and physical measures. Therapy then addresses tight muscles, with strengthening of weakened neck and shoulder girdle muscles. Range of motion and nerve gliding exercises are instituted simultaneously, and the patient is educated in proper posture and ergonomics at home and in the work setting.

Brachial plexus anatomy

The brachial plexus may be visualized simply as beginning with five nerves and terminating in five nerves. It begins with the anterior rami of C5, C6, C7, C8, and the first thoracic nerve. It terminates with the formation of the musculocutaneous, median, ulnar, axillary, and radial nerves. The intermediate portions are displayed in sets of threes: three trunks are formed, followed by three divisions, then three cords. Each trunk gives rise to two divisions and each cord gives rise to two branches. The lateral cord divides into the musculocutaneous nerve and the lateral branch of the median nerve. The medial cord divides into the medial branch of the median nerve and the ulnar nerve. The posterior cord divides into the axillary and the radial nerves. The anatomy of the brachial plexus can be confusing, especially because of frequent variations in length and caliber of each of its components.

Current trends in treatment of thoracic outlet syndrome

Even though the response from this survey was decent, it is not large enough to draw statistical conclusions. The data therefore are being presented from an interest standpoint and do reflect the current trends of treatment for TOS. Physicians who do not treat TOS do not have an accurate view of this disorder, its treatment, or the success rate of treatment. Surgeons who deal with this problem have encouraging results. Conservative treatment seems effective in approximately half of the patients afflicted with this condition. Surgery carries what seems to be a long-term cure rate of 65% and partial relief in 20% of patients. Significant complications are rare.

Trapezium Resection with Mersilene Suspension Sling

The reason there are numerous techniques for thumb carpometacarpal arthroplasty is that none of them are perfect. Sometimes the simplest procedures work best. This article presents a simple alternative, using a readily available suture to stabilize the thumb after resection of the trapezium, with long-term success.

A Carpal Ligament Substitute Part 1: Polyester Suture

We have searched for a synthetic substitute for the carpal ligaments, which would be widely available and easy to use. Four loops of 2-0 polyester fiber suture (Mersilene) were found to exceed the ultimate tensile strength of the scapholunate interosseous ligament. This construct approximates a normal ligament stress/strain curve and can theoretically facilitate fibrous tissue ingrowth. It is readily available, easy to handle, and inexpensive. Based on these findings, we recommend the use of polyester suture in the reconstruction of carpal and other ligaments.

Prosthetic Arthroplasty of the Distal Radioulnar Joint: Historical Perspective and 24-Year Follow-Up

This is a report of the first prosthetic hemiarthroplasty and full arthroplasty, designed and implanted for the distal radioulnar joint in 1988. Two case reports are presented, with follow-up of 24 years. Experience and problems in the design of both a hemiarthroplasty and total prosthetic arthroplasty are described, in the hope that future developments may avoid past failures.

Thoracic outlet syndrome

Thoracic outlet syndrome (TOS) is a specific disease, with specific symptoms, and it is treatable! A recent survey revealed astounding information. One out of each five hand surgeons actually believes that TOS does not exist! One out of six believes that these patients never get better, nomatter what the treatment. In a recent editorial, Peter C. Amadio, MD, stated, ‘‘There is not much agreement as to what exactly constitutes thoracic outlet syndrome’’ [1]. This attests to the difficulty in diagnosis and the variability in the results of treatment. To put this in perspective, consider that carpal tunnel syndrome (CTS) was first described in 1854 by Paget, and its surgical treatment was first reported in 1946 by Cannon and Love [2]. In contrast, TOS was described before CTS, in 1818 by Cooper, and its surgical treatment was first reported by Coote in 1861 and Keen in 1907 [3]. Why, then, hasn’t TOS made as much progress as CTS? First off, TOS is not as common as CTS. The methods used to diagnose and treat patients with TOS today are as numerous as the number of surgeons treating them. I have learned a great deal from each author, and have no doubt that each readerwill findhere a treasure of information about TOS. I have intentionally asked different authors to write seemingly identical articles; it is obvious that each approaches the problem in a unique way.