Surgical technique: hemi-extensor carpi radialis brevis tenodesis for stabilizing the midcarpal joint in Ehlers-Danlos syndrome.

Patients with the hypermobility type of Ehlers-Danlos (EDS-HT) often complain of wrist pain, usually originating from subluxations. As a result of the laxity, wrist function in these patients can be highly limited. This paper presents a surgical technique that stabilizes the lunocapitate joint with the use of an extensor carpi radialis brevis strip. Five patients with confirmed EDS-HT were treated with an extensor carpi radialis brevis tenodesis for their midcarpal instability. Two patients presented with complications following surgery, one major and one minor. This paper presents a potentially satisfactory surgical solution to recurrent midcarpal instability in EDS-HT patients and demonstrates that the use of an autologous tendon might be feasible in spite of a background of abnormal collagen metabolism.

Results of reoperation for failed ulnar nerve surgery at the elbow: a systematic review and meta-analysis.

OBJECTIVE: The clinical results of reoperation for recurrent or persistent ulnar nerve compression at the elbow have not been clearly determined. The aim of this review was to determine overall improvement, residual pain, and sensory and motor deficits following reoperation regardless of the type of primary surgery performed for this condition. METHODS: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, a systematic review and meta-analysis of studies was performed. An independent librarian performed a literature search using Ovid MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL). The Newcastle-Ottawa Scale and the quality appraisal tool described by Moga et al. were used to assess the quality of included case series. RESULTS: Of the 278 retrieved studies, 16 were eligible for analysis and included a total of 290 patients with failed surgery for ulnar nerve entrapment at the elbow. Relief of symptoms after reoperation was reported in 85% of patients. A decrease in pain was noted in 85% of the patients (95% CI 75%-93%). Only 2.4% of patients with preoperative pain experienced worse pain after reoperation. Motor and sensory function improvement was noted in 77% (95% CI 63%-88%) and 77% (95% CI 61%-90%) of cases, respectively. Complete recovery from signs and symptoms at the final follow-up was noted in 23% of elbows (95% CI 16%-31%). CONCLUSIONS: Although the level of evidence of the included studies was low, the majority of patients had relief from their complaints after reoperation for recurrent or persistent ulnar nerve compression at the elbow following a previous surgery. The success rate of surgical treatment for a failed surgery was quite remarkable since almost a quarter of the patients completely recovered. Therefore, the authors recommend reoperation as a serious option for patients with this condition.