New frontiers in hand arthroscopy.

This article covers new and emerging techniques in small joint arthroscopy in the hand. Recent improvement in the quality of small joint scopes and advancement in techniques have allowed for many new small joint arthroscopic procedures in the hand. The arthroscopic classification for thumb carpometacarpal (CMC) arthritis as well as treatment of each stage are described. Arthroscopic treatment of pantrapezial arthrosis is reviewed. Metacarpophalangeal arthroscopy for the treatment of synovitis, arthritis, fractures, and gamekeeper injuries are discussed, as is arthroscopy of the proximal interphalangeal, pisotriquetral, fourth and fifth CMC, and distal interphalangeal joints.

Endoscopic exploration and repair of brachial plexus with telerobotic manipulation: a cadaver trial.

OBJECT: The aim of this paper was to develop an effective minimally invasive approach to brachial plexus surgery and to determine the feasibility of using telerobotic manipulation to perform a diagnostic dissection and microsurgical repair of the brachial plexus utilizing an entirely endoscopic approach. METHODS: The authors performed an endoscopic approach using 3 supraclavicular portals in 2 fresh human cadaver brachial plexuses with the aid of the da Vinci telemanipulation system. Dissection was facilitated inflating the area with CO(2) at 4 mm Hg pressure. The normal supraclavicular plexus was dissected in its entirety to confirm the feasibility of a complete supraclavicular brachial plexus diagnostic exploration. Subsequently, an artificial lesion to the upper trunk was created, and nerve graft reconstruction was performed. Images and video of the entire procedure were obtained and edited to illustrate the technique. RESULTS: All supraclavicular structures of the brachial plexus could be safely dissected and identified, similar to the experience in open surgery. The reconstruction of the upper trunk with nerve graft was successfully completed using an epineural microsurgical suture technique performed exclusively with the aid of the robot. There were no instances of inadvertent macroscopic damage to the vascular and nervous structures involved. CONCLUSIONS: An endoscopic approach to the brachial plexus is feasible. The use of the robot makes it possible to perform microsurgical procedures in a very small space with telemanipulation and minimally invasive techniques. The ability to perform a minimally invasive procedure to explore and repair a brachial plexus injury may provide a new option in the acute management of these injuries.

Dynamic splinting in wrist extension following distal radius fractures.

BACKGROUND: Wrist flexion contracture is a common pathology which presents secondary to distal radius fractures. Joint stability, restoration and early mobilization are frequently achieved through surgical treatment after such an injury. The purpose of this retrospective study was to evaluate the initial effect of dynamic splinting on wrist extension (active range of motion), in both surgical and non-surgical patients following distal radius fractures. METHODS: Records were obtained from 133 patients who were treated with a Wrist Extension Dynasplint (WED) following distal radius fractures, between May 2007 and May 2009. Forty-two of these patients received surgical treatment for their fractures. This study specifically examined the initial usage of the WED as a home therapy. The retrospective analysis included categorization of patients who received the WED exclusively vs. patients who received WED treatment with concurrent hand therapy; surgical categorization included surgical patients vs. nonsurgical patients. RESULTS: There was a significant improvement in maximal active range of motion (AROM) for all patients (P < 0.0001) after a mean duration of 3.9 weeks of dynamic splinting. Patients showed a mean 62% increase in active extension. There was not a significant difference between patients who had received surgical treatment for the fracture vs. nonsurgical. CONCLUSION: This dynamic splinting modality contributed 138 to 185 hours of stretching at the end range of motion for these patients in their first month following fracture. This unique regime is considered directly responsible for significant gains in AROM.

Metacarpophalangeal arthroscopy: technique and applications.

Metacarpophalangeal joint arthroscopy is an emerging and useful tool for the upper extremity surgeon. Equipment, operating room set-up, and techniques are reviewed. Indications for diagnostic and therapeutic metacarpophalangeal joint arthroscopy are presented, including several relevant applications.