Current Evidence Involving WALANT Surgery.

Wide-awake local anesthesia no-tourniquet (WALANT) surgery is an attractive option for hand surgeons, particularly during resource-scarce periods, as it eliminates dependence on main operating rooms or hospital-based procedures. The limited prepping or draping used for WALANT field sterility is as effective, if not more effective, than standard sterile prepping or draping. Patient anxiety surrounding WALANT surgery is similar to or less than that of general or local anesthesia with or without tourniquet. Patients use the same or lower amounts of postoperative narcotics after WALANT as compared to after the other anesthetic methods. Wide-awake local anesthesia no-tourniquet surgery saves significant costs for the same surgeries when performed under general or local anesthesia with or without tourniquet. There are very few complications associated with the WALANT method of anesthesia; rare case reports include vasovagal syncope and cardiac arrhythmia due to inadvertent intravascular injection of epinephrine.

Radial Polydactyly.

¼ Radial polydactyly is one of the most common congenital anomalies of the hand, with an incidence of 0.08 to 1.40 per 1,000 live births; it requires surgical treatment early in life.¼ Polydactyly occurs during weeks 5, 6, 7, and 8 of embryogenesis, principally due to misregulation of the sonic hedgehog protein within the developing limb bud.¼ The Flatt classification system of preaxial polydactyly (types I to VII), as published by Wassel, categorizes preaxial polydactyly based on osseous abnormalities, but it has substantial limitations.¼ For improved function and appearance, preaxial polydactyly ideally requires surgical intervention at an early age (between 1 and 2 years of age) before the development of fine motor skills.

Minimally Invasive In Situ Cubital Tunnel Decompression.

The purpose of this study is to describe a modified technique for a minimally invasive approach to in situ ulnar nerve decompression and to provide long-term follow-up. Thirty-one patients were included. DASH and MHQ scores were measured. Mean postoperative DASH score was 10. Eighty percent of patients achieved a postoperative DASH score under 10. Average postoperative MHQ scores were as follows: overall hand function 89, activities of daily living 93, work 92, pain 7, esthetics 95, and satisfaction 84. There were no postoperative neurological complications. No patient required open decompression or transposition. There were no wound complications. This technique addresses all points of possible compression, results in outcomes similar to those reported in the literature, and results in excellent cosmesis. It is a simple and safe technique that avoids the complexities of endoscopy and transposition and has proven to be successful.

A novel approach for coronoid fractures.

The coronoid process serves as an important constraint that provides ulnohumeral joint stability. We describe a novel approach to coronoid fractures that minimizes surgical dissection, without compromising fracture visualization. We present the case of a 65-year-old woman who sustained an anteromedial facet fracture of the coronoid process. The elbow demonstrated intractable posteromedial instability and the inability to maintain reduction even up to 90 degrees. This report describes a surgical approach to the coronoid process that minimizes extensive soft tissue dissection. It is a variation of the previously described approach by Taylor and Scham, although it can achieve a similar exposure without elevation of the entirety of the flexor-pronator mass. Our approach involves a limited skin incision, followed by elevation of enough of the flexor-pronator mass such that adequate visualization of the posterior medial collateral ligament (which was repaired), anteromedial facet, and the fractured fragment of coronoid were achieved. Moreover, this approach enables the course of the ulnar nerve to remain unaltered.