Scapholunate Ligament Insufficiency in a Patient with Scaphocapitate Coalition.

We report a case of chronic scapholunate ligament insufficiency in a patient with scaphocapitate coalition. After more than 4 years of mild symptoms, there was no radiological evidence of progression to scapholunate advanced collapse in spite of minimal load-bearing repetitive physical activities undertaken by the patient as a professional guitarist. We believe that scaphocapitate coalition could contribute to mitigate the progression to scapholunate advanced collapse by preventing abnormal flexion of the scaphoid once the ligament is not competent anymore. The biomechanical and surgical implications of this type of carpal coalition are also discussed.

Denervation With Periosteal Resection of the First Carpometacarpal Joint.

Osteoarthritis of the first carpometacarpal joint is a frequent condition that hand surgeons have to deal with. When conservative measures such as physiotherapy, steroid injections, or splinting fail to alleviate symptoms, trapeziectomy is considered the gold standard for surgical treatment. In the present article, a novel technique is presented to denervate the joint capsule together with the periosteum and the endosteum to address sensory receptors located in these 2 extracapsular structures in the proximity of the first carpometacarpal joint area. Denervation with periosteal resection, apart from being a relatively easy and less aggressive technique compared with trapeziectomy, offers satisfactory pain relief with a faster recovery time.

Perspectives and Consensus among International Orthopaedic Surgeons during Initial and Mid-lockdown Phases of Coronavirus Disease.

With a lot of uncertainty, unclear, and frequently changing management protocols, COVID-19 has significantly impacted the orthopaedic surgical practice during this pandemic crisis. Surgeons around the world needed closed introspection, contemplation, and prospective consensual recommendations for safe surgical practice and prevention of viral contamination. One hundred orthopaedic surgeons from 50 countries were sent a Google online form with a questionnaire explicating protocols for admission, surgeries, discharge, follow-up, relevant information affecting their surgical practices, difficulties faced, and many more important issues that happened during and after the lockdown. Ten surgeons critically construed and interpreted the data to form rationale guidelines and recommendations. Of the total, hand and microsurgery surgeons (52%), trauma surgeons (32%), joint replacement surgeons (20%), and arthroscopy surgeons (14%) actively participated in the survey. Surgeons from national public health care/government college hospitals (44%) and private/semiprivate practitioners (54%) were involved in the study. Countries had lockdown started as early as January 3, 2020 with the implementation of partial or complete lifting of lockdown in few countries while writing this article. Surgeons (58%) did not stop their surgical practice or clinics but preferred only emergency cases during the lockdown. Most of the surgeons (49%) had three-fourths reduction in their total patients turn-up and the remaining cases were managed by conservative (54%) methods. There was a 50 to 75% reduction in the number of surgeries. Surgeons did perform emergency procedures without COVID-19 tests but preferred reverse transcription polymerase chain reaction (RT-PCR; 77%) and computed tomography (CT) scan chest (12%) tests for all elective surgical cases. Open fracture and emergency procedures (60%) and distal radius (55%) fractures were the most commonly performed surgeries. Surgeons preferred full personal protection equipment kits (69%) with a respirator (N95/FFP3), but in the case of unavailability, they used surgical masks and normal gowns. Regional/local anesthesia (70%) remained their choice for surgery to prevent the aerosolized risk of contaminations. Essential surgical follow-up with limited persons and visits was encouraged by 70% of the surgeons, whereas teleconsultation and telerehabilitation by 30% of the surgeons. Despite the protective equipment, one-third of the surgeons were afraid of getting infected and 56% feared of infecting their near and dear ones. Orthopaedic surgeons in private practice did face 50 to 75% financial loss and have to furlough 25% staff and 50% paramedical persons. Orthopaedics meetings were cancelled, and virtual meetings have become the preferred mode of sharing the knowledge and experiences avoiding human contacts. Staying at home, reading, and writing manuscripts became more interesting and an interesting lifestyle change is seen among the surgeons. Unanimously and without any doubt all accepted the fact that COVID-19 pandemic has reached an unprecedented level where personal hygiene, hand washing, social distancing, and safe surgical practices are the viable antidotes, and they have all slowly integrated these practices into their lives. Strict adherence to local authority recommendations and guidelines, uniform and standardized norms for admission, inpatient, and discharge, mandatory RT-PCR tests before surgery and in selective cases with CT scan chest, optimizing and regularizing the surgeries, avoiding and delaying nonemergency surgeries and follow-up protocols, use of teleconsultations cautiously, and working in close association with the World Health Organization and national health care systems will provide a conducive and safe working environment for orthopaedic surgeons and their fraternity and also will prevent the resurgence of COVID-19.

Radical Wrist Denervation and Preliminary Results.

Denervation is a well recognized procedure to treat degenerative or posttraumatic joint conditions, especially in cases where pain is a significant impediment to function even in the presence of stable and supple joint. However, this procedure currently is not as widely used for wrist surgeries as it merits. Denervation procedure obeys all-or-none phenomenon and we believe that even a few residual intact sensory fibers are able to transmit severe pain sensation and therefore every attempt should be made to target all the sensory supply to the wrist joint. In the present article a modified and radical technique using a single dorsal incision is proposed to address the hypothetical pitfalls of leaving undivided sensitive branches. Preliminary results of 21 cases operated on by this method are presented.

Digital mucous cyst excision using a proximally based skin flap.

Mucous cysts of the fingers are benign ganglionic lesions arising generally from the distal interphalangeal joint that are more frequent between the fifth and seventh decades. They are usually asymptomatic; however, in certain cases such as pain or when the overlying skin is excessively attenuated, leading to breakdown and oozing of synovial fluid and potential risk of infection, surgical excision is recommended. In the present article a technique to excise the cyst while preserving its overlying attenuated skin is presented.

Carpal tunnel syndrome secondary to Masson's tumour.

We present a case of a Masson's tumour causing carpal tunnel syndrome. Space occupying lesions should be considered as a differential in refractory cases of carpal tunnel syndrome, especially those in whom the symptoms are dynamic. Once radiological investigation confirms such a diagnosis, we advocate surgical excision, as malignancy can only be excluded via histological examination.

Scapholunate interosseus ligament reconstruction on a cadaver: A technique.

BACKGROUND: Acute rupture of the scapholunate interosseus ligament is a relatively frequent occurrence which can be repaired primarily by direct suturing. However, patients are often seen a few weeks after injury when most of the ligament fibers have degenerated. This poses a challenge because direct repair can be difficult and long term results have not been satisfying. In the present study, a technique is presented to address this problem and its possible advantages are discussed. MATERIALS AND METHODS: A fresh frozen wrist cadaver specimen, thawed to room temperature, was used to carry out the procedure. The scapholunate joint was exposed through a dorsal approach and stabilized using two percutaneous Kirschner wires. Using a U shaped chisel, a groove along the scapholunate articular margin was created to accommodate a strip from the extensor retinaculum as a ligament plasty. This has been secured using six anchor sutures and several pictures taken during the procedure to expose the key steps. RESULTS: The ligamentoplasty presented in this article preserves most of the articular surface of proximal carpus and at the same time stabilizes the scapholunate joint. However, more in vivo research should be carried out to validate this treatment. CONCLUSION: The technique suggests a possible way to repair a ruptured scapholunate interosseus ligament that cannot be repaired primarily. Because osteointegration of the ligament strips is not possible in the present experiment, biomechanics of the construct cannot be fully tested.

Denervation of the metacarpophalangeal joint.

Metacarpophalangeal joint osteoarthritis is a relatively common condition that hand surgeons have to deal with. When daily activities are impaired by pain and all conservative measures have failed, surgical treatments such as arthrodesis or joint replacement are indicated. In this article, a technique for joint denervation is presented as a treatment for painful degenerative or posttraumatic osteoarthritis. Its preliminary results, potential complications, and contraindications are also discussed.

Denervation of the distal interphalangeal joint.

Distal interphalangeal joint osteoarthritis is one of the most common conditions hand surgeons have to deal with. When daily manual activities are impaired by symptoms, surgical treatment is indicated. Usually, this is carried out by means of arthrodesis, being joint replacement another option. In this study, a technique for distal interphalangeal joint denervation is presented as a treatment for painful degenerative or posttraumatic osteoarthritis. Potential complications and contraindications are also discussed.

Wagner approach for first carpometacarpal joint denervation.

First carpometacarpal joint osteoarthritis is one of the most common conditions hand surgeons have to deal with. In this article, a more radical technique for joint denervation is presented as a treatment for painful degenerative or posttraumatic osteoarthritis. Moreover, a preliminary report of 18 cases treated with this technique is presented to support its benefits.