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Calcaneal fracture: Open reduction and internal fixation; percutaneous fixation

See also Video 47.1 . For open reduction techniques, either patients are operated on within the first 12 to 24 hours or, more commonly, surgery is delayed 10 to 14 days to allow soft tissue swelling to resolve enough for the skin to wrinkle. After 3 weeks, open reduction becomes more difficult, but it is possible up to 4 to 5 weeks. Advantages of a lateral…

Minimally invasive chevron-Akin osteotomy

There has been a growing interest in minimally invasive techniques for hallux valgus surgery, including large patient series. Although some authors have reported mixed or less than favorable results in the past, most now report satisfactory results with the percutaneous Akin or chevron-Akin osteotomies in patients with mild to moderate hallux valgus, especially with third-generation techniques. Comparison studies of open versus percutaneous techniques have shown comparable…

Distal chevron metatarsal osteotomy for hallux valgus

See also Video 44.1 . Modified chevron distal metatarsal osteotomy The modified chevron osteotomy is simply a more proximal placement of the apex of the osteotomy in the metatarsal head. Potential problems of this modification of the chevron osteotomy are instability of the osteotomy and insufficient metaphyseal bony contact. Proper placement of the osteotomy cuts is mandatory. The metatarsal osteotomy must be internally fixed. With some…

Trigger finger release: Open and percutaneous

Surgical release reliably relieves the problem of trigger finger for most patients: approximately 97% of patients have complete resolution after operative treatment. Persistence of triggering is more common than recurrence. Trigger release should be done with a local block so that the cessation of triggering of a particular finger can be evaluated. Some adjacent finger triggering may become obvious only after a given finger is released;…

Endoscopic carpal tunnel release through one or two incisions

Advocates of endoscopic carpal tunnel release cite less palmar scarring and ulnar “pillar” pain, rapid and complete return of strength and return to work, and activities at least 2 weeks sooner than for open release. The advantages of the endoscopic technique in grip strength and pain relief are realized within the first 12 weeks and seem to benefit those patients not involved in compensable injuries. Anecdotal…

Scaphoid fractures: Open reduction internal fixation and percutaneous fixation

See also Video 40.1 . Treatment of scaphoid fractures is determined by displacement and stability of the fracture. Operative treatment is generally required for displaced, unstable fractures in which the fragments are offset more than 1 mm on the anteroposterior or oblique view, lunocapitate angulation is more than 15 degrees, or the scapholunate angulation is more than 45 degrees on the lateral view (range 30–60 degrees). Reduction…

Subcutaneous fasciotomy, partial fasciectomy for dupuytren contracture

Surgical procedures commonly used in treating Dupuytren contracture are: (1) subcutaneous or percutaneous fasciotomy, (2) partial (selective) fasciectomy, (3) complete fasciectomy, (4) fasciectomy with skin grafting, (5) amputation, and (6) joint resection and arthrodesis. The appropriate procedure depends on the degree of contracture, nutritional status of the palmar skin, the presence or absence of bony deformities, and the patient’s age, occupation, and general health. The least…

Flexor tendon repair

The preparations and techniques for repair of flexor tendons vary from zone to zone ( Fig. 36.1 ). As a rule, flexor tendons should be repaired at whatever level they are severed. ■ Exposures for primary suture of tendons. Solid lines indicate examples of skin lacerations and broken lines show direction in which they can be enlarged to obtain additional exposure ( Fig. 36.2 ). Open…