Recurrence of Ganglion Cysts Following Re-excision

Previous studies have examined the recurrence of ganglion cysts after surgical excision at a rate of 4 to 40%. However, recurrence after revision surgical excision is unknown. The purpose of this study was to define the incidence of recurrent ganglion cysts in patients who underwent a 2nd excisional procedure.https://jdc.jefferson.edu/cwicposters/1032/thumbnail.jp

An Evaluation of Ultrasound-Guided Regional Block Anesthesia in Outpatient Hand Surgery

Introduction: The utilization of ultrasound-guided peripheral nerve blocks in orthopedic surgery has increased in popularity as the anesthesia of choice for the management of perioperative pain. Peripheral nerve blockade has been shown to increase overall surgical efficiency, improve patient satisfaction, reduce postoperative narcotic use, and decrease the duration of facility admissions, while increasing overall cost-effectiveness. To date, scant literature exists regarding the safety and efficacy of ultrasound-guided supraclavicular blocks used in common hand surgery procedures, and the rate of neurologic and vascular complications remains unknown. Objective: The purpose of this study was to examine the effectiveness and complication rate of supraclavicular nerve blocks in hand surgery. Methods: With institutional review board approval, 713 cases of outpatient upper extremity surgery, performed by three board certified orthopedic hand surgeons at a single ambulatory surgery center over a consecutive period of 2 years, were retrospectively reviewed. Adverse outcomes related to regional blocks were identified through reviewing the electronic medical record of the immediate 24-hour postoperative telephone call and the first postoperative visit note within two weeks of surgery. Results: 20 patients (2.8%) reported an excessively long block and 1 patient reported inadequate pain control in the PACU (0.1%), but no clinically significant pulmonary or neurovascular complications were identified. Conclusion: Ultrasound-guided supraclavicular block was associated with a high success rate and low complication rate. This technique as described may be safe for outpatients, although larger numbers of subjects will be required to make this statement with certainty

Flexor pollicis longus (FPL) tendon hypoplasia: A case report and literature review

An 18-year-old female presented with long-standing inability to flex her left thumb. MRI of the left thumb revealed flexor pollicus longus (FPL) tendon hypoplasia, and subsequent ultrasound of the bilateral thumbs confirmed a left-sided hypoplastic FPL tendon. Structural integrity of the left FPL tendon was confirmed during surgical examination under anesthesia. Multiple congenital anomalies of the FPL have been described, but FPL tendon hypoplasia and its appearance on imaging are rarely reported. This case demonstrates the diagnosis of FPL tendon hypoplasia on MRI, ultrasound, and surgical examination under anesthesia; and demonstrates the importance of including this entity in the differential diagnosis for impaired thumb flexion. Keywords: Flexor pollicis longus, FPL, Hypoplasi

Internal fixation of distal metacarpal fractures: new uses for an old plate.

Certain metacarpal fracture patterns require operative fixation to restore anatomy and optimize results. Compared with dorsal plating, the width of the minicondylar blade plate buttresses the deforming volar pull of the intrinsics and provides a stronger construct. The implant provides firm fixation in the juxta-articular fragment with minimal space requirements. Therefore, the purpose of this study was to examine the outcomes following the use of a minicondylar blade plate for the treatment of distal metacarpal fractures. Twenty-two distal metacarpal fractures in 20 patients treated with a minicondylar blade plate were retrospectively reviewed. Outcome measures collected included postoperative grip strength, range of motion, return to work, and radiographic evidence of osseous union. Average range of motion of the metacarpophalangeal joint was 62° postoperatively. Eighty-two percent (18/22) of fractures were able to flex their digits to their distal palmar crease. Seventy-one percent (12/17) of patients had at least 75% return to grip strength compared with the contralateral side. Seventeen patients returned to full activity at a mean of 2.5 months (range, 1-3 months) postoperatively; 1 patient was on disability, and data were not available for the final 2 patients. No major complications occurred. The minicondylar blade plate is a safe and effective technique for stabilizing unstable periarticular metacarpal fractures. Stable fixation allows for early range of motion, rapid return to strength, and a relatively quick return to full work duty