Abhijeet Wahegaonkar - Academia.edu (original) (raw)

Papers by Abhijeet Wahegaonkar

Objectives/Interrogation: Neglected posterior dislocation of the elbow is common in developing co... more Objectives/Interrogation: Neglected posterior dislocation of the elbow is common in developing countries. Neglected posterior dislocations often present with myositis ossificans from massage and treatment from bone-setters in developing countries. Such problems in young, active patients present[for full text, please go to the a.m. URL]

Objectives/Interrogation: Lateral epicondylitis is usually self-limiting and resolves within 8-12... more Objectives/Interrogation: Lateral epicondylitis is usually self-limiting and resolves within 8-12 months. Once it resolves, recurrence is rare. Conservative management remains the mainstay of treatment. When conservative treatment fails, surgery is required for resistant cases. Morrey had put forth[for full text, please go to the a.m. URL]

Objectives/Interrogation: Molluscum Contagiosum (MC) is a benign and contagious skin infection ca... more Objectives/Interrogation: Molluscum Contagiosum (MC) is a benign and contagious skin infection caused by molluscum contagiosum virus (MCV) of poxvirus family. MC is a self-limiting condition affecting the skin and mucus membrane. It is commonly seen in children of age 2 -5 years, but can be seen[for full text, please go to the a.m. URL]

Objectives/Interrogation: The triangular fibrocartilage complex (TFCC) is an important stabilizer... more Objectives/Interrogation: The triangular fibrocartilage complex (TFCC) is an important stabilizer and load absorber in the wrist. There is a significant load borne by the ulnar aspect of the wrist during different wrist positions that pass predominantly through the TFCC. Injury to the TFCC is a[for full text, please go to the a.m. URL]

Indian Journal of Orthopaedics, 2021

Background Ulnar-sided wrist pain is a common clinical problem, most often misdiagnosed as triang... more Background Ulnar-sided wrist pain is a common clinical problem, most often misdiagnosed as triangular fibrocartilage complex (TFCC) injury. It may be frustrating to the patient, as one may end up wearing a wrist splint for an unusually long period, disrupting their routine. Purpose Because of the dilemmas in the diagnosing the cause of ulnar-sided wrist pain, various algorithms have been suggested but it is an individual's choice to do a systematic assessment and follow in their routine clinical practice. We propose the 'storey concept' for examining the ulnar side of the wrist, with ulnar styloid as the reference point. The lower storey identifies the pathologies of the DRUJ, the intermediate storey identifies the pathologies of the radiocarpal joint and the upper storey identifies the pathologies of midcarpal and carpometacarpal joint. Conclusion Also, it is important to ramify the cause of pain into stable or unstable wrist, with or without arthritis, as this will guide us in managing the pain arising from distal radioulnar joint. In addition to methodical clinical examination, ideal radiographs and high-resolution MRI are critical to diagnose wrist pathologies. The role of wrist arthroscopy has consistently increased, and complements in both diagnosis and treatment of wrist pain especially in ambiguous situations.

Journal of Wrist Surgery, 2021

Giant cell tumors of tendon sheath are classified according to their clinical presentation as loc... more Giant cell tumors of tendon sheath are classified according to their clinical presentation as localized or diffuse, and they may occur at intra-articular or extra-articular locations. Although magnetic resonance imaging is mandatory and sufficient for diagnosis in many cases, histological examination is needed to confirm the diagnosis. Complete surgical resection is the mainstay of treatment. Radiotherapy as adjuvant or after recurrence shows promising results. Though small joint arthroscopy, especially of the thumb carpometacarpal (CMC) joint, is a relatively new technique and mainly used for the treatment of basal joint arthritis of the thumb, the indications are evolving. We report a rare case of nodular tenosynovitis of the CMC joint of the thumb managed with complete arthroscopic resection of the tumor, and no recurrence at a follow-up of 2.5 years. This is another addition to the list of indications for thumb CMC arthroscopy. Arthroscopic treatment provides the distinct advant...

Techniques in Hand & Upper Extremity Surgery, 2019

Lateral epicondylitis is the most common condition affecting the elbow and is self-limiting in mo... more Lateral epicondylitis is the most common condition affecting the elbow and is self-limiting in most cases. However, when conservative treatment fails, surgery is required for resistant cases. In this study, we describe a novel technique for the management of chronic lateral epicondylitis. The advantage of our technique is that all the 3 major components of the disease (as also all types of failure described by Morrey) are simultaneously dealt with, that is, pathology of the tendon, posterior interosseous nerve compression and intra-articular pathology are all addressed. We prospectively reviewed 14 consecutive cases of resistant lateral epicondylitis operated with our technique at our Institute from 2008 to 2013 with a minimum 2 years follow up. We included patients between 18 and 65 years of age who in addition to lateral epicondylitis also had an intra-articular pathology along with symptoms/signs suggestive of posterior interosseous nerve compression and had undergone a conservative trial of atleast 12 months. Excluded were those cases with localized infection and severe ankylosis, whereas previous surgery on the same elbow was a relative contraindication. Postoperatively all patients showed improvement in the VAS score and grip strength. Twelve of the 14 patients (85.7%) in our series had good to excellent functional outcomes on the Mayo Elbow Performance Index. This technique can therefore be recommended for wider surgical use; however, prospective randomized studies with a longer follow-up would add further evidence about the effectiveness of our technique.

The Journal of Hand Surgery, 2017

We present a case of a parosteal osteosarcoma mimicking an osteochondroma with atypical clinical ... more We present a case of a parosteal osteosarcoma mimicking an osteochondroma with atypical clinical features, radiographic findings, and histological examination. This report serves to exemplify the importance of recognizing the similarities between these 2 entities and other peculiar features that will help to differentiate between sessile osteochondromas and parosteal osteosarcomas, to prevent misdiagnosis.

Techniques in Hand & Upper Extremity Surgery, 2008

In Erb (C5-C6) type of palsy due to traumatic brachial plexus injury, function is dependent upon ... more In Erb (C5-C6) type of palsy due to traumatic brachial plexus injury, function is dependent upon the ability of the arm to maneuver and stabilize the hand for action. Complete loss of power of elbow flexion after brachial plexus injuries is a severe disability. If there is control of the shoulder, elbow flexion is of major importance. Various types of procedures have been described to recover or reanimate elbow flexion for chronic or failed upper type paralysis, including free muscle transfer, unipolar and bipolar pedicled muscle transfer, and various tendon transfers. In this article, we describe the surgical technique of bipolar pectoralis major transfer and our experience with this type of transfer, wherein we prefer to transfer all components of the pectoralis major muscle including the sternocostal and clavicular origins and humeral insertion without a fascial graft by the inclusion of a strip of the rectus abdominis fascia along with the flap.

Journal of Wrist Surgery, 2012

Fractures of the proximal pole of the scaphoid with associated avascular necrosis and nonunion ar... more Fractures of the proximal pole of the scaphoid with associated avascular necrosis and nonunion are well known to be problematic. Many techniques for fixation and reconstruction of the proximal pole of the scaphoid have been reported, often with poor results. One of the newer modalities of treatment for these difficult cases is excision of the proximal pole and replacement with a pyrocarbon implant. The ovoid shape of the implant acts as a spacer and repositions itself throughout the range of motion of the wrist. The procedure can be performed arthroscopically, thus reducing the morbidity and allowing the procedure to be a day case. Satisfactory results have been reported in elderly patients, but there is a paucity of literature regarding the outcomes in younger patients. This multicenter retrospective study evaluates the clinical, radiologic, and functional outcomes in patients under the age of 65 years with a minimum follow up of 5 years. There were 14 patients with scaphoid nonunion advanced collapse (SNAC) grade I, II, or III wrists, with a mean age of 53 years and mean follow up of 8.7 years. There were improvements in all of the patient related variables including VAS pain scores (7.5 to 0.7), extension (45°to 60°), flexion (32°to 53°), and grip strength (15.8 to 34.6 kg). Complications included volar subluxation of the implant, which was acutely surgically corrected (1), volar subluxation of the implant, with persistent pain that required a four-corner fusion (2), and secondary radial styloidectomy (3). This technique is an attractive, minimally invasive alternative for nonunion and avascular necrosis resulting from fractures of the proximal pole of the scaphoid. The authors provide details of the technique, including technical suggestions for performing the procedure.

Clinical and Translational Science, 2014

Sports Injuries, 2014

The management of ligament injuries of the wrist has always constituted a challenge for hand surg... more The management of ligament injuries of the wrist has always constituted a challenge for hand surgeons. The advent of wrist arthroscopy has facilitated the diagnosis, improved the understanding of the etiopathogenesis, and helped in the development of new therapies for these lesions with promising early to midterm results. Apart from the rare lunotriquetral ligament injuries and the complex midcarpal instability, triangular fibrocartilage complex (TFCC) injuries and scapholunate ligament (SLL) tears are the most frequently seen injuries in clinical practice. However, recent advances in the understanding of the anatomy and function of the scapholunate ligament have led to the evolution of a novel concept – the so-called scapholunate ligament complex. Triangular Fibrocartilage Complex (TFCC) Injuries Introduction According to the classification of Palmer (1989), lesions of the triangular fibrocartilage (TFCC) are divided into two basic categories, traumatic lesions (type 1) and degenerative (type 2), which are themselves divided into different subtypes depending on the location of the lesion and the presence or absence of cartilage defects. Traumatic lesions or type 1 injuries are divided into four types, of which type 1B corresponds to peripheral lesions located at the ulnar insertion of the TFCC. These lesions are the most common and best known. Recent anatomical and histological studies have shown that the ulnar part of the triangular fibrocartilage is actually located in separate complex threedimensional components, viz., the proximal part, the distal hammock/sling-like structure, and the ulnar collateral ligament (UCL) (Nakamura et al. 1996). The ulnar collateral ligament (UCL) can be thought of as being associated with the distal hammock because it shares the same function of suspension and transmission of forces on the ulnar aspect of the wrist (Nakamura et al. 1996). Both of these structures can be considered as the distal component of the ligament (TFCC) in comparison to the proximal portion of the TFCC (Fig. 1). The proximal portion of the triangular fibrocartilage (TFCC) is attached to the fovea of the ulnar head and inserts on both sides of the sigmoid notch of the distal radius by the palmar and dorsal radioulnar ligaments that stabilize the distal radioulnar joint (Nakamura andMakita 2000). Different components of these ligaments can be injured in isolation or in combination. Unlike lesions of the proximal portion of the TFCC that may cause instability of the distal radioulnar joint, the stability of the distal radioulnar joint is preserved in isolated lesions of the distal component, conventionally known as type 1B lesions according to Palmer. Many arthroscopic techniques have been proposed to suture the ligament damage to the dorsal capsule (Whipple and Geissler 1993; Zachee et al. 1993; Haugstvedt and Husby 1999; Bohringer et al. 2002; Conca *Email: cmathoulin@orange.fr Sports Injuries DOI 10.1007/978-3-642-36801-1_52-1 # Springer-Verlag Berlin Heidelberg 2014

Revue de Chirurgie Orthopédique et Traumatologique, 2012

Wrist and Elbow Arthroscopy, 2014

The treatment of scapholunate ligament injuries has always been a challenge for surgeons. Interve... more The treatment of scapholunate ligament injuries has always been a challenge for surgeons. Interventions by open surgery can achieve stability but with a particularly high stiffness in flexion.

Journal of Wrist Surgery, 2013

The author's name Luc Van Overstraeten was also incorrectly displayed as "Overstraeten, Luc Van."... more The author's name Luc Van Overstraeten was also incorrectly displayed as "Overstraeten, Luc Van." The correct listing is "Van Overstraeten, Luc."

Journal of Wrist Surgery, 2013

The Journal of Hand Surgery, 2014

Science of Variation Group Purpose This study tested the null hypothesis that there are no differ... more Science of Variation Group Purpose This study tested the null hypothesis that there are no differences between the preferences of hand surgeons and those patients with carpal tunnel syndrome (CTS) facing decisions about management of CTS (ie, the preferred content of a decision aid). Methods One hundred three hand surgeons of the Science of Variation Group and 79 patients with CTS completed a survey about their priorities and preferences in decision making regarding the management of CTS. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. Results Important areas on which patient and hand surgeon interests differed included a preference for nonpainful, nonoperative treatment and confirmation of the diagnosis with electrodiagnostic testing. For patients, the main disadvantage of nonoperative treatment was that it was likely to be only palliative and temporary. Patients preferred, on average, to take the lead in decision making, whereas physicians preferred shared decision making. Patients and physicians agreed on the value of support from family and other physicians in the decision-making process. Conclusions There were some differences between patient and surgeon priorities and preferences regarding decision making for CTS, particularly the risks and benefits of diagnostic and therapeutic procedures. Clinical relevance Information that helps inform patients of their options based on current best evidence might help patients understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.

Techniques in Hand & Upper Extremity Surgery, 2007

Brachial plexus palsy caused by traction injury, especially spinal nerve-root avulsion, represent... more Brachial plexus palsy caused by traction injury, especially spinal nerve-root avulsion, represents a severe handicap for the patient. Despite recent progress in diagnosis and microsurgical repair, the prognosis in such cases remains unfavorable. Neurotization is the only possibility for repair in cases of spinal nerve-root avulsion. Intercostal neurotization is a well-established technique in the treatment of some severe brachial plexus lesions in adults. In this article, we describe our experience and technique of intercostal nerve harvest for transfer in various neurotization strategies in posttraumatic brachial plexus reconstruction. Intercostal nerve harvest is a technique requiring meticulous technique and careful dissection along with proper hemostasis. It is also very important to preserve the serratus anterior muscle insertion and keep soft tissue stripping to a minimal. We do not osteotomize the ribs and believe that this adds to the morbidity and length of the procedure. Neurotization using intercostal nerves is a very viable procedure in avulsion injuries of the brachial plexus; however, there is some concern that in the presence of ipsilateral phrenic nerve palsy, it may lead to a significant compromise of respiratory function. In our experience, this is negligible with good long-term results.

Techniques in Hand & Upper Extremity Surgery, 2007

Double free-muscle transfer is a technique used to treat patients with total brachial plexus pals... more Double free-muscle transfer is a technique used to treat patients with total brachial plexus palsy to restore hand prehension. It involves the reconstruction of shoulder stability, the transfer of 2 functioning gracilis muscles, and other complementary procedures to optimize the function of the transferred muscles. Wrist arthrodesis is one of these complementary procedures. Our technique of wrist arthrodesis in these patients is different from the standard technique. In this article, we describe our technique and experience of wrist arthrodesis in patients with complete brachial plexus palsy treated with double free-muscle transfer technique. In our procedure, the plate is fixed from the second metacarpalVand not the third as is the usual practiceVto the radius to avoid friction with the extensor digitorum communis tendons. A very small bone graft, prepared from the removed Lister tubercle, is needed because of the very thin articular cartilage in these patients. A short arm splint is used for only 1 week postoperatively to avoid finger stiffness. There were no major complications such as pseudoarthrosis or metal failure in our patients because the affected limb is subjected only to mild stresses.

Objectives/Interrogation: Neglected posterior dislocation of the elbow is common in developing co... more Objectives/Interrogation: Neglected posterior dislocation of the elbow is common in developing countries. Neglected posterior dislocations often present with myositis ossificans from massage and treatment from bone-setters in developing countries. Such problems in young, active patients present[for full text, please go to the a.m. URL]

Objectives/Interrogation: Lateral epicondylitis is usually self-limiting and resolves within 8-12... more Objectives/Interrogation: Lateral epicondylitis is usually self-limiting and resolves within 8-12 months. Once it resolves, recurrence is rare. Conservative management remains the mainstay of treatment. When conservative treatment fails, surgery is required for resistant cases. Morrey had put forth[for full text, please go to the a.m. URL]

Objectives/Interrogation: Molluscum Contagiosum (MC) is a benign and contagious skin infection ca... more Objectives/Interrogation: Molluscum Contagiosum (MC) is a benign and contagious skin infection caused by molluscum contagiosum virus (MCV) of poxvirus family. MC is a self-limiting condition affecting the skin and mucus membrane. It is commonly seen in children of age 2 -5 years, but can be seen[for full text, please go to the a.m. URL]

Objectives/Interrogation: The triangular fibrocartilage complex (TFCC) is an important stabilizer... more Objectives/Interrogation: The triangular fibrocartilage complex (TFCC) is an important stabilizer and load absorber in the wrist. There is a significant load borne by the ulnar aspect of the wrist during different wrist positions that pass predominantly through the TFCC. Injury to the TFCC is a[for full text, please go to the a.m. URL]

Indian Journal of Orthopaedics, 2021

Background Ulnar-sided wrist pain is a common clinical problem, most often misdiagnosed as triang... more Background Ulnar-sided wrist pain is a common clinical problem, most often misdiagnosed as triangular fibrocartilage complex (TFCC) injury. It may be frustrating to the patient, as one may end up wearing a wrist splint for an unusually long period, disrupting their routine. Purpose Because of the dilemmas in the diagnosing the cause of ulnar-sided wrist pain, various algorithms have been suggested but it is an individual's choice to do a systematic assessment and follow in their routine clinical practice. We propose the 'storey concept' for examining the ulnar side of the wrist, with ulnar styloid as the reference point. The lower storey identifies the pathologies of the DRUJ, the intermediate storey identifies the pathologies of the radiocarpal joint and the upper storey identifies the pathologies of midcarpal and carpometacarpal joint. Conclusion Also, it is important to ramify the cause of pain into stable or unstable wrist, with or without arthritis, as this will guide us in managing the pain arising from distal radioulnar joint. In addition to methodical clinical examination, ideal radiographs and high-resolution MRI are critical to diagnose wrist pathologies. The role of wrist arthroscopy has consistently increased, and complements in both diagnosis and treatment of wrist pain especially in ambiguous situations.

Journal of Wrist Surgery, 2021

Giant cell tumors of tendon sheath are classified according to their clinical presentation as loc... more Giant cell tumors of tendon sheath are classified according to their clinical presentation as localized or diffuse, and they may occur at intra-articular or extra-articular locations. Although magnetic resonance imaging is mandatory and sufficient for diagnosis in many cases, histological examination is needed to confirm the diagnosis. Complete surgical resection is the mainstay of treatment. Radiotherapy as adjuvant or after recurrence shows promising results. Though small joint arthroscopy, especially of the thumb carpometacarpal (CMC) joint, is a relatively new technique and mainly used for the treatment of basal joint arthritis of the thumb, the indications are evolving. We report a rare case of nodular tenosynovitis of the CMC joint of the thumb managed with complete arthroscopic resection of the tumor, and no recurrence at a follow-up of 2.5 years. This is another addition to the list of indications for thumb CMC arthroscopy. Arthroscopic treatment provides the distinct advant...

Techniques in Hand & Upper Extremity Surgery, 2019

Lateral epicondylitis is the most common condition affecting the elbow and is self-limiting in mo... more Lateral epicondylitis is the most common condition affecting the elbow and is self-limiting in most cases. However, when conservative treatment fails, surgery is required for resistant cases. In this study, we describe a novel technique for the management of chronic lateral epicondylitis. The advantage of our technique is that all the 3 major components of the disease (as also all types of failure described by Morrey) are simultaneously dealt with, that is, pathology of the tendon, posterior interosseous nerve compression and intra-articular pathology are all addressed. We prospectively reviewed 14 consecutive cases of resistant lateral epicondylitis operated with our technique at our Institute from 2008 to 2013 with a minimum 2 years follow up. We included patients between 18 and 65 years of age who in addition to lateral epicondylitis also had an intra-articular pathology along with symptoms/signs suggestive of posterior interosseous nerve compression and had undergone a conservative trial of atleast 12 months. Excluded were those cases with localized infection and severe ankylosis, whereas previous surgery on the same elbow was a relative contraindication. Postoperatively all patients showed improvement in the VAS score and grip strength. Twelve of the 14 patients (85.7%) in our series had good to excellent functional outcomes on the Mayo Elbow Performance Index. This technique can therefore be recommended for wider surgical use; however, prospective randomized studies with a longer follow-up would add further evidence about the effectiveness of our technique.

The Journal of Hand Surgery, 2017

We present a case of a parosteal osteosarcoma mimicking an osteochondroma with atypical clinical ... more We present a case of a parosteal osteosarcoma mimicking an osteochondroma with atypical clinical features, radiographic findings, and histological examination. This report serves to exemplify the importance of recognizing the similarities between these 2 entities and other peculiar features that will help to differentiate between sessile osteochondromas and parosteal osteosarcomas, to prevent misdiagnosis.

Techniques in Hand & Upper Extremity Surgery, 2008

In Erb (C5-C6) type of palsy due to traumatic brachial plexus injury, function is dependent upon ... more In Erb (C5-C6) type of palsy due to traumatic brachial plexus injury, function is dependent upon the ability of the arm to maneuver and stabilize the hand for action. Complete loss of power of elbow flexion after brachial plexus injuries is a severe disability. If there is control of the shoulder, elbow flexion is of major importance. Various types of procedures have been described to recover or reanimate elbow flexion for chronic or failed upper type paralysis, including free muscle transfer, unipolar and bipolar pedicled muscle transfer, and various tendon transfers. In this article, we describe the surgical technique of bipolar pectoralis major transfer and our experience with this type of transfer, wherein we prefer to transfer all components of the pectoralis major muscle including the sternocostal and clavicular origins and humeral insertion without a fascial graft by the inclusion of a strip of the rectus abdominis fascia along with the flap.

Journal of Wrist Surgery, 2012

Fractures of the proximal pole of the scaphoid with associated avascular necrosis and nonunion ar... more Fractures of the proximal pole of the scaphoid with associated avascular necrosis and nonunion are well known to be problematic. Many techniques for fixation and reconstruction of the proximal pole of the scaphoid have been reported, often with poor results. One of the newer modalities of treatment for these difficult cases is excision of the proximal pole and replacement with a pyrocarbon implant. The ovoid shape of the implant acts as a spacer and repositions itself throughout the range of motion of the wrist. The procedure can be performed arthroscopically, thus reducing the morbidity and allowing the procedure to be a day case. Satisfactory results have been reported in elderly patients, but there is a paucity of literature regarding the outcomes in younger patients. This multicenter retrospective study evaluates the clinical, radiologic, and functional outcomes in patients under the age of 65 years with a minimum follow up of 5 years. There were 14 patients with scaphoid nonunion advanced collapse (SNAC) grade I, II, or III wrists, with a mean age of 53 years and mean follow up of 8.7 years. There were improvements in all of the patient related variables including VAS pain scores (7.5 to 0.7), extension (45°to 60°), flexion (32°to 53°), and grip strength (15.8 to 34.6 kg). Complications included volar subluxation of the implant, which was acutely surgically corrected (1), volar subluxation of the implant, with persistent pain that required a four-corner fusion (2), and secondary radial styloidectomy (3). This technique is an attractive, minimally invasive alternative for nonunion and avascular necrosis resulting from fractures of the proximal pole of the scaphoid. The authors provide details of the technique, including technical suggestions for performing the procedure.

Clinical and Translational Science, 2014

Sports Injuries, 2014

The management of ligament injuries of the wrist has always constituted a challenge for hand surg... more The management of ligament injuries of the wrist has always constituted a challenge for hand surgeons. The advent of wrist arthroscopy has facilitated the diagnosis, improved the understanding of the etiopathogenesis, and helped in the development of new therapies for these lesions with promising early to midterm results. Apart from the rare lunotriquetral ligament injuries and the complex midcarpal instability, triangular fibrocartilage complex (TFCC) injuries and scapholunate ligament (SLL) tears are the most frequently seen injuries in clinical practice. However, recent advances in the understanding of the anatomy and function of the scapholunate ligament have led to the evolution of a novel concept – the so-called scapholunate ligament complex. Triangular Fibrocartilage Complex (TFCC) Injuries Introduction According to the classification of Palmer (1989), lesions of the triangular fibrocartilage (TFCC) are divided into two basic categories, traumatic lesions (type 1) and degenerative (type 2), which are themselves divided into different subtypes depending on the location of the lesion and the presence or absence of cartilage defects. Traumatic lesions or type 1 injuries are divided into four types, of which type 1B corresponds to peripheral lesions located at the ulnar insertion of the TFCC. These lesions are the most common and best known. Recent anatomical and histological studies have shown that the ulnar part of the triangular fibrocartilage is actually located in separate complex threedimensional components, viz., the proximal part, the distal hammock/sling-like structure, and the ulnar collateral ligament (UCL) (Nakamura et al. 1996). The ulnar collateral ligament (UCL) can be thought of as being associated with the distal hammock because it shares the same function of suspension and transmission of forces on the ulnar aspect of the wrist (Nakamura et al. 1996). Both of these structures can be considered as the distal component of the ligament (TFCC) in comparison to the proximal portion of the TFCC (Fig. 1). The proximal portion of the triangular fibrocartilage (TFCC) is attached to the fovea of the ulnar head and inserts on both sides of the sigmoid notch of the distal radius by the palmar and dorsal radioulnar ligaments that stabilize the distal radioulnar joint (Nakamura andMakita 2000). Different components of these ligaments can be injured in isolation or in combination. Unlike lesions of the proximal portion of the TFCC that may cause instability of the distal radioulnar joint, the stability of the distal radioulnar joint is preserved in isolated lesions of the distal component, conventionally known as type 1B lesions according to Palmer. Many arthroscopic techniques have been proposed to suture the ligament damage to the dorsal capsule (Whipple and Geissler 1993; Zachee et al. 1993; Haugstvedt and Husby 1999; Bohringer et al. 2002; Conca *Email: cmathoulin@orange.fr Sports Injuries DOI 10.1007/978-3-642-36801-1_52-1 # Springer-Verlag Berlin Heidelberg 2014

Revue de Chirurgie Orthopédique et Traumatologique, 2012

Wrist and Elbow Arthroscopy, 2014

The treatment of scapholunate ligament injuries has always been a challenge for surgeons. Interve... more The treatment of scapholunate ligament injuries has always been a challenge for surgeons. Interventions by open surgery can achieve stability but with a particularly high stiffness in flexion.

Journal of Wrist Surgery, 2013

The author's name Luc Van Overstraeten was also incorrectly displayed as "Overstraeten, Luc Van."... more The author's name Luc Van Overstraeten was also incorrectly displayed as "Overstraeten, Luc Van." The correct listing is "Van Overstraeten, Luc."

Journal of Wrist Surgery, 2013

The Journal of Hand Surgery, 2014

Science of Variation Group Purpose This study tested the null hypothesis that there are no differ... more Science of Variation Group Purpose This study tested the null hypothesis that there are no differences between the preferences of hand surgeons and those patients with carpal tunnel syndrome (CTS) facing decisions about management of CTS (ie, the preferred content of a decision aid). Methods One hundred three hand surgeons of the Science of Variation Group and 79 patients with CTS completed a survey about their priorities and preferences in decision making regarding the management of CTS. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. Results Important areas on which patient and hand surgeon interests differed included a preference for nonpainful, nonoperative treatment and confirmation of the diagnosis with electrodiagnostic testing. For patients, the main disadvantage of nonoperative treatment was that it was likely to be only palliative and temporary. Patients preferred, on average, to take the lead in decision making, whereas physicians preferred shared decision making. Patients and physicians agreed on the value of support from family and other physicians in the decision-making process. Conclusions There were some differences between patient and surgeon priorities and preferences regarding decision making for CTS, particularly the risks and benefits of diagnostic and therapeutic procedures. Clinical relevance Information that helps inform patients of their options based on current best evidence might help patients understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health.

Techniques in Hand & Upper Extremity Surgery, 2007

Brachial plexus palsy caused by traction injury, especially spinal nerve-root avulsion, represent... more Brachial plexus palsy caused by traction injury, especially spinal nerve-root avulsion, represents a severe handicap for the patient. Despite recent progress in diagnosis and microsurgical repair, the prognosis in such cases remains unfavorable. Neurotization is the only possibility for repair in cases of spinal nerve-root avulsion. Intercostal neurotization is a well-established technique in the treatment of some severe brachial plexus lesions in adults. In this article, we describe our experience and technique of intercostal nerve harvest for transfer in various neurotization strategies in posttraumatic brachial plexus reconstruction. Intercostal nerve harvest is a technique requiring meticulous technique and careful dissection along with proper hemostasis. It is also very important to preserve the serratus anterior muscle insertion and keep soft tissue stripping to a minimal. We do not osteotomize the ribs and believe that this adds to the morbidity and length of the procedure. Neurotization using intercostal nerves is a very viable procedure in avulsion injuries of the brachial plexus; however, there is some concern that in the presence of ipsilateral phrenic nerve palsy, it may lead to a significant compromise of respiratory function. In our experience, this is negligible with good long-term results.

Techniques in Hand & Upper Extremity Surgery, 2007

Double free-muscle transfer is a technique used to treat patients with total brachial plexus pals... more Double free-muscle transfer is a technique used to treat patients with total brachial plexus palsy to restore hand prehension. It involves the reconstruction of shoulder stability, the transfer of 2 functioning gracilis muscles, and other complementary procedures to optimize the function of the transferred muscles. Wrist arthrodesis is one of these complementary procedures. Our technique of wrist arthrodesis in these patients is different from the standard technique. In this article, we describe our technique and experience of wrist arthrodesis in patients with complete brachial plexus palsy treated with double free-muscle transfer technique. In our procedure, the plate is fixed from the second metacarpalVand not the third as is the usual practiceVto the radius to avoid friction with the extensor digitorum communis tendons. A very small bone graft, prepared from the removed Lister tubercle, is needed because of the very thin articular cartilage in these patients. A short arm splint is used for only 1 week postoperatively to avoid finger stiffness. There were no major complications such as pseudoarthrosis or metal failure in our patients because the affected limb is subjected only to mild stresses.