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Zone III

– Discussion:     – extends from base of palm or distal end of transverse retinacular ligament to transverse crease in the palm;           – extends just proximal to the IP joint and to the MP joint;     – in this region tendons are essentially free of a tendon sheath … Read more

X-ray Findings in SLD

          – See:       – PA View       – AP View        – Radiology of Hand & Wrist        – Radiology of Scaphoid Fracture – Discussion:    – clenched fist AP – ulnar deviation view (see: AP view:)         – proper technique: for visualizing … Read more

Wrist Arthrodesis

– Indications: – painful or unstable wrist joint w/ advanced destruction due to OA, RA, post traumatic arthritis, SLAC wrist, spastic flexion contracture, degenerative scaphoid non-union, unsuccessful wrist arthroplasty, and Keinbock’s dz; – this procedure is more beneficial for young, active pts or middle aged pts, but not for elderly pts; – PreOp Considerations: – in … Read more

Wrist Arthrography

– Discussion:     – arthrography may be used in diagnosis of carpal instability because it is technically easy & is only minimally invasive;     – normally there should be no communication between the radiocarpal, mid-carpal, and distal radial-ulnar joints;     – it is noteworthy that in normal wrists there may be communications … Read more

Wrist Arthroscopy

– Positioning and Preparation: – joint is distended w/ finger traps (to index and long fingers) w/ about 10 lbs, using a pulley system; – counter traction is applied to the arm w/ use of a second 10 lb pulley – this allows the elbow to be flexed 90 deg; – gravity assistant inflow; – initially … Read more

Wrist Disarticulation

– Discussion:     – wrist disarticulation: include the removal of the radius and ulna to styloid processes;     – shape of stump remains bulbous, thus permitting prosthetic attachment, leaving the elbow free and preserving full pronation & supination;     – wrist disarticulation retains distal radio-ulnar joint preserves more forearm rotation, & retaining distal radial flare dramatically … Read more

Wrist Joint Aspiration & Arthroscopy

– Discussion:       – joint is entered dorsally;       – if there is any difficulty in entering Wrist Joint, hand can be suspended in Chinese finger traps to help open the joint space;       – there are 2 main entry sites, 3-4 & 4-5 sites;         … Read more

Wound Closure for TKR

 – Discussion:         – Should Subcuticular Sutures be Avoided in TKR?               – references:                       – Modality of wound closure after total knee replacement: are staples as safe as sutures? A retrospective study of 181 patients.                       – Wound complications in joint arthroplasty: comparing traditional and modern methods of skin closure                       – Staple vs. … Read more

Work Up for Scaphoid Frx

– History and Exam:     – fracture of the scaphoid is suspected w/ fall on an outstretched hand;     – snuff box tenderness (see clinical differential diagnosis:)            – scaphoid impaction syndrome     – tenderness to palpation over scaphoid tuberosity and/or proximal pole just distal to Lister’s tubercle; … Read more