Carpal Tunnel Release In this procedure, the surgeon releases, or cuts free, the carpal ligament from the median nerve to relieve the symptoms of carpal tunnel syndrome. Traditionally this has been done through an open surgical procedure, meaning the wrist was opened. In recent years, surgeons have used two less invasive approaches to carpal tunnel surgery, a mini open procedure and an endoscopy approach.
Finger Fixation This procedure is used to resolve the pain of a severely arthritic joint of the finger by permanently stopping finger movement. It is most commonly used for the joint nearest the fingertip, known as the DIP joint, although any joint in the finger can be fused. The surgeon will make an incision on the anterior finger to access the joint. A burr will be used to remove all cartilage and prepare the bone for fusion. A K-wire is placed through the tip of the finger through the joint to hold the joint in place while it fuses. Later, the K-wire is removed to allow the soft tissue to heal after the joint is fused.
Distal Radius Fracture this procedure is at its root an ORIF for the wrist. It only differs in the complexity of the fracture and the plate used to correctly align the wrist back to its’ anatomical position. Once the fracture is assessed the surgeon will make an incision over the fractured area to expose the fracture. The wrist will be manipulated to return the fractured bone to its’ original position. K-wires can be inserted to hold the bone in position while the Distal radius plate is chosen by size. The complexity of the fracture and size of the wrist determine the size of the plate needed for each surgery. They are also pre-bent and pre-shaped anatomically for left and right sided procedures. Once the plate is chosen, it is fixated temporarily with K-wires, the surgeon will drill pilot holes for each screw. They will use a depth gauge to determine the length of the screw needed. Then place the screw through the plate into the pilot hole securing the plate to bone. Most systems have compression and locking screw options.
Hammer Toe Release Joint resection can be used to treat a toe suffering from hammertoe syndrome. In this procedure an incision is made at the top (Anterior) of the effected toe joint. The end of the bone is removed to allow the toe to straighten completely. Pins or K-wires are temporarily used to hold the toe straight. The pins are usually removed three to four weeks after the surgery.
Bunion repair Lapidus Bunionectomy surgery is a type of corrective bunion surgery that restores the big toe joint to its natural anatomic position by realigning the metatarsal to its proper position. The procedure starts by making an anterior incision along the medial line of the big toe exposing the effected metatarsal joint. After the joint is exposed the surgeon will release all soft tissues and tendons surrounding the joint to ensure full mobility is achieved. An incision in made into the joint capsule to expose the bunion. A small surgical saw is used to remove the bony prominence to create a flush and proper anatomic line of the foot. The head of the metatarsal is cut and moved laterally into a corrected anatomical position. There are various techniques used to achieve this step. Once in the corrected position a K-wire in placed to hold the bone in place, a cannulated screw is placed over the wire and tightened to hold the bone in its’ final position. Next, If any overhanging bone exists the surgeon will remove it with the saw, then smooth and round the bone to prevent any sharp edges. The joint capsule is then closed, followed by the incision.
Ankle Fractures (ORIF of the ankle) An ankle fracture is a very common surgery, it can have many different names depending on the effected bone and placement of the fracture or break. The surgeon will expose the bone, assess the fracture, manually manipulate the bone (if possible) back to the anatomic position, then “pin” the bone with a K-wire. Depending on the size of the bone, placement of the fracture(s), and size of the patient, the surgeon will select the appropriate plate for the procedure. A fixation wire is placed to hold the plate in place. The surgeon will brill pilot holes for the screws, use a depth gauge to determine the appropriate screw length and place the screw through the pre-drilled hole to fixate the plate to the bone. They will repeat the process for all screws. Some plates are called dynamic compression plates, meaning they have elongated holes for compression of a complicated fracture.
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