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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_1 | Pages 28 - 28
1 Jan 2022
ARTHROSCOPIC-ASSISTED FIXATION OF SCAPHOID NONUNION USING BONE GRAFT AND FIBRIN GLUE
Sree DV Iyengar KP Loh D Shrestha S Loh WYC
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Abstract

Background

Scaphoid non-union can result in pain, altered wrist kinematics leading to a Scaphoid Non-union Advance Collapse, ultimately to symptomatic radio-carpal arthritis. Open techniques have their limitations. We describe the rationale, surgical technique and outcomes of our series of arthroscopic bone-grafting (ABG) and fixation of scaphoid non-union.

Methods

We performed a prospective single-surgeon series of 22 consecutive patients with clinico-radiologically established scaphoid non-union between March 2015 and April 2019. Data was collected from Electronic Patient Records, Patient Archived Computer system (PACS) and hand therapy assessments. We collected demographic data including age, hand-dominance, occupation and mechanism of injury. The Disabilities of the Arm, Shoulder and Hand Score (Quick DASH), Mayo wrist score, Patient Rated Wrist Evaluation (PRWE) and grip-strength measurements were collected preoperatively and at follow-up appointments.

Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_1 | Pages 12 - 12
1 Jan 2022
PATIENT SATISFACTION AND BOSTON CARPAL TUNNEL QUESTIONNAIRE ASSESSMENT FOLLOWING WALANT TECHNIQUE FOR CARPAL TUNNEL RELEASE
Belcher P Iyengar KP Loh WYC Uwadiae E
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Introduction

Wide Awake Local Anaesthetic No Tourniquet (WALANT) is a well- established day case procedure for carpal tunnel release with several advantages and enhanced post-operative recovery. Use of Local anaesthesia with Adrenaline using a 27G needle allows a bloodless field and distraction techniques achieve patient comfort during the procedure.

Objectives

This retrospective, observational cohort study assesses patient satisfaction and undertakes functional evaluation using the validated Boston Carpal Tunnel Questionnaire (BCTQ) following WALANT technique for carpal tunnel release (CTR). The BCTQ has a symptom severity scale based on 11 items and a functional status scale of 8 elements. Further we compare surgical outcomes between techniques of WALANT and traditional CTR.

Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_II | Pages 253 - 253
1 May 2006
ROLE OF FLOWTRON IN IMPROVING FIXED FLEXION DEFORMITY PRIOR TO TKR.
Iyengar KP Tauro B
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Aim: A prospective cohort study on the role of flowtron intermittent compression garment (Flowtron) in improving fixed flexion deformity (FFD) in patients coming in for Total Knee Replacement (TKR).

Methods: A total of 36 patients with FFD of the knee averaging 26 deg. (range: 22 to 38 deg.) were included. There were 22 men & 14 women, with a mean age of 66 yrs (58 to 78). The diagnosis was osteoarthritis in 26 knees and rheumatoid arthritis in 10. The right knee was involved in 24 patients and the left in 12.There were 26 varus knees and 10 valgus. Patients with peripheral vascular disease and congestive cardiac failure were excluded from the study.

Results: Use of flowtrons for one week at home resulted in 80% mean improvement in fixed flexion deformity from an average 26 to 6 degrees (p< 0.001). The residual correction was obtained on the table without excessive posterior release or bone resection. The correction was found to be maintained at 6 months and 1year follow-up. There were no complications with Flowtron treatment. We also noticed that the improvement was better in Osteoarthritis group (26 to 5 degrees) as compared to Rheumatoid arthritis (31 to 9 degrees).

Conclusions: Conventional TKR in patients with moderate to severe FFD requires extensive posterior soft tissue release and bone resection. This prolongs surgical time, increases blood loss and has potential soft tissue complications. Flowtron has been used in the past to improve FFD with good early correction but the deformity gradually recurred. We have overcome this problem by doing definitive surgical procedure in the form of TKR. In summary, flowtron is safe and effective in reducing FFD, helping the surgeon to perform TKR without extensive posterior soft tissue release or bone resection with its attendant complications. The correction is maintained with no complications with its use. We recommend that flowtron be used in patients with moderate to severe FFD.