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Postoperative Elbow Instability: Options for Revision Stabilization

Foster, Brian K; Ayalon, Omri; Hoyer, Reed; Hoyen, Harry A; Grandizio, Louis C
Persistent and recurrent postoperative elbow instability includes a spectrum of pathologies ranging from joint incongruity and subluxation to dislocation. Restoration of osseous anatomy, particularly the coronoid, is a priority in restoring elbow alignment and maintaining ulnohumeral joint stability. After managing bony deficiencies, soft-tissue and ligamentous structures are typically addressed. When required, both static and dynamic adjunctive stabilization procedures have been described, which aid in maintaining a concentric reduction. In these complex procedures, both complication avoidance and early recognition of postoperative complications assist in obtaining a good result. In this review, we discuss current treatment options for revision stabilization for patients with persistent and recurrent elbow subluxation or dislocation after primary stabilization.
PMID: 37999700
ISSN: 1531-6564
CID: 5608912

Reducing Tourniquet Pressures in Hand Surgery: Are Lower Pressures as Effective?

Azad, Ali; Sager, Brian; Gupta, Salil; Ayalon, Omri; Paksima, Nader
PMCID:10202587
PMID: 37223384
ISSN: 2163-3916
CID: 5543742

Determining the Optimal Dosage of Corticosteroid Injection in Trigger Finger

Bookman, Jared; Rocks, Madeline; Noh, Karen; Ayalon, Omri; Hacquebord, Jacques; Catalano, Louis; Glickel, Steven
BACKGROUND/UNASSIGNED:Corticosteroid injection is the mainstay of nonoperative treatment for trigger finger (stenosing tenosynovitis), but despite substantial experience with this treatment, there is minimal available evidence as to the optimal corticosteroid dosing. The purpose of this study is to compare the efficacy of 3 different injection dosages of triamcinolone acetonide for the treatment of trigger finger. METHODS/UNASSIGNED:Patients diagnosed with a trigger finger were prospectively enrolled and treated with an initial triamcinolone acetonide (Kenalog) injection of 5 mg, 10 mg, or 20 mg. Patients were followed longitudinally over a 6-month period. Patients were assessed for duration of clinical response, clinical failure, Visual Analog Scale (VAS) pain scores, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. RESULTS/UNASSIGNED:A total of 146 patients (163 trigger fingers) were enrolled over a 26-month period. At 6-month follow-up, injections were still effective (without recurrence, secondary injection, or surgery) in 52% of the 5-mg group, 62% of the 10-mg group, and 79% of the 20-mg group. Visual Analog Scale at final follow-up improved by 2.2 in the 5-mg group, 2.7 in the 10-mg group, and 4.5 in the 20-mg group. The QuickDASH scores at final follow-up improved by 11.8 in the 5-mg group, 21.5 in the 10-mg group, and 28.9 in the 20-mg group. CONCLUSIONS/UNASSIGNED:Minimal evidence exists to guide the optimal dosing of steroid injection in trigger digits. When compared with 5-mg and 10-mg doses, a 20-mg dose was found to have a significantly higher rate of clinical effectiveness at 6-month follow-up. The VAS and QuickDASH scores were not significantly different between the 3 groups.
PMID: 37191248
ISSN: 1558-9455
CID: 5544232

Management of Bicondylar Distal Humerus Fractures

Mahmood, Bilal; Tanner, Natalie; Ayalon, Omri
Bicondylar distal humerus fractures are difficult injuries requiring a comprehensive treatment strategy. Nonoperative treatment is generally reserved for elderly, low demand patients and those whose medical co-morbidities preclude surgery. Considerations for surgery include fracture morphology, osteoporotic bone quality, and degree of articular comminution. Surgical treatment with plate fixation is a reliable solution to facilitate early mobilization for a functional recovery. In fractures not amenable to operative fixation, implant arthroplasty may provide improved functional results. Satisfactory outcomes following such injuries can be achieved through surgical fixation and arthroplasty, allowing for early rehabilitation and elbow motion to facilitate a functional recovery. Postoperative complications remain a concern in managing these fractures. In this review, we share our recommendations for management of bicondylar fractures of the distal humerus.
SCOPUS:85149974654
ISSN: 1048-6666
CID: 5446912

Carpometacarpal Arthroplasty What's the Rule of Thumb?

Moses, Michael J; Lorentz, Nathan A; Ayalon, Omri B; Catalano, Louis W
Carpometacarpal (CMC) arthritis of the thumb is one of the most common pathologies encountered in clinical hand and orthopedic surgery practices. Anatomy of the CMC joint and its biomechanics are theorized to predispose the articulation to laxity and subsequent degenerative changes. Diagnosis of CMC arthritis is primarily based on history, physical examination, and imaging findings, all of which coalesce to guide treatment. There are a multitude of treatment options for CMC arthritis, each with its own set of pearls and pitfalls with treatment decision making shared by surgeon and patient. Continued research and longitudinal data on outcome measures will assist in determining the ultimate "rule of thumb" for the treatment of CMC arthritis.
PMID: 36821741
ISSN: 2328-5273
CID: 5508982

Late Repair of Flexor Tendon Lacerations Within the Digital Sheaths

Ayalon, Omri; Posner, Martin A; Green, Steven M
PURPOSE/OBJECTIVE:This article presents the outcomes of repairs of flexor tendon lacerations within digital sheaths performed more than 2 weeks after injury. METHODS:A retrospective review of 46 patients; 37 with finger lacerations involving a total of 54 severed tendons in 42 fingers and nine with thumb lacerations of the flexor pollicis longus (FPL). In those patients with finger lacera- tions, 30 lacerations were isolated to the flexor digitorum profundus (FDP; 17 in Zone I and 13 in Zone II), and 12 involved both FDP and flexor digitorum superficialis (FDS) for a total of 24 tendon lacerations. RESULTS:The delay in surgery for finger lacerations ranged from 2 to 96 weeks (average: 8.5 weeks) and for thumb lacerations, 2 to 17 weeks (average: 5.5 weeks). In Zone I finger lacerations, postoperative flexion of the distal interphalangeal (DIP) joint averaged 35° with 82% of patients regaining total active motion (TAM) in the good to excellent range. In Zone II injuries isolated to the FDP tendon, postoperative DIP joint flexion averaged 36.5° with 73% of patients regaining good to excellent TAM. In Zone II injuries involving both flexor tendons, final average DIP flexion was 37° with only 45% of patients regaining good to excellent TAM. All patients with FPL lacerations regained at least 30° (average: 46°) of active interphalangeal joint flexion. CONCLUSION/CONCLUSIONS:When certain conditions exist that are deter- mined at surgery, delayed repairs of isolated FDP lacera- tions in fingers and FPL lacerations in thumbs can restore satisfactory mobility. Results are less favorable when both flexor tendons in the finger are lacerated and only the FDP repaired.
PMID: 35643473
ISSN: 2328-5273
CID: 5244722

Penlight versus Smartphone: Diagnostic Efficacy of Transillumination

Azad, Ali; DE Tolla, Jadie; Ayalon, Omri; Hacquebord, Jacques H; Glickel, Steven Z; Catalano, Louis W
PMID: 35404214
ISSN: 2424-8363
CID: 5205072

Targeted Muscle Reinnervation (TMR) and Other Considerations in Upper Extremity Amputation

Ryan, Devon J; Ayalon, Omri; Hacquebord, Jacques
Targeted muscle reinnervation (TMR) is a procedure in which amputated nerves are transferred to motor branches of functionally expendable muscles, which can then serve as "biological amplifiers" of neurologic information. It is a technique that was developed with the primary intent of improving myoelectric prosthesis control in high level upper extremity amputees. Over time, TMR has been shown to confer significant benefits in terms of both residual and phantom limb pain and as such has become a powerful tool in neuroma management in amputees and non-amputees. This review first discusses general principles of amputation management in the upper extremity, including the different types of prosthetics that are available for these patients. The history, rationale, and evolution of TMR will then be outlined, followed by several relevant surgical principles. Finally, the current evidence for and against TMR will be reviewed. Robust data on the functional benefits are still needed, and future studies will continue to clarify its role in both upper and lower extremity amputees.
PMID: 35234583
ISSN: 2328-5273
CID: 5183382

Surgical and Technological Advances in the Management of Upper Limb Amputation

Ayalon, Omri; Hacquebord, Jacques H.
ISI:000751675600001
ISSN: 2167-4833
CID: 5242752

Extensive Tumoral Calcinosis of the Hand [Case Report]

Gonzalez, Matthew; Rettig, Michael; Ayalon, Omri
Tumoral calcinosis is a rare and benign subtype of calcinosis cutis, a group of disorders involving soft tissue calcium deposition. Only 250 cases have been described since 1898; hand involvement is exceedingly rare. We report a case of extensive calcinosis within the flexor sheath of the little finger. Presentation included a painful mass over the volar aspect of the little finger, restricted digit motion, and skin compromise at the site of the mass. Surgical debulking was performed resulting in restoration of finger function.
PMID: 33375992
ISSN: 1531-6564
CID: 4807252