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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.
Purpose of Review: The surgical management of upper limb amputees has undergone a long period of minimal advancement. However, recent developments in the field have sparked significant innovation. This review will focus on surgical advancements in peripheral nerve management, partial hand amputations, and residual limb optimization. Recent Findings: Targeted muscle reinnervation and regenerative peripheral nerve interface are relatively new techniques for peripheral motor nerve and pain management. Intraneural peripheral electrodes have shown promising early results for sensory nerve input. The "Starfish procedure" and the advancement of mechanical prostheses relying on myoelectric signals have revolutionized function and prosthetic use for partial hand amputees. Lastly, osseointegration implants, which protrude through skin and anchor directly to a prosthetic, can provide optimization of the residual upper limb. Summary: Recent advancements have improved neural and osseous integration of advanced prostheses into the residual upper limb. Restoration of function and relief from chronic pain are more possible than ever before.
ISSN: 2167-4833
CID: 5165892

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

Updates on Distal Radius Fractures Past, Present, and Complications

Bravo, Dalibel; Moses, Akini; Ayalon, Omri; Tahmassebi, Ramon; Catalano, Louis W
Before the 1900s, distal radius fractures were misdiagnosed as radiocarpal dislocations and most were treated nonoperatively. Between the 1900s and 1920s there were several anesthesia and antiseptic advancements that led to the advancement of surgical interventions. Then after the continued use and implementation of radiographs in orthopedics, radiographic parameters allowed for a critical analysis of treatment and patient outcomes that led to the further advancement of distal radius fracture treatment. This review will detail the historical content that led us to current practices. Additionally, current methods are critiqued, and common complications are reviewed in order to allow orthopedic surgeons to avoid these complications today.
PMID: 34081887
ISSN: 2328-5273
CID: 5148212

Cerclage Wire Fixation for Fracture-Dislocations of the Proximal Interphalangeal Joint

Ayalon, Omri; Posner, Martin
Proximal interphalangeal (PIP) joint fracture dislocations are challenging injuries to treat. Multiple and varied treatments have been proposed. We present the use of cerclage wiring as a helpful technique in these challenging scenarios. The technique has the benefit of securing fracture fragments from the volar or dorsal base of middle phalanges or a comminuted fracture involving the entire articular surface. We report on the use of cerclage wires in eight patients (average: 43 years of age). Three patients had volar base fractures, three dorsal base fractures, and two impacted fractures involving the entire articular surface. All fractures healed, and average postoperative PIP active flexion motion arc was 21° to 95° (functional arc of 74°). We believe cerclage wire fixation is an effective and reproducible method to treat intra-articular fractures of middle phalanges, especially comminuted fractures involving the entire articular surface, and should be available to hand surgeons treating these difficult injuries.
PMID: 32857025
ISSN: 2328-5273
CID: 4586992

Crossed K-Wires Versus Intramedullary Headless Screw Fixation of Unstable Metacarpal Neck Fractures: A Biomechanical Study

Beutel, Bryan G; Ayalon, Omri; Kennedy, Oran D; Lendhey, Matin; Capo, John T; Melamed, Eitan
Background/UNASSIGNED:Intramedullary headless screw (IMHS) has shown promise as an alternative to other fixation devices for metacarpal neck fractures. The purpose of this study was to assess the biomechanical performance of IMHS versus the commonly-used crossed K-wire technique. We hypothesized that IMHS fixation provides superior stability to K-wires. Methods/UNASSIGNED:A metacarpal neck fracture model in 23 human cadaveric metacarpals was created. The specimens were divided into two groups based upon fixation method: Group 1, 3 mm intramedullary headless screw; and Group 2, 0.045 inch crossed K-wires. A cantilever bending model was used to assess load-to-failure (LTF), maximum displacement, energy absorption, and stiffness. Results/UNASSIGNED:The mean LTF was 70.6 ± 30.1 N for IMHS and 97.5 ± 34.7 N for crossed K-wires. Mean stiffness was 11.3 ± 3.4 N/mm and 17.7 ± 7.8 N/mm for IMHS and crossed K-wires, respectively. The mean maximum displacement was 20.2 ± 4.6 mm for IMHS and 24.1 ± 3.7 mm for crossed K-wires. Moreover, mean energy absorption was 778.3 ± 528.9 Nmm and 1095.9 ± 454.4 Nmm, respectively, for IMHS and crossed K-wires. Crossed K-wires demonstrated significantly higher stiffness and maximum displacement than IMHS (p < 0.05). Conclusions/UNASSIGNED:IMHS fixation of unstable metacarpal neck fractures offers less stability compared to crossed K-wires when loaded in bending. Clinical Relevance/UNASSIGNED:Crossed K-wires offer superior stability for the treatment of metacarpal neck fractures. These results reveal that IMHS fixation is less favorable biomechanically and should be cautiously selected with regards to fracture stability.
PMID: 30104939
ISSN: 1555-1377
CID: 3240962

The Relationships Between Surface Measurements and Underlying Tendon Autograft Length for Upper Extremity Reconstructive Surgery

Milone, Michael T; Starecki, Mikael; Ayalon, Omri; Aversano, Michael W; Sapienza, Anthony
PURPOSE: The availability of tendon grafts is an important consideration for successful upper extremity reconstructive surgery, including flexor or extensor tendon reconstructions, tendon transfers, and ligament reconstructions. Graft selection is based on availability, expendability, ease of harvest, and length. Given variations in patient height and extremity length, existing average values may provide suboptimal insight into actual tendon lengths available. The purpose of this study is, therefore, to pursue a method of estimating available donor tendon lengths based on easily measured anatomical surface landmarks. METHODS: Thirty cadaveric upper and lower extremity limbs were dissected and the length of commonly harvested tendon grafts including the palmaris longus, extensor indicis proprius, extensor digiti minimi, plantaris, and second long toe extensor was measured. Surface forearm length (from finger tip to cubital fossa) and surface fibular length (from lateral malleolus to fibular head) were also measured. Correlations between surface measurements and underlying tendon lengths were analyzed, and linear models were generated that predicted tendon length as a function of surface measurements. RESULTS: Surface measurements were correlated with underlying tendon length (R = 0.46 - 0.66). Linear models could predict tendon lengths based on surface measurements (P < .05). A ratio of donor tendon length compared with the limb segment measured was established for each tendon and can be applied to estimate donor tendon length. For the upper extremity tendons, the multipliers for the palmaris longus, extensor indicis proprius, and extensor digiti minimi were 0.51, 0.20, and 0.18, respectively. Lower extremity tendon ratios for the plantaris and extensor digitorum longus were 0.69 and 0.60, respectively. CONCLUSIONS: Although length of available donor tendon can be a limiting variable at the time of surgery, surgeons may be better able to estimate underlying tendon lengths using easily obtained superficial measurements. CLINICAL RELEVANCE: Information obtained from these cadaveric measurements may aid in preoperative planning in hand and upper extremity surgery.
PMID: 28606434
ISSN: 1531-6564
CID: 2617792

Dorsal Plating of Distal Radius Fractures Historical Context and Appropriate Use [Historical Article]

Ayalon, Omri; Paksima, Nader
The management of distal radius fractures has evolved over time from a largely nonoperative paradigm to a more commonly performed operative procedures today. Surgical trends have similarly developed, with dorsal plating falling out of favor due to complications involving extensor tendon pathology as well as due to the ubiquity of the volar plate along with the advent of locking plate technology. However, with the improvement in design of newer generation dorsal plates, this technique should be used in the appropriate clinical situation, including dorsal comminution and angulation with concomitant carpal pathology. Outcome data supports dorsal plating and has been shown to be comparable to that of volar plating, with some unique advantages. As such, the technique of dorsal plating should have a role in surgical management of these injuries.
PMID: 28214455
ISSN: 2328-5273
CID: 2478822

Volar-Ulnar Approach for Fixation of the Volar Lunate Facet Fragment in Distal Radius Fractures: A Technical Tip

Tordjman, Daniel; Hinds, Richard M; Ayalon, Omri; Yang, S Steven; Capo, John T
The volar Henry approach is most commonly used for surgical fixation of distal radius fractures. However, this approach is limited in achieving adequate exposure for the fixation of the volar-ulnar portion of the distal radius, rendering it difficult for the ideal placement of the fixation construct. We propose the use of the extensile volar-ulnar approach for fixation of distal radius fracture involving a small volar-ulnar fragment. This approach allows optimal reduction of the sigmoid notch and the volar lunate facet, which anatomically reduces both the radiocarpal joint and the sigmoid notch. In addition, extension of this approach may safely be performed if concomitant carpal tunnel release is necessary.
PMID: 27916152
ISSN: 1531-6564
CID: 2353362