Olecranon ORIF Plate

History: 79 year old gentleman sustained an elbow injury when he fell from his bicycle.  He went to the emergency department where he was diagnosed as having an olecranon fracture.  I met him in the emergency department to discuss surgery. 

Diagnosis: Right olecranon fracture

Treatment: Olecranon open reduction and internal fixation with plates and screws

Outcome: Within 3 weeks hhe had near full motion and no pain.  The scar was fully healed and nearly invisible. He was very happy with the results. 

Humerus ORIF

History: 29 year old female sustained multiple injuries after a car accident, including a right comminuted humerus fracture.  She was admitted to the hospital for treatment. 

Diagnosis: Right comminuted humeral shaft fracture

Treatment: Humerus open reduction and internal fixation with plates and screws

Outcome: Within 3 weeks she had near full motion and no pain.  The scar was fully healed and nearly invisible. She was very happy with the results. 

Distal Radius Osteotomy

History: 55 year old female had sustained a left wrist fracture 3 months prior to coming to my office.  A different surgeon treated her with a cast for 6 weeks followed by brace.  For the prior 2 months however she had progressive pain, swelling, and numbness/tingling in her wrist and fingers suggestive of carpal tunnel syndrome.  X-rays showed the fracture did not heal properly and she was very bothered by it.  She requested the distal radius be fixed. 

Diagnosis: Left distal radius malunion with carpal tunnel syndrome

Treatment: Distal radius osteotomy through volar approach with iliac crest bone graft and carpal tunnel release

Outcome: Over the first 2 weeks after surgery she had immediate improvement in her carpal tunnel symptoms.  As the pain improved, she regained full motion and strength in her wrist.  All of her pain was alleviated and she was very happy by 3 months after surgery. 

 

Nail Bed Avulsion

History: 18 year old male injured his index finger after dropping a 60-pound weight at the gym.  He presented to the emergency department for an open injury with an avulsed nail and nail bed laceration.  

Diagnosis: Right index finger open distal phalanx fracture with nail bed laceration and nail avulsion

Treatment: Repair of nail bed and replacement of nail plate

Outcome: He had a fast recovery.  The nail bed healed beautifully and the nail plate grew back without any abnormality.  He was back in the gym within a few weeks and by 3 months had a normal appearance of his finger.

Mucous Cyst Bilobed Flap

History: 44 year old female with a chronic mass at her fingernail.  The mass had been present for many months and would occasionally become infected and drain.  It was also causing a depression in her nail and quite uncomfortable and unsightly.  

Diagnosis: Left ring finger mucous cyst

Treatment: Mucous cyst excision with bilobed advancement flap

Outcome: She healed the incision beautifully and by 4 weeks the area was painless and improved. At her 3 month visit the nail plate and returned to normal appearance and she was very pleased. 

Finger Crush – Franko

History: 37 year old gentleman was in a motorcycle accident where he sustained a severe trauma and crush to his middle and ring fingers.  I met him in the trauma bay where he had significant crushed finger tips and open wounds.  Based on the amount of injury, I recommended revising the amputated digit tips to regain function.

Diagnosis: Left 3rd and 4th digits open distal tuft fractures


Treatment: Revision amputation of the 3rd and 4th digits

Outcome: He had a rapid and smooth recovery.  He worked hard on therapy and regained function and strength within a few months.  Images below are from his 5 month appointment where he had returned to fully normal function. 

Dorsal Wrist Skin Graft

History: 61 year old female sustained an injury to her right wrist resulting in complete loss of skin over a large area measuring 10 x 6 cm.  The existing skin had previously become infected and required debridement.  I recommended a skin graft to provide coverage to the area. 

Diagnosis: Dorsal wrist large skin defect

Treatment: Full thickness skin graft to wrist and hand

Outcome: Over the next 6 weeks the skin graft became fully incorporated and she regained full motion and full function of her hand. 

 

Bilateral Galeazzi ORIF

History: 21 year old male presented as a trauma patient after a motorcycle accident with injuries to his bilateral forearms.  He was found to have a fracture radius on both side with a ligament injury at the wrist.  He was initially splinted with recommendations for surgery. 

Diagnosis: Bilateral radial shaft (Galeazzi) fractures

Treatment: Bilateral radial shaft ORIF

Outcome: At his first post-operative visit he was doing exceptionally well.  He had nearly full forearm range of motion, minimal pain, and was already doing his normal activities. He was eager to return to the gym but needed to wait at least 6 weeks for the bone to start healing. 

Thumb Arthritis

History: 51 year old female with right thumb pain that had been present for over a year.  Although it began after a fall, x-rays showed arthritis at the base of the thumb (CMC joint arthritis).  After trying splinting, a steroid injection, and anti-inflammatory medication, she elected for surgery to alleviate her pain. 

Diagnosis: Right thumb CMC arthritis

Treatment: Right thumb trapezium excision with ligament reconstruction and tendon interposition (LRTI)

Outcome: Her recovery proceeded smoothly and by 5 months after surgery she had regained full motion, had returned to all her activities, and no longer had any pain.  She was very happy. 

P1 Percutaneous Screws

History: 40 year-old male school principal came to my office after injuring his finger playing basketball and jamming the finger. He had significant pain and swelling and was unable to make a fist. X-rays showed a fracture of the proximal phalanx with displacement and rotation.

Diagnosis: Left 5th proximal phalanx oblique fracture

Treatment: Proximal phalanx closed reduction with percutaneous screws

Outcome: Within 3 weeks he had near full motion. Aside from some mild swelling he had no pain. Because the screws were percutaneous, or through the skin, there was no scar and no incision.