Silicone arthroplasty of the proximal interphalangeal joint is traditionally performed through a dorsal approach, which requires violation of the extensor mechanism and may contribute to postoperative stiffness and extension lag. Volar approaches preserve the extensor apparatus and permit earlier active mobilization; however, previously described techniques differ in flexor sheath entry, volar plate management, and collateral ligament handling, limiting reproducibility. We describe a standardized volar technique that emphasizes controlled neurovascular mobilization; elevation of the A3 pulley as a laterally based flap (preserving A2 and A4); proximal disinsertion of the volar plate while maintaining its distal attachment; and bilateral complete proximal detachment of the proper collateral ligaments to achieve symmetric "shotgun" exposure. This collateral release corrects asymmetric ligament elongation or contracture in arthritic and post-traumatic deformities, restores coronal balance, and facilitates centered implant placement. Flexor tendons are retracted without division. After canal preparation and implant insertion, axial alignment and coronal and sagittal stability are assessed throughout the flexion-extension arc. The volar plate and collateral ligaments are not routinely repaired. Postoperative stability relies on implant-centered alignment and progressive peri-implant capsular fibrosis, with support from temporary buddy taping. This technique provides reproducible exposure while also serving as a structured soft-tissue rebalancing strategy. Clinical application should be limited to cases in which soft tissue balance can be restored and implant-centered stability achieved intraoperatively.

Thumb carpometacarpal (CMC) osteoarthritis in advanced stages is frequently associated with metacarpophalangeal (MCP) hyperextension, resulting in the characteristic Z-deformity and reduced pinch stability. Standard basal joint reconstruction may fail to correct MCP hyperextension, contributing to persistent functional impairment. Prosthetic trapeziometacarpal arthroplasty may partially correct Z-deformity but becomes unreliable when MCP hyperextension exceeds 30 degrees. This article describes a reproducible surgical technique combining trapeziectomy, APL suspension arthroplasty, and EPB reinsertion onto the dorsal aspect of the first metacarpal head to restore sagittal balance of the MCP joint. In this configuration, the EPB is intentionally converted from an active extensor into a passive dorsal stabilizer, providing a tenodesis-like restraint against hyperextension while preserving flexion arc. In 10 consecutive patients with Eaton-Littler stage III-IV disease and MCP hyperextension ≥30 degrees, mean hyperextension improved from 38.6 degrees preoperatively to 5.4 degrees at 12-month follow-up, with preservation of MCP flexion and improvement of key pinch strength and QuickDASH scores. This approach provides stable correction of MCP hyperextension while maintaining MCP motion, offering a motion-preserving alternative to capsulodesis or arthrodesis.

Recurrent anterior shoulder instability associated with glenoid bone loss poses a significant surgical challenge. The open Latarjet procedure with screw fixation remains a reliable option. However, screw-related complications, such as hardware irritation and graft fracture, have prompted the exploration of alternative fixation systems. This article describes a guided open Latarjet technique using dual suture-button constructs for coracoid fixation and reports early clinical and radiographic outcomes. Five male patients (median age, 27.5 y) with recurrent anterior instability and glenoid bone loss exceeding 15% or failed previous stabilization underwent this procedure. Functional outcomes, as assessed by the American Shoulder and Elbow Surgeons (ASES) score, pain levels quantified by the visual analog scale (VAS), and graft consolidation, were evaluated at 6, 12, and 24 months postoperatively. The mean ASES score improved from 46.5 preoperatively to 98 at 24 months, while median pain levels decreased from 7.5 to 0. Serial postoperative radiographs suggested graft consolidation in 4 of 5 patients within 6 months, with acceptable graft positioning in most cases. No redislocations, subjective instability, or hardware complications occurred. In this small single-center preliminary series, the guided open Latarjet with suture-button fixation appeared technically feasible and was associated with encouraging early clinical and radiographic findings. These results should be interpreted cautiously as descriptive and exploratory rather than definitive evidence of reproducibility or effectiveness.

Circumferential degloving injuries of the digits are common but continue to be a challenge to achieve stable coverage. Many techniques have been used to tackle these, ranging from skin grafts to multiple free flaps. This article describes a straightforward technique of using 2 pedicled flaps from the abdominal region to simultaneously cover both the volar and dorsal aspects of the digit. The dimensions, design, and method of using the technique are explained in detail with illustrative case examples. This "sandwich" flap design is simple, reliable, does not require a delay stage and minimises the need for later debulking procedures.

Several methods of surgically treating displaced, ulno-humerally stable olecranon fractures (Mayo type 2a and 2b) have been suggested. Cerclage wires have been used for at least a century to achieve fracture fixation but have been replaced by tension band wiring or plate fixation as the commonly recognized "gold standard" treatments. Thin soft tissues and migrating K-wires result in high complication rates following these 2 methods. We suggest double cerclage wiring as an alternative method that allows for the omission of K-wires. The method can be used for the same indications as tension band wiring: Mayo type 2a and 2b fractures. Two cerclages are placed, in figure-of-eight and figure-of-zero configurations, respectively, through separate drill holes distally and through the triceps tendon proximally. In a retrospective study, the reoperation rate and complication rate were twice as high following tension band wiring compared with double cerclage wiring (27% vs. 13% and 45% vs. 18%, respectively). An ongoing RCT will provide more robust evidence, but current studies indicate that double cerclage wiring is a safe and possibly superior alternative to tension band wiring.

Distal radius fractures are common upper extremity injuries. Some intra-articular fracture patterns may benefit from a dorsal approach to assist in optimizing joint congruency by direct visualization and reduction of the articular surface. Dorsal plating can be associated with extensor tendon irritation and possible risk of attritional rupture. However, in combination with newer-generation thinner dorsal plates or fragment-specific dorsal plating, the risk of extensor tendon complications can be minimized with the use of extensor retinacular flaps for plate coverage. This paper summarizes a technique that utilizes an interdigitating flap design that can be done to optimize dorsal plate coverage in the treatment of certain intra-articular distal radius fractures.

Metacarpal and phalangeal nonunion is rare; however, surgery is required if these fractures result in instability or persistent pain. Revision of nonunion following plate fixation is challenging, as it demands bone grafting at the nonunion site and stable fixation. Here, we present a surgical technique for managing metacarpal and phalangeal nonunion after failed plate fixation using an intramedullary strut bone peg reinforced with intramedullary K-wires. This technique achieves a high union rate by increasing the intramedullary contact surface, promoting bone healing. Moreover, intramedullary K-wires bypass previous screw holes and help maintain fracture apposition and alignment at the nonunion sites.

Ruptures of the distal head of the biceps are quite common and are a consequence of eccentric load. Chronic lesions are defined as treated after 4 weeks from injury. Treatment of chronic lesions is challenging and typically requires a tendon graft due to proximal stump retraction and degeneration. We propose a new reconstruction technique using a Flexor Carpi Radialis (FCR) autograft reinforced with a Palmaris Longus (PL) autograft and fixed to the radial tuberosity with an Endobutton. We applied this technique in 6 patients with excellent functional outcomes. No major complications were observed and no morbidity or functional limitations were noticed at the harvest sites.

Two patients, a 65-year-old male and a 61-year-old female, presented with 5-digit partial hand amputations following pressor-induced necrosis and an industrial accident, respectively. Both patients had thumb metacarpophalangeal disarticulations with healthy interossei. These patients underwent combined Starfish procedures and thumb on-top-plasty utilizing the necessarily resected distal index metacarpals. Both patients went on to bony union, functional opposition, and use of their myoelectric prostheses. For patients with 5-digit partial hand amputations, the use of the resected distal 3 cm of index metacarpal to lengthen the remnant thumb can be done safely while performing a Starfish reconstruction.

Gartland type IV supracondylar humerus fractures in children are characterized by complete periosteal disruption and multidirectional instability, frequently resulting in failure of standard closed reduction maneuvers. Persistent rotational instability is the primary factor leading to loss of reduction and the subsequent need for open reduction. Although open reduction is effective, it is associated with increased soft-tissue dissection, longer operative times, and a higher risk of postoperative stiffness and neurovascular complications. We describe a temporary lateral cortical pin-assisted closed reduction technique that facilitates controlled rotational correction while preserving lateral cortical alignment. After restoration of lateral cortical continuity under fluoroscopic guidance, a temporary lateral Kirschner wire is inserted to act as a hinge, stabilizing the reduction and allowing precise rotational adjustment of the distal fragment before definitive fixation. Definitive stabilization is then achieved with standard percutaneous pinning, most commonly using a lateral-only configuration. This technique is simple, reproducible, and may expand the indications for successful closed reduction, thereby reducing the need for open reduction in selected Gartland type IV supracondylar humerus fractures.

Pain in the dorsoulnar region of the wrist is a common complaint and may be caused by a variety of pathologies. Longitudinal tears of the extensor carpi ulnaris (ECU) tendon are among them, and it has recently been noted that these lesions are more frequent than previously thought. Most ECU injuries can be managed conservatively. Surgical treatment is indicated in cases of tendon rupture, especially when associated with instability or injury to the triangular fibrocartilage complex (TFCC). In such cases, the procedure should include tendon debridement with resection of inflammatory tissue, debridement of the lesion margins, and subsequent suture repair. Traditionally, ECU tendon repairshave been performed through open surgery. However, arthroscopy now allows access to the ECU tendon within the sixth extensor compartment through tenoscopy. On the basis of this, we describe and demonstrate a novel technique for the arthroscopic repair of longitudinal ECU tendon tears, combining wrist arthroscopy with ECU tenoscopy. This procedure enables debridement and tendon repair using horizontal, interrupted sutures in a minimally invasive manner, resulting in less damage to healthy tissues. Furthermore, it allows for the diagnosis and treatment of other ulnar-sided wrist injuries, which are frequently associated with ECU pathology.

Level IV-case report; cadaveric study.

Fractures of the metacarpals account for 18% to 44% of all hand fractures, with malunion being the most common complication. Sagittal plane malunion may result in extensor lag, bone shortening, loss of knuckle contour, and prominent dorsal or palmar bony deformity. In this paper, we describe a novel crescentic osteotomy technique of the border metacarpals stabilized with intramedullary screw fixation for the correction of extra-articular malunions. We report 3 cases of border metacarpal malunion treated with this method. At a median follow-up of 9 months (mean: 12.3 mo), patients achieved excellent outcomes, with a mean QuickDASH score of 1.5. This technique provides a safe, effective, and reproducible option for the correction of metacarpal malunions.