Virtual Operating Room
Video: How I Do An Endoscopic Carpal Tunnel Release, Wide Awake – Dr. Peter DeNoble
Hey guys, it’s Dr. DeNoble here. I’m going to show you how I do my endoscopic carpal tunnel releases in 60 seconds. Now I do these procedures under straight local, which means the hand is numb but my patients are wide awake. They’re usually listening to the music of their choice and, for about 15 minutes, hanging out with us, chit-chatting and very comfortable. I start by making an incision in the middle of the Palm about a centimeter and a half in length. I gently retract the skin edges with retractors and insert a clear cannula. Once the clear candle is inserted into the carpal tunnel, I take a look. I make sure that there’s nothing interposed between me and the transverse carpal ligament. Once I am comfortable that there’s a nice track, I mount a blade on the head of the scope and from a district approximate direction, I advance this very gently. As you’ll see, as I draw it back, the fibers have spread nicely and the release has almost finished. I then advanced one more time to complete the release and that’s it. A couple of stitches, small incisions, happy patients.
Video: Wrist Fracture-Dislocation – Transscaphoid Perilunate DislocationA young man was in an ATV accident that resulted in scaphoid bone fractures and wrist dislocation. The fracture was reduced and pinned and bones in the wrist were pinned to allow ligaments to heal. Watch the full video below.
This is Dr. Ratliff from Modern Orthopedics of New Jersey. This video is discussing a wrist fracture-dislocation that occurred in a young man in a quad ATV accident. Here, you see a displaced fracture in the scaphoid bone. The lateral x-ray shows that the wrist is actually dislocated, the capitate should be sitting in the cup of the lunate. This is a perilunate dislocation.
The incision is placed at the back of the wrist with the hand to the left, going through the skin and subcutaneous tissues. Next, we’ll identify the extensor pollicis longus tendon, pulling on it to show that the thumb moves with the tendon and then tracing and exposing the tendon through its sheath. Next, the posterior interosseous nerve is identified at the back of the wrist, crushed, cut and cauterized to try to limit pain and problems down the road. The tendons within their sheaths are elevated away from the bone, using the scalpel to peel those tissues away and expose the capsule on the back of the wrist as well as the radius.
Once the capsule is exposed, we can begin to work on the joint itself. Here, you can see two transverse tears in the capsule that occurred from the injury, not preexisting, and then identifying a loose piece of cartilage within the joint, which won’t be able to heal. Now using the instrument into that dislocation to shoehorn it back into place and the joint is now reduced and in proper position, but the fracture is still remaining. So here, showing the bones now no longer dislocated.
Next, we can expose the wrist with a V-shaped incision in the capsule to show the bones within the wrist and the dislocation, which has now been reduced. But that fracture at the scaphoid is still there, which you could see just moving. The wires are put in as joysticks to manipulate the fracture, and then this wire holds the bone in the proper position. These are adjusted, and now we can see that the joint is well lined up. This instrument shows that the joint surface is smooth and the fracture is in good position. So further wires are adjusted and put into position into that bone to hold it in place.
With the majority of the fracture now fixed, a piece on the back had pulled off with cartilage but still had good healthy bone. So this was sutured back to the bone to hold it in place and stabilize those ligaments that are attached to it. Now the wires are driven distally out past the base of the thumb where they will remain buried for approximately 10 weeks. The joint can now move freely with the wires buried beneath the cartilage. The ligament between those two bones just adjacent to the fracture is now examined, and they’re noted to be moving in unison without any direct injury to the ligament.
The wrist bones themselves all need to be stabilized, so wires are placed on both sides of the wrist. These wires will crisscross all of the little bones in the wrist and hold them in place for 10 weeks to allow ligament and bone healing. The capsule that was opened is now repaired. [inaudible] bone is now fixed and held with wires and the dislocation is back in place.