OKOJ, Volume 11, No. 9

Management of Extensor Tendon Injuries in the Hand

Although injuries to the extensor mechanism of the hand and wrist are relatively common, their management is often given less attention than that of flexor tendon injuries. This is unfortunate because the extensor mechanism is in many ways more complicated than the flexor tendon system, and restoration of satisfactory function following injury of an extensor tendon remains a frequent challenge. Most extensor tendon injuries in the hand and wrist are the result of laceration, but crush injuries can disrupt the extensor mechanism as well, and tendon failure may also occur in traction during treatment of closed injuries. Primary treatment of most extensor tendon injuries is relatively straightforward, but some closed injuries and injuries with extensive tendon defects can be difficult to treat. The specific repair technique and treatment protocol used in the management of an extensor tendon injury varies according to the level of injury. For most patients, rehabilitation is extensive, and is continued for up to 6 weeks before gradual resistive exercises can be started. Early diagnosis, meticulous surgical technique, and supervised rehabilitation are integral for satisfactory function following an extensor tendon injury. The purpose of this article is to review the relevant guidelines for evaluation and treatment of injuries of the extensor mechanism of the hand, with special emphasis on management of injuries in the eight zones of the hand, wrist, and forearm.

    • Keywords:
    • extensor tendon injury

    • extensor tendon laceration

    • extensor tendon repair

    • extensor mechanism

    • anatomy

    • mallet finger

    • rehabilitation

    • Subspecialty:
    • Hand and Wrist

The Basic Science of Biofilm and Its Relevance to the Treatment of Periprosthetic Joint Infection

Throughout the natural environment, bacteria adhere to solid surfaces and form microcolonies surrounded by hydrated polymeric matrices of their own synthesis. First identified in environmental aquatic systems, these adherent bacterial microcolonies, known as biofilms, are now recognized as playing a key role in the pathogenesis and resistance to treatment of periprosthetic joint infections. Recent advances in imaging and molecular diagnostic techniques have allowed closer examination of the complexity of biofilms on prosthetic implants, including investigation of the ability of bacteria in such biofilms to communicate with one another and adapt to changes in their environment. Through transformation from a planktonic to a sessile state, the bacteria in a biofilm become resistant to antibiotics and host defenses, and may not be detected by conventional microbiologic culture techniques. Although some important advances have been made in the understanding and control of periprosthetic biofilms, current research in this field is focused on preventing bacterial adhesion to the surfaces of implants, disrupting biofilms to improve the diagnosis and treatment of periprosthetic joint infections, molecular techniques for detecting biofilms, and the eradication of biofilms in the setting of periprosthetic joint infections.

    • Keywords:
    • prosthesis-related infections

    • diagnosis

    • therapy

    • microbiology

    • antibacterial agents

    • biofilms

    • joint prosthesis

    • Subspecialty:
    • Adult Reconstruction

    • Basic Science

Deltopectoral Approach With Lesser Tuberosity Osteotomy and Capsulectomy: Tips for Success in Anatomic Total Shoulder Arthroplasty

Total shoulder arthroplasty is a challenging operation that, when performed properly, can lead to lasting improvements in function and pain. Frequent problems along the learning curve for this procedure include difficulty with intraoperative glenoid exposure, along with postoperative shoulder stiffness and postoperative subscapularis insufficiency. Steps to address these pitfalls, with particular emphasis on anteroinferior capsulectomy and lesser tuberosity osteotomy, are described. In addition, a detailed description of our chosen surgical approach is presented to accompany a video detailing the steps.

    • Keywords:
    • total shoulder arthroplasty

    • total shoulder replacement

    • capsulectomy

    • deltopectoral approach

    • lesser tuberosity osteotomy

    • glenohumeral osteoarthritis

    • Subspecialty:
    • Shoulder and Elbow