Abstract
Standard Titanium Elastic Nail (TEN; Synthes, Welwyn Garden City, UK) fixation requires a 2.5mm drilled entry point at the base of the metacarpal. This can damage soft tissues including the extensor tendon and also risks breaching the volar cortex. We recommend opening the dorsal metacarpal cortex with a curved artery clip (Fig 1). Initially, point the tip downwards to penetrate the cortex, turning the clip 180° to advance it down the medullary canal (Fig 2). The curve on the clip mimics the profile of a 2.0mm TEN (Fig 3) and its natural entry to the metacarpal. The less traumatic nature of this approach may lead to improved soft tissue protection. Figure 1 Entry point gained using clip to penetrate the near cortex Figure 2 Clip turned 180° to continue along medullary canal Figure 3 Titanium Elastic Nails, showing the curved profile
Highlights
A size 0 Ethilon® suture (Ethicon, Somerville, NJ, US) is advanced through the needle and across the face of the glenoid as a shuttle suture (Fig 1), and the labral repair is undertaken in the normal way. This technique uses readily available equipment and allows access to the inferior labrum as a Tuohy needle is sufficiently slim to pass through the superior part of the subscapularis
Delayed or incomplete fasciotomy may result in limb loss or even death in severe polytrauma.[1]
The anterior and lateral compartments may be decompressed via separate fascial incisions through an axial skin incision.[2]
Summary
Standard Titanium Elastic Nail (TEN; Synthes, Welwyn Garden City, UK) fixation requires a 2.5mm drilled entry point at the base of the metacarpal. This can damage soft tissues including the extensor tendon and risks breaching the volar cortex. We recommend opening the dorsal metacarpal cortex with a curved artery clip (Fig 1). Graspers can be inserted through the 6mm cannula to aid manipulation of the labrum or the Tuohy needle. A size 0 Ethilon® suture (Ethicon, Somerville, NJ, US) is advanced through the needle and across the face of the glenoid as a shuttle suture (Fig 1), and the labral repair is undertaken in the normal way
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