Mini-open Incision Research Articles

Navigated Simultaneous Lateral Minimally Invasive Tubular and Posterior Mini-Open Access for Removal and Revision of Triangular Sacroiliac Joint Implants: A Technical Note

Sacroiliac joint (SIJ) fusion, to treat back pain caused by SIJ dysfunction, can employ open or minimally invasive surgery (MIS) techniques and either cylindrical (screw-shaped) or triangular (wedge-shaped) implants. Fusion nonunion sometimes explains recurrent SIJ pain following fusion and occasionally requires hardware revision. MIS revision minimizes patient pain, infection, and disability, but due to the triangular implant size and form factor, implant removal can present challenges for MIS access during the explantation and achieving good bony purchase for reinstrumentation. Here, we report a prone single-position lateral MIS/posterior mini-open procedure for triangular-implant SIJ fusion revision. The patient is a 72-year-old female who underwent right SIJ fusion for lower back and leg pain sustained after a fall 2 years prior but experienced recurrent pain over the subsequent 2 years, with imaging findings of right SIJ peri-hardware lucencies and diagnostic injections confirming persistent right-sided sacroiliitis. The patient underwent hardware removal using the lateral MIS incision with table-mounted tubular access and image-guided navigation to maintain exposure, plus simultaneous reinstrumentation using a navigated S2-alar-iliac screw and iliac bolt construct with connecting rod through the posterior mini-open incision made for the navigation reference frame spinous process clamp. The use of navigation and MIS access can significantly decrease the complexity of lateral hardware removal, and mini-open navigated screw-and-rod constructs offer reinstrumentation options accessible to surgeons unfamiliar with specialized posterior SIJ systems.

Patient Reported Outcomes with the Use of Fibular Nail Fixation, Retrospective Review of 41 Cases

Category: Trauma; Ankle Introduction/Purpose: Traditionally, open reduction and internal fixation of unstable lateral malleolus fractures with plate and screw constructs has been considered the gold standard treatment. More recently, the use of an intramedullary fibula nail has gained popularity as an alternative treatment method using a mini open incision to obtain anatomic reduction. The minimally invasive nature of this technique and the no profile load bearing/sharing implant is reported with very low complication rates and a much lower incidence of implant irritation and removal. We report our surgical and patient reported outcomes for a cohort of single surgeon consecutive fibula nails with proximal and distal locking fixation. Methods: We retrospectively reviewed prospectively collected data on 41 patients that were implanted with the Fibulock® Fibula Nail (Arthrex, Naples, Florida, USA). All nails were implanted by a single surgeon. Intraoperative reduction quality was recorded, and patients were followed post operatively with radiographs that were assessed for maintenance of reduction, healing, and complications. Patient reported outcome questionnaires (PROMs) were collected preoperatively and at 3, 6, 12, and 24 months postoperatively. The Foot and Ankle Ability Measure (FAAM) assessed the patient’s functional status in terms of activities of daily living and sports. The Visual Analogue Score (VAS) was also collected. Results: All 41 patients had one- to two- year follow-up (14.68 months ± 5.92). Demographics are listed on table 1. Forty of the patients were reduced via mini open incision and one was reduced closed. There were no conversions to a plate, no intraoperative complications, and no cases of loss of reduction postoperatively. No patient required revision surgeries, no cases of delayed union or nonunion, and zero superficial or deep postoperative infections. Statistical analysis revealed a significant difference between preoperative and postoperative FAAM scores overall (+67.52, p < 0.001), within activities of daily living (+68.07, p < 0.001), and sport (+65.95, p < 0.001). Also, there was a significant difference between preoperative VAS and postoperative VAS (+4.73, p < 0.001). Conclusion: Our results support existing literature that fixation of fibula fractures with an intramedullary nail with proximal and distal locking capabilities is an alternative option to a plate and screw construct, with a very low incidence of hardware related complications requiring removal, and favorable patient reported outcomes.

Retrospective Review of 200 Consecutive, Single Surgeon, Fibula Nails with Proximal and Distal Fixation

Category: Trauma; Ankle Introduction/Purpose: Ankle fractures are one of the most common injuries presenting to orthopedic surgeons. Unstable ankle fractures require surgical intervention and the most common fixation method is the use of a plate and screw construct. However, this requires an extensive open incision, which potentially increases the risk of post-operative wound complications and the possibility of hardware irritation. The purpose of this abstract is to evaluate the clinical outcomes of the treatment of unstable lateral malleolar fractures using a fibula nail with both proximal and distal locking capabilities from our original cohort, and in our increased cohort of 200 consecutive single surgeon fibula nails using a mini open incision to anatomically reduce. Methods: We retrospectively reviewed 200 consecutive FibuLock Fibula Nail® fixation constructs (Arthrex, Naples, FL, USA) of a single surgeon in a private practice community hospital. Demographic, operative, clinical, and radiographic outcome data were analyzed. Results: The average follow-up time of the patients was 18.5 months. The demographics of the patients can be found in table 1. There were no cases of infection, loss of reduction, delayed union, or nonunion. All fractures healed. There were two cases of focal superficial epidermal lysis treated with local wound care, that did not require antibiotics. One patient required removal of the nail as a result of it being proud, which was an iatrogenic error. In our previously reported first 110 nails, we had to convert two fractures to plate fixation intraoperatively due to excessive comminution, which made the implantation more difficult. There were no further episodes of this in our next 90 cases due to adoption of plate assisted nail technique. Conclusion: The use of an intramedullary nail with a mini-open technique allows for anatomic fracture reduction and no-profile fixation, thus reducing the risk of wound complications and providing stable fixation. Our technique results in anatomic healing in nearly all patients. Also, there were no incidents of delayed or malunion and no postoperative loss of reduction. Our results demonstrated a very low complication rate compared to traditional plate fixation with good patient reported outcomes.

Mini-incision Carpal Tunnel Release

Carpal tunnel syndrome has been reported as the most common neuropathy in humans. The syndrome has a major impact on socio-economic life due to its high incidence and it usually affects the working-age population. The purpose of this study was to evaluate the results and reliability after our own mini-open incision with simple retractors from eye surgery, through a 1.5–2.0 cm long incision. For this reason, we used Disabilities of the Arm, Shoulder, and Hand score, Boston Carpal Tunnel Questionnaire and Pittsburgh Sleep Quality Index. The study included 24 operated hands in 23 patients (79% females; 21% males). The right hand was affected in 19 patients (83%), the left – in three patients (13%) and in one patient (4%) we performed bilateral decompression. The mean length of the incision scar was 1.5 ± 0.3 cm.В Subjectively, most of the patients (20 of 23) had improvement of paresthesia after 3 months postoperative examination. No patients reported recurrence of the symptoms that would require second decompression. Significant differences between the preand postoperative evaluation were observed in Disabilities of the Arm, Shoulder, and Hand score, Boston Carpal Tunnel Questionnaire and Pittsburgh Sleep Quality Index. In conclusion, our study presented that the median nerve decompression with a mini-incision technique was safe and effective operative technique with short learning curve, especially for experienced with opened techniques hand surgeons. The final results revealed that patients with mini-incision approach have satisfactory surgical outcomes, low postoperative complications, good patient satisfaction and appearance.

Prolene Hernia System Maximum Repair: A New Concept in Sports Hernia Surgery.

To describe and present the clinical results of a new surgical treatment for sports hernia. Retrospective cohort study. Tertiary hospital. Athletes who underwent sports hernia repair using the proposed technique between July 2006 and June 2020. The surgery consists of a combination of a mini-open incision and preperitoneal placement of a three-dimensional bilayer permanent mesh (PHS). The main clinical outcomes of the procedure were reviewed, including incidence of complications, long-term results, and recurrence rate. Ninety-two sports hernia repairs were performed on 87 patients (79 male and 8 female patients, median age 30.2 ± 7.8 years). No intraoperative complications were observed. The mean follow-up was 15 months. Seventy-seven patients (88.5%) successfully resumed preinjury physical activities within 8 weeks; 80 patients (91.9%) within 12 weeks; and 83 (95.4%) within 6 months (median time of 10 weeks). Only one patient reported recurrence of symptoms. Mini-open incision PHS repair seems to be a safe and effective method for treatment of sports hernia, resulting in early return to physical activities, with few complications, and low recurrence rate.

Complication rates, fluoroscopy exposure time, and functional outcomes of the two K-wire fixation methods for distal radius fractures in pediatric patients; mini-incision as a feasible surgical option

Objectives. In this study, we aimed to compare complication rates and fluoroscopy exposure time, as well as to analyze the functional results of percutaneous K-wire fixation and K-wire fixation with mini-open techniques in pediatric distal radius fractures. Materials and Methods. In this retrospective design study, one-hundred patients with completely displaced fracture of the distal radius were evaluated in terms of demographic data, radiological and functional evaluations, fluoroscopy exposure time, and complications. In Group 1, 50 patients were treated by closed reduction and percutaneous K wire application. In Group 2, 50 patients were treated with close reduction and K-wire fixation using a mini-incision. Results. There were no statistically significant differences between the two groups in terms of age, fracture degree, reduction degree, and follow-up duration. We found the fluoroscopy time and redisplacement rate were significantly lower in group 2. We did not notice tendon irritation and neuropraxia complications in any of the patients in group 2. We observed good functional results and no malalignment in both groups. Conclusions. The mini-open incision technique had lower complication rates and fluoroscopy durations. Based on the results of this study, K-wire fixation with the mini-open technique may be recommended as an alternative method for pediatric distal radius fractures.

Carpal tunnel syndrome: Does preoperative disease severity influence the outcome of mini-open surgery?

In the practice of carpal tunnel surgery, open decompression of the median nerve in carpal tunnel syndrome (CTS) is recognized as the therapeutic priority. However, the speed and completeness of postoperative recovery of sensitivity and function depend on the initial clinical manifestations of the disease and the severity of the electrophysiological disorder. The aim of this study was to investigate the influence of preoperative clinical and electrophysiological factors on the outcome of surgical treatment of patients with CTS of varying severity. One-hundred and eighty-nine open decompressions of the median nerve via a mini-open incision were performed in 161 patients with idiopathic CTS. Clinical observations were classified in 5 groups, according to severity. Treatment results were evaluated per group at 6 weeks and 3, 6 and 12 months after surgery. In all cases, there was improvement and positive dynamics according to clinical and electroneuromyographic data. Open decompression of the median nerve via mini-open incision can achieve significant clinical and functional improvement in the majority of patients with CTS. However, the most favorable results were mainly seen in patients with initial severity classified in the first, second and third (lower severity) groups.

Technical Guide and Tips to Posterior Arthroscopic Latissimus Dorsi Transfer for Irreparable Posterosuperior Rotator Cuff Tears

Latissimus dorsi (LD) transfer is a reliable treatment option for irreparable posterosuperior (PS) rotator cuff tears in young and active patients that need to recover the range of motion for their daily living activities. The technique starts with an arthroscopic assessment of the tear. The next step is the mini-open stage for muscle release from the subcutaneous layer of the skin, the teres major (TM), the triceps, and the lateral border and inferior angle of the scapula. Later, the scope is used to prepare the footprint (arthroscopy) and for the release and the harvest of the tendon (endoscopy), taking care not to detach the TM and not to damage the radial nerve. A grasper is used to push the LD to its correct path medial to the triceps. After that the same instrument is placed from the anterolateral and the anterior arthroscopic portals toward the mini-open incision to catch the sutures previously loaded on the LD tendon with Krackow stitches. The LD is transferred to the greater tuberosity and is attached with one medial and one lateral knotless anchors. A third point of fixation enables a partial RC repair and ensures a surface of bone to tendon healing.

Initial surgical outcomes of two modified minimally invasive repair techniques for acute achilles tendon rupture

Despite numerous treatment modalities, there remains no clear consensus on the optimal surgical approach to mid-substance acute Achilles tendon ruptures (AATR). The purpose of this study is to present two novel minimally invasive surgery (MIS) approaches for AATR and compare their outcomes. Retrospective analysis of two surgeons's AATR patients (N=18) who underwent one of two modified minimally invasive repairs (MMIR). Group A received a modified Krackow suture repair via mini-open incision with percutaneous calcaneal anchors. Group B received a modified Kessler suture repair percutaneously. The mean follow-up period was 23.9 +/- 5.1 and 14.7 +/- 1.9 months respectively. Surgical outcomes were measured using Maryland Foot Score (MFS) and The Self-Reported Foot and Ankle Score (SEFAS). There was no statistically significant difference in patient outcomes between the two MMIR techniques. Overall, patient satisfaction with Maryland score was 95.7 +/- 9.0 in Group A and 89.6 +/- 19.0 in Group B (p=0.41). Overall SEFAS score was 43 +/- 4.73 in Group A and 39 +/- 11.6 in Group B (p=0.15). Sural nerve injury occurred in two of the eight patients in Group B (25%), with only one of the patients seeking further treatment for neuritic pain. There were no other complications in terms of wound dehiscence, infection, rerupture or functionality in either of the two surgical groups. These findings suggest that the reported MIS techniques may be an acceptable consideration for surgical treatment of acute Achilles tendon ruptures.

Home based unsupervised rehabilitation protocol following rotator cuff repair has good outcomes: A prospective study

Background: Rehabilitation after rotator cuff repair achieves good results but it involves time and costs. A simple home based program will reduce costs, time to travel and chance of exposure in a pandemic scenario. The objective of the study was to assess outcomes of home based rehabilitation protocol following rotator cuff repair. Methods: This was a prospective study of 42 patients who underwent rotator cuff repair followed by an unsupervised home based rehabilitation protocol. The tears were identified using clinical examination and Magnetic Resonance Imaging. The cuff repair was done with mini open incision technique. The patients were taught an exercise protocol, which they did by themselves at home. There was no daily supervision by the treating surgeon or a physiotherapist. The study measured pain scores, return to work, range of motion and failures at one year. Results: Mean duration of followup was 14 months. Visual Analogue Score for pain improved from preoperative mean 7.5 to followup mean 1.3. Disability of the Arm, Hand and Shoulder score, measured in 26 patients improved from preoperative mean 33.2 to followup mean 4.5. Range of motion improved in 39 patients. Cuff strength was normal in 39 patients. 37 patients returned to full work by three months. There were three failures with one patient developing significant stiffness and two patients showing a retear. The retear was seen in patients with large retracted tears and the repair was done under tension. Conclusion: Home based exercise protocol for postoperative rehabilitation in rotator cuff repairs can achieve good results in carefully selected patients. The study does not recommend this for large tears with difficult repairs. Since the patients are doing the postoperative rehabilitation at home, this reduces the costs, time lost in travel and exposure to external factors.

Mini-open transverse flexor crease incision versus limited longitudinal palmar incision carpal tunnel release: A short term outcome study

ObjectiveTo compare the outcome of carpal tunnel release using the limited longitudinal palmar incision technique and mini open transverse flexor crease incision technique. Materials and methodslBetween October 2017 and September 2019, we performed Carpal Tunnel release procedures on 122 consecutive patients with unilateral idiopathic CTS. Patients in Group A (64 patients) had a palmar mini open longitudinal incision at wrist. Patients in Group B (58 patients) had a small flexor crease transverse incision. In the non palmar transverse incision group, we used a blunt ended facelift scissors to cut the flexor retinaculum after placing a dural retractor between the retinaculum and median nerve. The preoperative and postoperative (2 weeks,6 weeks,3 months, 6 months and 1 year) patient statuses were evaluated with the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) scores, VAS, grip strength and return to work days. ResultsThe BCTSQ symptom severity scale and functional status scale showed significant improvement following surgery in Group B compared to Group A at 2 weeks,6 weeks and 3 months (p < 0.05). At 6 months and 1 year follow up, both the symptom severity and functional status scale were comparable in both the groups. Grip strength, pillar pain and scar tenderness showed significant improvement in transverse flexor incision group compared to longitudinal palmar incision group at 6 weeks and 3 months and were comparable later on. ConclusionWe conclude that the mini open transverse flexor crease incision technique using the conventional instruments is simple, safe and cost-effective mode of treatment of idiopathic CTS when compared to the limited palmar incision technique. Though the long term outcomes are comparable in both groups, the flexor crease transverse incision group patients had better pain relief, better cosmesis and shorter recovery period than the palmar incision group

Comparison of lateral entry and crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis of randomized controlled trials

BackgroundClosed reduction and pinning entry fixation have been proposed as treatment strategies for displaced supracondylar humeral fractures (SCHFs) in children. However, controversy exists regarding the selection of the appropriate procedure. Hence, this meta-analysis was conducted to compare the effect of lateral and crossed pin fixation for pediatric SCHFs, providing a reference for clinical treatment.MethodsOnline databases were systematically searched for randomized controlled trials (RCTs) comparing lateral pinning entry and crossed pinning entry for children with SCHFs. The primary endpoints were iatrogenic ulnar nerve injuries, complications, and radiographic and functional outcomes.ResultsOur results showed that iatrogenic ulnar nerve injuries occurred more commonly in the crossed pinning entry group than in the lateral pinning entry group (RR = 4.41, 95% CI 1.97–9.86, P < 0.05). However, its risk between the crossed pinning with mini-open incisions group and the lateral pinning entry group was not significantly different (RR = 1.58, 95% CI 0.008–29.57, P = 0.76). The loss of reduction risk was higher in the lateral pinning entry group than in the crossed pinning entry group (RR = 0.66; 95% CI 0.49–0.89, P < 0.05). There were no significant differences in the carry angle, Baumann angle, Flynn scores, infections, and other complications between these two groups.ConclusionsThe crossed pinning entry with mini-open incision technique reduced the loss of reduction risk, and the risk of iatrogenic ulnar nerve injury was lower than in the lateral pinning entry group. The crossed pinning entry with mini-open incision technique is an effective therapeutic strategy for managing displaced supracondylar humeral fractures in children.

Does a medial mini-incision decrease the risk of iatrogenic ulnar nerve injury in pediatric supracondylar humeral fractures treated with closed reduction and percutaneous pinning? A retrospective cohort study

Background: The authors compared two techniques for safe medial pin placement during fixation of supracondylar humeral fractures, namely closed pinning and mini-open pinning of medial wire insertion, and their effectiveness in protection against iatrogenic ulnar nerve injury. Methods: One hundred and nineteen patients with type 2 and 3 Gartland supracondylar humeral fractures (AO Foundation/Orthopaedic Trauma Association [AO/OTA] 13-M/3.1 II, III and IV) were included in this study after applying the exclusion criteria. All patients were managed with cross pinning with identification of two groups. The first group was for percutaneous pinning (N=63), and the second group for patients with medial open incision during medial wire insertion (N=56). All patients were evaluated for the incidence of nerve injury after surgery. Results: Nerve injury occurred in 12 of 119 patients. The estimated duration of follow-up was 43.6±10.2 wk. The results revealed nine patients who had ulnar nerve injury among both groups (group 1, N=8, group 2, N=1), with statistically better results in group 2 (P=0.02). The incidence of nerve injury was not found to be correlated with other variables, which included age, gender, type of fracture, number of Kirschner wires that were inserted, and the level of the surgeon. Conclusions: A medial mini-open incision decreased the risk of ulnar nerve injury during cross pin fixation in the treatment of displaced supracondylar humeral fractures, without additional morbidity. Level of Evidence: Level III.

The Use of Modified Ollier Approach and Structural Allograft for Fixation of Intra-articular Calcaneal Fractures

We describe the combination of an Ollier approach and use of a structural allograft, for displaced intra-articular calcaneal fractures, that minimizes soft issue complications known to plague such fractures. The soft tissue envelope around the fracture fragments is maintained, facilitating fracture reduction. The mini-open incision is positioned such that critical elements of the subtalar joint are adequately visualized throughout the reduction and fixation. We have used this procedure for all grades of Sanders intra-articular fractures with no significant short-term complications thus far. Level of Evidence: Diagnostic Level V—Expert opinion. See Instructions for Authors for a complete description of levels of evidence.

Safe Level for the Syndesmotic Stabilization: A Simulated MRI Study

Category:Trauma; SportsIntroduction/Purpose:Great saphenous vein and saphenous nerve were reported as the high risk of injury from the syndesmotic stabilization. However, little is known about the safe level and area of the syndesmotic stabilization regarding the risks on the great saphenous neurovascular structures. This study was to demonstrate the safe level of syndesmotic stabilization via a simulated MRI study.Methods:A total of 10 living volunteers with intact conditions of syndesmosis on their ankle MRI was recruited in this study. Each volunteer’s ankle MRI was divided into 3 groups as 15-mm, 20-mm, and 25-mm level above the ankle joint line. The simulated reduction and fixation (stabilization) line was created through the tibiofubular syndesmosis at each level in accordance with the direction guidance by Phisitkul et al. The distance between great saphenous neurovascular structures and simulated line was measured in each level of simulated stabilization for each subject. The statistical analyses using IBM SPSS version 22 were performed to demonstrate the differences among the three groups (pair 1: 15-mm vs 20 mm groups; pair 2: 20-mm vs 25-mm; pair 3: 15-mm vs 25-mm level above the ankle joint line).Results:The mean distances between great saphenous neurovascular structures and simulated line of syndesmotic stabilization were shown in an attached picture. The syndesmotic stabilization at the 15-mm level above the joint line demonstrated the closest distance to the mentioned neurovascular structures. For the comparison among the three groups, pairs 2 and 3 showed the statistically significant differences at p-values as 0.004 and 0.001 respectively. A pair 1 did not show the significant difference at p- value as 0.260.Conclusion:Based on the results of this study, all levels of syndesmotic stabilization above the ankle joint line are safe for the great saphenous neurovascular structures. However, a 25-mm level above the joint line was the safest level for the syndesmotic stabilization when compared to other lower levels. Mini-open incision is recommended during the syndesmotic reduction and fixation on the tibial side to prevent the iatrogenic injury to the great saphenous neurovascular structures especially on the 1.5- mm and 2-mm level above the ankle joint line.

Subjective Outcomes of Carpal Tunnel Release in Patients with Diabetes and Patients without Diabetes

Introduction This study aims to compare the subjective outcomes of carpal tunnel surgery in the patients with diabetes and patients without diabetes, and it tries to determine the difference between insulin-dependent and noninsulin-dependent patients.Materials and Methods This retrospective cohort study compares subjective outcomes of 35 patients with type 2 diabetes and 35 patients without diabetes who had a unilateral carpal tunnel release. None of the patients with diabetes had neuropathy. All the patients had surgery by a single surgeon with miniopen incision under local anesthesia. The patients were evaluated before surgery and 6 months after surgery using two Brigham and Women's Carpal Tunnel QuestionnairesResults Carpal tunnel release was improved based on symptom severity scale (SSS) and functional status scale scores in patients with diabetes and nondiabetic patients. However, the mean SSS scores were higher in patients without diabetes 6 months after the surgery. Comparison between the mean SSS scores of the patients with diabetes showed higher scores in noninsulin-dependent patients. In patients with diabetes, SSS scores were positively correlated with carpal tunnel syndrome and diabetes durations.Conclusion The outcomes of carpal tunnel release were improved in both patients with diabetes and patients without diabetes suffering from median nerve compression at the wrist. However, the duration of diabetes and its treatment can be related to the severity of the disease symptoms after the carpal tunnel releasing surgeries. In some diabetic patients, the severity of the symptoms was persistent.Level of Evidence This is a prognostic level IV study.

Evaluation of Anatomic Relationship between Sural Nerve and Instrumentation during Mini-open Achilles Tendon Repair: A Cadaveric Study

Category:SportsIntroduction/Purpose:The Achilles tendon is one of the most commonly ruptured tendons in the adult population, and there is still no consensus on optimal treatment. While surgical repair may result in a lower re-rupture rate and quicker functional return, it also comes with risk of wound complications and sural nerve injury. If surgical repair is chosen, the surgeon may choose a traditional open procedure, a mini-open technique, or a percutaneous approach. The main advantage of the mini open repair method is the reduced wound complications that comes with a much smaller incision, while still maintaining similar re-rupture rates. The purpose of this study was to determine the relationship of the sural nerve to the Arthrex PARS jig and repair sutures.Methods:Cadaveric dissection was performed on 10 unpaired above knee amputation specimens. After severing the Achilles tendon and inserting the jig for a mini open repair, the sural nerve was dissected out to determine the rate of nerve puncture by the passed sutures. The jig was then removed to determine if the nerve was bound by the passing sutures or wrapped during suture locking.Results:The sural nerve was punctured 9 times out of the total of 50 sutures passed for an 18% puncture rate. All 9 punctures occurred in 4 specimens (Image 1), with the remaining 6 cadavers sustaining no punctures. Of the 6 unpunctured cadavers, 5 had all sutures passing anterior to the sural nerve, but in close proximity. One cadaver had all sutures passing posterior to the sural nerve. In all cadavers, removal of the jig and locking of the sutures left the sural nerve free with the sutures well fixed within the Achilles tendon. The sural nerve was also found to be within 1 cm of the lateral edge of the mini-open transverse incision in all cadavers.Conclusion:The Arthrex PARS jig was successful in preventing binding of the sural nerve during mini-open Achilles repair, but the sutures are often passed directly through the nerve during the procedure. The sural nerve is also at risk at the lateral edge of the mini-open incision used to insert the jig, and must be carefully protected during dissection down to the tendon.

Limited Open Achilles Tendon Repair in Supine Position With Modified Ring Forceps: A Technique Tip.

We present a modification to prior Achilles tendon repair techniques that utilizes readily available noncommercial instrumentation, mini-open incisions, and supine positioning, thus maximizing surgical efficiencies and reducing complications. In our experience, this is a safe and effective technique that minimizes anesthetic requirements and operating room time. Levels of Evidence: Level V, expert opinion.

Analysis of the functional outcome in patients following mini-open latarjet procedure for the treatment of anterior instability of shoulder

More than 200 different operations have been described for the treatment of recurrent anterior dislocation of shoulder. The Latarjet procedure employs re-routing of the osteotomised coracoid process with its attached conjoined tendon through a split in the substance of sub scapularis and fixed to the antero inferior aspect of glenoid rim. The present study is done to analyse the functional outcome of Latarjet procedure by mini-open technique in recurrent anterior shoulder dislocations with or without bony Bankart lesion/ Hillsachs lesion. A total of 25 (23 men and 2 women). patients managed by mini open Latarjet technique with a 4-5 cms long incision(3cm in young females) and splitting the subscapularis tendon were followed up for a minimum of one year. Patients were evaluated using ROWE instability score, Oxford Shoulder Instability index Score at the last follow up. The mean external rotation achieved was 60 degrees (45-70 degrees). Mean abduction was 160 deg (150-180 deg).There was no single episode of recurrence of dislocation or subluxation, all the patients regained preoperative range of motion. Mean ROWE score is 90(excellent) & mean oxford shoulder instability index is 38.1(good). One patient has developed fibrous union (4%). None has developed osteoarthritic changes. The classic Open Latarjet procedure results in a large scar and decreased external rotation. Adequate exposure can be obtained by a mini open incision with splitting of the subscapularis. In our technique we split subscapularis at its distal edge in order to place the bone block in right position only splitting of the subscapularis tendon leads to better outcomes with a smaller scar. Latarjet procedure is an excellent surgical option for recurrent shoulder instability associated with glenoid bone deficiency with or without engaging hill Sachs lesion.

Evaluating of the Outcomes of Median Nerve Decompression with a Mini Incision Proximal to the Distal Wrist Crease.

To evaluate the feasibility of the mini-open incision method in patients who underwent median nerve decompression in the carpal tunnel with a mini incision made proximal to the distal wrist crease. A total of 80 patients (84 hands) operated by a single surgeon with a mini incision were included. The patients were evaluated postoperatively for the presence of pillar pain, pain on the incision scar, and scar sensitivity in addition to preoperative findings. The Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) questionnaire was used for clinical scoring. To evaluate the effectiveness of the method, the findings were recorded at and compared between at 12 and 24 months follow-ups. No complications were observed at the wound site in the early postoperative period. Ten patients reported numbness, 5 experienced weakness, and 4 revealed positive Tinel's sign. Keloid formation without pain and scar sensitivity was detected in 2 patients at 6 months. No patient reported night pain, pain on pillar or incision scar, scar sensitivity, recent sensory loss, and disease recurrence. Numbness was present in 7 patients at 12 months and in 3 at 24 months; 3 and 2 patients reported weakness at 12 and 24 months, respectively. The mean Quick DASH score was 72.7 preoperatively, 10.2 at 12 months, and 9.1 at 24 months. The median nerve decompression in the carpal tunnel may be performed with a mini incision made proximal to the distal wrist crease is effective and safe method, and provides less complications and higher patient comfort.