PubMed · 8683080
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T L Whipple, G G Poehling. 1996. Kirschner wire fixation through anatomic snuffbox.. https://doi.org/10.1016/s0363-5023(96)80135-3
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This article describes a new technique to achieve access to the epidural space via a direct posterior portal. This minimally invasive technique allows treatment of disc protrusions and extrusions with full visualization and minimal dissection of the paraspinal musculature. Hemostasis, visualization, and triangulation is performed with standard arthroscopic instrumentation. The anatomy of, indications for, and advantages of this techniques are described.
Increases security of fixation in rotator cuff repair is usually achieved by increasing the strength of fixation. Paradoxically, the problem can be approached by techniques that decrease the strain at the margins of the tear so that weaker fixation will still be adequate. Such techniques provide greater safety tolerances for the strength characteristics of suture, tendon, and bone. The principle of margin convergence can be applied to rotator cuff repair as a means to enhance the security of fixation by decreasing the mechanical strain at the margins of the tear. This strain reduction should also contribute to pain reduction by virtue of decreased stimulation of mechanoreceptors in the rotator cuff. The cliché no pain, no strain can be converted to a paradigm by reversal of its components to no strain, no pain.
Treatment of triangular fibrocartilage complex (TFCC) tears is receiving considerable attention. Repair of peripheral tears of the TFCC has been recommended to restore the important functions of stability and load-bearing. Techniques for the reattachment of the periphery of the TFCC are evolving. Previous reports have mainly dealt with ulnar-sided (Palmer Class I-B) repairs. This report describes an arthroscopic technique for repair of radial-sided (Palmer Class I-D) TFCC tears. The procedure utilizes arthroscopic visualization with direct reattachment of the radial edge of the horizontal disk of the TFCC into the sigmoid notch of the distal radius. Fixation is achieved using sutures driven through the distal radius using long straight meniscal repair needles. Early clinical results following arthroscopic reattachment of radial-sided TFCC tears using this technique have been favorable. The technique is presented as an alternative method for repair of these lesions.