1.0 Carpal Tunnel Release
Infographic content for Carpal Tunnel Release will be added here.
2.0 Digital Block Anesthesia
Infographic content for Digital Block Anesthesia will be added here.
3.0 Fingertip Injury & Nail Plate Management
The Doctrine: PRESERVE THE PLATE
- Anatomic Splint: Stabilizes tuft fractures.
- Eponychial Stent: Prevents synechiae (critical!).
- Pain Reduction: Shields the exposed nail bed.
- To Repair the Bed: The *only* reason.
- Washout: For suspected open fractures.
Decision Algorithm
Check for ANY:
- Nail plate avulsed/fragmented.
- Tuft fracture is present.
- Hematoma >50% (adult) or any (pediatric).
Protocol B: ELEVATE & REPAIR
Protocol A: RETAIN
1. ELEVATE, not Avulse
Use a blunt elevator. Go distal to proximal.
2. Meticulous Bed Repair
Use 5-0 or 6-0 chromic gut.
3. Stenting is MANDATORY
Replace nail or use Xeroform. Seat with 1 distal suture.
4.0 Vaughan-Jackson Syndrome
Surgical Management of Vaughan-Jackson Syndrome
A Visual Guide to the Reconstructive Ladder
The Pathologic Process: A Mechanical Failure
Vaughan-Jackson syndrome is the result of attritional rupture of extensor tendons over a dorsally subluxated and eroded ulnar head (Caput Ulna Syndrome), creating a predictable cascade of tendon failure.
Key Diagnostic Differentiators
- Vaughan-Jackson: Absent tenodesis effect. Prominent, tender ulnar head.
- PIN Palsy: Preserved wrist extension, no active finger/thumb MP extension.
- Tendon Subluxation: Passive MP extension relocates the tendon, allowing active hold.
The Cascade of Failure
1. EDC V & EDM: Rupture begins at the little finger.
2. EDC IV: Progresses to the ring finger.
3. EDC III: Continues to the middle finger.
4. EDC II: May not have IF extensor lag ∵ EIP.
The Non-Negotiables: Foundational Surgical Steps
Dorsal Tenosynovectomy
Complete removal of all hypertrophic synovial tissue.
Distal Ulna Management
Resection (e.g., Darrach) to eliminate the mechanical cause.
Soft Tissue Interposition
Retinacular flap to protect the repair from resected bone.
The Reconstructive Ladder
This chart illustrates primary options. As more tendons rupture, more robust motor donors are required.