Chapter 28 Thumb Metacarpophalangeal Joint Fusion and Ulnar Collateral Ligament Repair



10.1055/b-0037-142199

Chapter 28 Thumb Metacarpophalangeal Joint Fusion and Ulnar Collateral Ligament Repair

Donald H. Lalonde

ADVANTAGES OF WALANT VERSUS SEDATION AND TOURNIQUET IN THUMB METACARPOPHALANGEAL JOINT FUSION




  • You can walk around the operating table and assess how the thumb looks with patient active movement after you fix the metacarpophalangeal (MCP) joint with K-wires. You and the patient can compare the active movement of the K-wired thumb to the normal thumb on the other hand.



  • Patients can see the thumb position and their thumb move after you place the first K-wires. They can participate in choosing the final angle of fixation, because you can reposition the K-wires if you choose to do so.



  • Both you and the patient leave the operating room with realistic expectations of final possible thumb movement.



  • Patients get to see that the thumb will still be able to move before the skin is closed. They know that all can work well once they get past the postoperative discomfort and stiffness. They will be motivated to regain the movement they saw in the operating room.



  • All of the general advantages listed in Chapter 2 apply to both the surgeon and the patient.



ADVANTAGES OF WALANT VERSUS SEDATION AND TOURNIQUET IN ULNAR COLLATERAL LIGAMENT REPAIR




  • You can check the stability of the reconstructed MCP joint by observing active movement during the surgery.



  • All of the other advantages listed above with fusion also apply.



WHERE TO INJECT THE LOCAL ANESTHETIC FOR THUMB MCP JOINT FUSION AND ULNAR COLLATERAL LIGAMENT REPAIR

Injection of the hand for thumb MP joint fusion and ulnar collateral ligament (UCL) repair. Volar injection: Inject 12 ml of 1% lidocaine with 1:100,000 epinephrine (buffered with 10 ml lido/epi:1 ml of 8.4% sodium bicarbonate). Dorsal injection: Inject 12 ml of 1% lidocaine with 1:100,000 epinephrine (buffered with 10 ml lido/epi:1 ml of 8.4% sodium bicarbonate).



  • See Chapter 1, Atlas, for more illustrations of the anatomy of diffusion of tumescent local anesthetic in the forearm, wrist, and hand.

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May 29, 2020 | Posted by in ORTHOPEDIC | Comments Off on Chapter 28 Thumb Metacarpophalangeal Joint Fusion and Ulnar Collateral Ligament Repair
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