Background:Endoscopic carpal tunnel release (ECTR) has gained recognition as an alternative to the current gold standard, the open carpal tunnel release (OCTR). Detailed technical points for the ECTR have not been explained in the literature, especially for surgeons who are considering trying this technique.Objectives:In this paper, we present our 5-year experience with the ECTR and special emphasis will be placed on less frequently discussed technical points, such as the optimal site to make the skin incision and the signs to look for in a completely divided retinaculum.Patients and Methods:In this prospective nonrandomized clinical trial, 176 patients with carpal tunnel syndrome who underwent surgical operation using the Agee uni-portal endoscopic carpal tunnel release technique, over a period of 5 years, were included. The “Hand Questionnaire”, a standard questionnaire for hand surgery, was used to evaluate the patients at one, three, six and twelve month post-operative time points. Pain and scar tenderness were measured using the visual analog scale system. We propose the ‘most proximally present wrist crease’ for the skin incision and the ‘proximal to distal sequential division of the retinaculum’ as our methods of choice. Two signs, named ‘railroad’ and ‘drop in’, are proposed and these will be discussed in detail as hallmarks of complete retinaculum release.Results:Of the 176 patients who underwent the ECTR operation, 164 cases (93.2%) had no or very little pain at the one year postoperative visit, and nearly all of the patients reported no relapse of symptoms at the previously mentioned postoperative time points. Patient satisfaction and functional recovery was comparable to other published ECTR studies, and showed better short-term results of this technique over the OCTR. One deep seated infection, three cases of transient index finger paresthesia due to scope pressure on the median nerve, and one case of median nerve branch transection, were observed. Scar complications, including; tenderness, redness and pain, were significantly lower in the proximally placed incision in comparison with the distally placed incision (P < 0.005).Conclusions:The ‘most proximally present wrist crease’ and the ‘distal to proximal division of the retinaculum’ using the two signs of ‘railroad’ and ‘drop in’ to confirm a complete division of retinaculum are proposed techniques that should be considered in order to produce good outcomes in ECTR. The ‘railroad’ sign is the parallel standing of the retinaculum edges, and the ‘drop in’ sign is the dropping of the retinaculum edge into the scope denote a completely divided retinaculum.

Background Arthroscopic total wrist arthrodesis is a procedure with minimal violation of extensor compartments and less scar formation, compared with open wrist arthrodesis. In this paper, we would like to present our experience with a modified surgical technique for arthroscopic total wrist arthrodesis. Description of Technique After an arthroscopic cartilage removal through radiocarpal and midcarpal portals, the operation is continued under fluoroscopic control. In this technique, four wires are inserted separately in four various directions (as described in the paper), followed by insertion of self-tapping cannulated screw, under fluoroscopic control. Patients and Methods In this prospective study, a total of four patients underwent arthroscopic total wrist arthrodesis using our surgical technique within a period of 2 years. All four patients were followed for a minimum of 3 months for possible complications and functional outcome. Results The results were satisfactory, and no complication was observed. All the patients had complete union after 12 weeks, and the fusion was radiographically complete in all cases by 12 weeks. All patients were happy with their functional outcomes. Conclusion Using the described modified arthroscopic technique, we did four total wrist arthrodeses with minimal scar, no complication and acceptable functional results.

Necrotizing fasciitis is a rare, life-threatening infection most commonly seen in patients with diabetes mellitus, intravenous drug abuse, and immunocompromised conditions. The extremities are the primary sites of involvement in as many as two thirds of the cases. In a significant proportion of patients, the extremities are involved as a result of trauma, needle puncture or extravasation of drugs. The infection is usually polymicrobial. Treatment involves broad-spectrum antibiotics and multiple surgical debridements or amputation. We present a patient with necrotizing fasciitis of the upper limb and present our experience with this often lethal condition.

Between 2018 and 2020, 14 patients with closed metacarpal fractures requiring open reduction were operated on via a palmar approach. Reduction and fixation were done with screws or plates. We assessed range of motion, grip strength, Mayo score, possible nerve damage and cosmesis. The range of motion and grip strength were fully restored by 6 months after operation. Transient paraesthesiae in the digital nerve territory occurred in two patients and had resolved by 3 months. In selected patients the palmar approach for metacarpal shaft fractures can provide satisfactory cosmesis and function of the hand. This method can be useful in patients with history of hypertrophic scarring or in patients who would prefer to avoid a visible scar on the dorsum of the hand. Level of evidence: IV