Vaikunthan Rajaratnam

Publications

• 0.40

  Impact points

  Operative management of intra-articular distal interphalangeal joint fractures of the hand.

  Kanthan Theivendran, Talvinder Singh, Vaikunthan Rajaratnam

  Acta orthopaedica Belgica. 08/2010; 76(4):425-31.

  The management of intra-articular fractures of the hand represents a challenge. Large articular fragments require reduction and operative fixation. A number of surgical techniques have been described in literature, with variable results. Distal interphalangeal joint fractures have been fixed by vari... [more] The management of intra-articular fractures of the hand represents a challenge. Large articular fragments require reduction and operative fixation. A number of surgical techniques have been described in literature, with variable results. Distal interphalangeal joint fractures have been fixed by various methods including screw, plate and suture techniques. Generally operative fixation is indicated when more than 30% of the articular surface is involved with or without subluxation of the joint. The aim of surgery is to reduce the fracture fragments anatomically whilst providing osseous stability, and to commence early active movement of the joint to prevent stiffness. In this review we aim to summarise the main management options for intra-articular distal interphalangeal fractures, placing particular emphasis on surgical treatment.

• Digital video documentation as evidence of clinical skill acquisition.

  Simon Edwards, V Rajaratnam

  Journal of visual communication in medicine. 01/2009; 32(3-4):78-85.

  Video recordings have become requirements for the assessment and recording of the consulting skills module of the MRCGP examination and surgical skill modules for the post FRCS hand diploma examination. Previous research has shown that the knowledge and judgement skills needed by trainees to achieve... [more] Video recordings have become requirements for the assessment and recording of the consulting skills module of the MRCGP examination and surgical skill modules for the post FRCS hand diploma examination. Previous research has shown that the knowledge and judgement skills needed by trainees to achieve operative competence can be reliably assessed using structured checklists. However evaluation of surgical competency should also include technical skills, which have been difficult to document adequately and transparently. There is now evidence demonstrating that surgeons can discriminate between the video recordings of a competent and non-competent trainee. Like those of previous researchers our findings indicate that intra-operative video monitoring enables an objective and permanent recordable assessment of the a trainees skill level whilst completing the checklist after a particular procedure. Video evidence can also be distributed widely to assessors outside the trainee's locale.
• 1.76

  Impact points

  Biomechanical comparison of pull-out force of unicortical versus bicortical screws in proximal phalanges of the hand: a human cadaveric study.

  Mohamed Khalid, Kanthan Theivendran, Mubashir Cheema, Vaikunthan Rajaratnam, Subodh C Deshmukh

  Clinical biomechanics (Bristol, Avon). 11/2008; 23(9):1136-40.

  Bicortical fixation of proximal phalangeal fractures may damage underlying flexor tendons secondary to drilling and screw protrusion in the dorsal-ventral direction. The aim of this study was to measure and compare the pull-out force of unicortical screws compared to bicortical screws in human cadav... [more] Bicortical fixation of proximal phalangeal fractures may damage underlying flexor tendons secondary to drilling and screw protrusion in the dorsal-ventral direction. The aim of this study was to measure and compare the pull-out force of unicortical screws compared to bicortical screws in human cadaveric proximal phalanges to identify optimal configuration for internal fixation. Forty proximal phalanges were harvested. Bicortical and unicortical self tapping 1.7mm screws were inserted into paired phalanges at the distal and proximal metaphysis and at the mid-diaphysis placed in the dorso-ventral direction. Pull-out force of unicortical and bicortical screws were measured and compared. Bicortical screw pull-out force is significantly higher than that of unicortical screws in the dorsal-ventral direction. Pull-out strength of unicortical screws at the mid-diaphysis was significantly higher than the pull-out strength of bicortical screws at the proximal metaphysis (181.8N versus 31.5N, P<0.0001). Diaphyseal fixation is stronger than metaphyseal for both unicortical and bicortical configurations. Unicortical mid-diaphyseal is stronger than bicortical proximal metaphyseal screw pull-out strength. This study provides biomechanical data that may be helpful for individualizing fracture fixation techniques at the proximal phalanx.
• 1.29

  Impact points

  High-resolution ultrasound in the diagnosis of upper limb disorders: a tertiary referral centre experience.

  Gina M Allen, Eleni E Drakonaki, Melissa Ley H Tan, Manpreet Dhillon, Vaikunthan Rajaratnam

  Annals of plastic surgery. 10/2008; 61(3):259-64.

  The purpose of this study is to determine the reliability of high-resolution ultrasound (HRUS) in the diagnosis of upper limb disorders compared with the initial clinical opinion. We prospectively studied 178 patients referred for HRUS examination (47.2% hand, 34.8% wrist, and 18% elbow examinations... [more] The purpose of this study is to determine the reliability of high-resolution ultrasound (HRUS) in the diagnosis of upper limb disorders compared with the initial clinical opinion. We prospectively studied 178 patients referred for HRUS examination (47.2% hand, 34.8% wrist, and 18% elbow examinations) by recording the clinical opinion, the specific ultrasound diagnosis, and the final diagnosis, as established by surgery (79.9%) or follow-up (20.1%). HRUS examination was highly reliable in diagnosing cystic lesions, synovial disease, ligament injury and foreign bodies (100%), and slightly less reliable for solid lesions (82.1%) and nerve, bone, and tendon disorders (97%, 91.7%, 86.5%, respectively). HRUS examination resulted in significantly more correct diagnoses (92.1%) than the clinical opinion (70.8%) (McNemar test, P = 0.001). The agreement between the HRUS diagnosis and the clinical opinion was slight (Kappa test, k = 0.16). HRUS examination is more reliable than clinical examination in diagnosing upper limb disorders.
• 1.29

  Impact points

  A biomechanical analysis of distraction force in modified hynes-Giddins dynamic external fixator.

  Mubashir Cheema, Karanjit Mangat, Nicola Holbrook, Vaikunthan Rajaratnam

  Annals of plastic surgery. 10/2007; 59(3):300-1.

  Hynes and Giddins modified the rubber band traction device advocated by Suzuki for management of phalangeal pilon fractures and fracture-dislocations. We present here a modification of the Hynes-Giddins version of this dynamic external fixator, which allows alteration of the distracting force by a s... [more] Hynes and Giddins modified the rubber band traction device advocated by Suzuki for management of phalangeal pilon fractures and fracture-dislocations. We present here a modification of the Hynes-Giddins version of this dynamic external fixator, which allows alteration of the distracting force by a simple adjustment of the construct.

• Mr

  Vaikunthan Rajaratnam, Mubashir Cheema, Syed Nadir Ali

  07/2007;

  ISBN: 978-0-9558489-1-9
• 1.29

  Impact points

  Proximal interphalangeal joint fractures of the hand: treatment with an external dynamic traction device.

  Kanthan Theivendran, Jonathan Pollock, Vaikunthan Rajaratnam

  Annals of plastic surgery. 07/2007; 58(6):625-9.

  The authors present a series of 11 consecutive patients who sustained an intra-articular fracture of the proximal interphalangeal (PIP) joint and 1 patient with a fracture of the interphalangeal joint of the thumb treated with a Kirschner wire external dynamic traction device. Range of motion and gr... [more] The authors present a series of 11 consecutive patients who sustained an intra-articular fracture of the proximal interphalangeal (PIP) joint and 1 patient with a fracture of the interphalangeal joint of the thumb treated with a Kirschner wire external dynamic traction device. Range of motion and grip strength were measured. We used the Michigan Hand Outcome Questionnaire (MHQ) to obtain a subjective response to the treatment. Average range of motion of the PIP joint was 64 degrees and distal interphalangeal joint was 52 degrees . The average grip strength was 86% with a mean MHQ score of 90. Two patients had pin site infections treated successfully with antibiotics. All fractures had united at final follow up with <1-mm articular step present. Our series highlights that these are difficult injuries to treat and that anatomic reduction is not always possible. However, this technique is simple and quick to perform while allowing early joint mobilization. The subjective response to treatment is comparable with other studies using a similar device.

• The diagnostic accuracy of clinical examination in hand lacerations.

  R Nassab, K Kok, J Constantinides, V Rajaratnam

  International journal of surgery (London, England). 04/2007; 5(2):105-8.

  INTRODUCTION: Hand injuries account for a significant proportion of emergency department attendance. We investigated the diagnostic accuracy of clinical examination in patients with simple hand lacerations undergoing surgical exploration at our unit. METHODS: One hundred and sixty-five consecutive p... [more] INTRODUCTION: Hand injuries account for a significant proportion of emergency department attendance. We investigated the diagnostic accuracy of clinical examination in patients with simple hand lacerations undergoing surgical exploration at our unit. METHODS: One hundred and sixty-five consecutive patients were identified as undergoing exploration of the hand. Case notes of these patients were reviewed. The clinical findings, made by emergency department doctors (ED) and hand surgeons (HS), were compared with the operative findings. RESULTS: A total of 101 patients were included following exclusion criteria. Both ED and HS correctly identified 68.2% of flexor tendon injuries. Overall, the ED diagnosed accurately significantly fewer extensor tendon injuries (ED 65.6% vs HS 75.0%, p<0.001). Similarly, HS diagnosed nerve injuries more accurately than ED (ED 54.5% vs HS 78.8%, p<0.005). DISCUSSION: Clinical examination forms an important part of the patient assessment, provides the surgeon with an idea of which structures are potentially injured, and its value should never be underestimated. Formal exploration, however, should be undertaken since both ED and HS missed about 30% injuries.
• 1.38

  Impact points

  Basal thumb arthritis.

  Richard Dias, Jeevan Chandrasenan, Vaikunthan Rajaratnam, Frank D Burke

  Postgraduate medical journal. 02/2007; 83(975):40-3.

  Basal thumb arthritis is a common condition seen in hand clinics across the United Kingdom and is often associated with other pathological conditions such as carpal tunnel syndrome and scaphotrapezial arthritis. Typically, patients complain of pain localised to the base of the thumb. This pain is of... [more] Basal thumb arthritis is a common condition seen in hand clinics across the United Kingdom and is often associated with other pathological conditions such as carpal tunnel syndrome and scaphotrapezial arthritis. Typically, patients complain of pain localised to the base of the thumb. This pain is often activity related, particularly after excessive use involving forceful pinch. A detailed history and examination is normally all that is needed to make the diagnosis. Provocative manoeuvres may be helpful in localising symptoms to the basal joint with degenerative changes or synovitis. Radiographs are useful for confirming the diagnosis and staging the disease in order to plan for surgery. The mainstay of initial treatment of basal thumb arthritis of any stage is activity modifications, rest, nonsteroidal anti-inflammatory drugs, exercises and splinting. A variety of surgical procedures are available to treat the condition when conservative measures have failed, in order to control symptoms and improve function. We review the current literature and discuss the clinical aspects of this condition, staging, and treatment options available, and the difficulties treating this group of patients.
• 1.29

  Impact points

  A novel hook plate fixation technique for the treatment of mallet fractures.

  Kanthan Theivendran, Andrew Mahon, Vaikunthan Rajaratnam

  Annals of plastic surgery. 02/2007; 58(1):112-5.

  Bony mallet injuries are generally treated nonoperatively, but when the fragment involves a significant percentage of the articular surface, articular incongruity and instability can occur. A number of techniques have been described for the fixation of such fractures and each has its own problems. A... [more] Bony mallet injuries are generally treated nonoperatively, but when the fragment involves a significant percentage of the articular surface, articular incongruity and instability can occur. A number of techniques have been described for the fixation of such fractures and each has its own problems. Anatomic reduction and secure fixation of small fragments can be challenging. Our objective is to describe a new surgical technique using a 1.3-mm hook plate that provides good reduction and stable fixation of a mallet fracture, with early mobilization of the distal interphalangeal joint.

• Surgical process re-engineering: carpal tunnel decompression--a model.

  J A Casaletto, V Rajaratnam

  Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand. 08/2004; 9(1):19-27.

  Surgical process re-engineering is a methodology where the entire surgical process is systematically analysed and re-designed. The process starts with mapping of the current process followed by in-depth analysis of the existing process. A new process is drafted with the aim of making the whole proce... [more] Surgical process re-engineering is a methodology where the entire surgical process is systematically analysed and re-designed. The process starts with mapping of the current process followed by in-depth analysis of the existing process. A new process is drafted with the aim of making the whole procedure more efficient. The new process is then discussed with all the staff involved in the operating room. Following implementation of the process, surgical process re-engineering should ideally be routinely carried out to continuously improve the procedure. We present an example of surgical process re-engineering which we carried out on the procedure of carpal tunnel release. We used carpal tunnel release as a model as it is a very common operation, with predictable intra-operative findings, and the patient is likely to benefit directly from procedure time reduction. A preliminary mapping of three procedures was done followed by a detailed timed mapping of five routine carpal tunnel decompression procedures. The mapped process was analysed in detail and a number of changes were made in the process. After implementing the new process, a further five procedures were mapped and timed again. In comparison to the original process, we achieved a reduction of 20% in the mean procedure time and a reduction of 42% in the number of steps from 66 to 37.