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Reconstruction of the Flexor Pollicis Longus Tendon with Vascularized Tendon with Ulnar Artery Preservation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4853. [PMID: 36910734 PMCID: PMC9995099 DOI: 10.1097/gox.0000000000004853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/18/2023] [Indexed: 03/11/2023]
Abstract
Reconstruction of the flexor pollicis longus tendon using staged grafting yields modest results. A modification of the pedicled vascularized flexor digitorum superficialis transfer, without division of the ulnar artery, was used in five patients. Methods The flexor digitorum superficialis and its gliding tissue were transferred in five patients, based on a branch of the ulnar artery without division of the ulnar vessels. Functional results were evaluated using a total active range of motion and Buck-Gramko score at 10 months by an independent hand therapist. Results The mean total active motion of the interphalangeal joint was 49 degrees, with a Buck-Gramko score of excellent in three cases and good in two. No complications were recorded. Conclusion Reconstruction of the flexor pollicis longus tendon with single-staged vascularized FDS transfer without ulnar artery division yielded good results in a small cohort of five cases.
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Macken AA, Lans J, Özkan S, Kramer S, Jupiter JB, Chen NC. Outcomes of Flexor Pollicis Longus Reconstruction for Volar Plate Related Ruptures. J Hand Microsurg 2021. [DOI: 10.1055/s-0041-1739961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Aim A rare complication following volar plate fixation of a distal radius fracture is flexor pollicis longus (FPL) rupture. This study aims primarily to analyze the radiographic features and secondly to report the patient-reported outcomes of FPL reconstruction after volar plate fixation.
Methods Ten patients were retrospectively identified and contacted for follow-up. Seven patients participated in the study and completed the numeric rating scale (NRS) for pain, patient-reported outcome measurement information system—upper extremity (PROMIS-UE), and quick disability of arm, shoulder, and hand (QuickDASH) questionnaires at a median of 3.4 years following FPL reconstruction. Soong grade was determined on preoperative radiographs.
Results Six patients were classified as Soong grade 1 and two patients had a screw or wire protruding volarly. The median time to tendon rupture was 21.6 months. At final follow-up, the median NRS pain score was 0 (range: 0–7); the median PROMIS-UE score was 47.1 (range: 25.9–61); and the median QuickDASH-score was 12.5 (range: 4.5–75).
Conclusions The outcome of FPL reconstruction after volar plate fixation is highly variable. All ruptures in our cohort occurred in patients with plate positioning classified as Soong grade 1 and occurred at up to 3 years following distal radius fixation.
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Affiliation(s)
- Arno A. Macken
- Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Jonathan Lans
- Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Sezai Özkan
- Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Simon Kramer
- Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Jesse B. Jupiter
- Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Neal C. Chen
- Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Gonera B, Kurtys K, Paulsen F, Polguj M, LaPrade RF, Grzelecki D, Karauda P, Olewnik Ł. The plantaris muscle - Anatomical curiosity or a structure with important clinical value? - A comprehensive review of the current literature. Ann Anat 2021; 235:151681. [PMID: 33561523 DOI: 10.1016/j.aanat.2021.151681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Although the plantaris muscle is vestigial in humans, it is far too important to remain omitted. The aim of this study is to provide a comprehensive review of the existing literature focused on plantaris muscle clinical value, grafting usefulness and its morphological variations. Hopefully this study will be of great use for every medical practitioner due to its clarity and conciseness despite such broaden scope of this article. MATERIAL AND METHODS The article is written based on 100 studies published since 1868 until 2020. During careful selection process 12 papers were dismissed due to their insufficient sample size, wrong methods used or results that were previously discovered. RESULTS Many aspects concerning the plantaris muscle are already well examined, summarized and described. However this study has shown how much we still do not know and which fields require further investigations. CONCLUSION The anatomical variations of plantaris muscle morphology may cause mid-portion Achilles tendinopathy, tennis leg syndrome or increase the risk of failure while harvesting the tendons.
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Affiliation(s)
- Bartosz Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
| | - Konrad Kurtys
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | | | - Dariusz Grzelecki
- Centre of Postgraduate Medical Education, Department of Orthopedics and Rheumoorthopedics, Otwock, Poland
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
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4
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Gonera B, Kurtys K, Karauda P, Olewnik Ł, Polguj M. Possible effect of morphological variations of plantaris muscle tendon on harvesting at reconstruction surgery-case report. Surg Radiol Anat 2020; 42:1183-1188. [PMID: 32248255 PMCID: PMC7366566 DOI: 10.1007/s00276-020-02463-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/23/2020] [Indexed: 01/11/2023]
Abstract
Purpose Seemingly a well-known, weak, and vestigial plantaris muscle should not be a revelation. However, recent studies have shown that this structure is incredibly underestimated and perceived only as an infirm flexor of the talocrural joint, the knee joint or a great source of graft tissue. Usually, the origin of this inconspicuous muscle begins at the lateral supracondylar line of the femur and the knee joint capsule. It continues distally, forming a long and slender tendon. In most cases, it inserts onto the calcaneal tuberosity on the medial side of the Achilles tendon. However, many morphological variations have been discovered during anatomical dissections and surgical procedures. Nevertheless, according to the present literature, no other studies presented such a complex insertion variant, with indisputable clinical value and significant proof of development of this forgotten muscle. Methods The dissection of the right thigh, knee, crural and talocrural region was performed using standard techniques according to a strictly specified protocol. Results Four different insertion points were observed. The first band (A) inserted near to the tarsal canal flexor retinaculum. The second band (B) bifurcates into two branches—B1 and B2. B1 is located on the medial side and B2 is located on the lateral side of the calcaneal tuberosity. The third band (C) is inserted into the superior nonarticular calcaneal surface of the calcaneus anteriorly to the Achilles tendon. Conclusion A differently shaped plantaris tendon could be considered a cause of harvesting procedure failure. In the light of new case reports perhaps what we are now witnessing is remodeling and transformation of the Plantaris muscle. If so, the awareness of the influence on the onset of Achilles midportion tendinopathy or a potential role in tibialis posterior conflict can be crucial for every clinician.
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Affiliation(s)
- B Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Mechaniczna 5a, 92-310, Lodz, Poland.
| | - K Kurtys
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Mechaniczna 5a, 92-310, Lodz, Poland
| | - P Karauda
- Department of Normal and Clinical Anatomy, Medical University of Lodz, Lodz, Poland
| | - Ł Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Mechaniczna 5a, 92-310, Lodz, Poland
| | - M Polguj
- Department of Normal and Clinical Anatomy, Medical University of Lodz, Lodz, Poland
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5
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Langer MF, Wieskötter B, Oeckenpöhler S, Unglaub F, Spies C, Grünert JG. [Secondary reconstruction of flexor tendons]. Unfallchirurg 2020; 123:114-125. [PMID: 31822942 DOI: 10.1007/s00113-019-00747-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The secondary reconstruction of flexor tendons is in most cases very demanding and tedious. The indications, selection of the correct surgical procedure, operative technique and further treatment have to be individually adjusted and are mostly very difficult. Due to the previous operations unpleasant surprises may occur intraoperatively, which must be recognized and treated by the surgeon. Nevertheless, a significant improvement of the function of the whole hand can be achieved for most patients, e.g. by a two-stage flexor tendon transplantation or other techniques described in this article.
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Affiliation(s)
- Martin Franz Langer
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland.
| | - Britta Wieskötter
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland
| | - Simon Oeckenpöhler
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland
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Rajan PV, Qudsi RA, Dyer GS, Losina E. The Cost-Effectiveness of Surgical Fixation of Distal Radial Fractures: A Computer Model-Based Evaluation of Three Operative Modalities. J Bone Joint Surg Am 2018; 100:e13. [PMID: 29406347 PMCID: PMC6819022 DOI: 10.2106/jbjs.17.00181] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is no consensus on the optimal fixation method for patients who require a surgical procedure for distal radial fractures. We used cost-effectiveness analyses to determine which of 3 modalities offers the best value: closed reduction and percutaneous pinning, open reduction and internal fixation, or external fixation. METHODS We developed a Markov model that projected short-term and long-term health benefits and costs in patients undergoing a surgical procedure for a distal radial fracture. Simulations began at the patient age of 50 years and were run over the patient's lifetime. The analysis was conducted from health-care payer and societal perspectives. We estimated transition probabilities and quality-of-life values from the literature and determined costs from Medicare reimbursement schedules in 2016 U.S. dollars. Suboptimal postoperative outcomes were determined by rates of reduction loss (4% for closed reduction and percutaneous pinning, 1% for open reduction and internal fixation, and 11% for external fixation) and rates of orthopaedic complications. Procedural costs were $7,638 for closed reduction and percutaneous pinning, $10,170 for open reduction and internal fixation, and $9,886 for external fixation. Outputs were total costs and quality-adjusted life-years (QALYs), discounted at 3% per year. We considered willingness-to-pay thresholds of $50,000 and $100,000. We conducted deterministic and probabilistic sensitivity analyses to evaluate the impact of data uncertainty. RESULTS From the health-care payer perspective, closed reduction and percutaneous pinning dominated (i.e., produced greater QALYs at lower costs than) open reduction and internal fixation and dominated external fixation. From the societal perspective, the incremental cost-effectiveness ratio for closed reduction and percutaneous pinning compared with open reduction and internal fixation was $21,058 per QALY and external fixation was dominated. In probabilistic sensitivity analysis, open reduction and internal fixation was cost-effective roughly 50% of the time compared with roughly 45% for closed reduction and percutaneous pinning. CONCLUSIONS When considering data uncertainty, there is only a 5% to 10% difference in the frequency of probability combinations that find open reduction and internal fixation to be more cost-effective. The current degree of uncertainty in the data produces difficulty in distinguishing either strategy as being more cost-effective overall and thus it may be left to surgeon and patient shared decision-making. LEVEL OF EVIDENCE Economic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Prashant V. Rajan
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center (P.V.R., R.A.Q., and E.L.) and Department of Orthopaedic Surgery (P.V.R., G.S.M.D., and E.L.), Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Rameez A. Qudsi
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center (P.V.R., R.A.Q., and E.L.) and Department of Orthopaedic Surgery (P.V.R., G.S.M.D., and E.L.), Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
| | - George S.M. Dyer
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center (P.V.R., R.A.Q., and E.L.) and Department of Orthopaedic Surgery (P.V.R., G.S.M.D., and E.L.), Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elena Losina
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center (P.V.R., R.A.Q., and E.L.) and Department of Orthopaedic Surgery (P.V.R., G.S.M.D., and E.L.), Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
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Step Cut Lengthening: A Technique for Treatment of Flexor Pollicis Longus Tendon Rupture. Ann Plast Surg 2017; 80:353-355. [PMID: 29166314 DOI: 10.1097/sap.0000000000001266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Reconstruction of a tendon defect is a challenging task in hand surgery. Delayed repair of a ruptured flexor pollicis longus (FPL) tendon is often associated with tendon defect. Primary repair of the tendon is often not possible, particularly after debridement of the unhealthy segment of the tendon. As such, various surgical treatments have been described in the literature, including single-stage tendon grafting, 2-stage tendon grafting, flexor digitorum superficialis tendon transfer from ring finger, and interphalangeal joint arthrodesis. We describe step cut lengthening of FPL tendon for the reconstruction of FPL rupture. This is a single-stage reconstruction without the need for tendon grafting or tendon transfer. To our knowledge, no such technique has been previously described.
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Ohi H, Uchiyama S, Kanda T, Mukoda M, Hayashi M, Kato H. Outcomes of grafting intrasynovial tendons of the toes to the hands in 10 patients: a preliminary report. J Hand Surg Eur Vol 2017; 42:469-472. [PMID: 28193099 DOI: 10.1177/1753193417691653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ten patients had intrasynovial tendon grafting harvested from the toes for secondary flexor tendon reconstruction in nine fingers and one thumb in our institutes from 2009 to 2014. These patients were followed for a mean of 15 (range: 8-36) months. The ranges of total active motion of the proximal and distal interphalangeal joints of these nine fingers were 143° (range: 108-175°) and of the metacarpophalangeal and interphalangeal joints of one thumb were 110°. In conclusion, this technique is feasible and gives a good result when successful but with a high complication rate. Level of Evidence IV.
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Affiliation(s)
- H Ohi
- 1 Hand and Microsurgery Center, Seirei Hamamatsu Hospital, Hamamatsu, Japan
| | - S Uchiyama
- 2 Department of Orthopaedic Surgery, Shinshu University School of Medicine. Matsumoto, Japan
| | - T Kanda
- 1 Hand and Microsurgery Center, Seirei Hamamatsu Hospital, Hamamatsu, Japan
| | - M Mukoda
- 1 Hand and Microsurgery Center, Seirei Hamamatsu Hospital, Hamamatsu, Japan
| | - M Hayashi
- 2 Department of Orthopaedic Surgery, Shinshu University School of Medicine. Matsumoto, Japan
| | - H Kato
- 2 Department of Orthopaedic Surgery, Shinshu University School of Medicine. Matsumoto, Japan
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9
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Ahmad T, Bashir SA, Zaroo MI, Wani AH, Rashid S, Jan S. Silicone Foley's catheter as an effective alternative to Hunter's rod in staged flexor tendon reconstruction of the hand. Indian J Plast Surg 2017; 49:322-328. [PMID: 28216811 PMCID: PMC5288906 DOI: 10.4103/0970-0358.197232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: Staged flexor tendon reconstruction is most suitable treatment method for extensive zone II tendon injuries. The Hunter's rod used in this procedure is costly and not easily available, which adds to the miseries of both patients as well as treating surgeon. Aims: The aim of this study is to evaluate the results of staged zone II flexor tendon repair using silicone Foley's catheter as a cheaper and readily available alternative to Hunter's rod. Settings and Design: This was a prospective study. Materials and Methods: Seventy digits in 35 patients were treated by the staged flexor tendon reconstruction using silicone Foley's catheter in place of Hunter's rod, and the patients were followed for an average period of 18 months. Early controlled motion exercise protocol was instituted in all cases. Results: As per the Strickland scale, total active motion obtained was excellent in 70%, good in 20%, fair in 7.1% and poor in 2.9% of patients. Conclusions: Silicone Foley's catheter is cheaper, easily available and an effective alternative to Hunter's rod in staged flexor tendon reconstruction procedure, yielding high rates of excellent and good results with fewer complications.
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Affiliation(s)
- Tawheed Ahmad
- Department of Plastic and Reconstructive Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sheikh Adil Bashir
- Department of Plastic and Reconstructive Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Mohammad Inam Zaroo
- Department of Plastic and Reconstructive Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Adil Hafeez Wani
- Department of Plastic and Reconstructive Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Saima Rashid
- Department of Plastic and Reconstructive Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Summaira Jan
- Department of Plastic and Reconstructive Surgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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10
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Toney CB, Owen JR, Khatri IA, Wayne JS, McDowell CL. Bone-Prosthesis Junction for Active Tendon Implants: A Biomechanical Comparison of 2 Fixation Techniques. J Hand Surg Am 2016; 41:526-31. [PMID: 26880494 DOI: 10.1016/j.jhsa.2016.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/05/2016] [Accepted: 01/08/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To study the biomechanical characteristics (percent stretch, stiffness, and ultimate load) of 2 distal fixation techniques for an active tendon implant used in the reconstruction of flexor tendons. METHODS We evaluated percent stretch after cyclical loading and at failure, stiffness during load-to-failure, and peak load of 28 bone-prosthesis junctions using cadaveric canine middle phalanges to study 2 fixation techniques: metal cleat and screw versus polyester cords secured with a knot. RESULTS The knot constructs displayed greater percent stretch during and following cyclical loading between 2 N and 50 N and at peak load. The screw construct showed greater stiffness from 50 N to 150 N during load-to-failure. Both fixation techniques failed at a mean peak load greater than 340 N. CONCLUSIONS Both fixation techniques for active tendon implants withstood loads seen with passive and active motion in the immediate postoperative period. Knot constructs displayed significant stretch during cyclical and load-to-failure testing, which would need to be compensated for during surgery. The screw constructs showed greater stiffness than the constructs secured with the surgeon's knot, but failure created an intra-articular fracture. CLINICAL RELEVANCE The results may aid the surgeon in choosing which fixation technique to use, during tensioning of cords, and in permitting active motion following surgery.
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Affiliation(s)
- Clarence B Toney
- Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, Richmond, VA
| | - John R Owen
- Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, Richmond, VA
| | - Imran A Khatri
- Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, Richmond, VA
| | - Jennifer S Wayne
- Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, Richmond, VA.
| | - Charles L McDowell
- Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, Richmond, VA
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Abstract
BACKGROUND Insufficiency of both flexor tendons of a finger considerably disrupts the function of the whole hand. Flexor tendon transplantation represents the best way to reconstruct or improv function in many cases. OBJECTIVES Based on the literature and our own results, not only the current state of the surgical technique, but also the opportunities and dangers of this sophisticated operation, are represented. Knowledge of alternative methods is important. METHODS With a follow-up of between 2 to 12 years, a total of 272 patients who underwent flexor tendon transplantation in the hand during several periods from 1974 to 2000 were investigated. RESULTS Similar to the international literature, our long-term results did not specify the exact surgical technique (pedicled or free). According to the Buck-Gramcko score, 32 % had very good results, 26.4 % good, 15.1 % satisfactory, and 26.5 % poor. CONCLUSIONS Numerous details need to be considered before, during, and after surgery. For the patient, the procedure has tremendous significance in many ways; thus, this operation should only be performed by an experienced hand surgeon.
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12
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Abstract
Treating a fracture of the distal radius may require the surgeon to make a difficult decision between surgical treatment and nonsurgical management. The use of surgical fixation has recently increased because of complications associated with conservative treatment. However, conservative action may be necessary depending on certain patient factors. The treating surgeon must be aware of the possible complications associated with distal radius fracture treatments to prevent their occurrence. Prevention can be achieved with a proper understanding of the mechanism of these complications. This article discusses the most recent evidence on how to manage and prevent complications following a fracture of the distal radius.
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Affiliation(s)
- Kevin C. Chung
- Professor of Surgery, Section of Plastic Surgery, Assistant Dean for Faculty Affairs, The University of Michigan
| | - Alexandra L. Mathews
- Research Assistant, Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System
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13
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Cavadas PC, Pérez-García A, Thione A, Lorca-García C. Single-stage reconstruction of flexor tendons with vascularized tendon transfers. J Hand Surg Eur Vol 2015; 40:259-68. [PMID: 24436359 DOI: 10.1177/1753193413520277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The reconstruction of finger flexor tendons with vascularized flexor digitorum superficialis (FDS) tendon grafts (flaps) based on the ulnar vessels as a single stage is not a popular technique. We reviewed 40 flexor tendon reconstructions (four flexor pollicis longus and 36 finger flexors) with vascularized FDS tendon grafts in 38 consecutive patients. The donor tendons were transferred based on the ulnar vessels as a single-stage procedure (37 pedicled flaps, three free flaps). Four patients required composite tendon and skin island transfer. Minimum follow-up was 12 months, and functional results were evaluated using a total active range of motion score. Multiple linear regression analysis was performed to evaluate the factors that could be associated with the postoperative total active range of motion. The average postoperative total active range of motion (excluding the thumbs) was 178.05° (SD 50°). The total active range of motion was significantly lower for patients who were reconstructed with free flaps and for those who required composite tendon and skin island flap. Age, right or left hand, donor/motor tendon and pulley reconstruction had no linear effect on total active range of motion. Overall results were comparable with a published series on staged tendon grafting but with a lower complication rate. Vascularized pedicled tendon grafts/flaps are useful in the reconstruction of defects of finger flexor tendons in a single stage, although its role in the reconstructive armamentarium remains to be clearly established.
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Affiliation(s)
- P C Cavadas
- Reconstructive Surgery, Hospital de Manises, Valencia, Spain
| | - A Pérez-García
- Reconstructive Surgery, Hospital de Manises, Valencia, Spain
| | - A Thione
- Reconstructive Surgery, Hospital de Manises, Valencia, Spain
| | - C Lorca-García
- Reconstructive Surgery, Hospital de Manises, Valencia, Spain
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14
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Thompson MJ, Owen JR, McDowell CL, Wayne JS. Proximal tendon-prosthesis junction for active tendon implants of the hand: a biomechanical comparison of 2 techniques. J Hand Surg Am 2015; 40:109-14. [PMID: 25534839 DOI: 10.1016/j.jhsa.2014.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 10/17/2014] [Accepted: 10/20/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To study the biomechanical characteristics (percent stretch, stiffness, and ultimate load) of 2 tendon-prosthesis techniques used to connect the proximal tendon stump to silicone active tendon implants used in reconstruction of flexor tendons. METHODS We evaluated percent stretch following cyclic loading and at failure, stiffness during load to failure, and ultimate load of 16 tendon-prosthesis junctions using cadaveric canine flexor digitorum profundus tendons to re-create 2 junction techniques: the tendon loop (TL) and the polyester weave (PW). RESULTS The TL junction showed greater percent stretch at a static load of 2 N, following 500 cycles of loading between 2 N and 50 N, and at peak load. The PW junction displayed greater stiffness from 50 to 150 N during load to failure. Both junctions failed at a mean ultimate load greater than 220 N. CONCLUSIONS The described proximal junction techniques for active tendon implants were strong enough to resist early active motion in the immediate postoperative period without significant elongation. The PW technique displayed greater stiffness and ultimate load compared with the TL. CLINICAL RELEVANCE Data on tendon-prosthesis characteristics of these 2 methods may aid the surgeon in choosing which junction technique to use, during surgical tensioning decisions, and in considering activity protocols after surgery. These data may also serve as a baseline for further investigations regarding active tendon implants.
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Affiliation(s)
- Matthew J Thompson
- Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery & Biomedical Engineering, Virginia Commonwealth University, Richmond, VA
| | - John R Owen
- Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery & Biomedical Engineering, Virginia Commonwealth University, Richmond, VA
| | - Charles L McDowell
- Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery & Biomedical Engineering, Virginia Commonwealth University, Richmond, VA
| | - Jennifer S Wayne
- Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery & Biomedical Engineering, Virginia Commonwealth University, Richmond, VA.
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Sasaki J, Itsubo T, Nakamura K, Hayashi M, Uchiyama S, Kato H. Intrasynovial tendon graft for chronic flexor tendon laceration of the finger: a case report. Open Orthop J 2013; 7:282-5. [PMID: 24015158 PMCID: PMC3763753 DOI: 10.2174/1874325001307010282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 06/08/2013] [Accepted: 06/09/2013] [Indexed: 11/22/2022] Open
Abstract
We present the case of a patient with flexor digitorum profundus tendon laceration at the A2 pulley level caused by an injury to the base of the right ring finger by a knife. The patient was treated by flexor tendon reconstruction from the palm to the fingertip by using the left second toe flexor tendon as a graft, which improved the active range of motion. Further improvement was achieved by subsequent tenolysis, which eventually restored nearly normal function. Our experience with this case indicates that the intrasynovial tendon is a reasonable graft source for the synovial space in fingers and may enable restoration of excellent postoperative function.
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Affiliation(s)
- Jun Sasaki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto-City, Nagano 390-8621, Japan
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Abstract
Tendon injuries in the digital flexor sheath area (zone II) are the most difficult to treat and remain a focus of both clinical attention and basic investigations. Although some new techniques have been developed, the clinical results are still not satisfying, especially in old injuries. This retrospective study was designed to investigate the results of delayed zone II flexor tendon repair using Hunter rods. Between July 1974 and June 1998, 81 patients at our institution underwent 2-stage reconstruction using Hunter's technique. Sixty-one patients with 106 fingers were included in this study. Digital flexor tendon resection and Hunter rod implantation were performed in the first-stage operation. Combined digital nerve injuries and damaged pulleys were repaired or reconstructed at the same time. Plaster was used to immobilize the hand for 3 weeks. During the second-stage operation, performed 2 to 6 months later, palmaris longus or plantaris were grafted into the pseudosheath formed surrounding the Hunter rods. The proximal end of the transplanted tendon was fixated with flexor digitorum profundus tendon using the Pulvertaft method, and the distal end was fixated to the distal phalanx using Bunnell's pullout wire method. Early controlled motion was performed in all cases. Evaluation based on total active motion was good to excellent in 84%, fair in 12%, and poor in 4% of patients. Flexor tendon reconstruction using Hunter technique is an effective way to restore digital function in delayed zone II flexor tendon injuries.
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Affiliation(s)
- Siguo Sun
- Department of Orthopedic Surgery, Tangdu Hospital, the Fourth Military Medical University, Xi’an, Shhanxi Province, China
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Stecco C, Lancerotto L, Porzionato A, Macchi V, Tiengo C, Parenti A, Sanudo JR, De Caro R. The palmaris longus muscle and its relations with the antebrachial fascia and the palmar aponeurosis. Clin Anat 2009; 22:221-9. [DOI: 10.1002/ca.20747] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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