1
|
Bhat AK, Pai GM, Acharya AM, Manohar A. Wrist Arthrodesis Using a Trapezoidal Wedge Graft from the Distal Radius and a Low-Profile Reconstruction Plate. Indian J Orthop 2023; 57:1092-1099. [PMID: 37384010 PMCID: PMC10293482 DOI: 10.1007/s43465-023-00884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/24/2023] [Indexed: 06/30/2023]
Abstract
Background Various intramedullary or dorsally based fusions have been utilised to perform wrist arthrodesis. Although the dorsal plate is rigid and well constructed, the standard of care was replenishing the arthrodesis site with an iliac crest bone graft. Due to the high morbidity of the donor site, alternatives such as distal radius bone grafts have gained popularity. In this study, wrist arthrodesis was performed with a locally accessible trapezoidal wedge graft from the distal radius and a low-profile reconstruction plate to evaluate the radiological and functional outcome. Methods We retrospectively reviewed 22 wrists, 14 brachial plexus injuries, 4 post-traumatic injuries, and 4 rheumatoid arthritis patients, with a mean follow-up of 31 months. Union was evaluated on radiography. The functional outcomes were evaluated using a visual analog scale incorporated into a questionnaire. Results All 22 fusions united successfully, with a mean duration of 12 weeks and a wrist position of an average 17.5 degrees of extension and 6 degrees of ulnar deviation. The aesthetics of the wrist showed the most significant change, and overall satisfaction levels increased. Conclusions A locally accessible cortico-cancellous graft from the dorsum of the radius is a reliable alternative to an iliac crest or carpal bone graft with high potential for the union. It also serves as a stable strut in our construct, allowing us to use a low-profile reconstruction plate. The Reconstruction (3.5 System) plate can be used safely with excellent results and a low implant prominence or breakage risk.
Collapse
Affiliation(s)
- Anil K. Bhat
- Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | - G. Mithun Pai
- Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | - Ashwath M. Acharya
- Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| | - Amruth Manohar
- Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104 India
| |
Collapse
|
2
|
Fundaun J, Kolski M, Baskozos G, Dilley A, Sterling M, Schmid AB. Nerve pathology and neuropathic pain after whiplash injury: a systematic review and meta-analysis. Pain 2022; 163:e789-e811. [PMID: 35050963 PMCID: PMC7612893 DOI: 10.1097/j.pain.0000000000002509] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/29/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT There is no clear understanding of the mechanisms causing persistent pain in patients with whiplash-associated disorder (WAD). The aim of this systematic review was to assess the evidence for nerve pathology and neuropathic pain in patients with WAD. EMBASE, PubMed, CINAHL (EBSCO), and MEDLINE were searched from inception to September 1, 2020. Study quality and risk of bias were assessed using the Newcastle-Ottawa Quality Assessment Scales. Fifty-four studies reporting on 390,644 patients and 918 controls were included. Clinical questionnaires suggested symptoms of predominant neuropathic characteristic in 34% of patients (range 25%-75%). The mean prevalence of nerve pathology detected with neurological examination was 13% (0%-100%) and 32% (10%-100%) with electrodiagnostic testing. Patients independent of WAD severity (Quebec Task Force grades I-IV) demonstrated significantly impaired sensory detection thresholds of the index finger compared with controls, including mechanical (SMD 0.65 [0.30; 1.00] P < 0.005), current (SMD 0.82 [0.25; 1.39] P = 0.0165), cold (SMD -0.43 [-0.73; -0.13] P = 0.0204), and warm detection (SMD 0.84 [0.25; 1.42] P = 0.0200). Patients with WAD had significantly heightened nerve mechanosensitivity compared with controls on median nerve pressure pain thresholds (SMD -1.10 [-1.50; -0.70], P < 0.0001) and neurodynamic tests (SMD 1.68 [0.92; 2.44], P = 0.0004). Similar sensory dysfunction and nerve mechanosensitivity was seen in WAD grade II, which contradicts its traditional definition of absent nerve involvement. Our findings strongly suggest a subset of patients with WAD demonstrate signs of peripheral nerve pathology and neuropathic pain. Although there was heterogeneity among some studies, typical WAD classifications may need to be reconsidered and include detailed clinical assessments for nerve integrity.
Collapse
Affiliation(s)
- Joel Fundaun
- Nuffield Department of Clinical Neurosciences, The University of Oxford, Oxford, United Kingdom
| | - Melissa Kolski
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
- Musculoskeletal Outpatient Department, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Georgios Baskozos
- Nuffield Department of Clinical Neurosciences, The University of Oxford, Oxford, United Kingdom
| | - Andrew Dilley
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Queensland, Australia
| | - Annina B Schmid
- Nuffield Department of Clinical Neurosciences, The University of Oxford, Oxford, United Kingdom
| |
Collapse
|
3
|
Ding W, Li X, Chen H, Wang X, Zhou D, Wang X. Nerve merging repair in the replantation of a severed limb with defects in multiple nerves: five cases and long-term follow-up. BMC Surg 2022; 22:222. [PMID: 35681188 PMCID: PMC9185902 DOI: 10.1186/s12893-022-01673-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Repairing all nerves is challenging in cases of upper arm avulsion combined with defects in multiple nerves because the donor area for autogenous nerve transplantation is limited and the outcomes of long-segment allogeneic nerve transplantation are poor. Based on the principle of magnified nerve regeneration, we present a method called nerve merging repair, the feasibility of which needs to be confirmed in clinical practice. Methods The nerve merging repair method relies on the use of fewer proximal nerves to innervate more distal nerves and depends mainly on whether the radial nerve (RN) can repair itself. In the case of defects in multiple nerves precluding RN self-repair, median-(median + radial) (M-(M + R)) repair is performed. If the RN can undergo self-repair, median-(median + ulnar) (M-(M + U)) or ulnar-(ulnar + median) (U-(U + M)) is used to repair the three nerves. Five cases were included in the study and involved the analysis of joint motor function, muscle strength and sensory recovery of the affected limb. Results The replanted limb survived in all 5 cases. Follow-up visits were conducted with the patients for 51–80 months, during which they experienced satisfactory recovery of skin sensation, elbow flexion and extension and partial recovery of hand muscle strength. Conclusions To a certain extent, treatment with the nerve merging repair method improved the sensory and motor function of the affected limb and limited the loss of function of the donor nerve area. This intervention provides a new approach for repairing long-segment defects in multiple nerves caused by avulsion amputation of the upper limb.
Collapse
Affiliation(s)
- Wenquan Ding
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, 315040, Ningbo, China
| | - Xueyuan Li
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, 315040, Ningbo, China
| | - Hong Chen
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, 315040, Ningbo, China
| | - Xiaofeng Wang
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, 315040, Ningbo, China
| | - Danya Zhou
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, 315040, Ningbo, China
| | - Xin Wang
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, 315040, Ningbo, China.
| |
Collapse
|
4
|
Le Nen D, Kerfant N, Dellestable A, Andro C, Letissier H. Wrist fusion in peripheral paralysis. HAND SURGERY & REHABILITATION 2021; 41S:S98-S104. [PMID: 34487861 DOI: 10.1016/j.hansur.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/19/2022]
Abstract
In cases of paralysis of the upper limb, wrist fusion is useful in selected indications, especially when there are little to no tendon transfers available to restore finger function and wrist extension. Wrist fusion is particularly useful in the sequelae of brachial plexus lesions and in total paralysis of the radial nerve with hand drop and preserved wrist flexors. Numerous fusion techniques have been proposed. In cases of sequelae of brachial plexus lesions, locking of pronation-supination is associated with the wrist fusion. The use of anatomical plates has dropped the non-union and complication rates.
Collapse
Affiliation(s)
- D Le Nen
- Service de Chirurgie de la Main et du Membre Supérieur, CHU, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France.
| | - N Kerfant
- Service de Chirurgie Plastique et Reconstructrice, CHU, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France
| | - A Dellestable
- Service de Chirurgie de la Main et du Membre Supérieur, CHU, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France
| | - C Andro
- Service de Chirurgie de la Main et du Membre Supérieur, CHU, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France
| | - H Letissier
- Service de Chirurgie de la Main et du Membre Supérieur, CHU, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France
| |
Collapse
|
5
|
Abstract
Brachial plexus injuries are still challenging for every surgeon taking part in treating patients with BPI. Injuries of the brachial plexus can be divided into injuries of the upper trunk, extended upper trunk, injuries of the lower trunk and swinging hand where all of the roots are involved in this type of the injury. Brachial plexus can be divided in five anatomical sections from its roots to its terminal branches: roots, trunks, division, cords and terminal branches. Brachial plexus ends up as five terminal branches, responsible for upper limb innervation, musculocutaneous, median nerve, axillary nerve, radial and ulnar nerve. According to the findings from the preoperative investigation combined with clinically found functional deficit, the type of BPI will be confirmed and that is going to determine which surgical procedure, from variety of them (neurolysis, nerve graft, neurotization, arthrodesis, tendon transfer, free muscle transfer, bionic reconstruction) is appropriate for treating the patient.
Collapse
|
6
|
Atthakomol P, Ozkan S, Eberlin KR, Chen N, Winograd J, Lee SG. Reoperation Rate and Indication for Reoperation after Free Functional Muscle Transfers in Traumatic Brachial Plexus Injury. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:368-372. [PMID: 32766394 DOI: 10.22038/abjs.2019.41123.2113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Free functional gracilis muscle transfers (FFGT) are an option for reconstruction after traumatic brachial plexus injury. Few studies report the rate of revision surgeries following free functional muscle transfers. We examined the reoperation rate and indication for reoperation after primary reconstruction of upper extremity function with a free gracilis transfer after brachial plexus injury. Methods From 2003-2016, we identified 25 patients who underwent a free functional gracilis muscle transfer for restoration of upper extremity function. We reviewed their medical charts to record patient, injury, and treatment characteristics. Indication for reoperation and reoperative procedure were also identified. Results Fourteen out of 25 patients (56%) had a reoperation after FFGT. Four flaps were re-explored for vascular compromise, but there were no flap failures. The majority of reoperations involved adjustment of tendon excursion (8/14) which demonstrated that tenolysis was the main procedure. Conclusion Despite promising results of free functional gracilis transfers, reoperation is relatively common and should be discussed with the patient as a preoperative strategy. Early exploration of vascular compromise may decrease the flap failure. Poor tendon excursion is a common unpredicted consequence after FFMT and is the main indication for reoperation.
Collapse
Affiliation(s)
- Pichitchai Atthakomol
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.,Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Thailand
| | - Sezai Ozkan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kyle R Eberlin
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Neal Chen
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Winograd
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Sang-Gil Lee
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
7
|
Yoo M, Nelson RE, Illing DA, Martin BI, Tyser AR, Kazmers NH. Cost-Effectiveness Analysis Comparing Proximal Row Carpectomy and Four-Corner Arthrodesis. JB JS Open Access 2020; 5:e0080. [PMID: 33123669 PMCID: PMC7418915 DOI: 10.2106/jbjs.oa.19.00080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: The optimal surgical treatment for scapholunate advanced collapse (SLAC) and
scaphoid nonunion advanced collapse (SNAC) remains unclear. To inform
clinical decision-makers, we conducted a cost-effectiveness analysis
comparing proximal row carpectomy (PRC) and four-corner arthrodesis
(FCA). Methods: A Markov microsimulation model was used to compare clinical outcomes, costs,
and health utilities between PRC and FCA. The model used a 10-year time
horizon and a 1-month cycle length, and it was evaluated from the societal
perspective. Utilities and clinical parameters including transition
probabilities for debridement for infection, removal of implants, conversion
to total wrist arthrodesis, revision FCA, and revision total wrist
arthrodesis were obtained from published literature. Timing of complications
was estimated from the literature. Direct medical costs were derived from
Medicare ambulatory surgical cost data, and indirect costs for missed work
due to surgical procedures and complications were included. The
effectiveness outcome was quality-adjusted life years (QALYs). Probabilistic
sensitivity analysis and 1-way threshold analysis for utilities were
performed. Results: In the base-case model, PRC dominated FCA (i.e., PRC had lower cost and
greater effectiveness). The mean (and standard deviation) for the total cost
and QALYs per patient were $30,970 ± $5,931 and 8.24 ± 1.28,
respectively, for PRC and $44,526 ± $11,205 and 8.23 ± 1.26,
respectively, for FCA. In the probabilistic sensitivity analysis, PRC
dominated FCA in 57% of the 1 million iterations. The cost-effectiveness
acceptability curve indicated that PRC is the most cost-effective strategy
regardless of the willingness-to-pay threshold up to $100,000/QALY. Conclusions: PRC dominated FCA in the base-case analysis and in the probabilistic
sensitivity analysis. These results suggest that PRC is the optimal strategy
for Stage-I or II SLAC and for SNAC in patients ≥55 years of age. Level of Evidence: Economic Level IV. See Instructions for Authors for a
complete description of levels of evidence.
Collapse
Affiliation(s)
- Minkyoung Yoo
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Richard E Nelson
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah.,VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Damian A Illing
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Brook I Martin
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Andrew R Tyser
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Nikolas H Kazmers
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| |
Collapse
|
8
|
Nazerani S, Nazerani T, Molayem A, Keramati MR. A Modified Surgical Technique for Minimally Invasive Arthroscopic Total Wrist Fusion. J Wrist Surg 2019; 8:84-88. [PMID: 30723609 PMCID: PMC6358453 DOI: 10.1055/s-0038-1669918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
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.
Collapse
Affiliation(s)
| | - Tina Nazerani
- Faculty of Medicine, Karl Josef Medical University, Graz, Austria
| | | | | |
Collapse
|
9
|
Rancy SK, Ek ET, Paul S, Hotchkiss RN, Wolfe SW. Nonspanning Total Wrist Arthrodesis with a Low-Profile Locking Plate. J Wrist Surg 2018; 7:127-132. [PMID: 29576918 PMCID: PMC5864497 DOI: 10.1055/s-0037-1606257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
Purpose This study aims to compare the outcomes and complications of our technique for nonspanning total wrist arthrodesis using a locking plate with the standard carpometacarpal spanning technique. Methods A retrospective review of charts was performed to identify patients who underwent total wrist arthrodesis by the senior author (S.W.W.). We compared the outcomes of 15 cases of nonspanning wrist fusion with a 2.4/2.7 mm locking T plate to 11 cases of spanning wrist fusion with a 2.7/3.5 mm locking compression plate. Minimum follow-up was 3 months. Indications for fusion included rheumatoid arthritis, posttraumatic arthritis, Kienböck's disease, primary osteoarthritis, juvenile inflammatory arthropathy, psoriasis, brachial plexopathy, failed hemi or total wrist arthroplasty, failed four-corner fusion, and failed proximal row carpectomy. The primary outcome was fusion. Secondary outcomes included time to union, patient-rated wrist evaluation score, numerical rating scale pain score, grip strength, and complications. Results All the wrists got fused. There were no significant differences in objective and subjective outcomes between cohorts. There were three complications (27%) in the spanning group, including tendon rupture and peri-implant fracture at the third metacarpal. This was compared with three complications (20%) in the nonspanning group, consisting of hardware removal. Discussion We achieved similar fusion rates employing both spanning and nonspanning total wrist arthrodesis techniques, without necessitating carpometacarpal arthrodesis in the latter. Complications associated with our method were comparably less severe than those reported in the literature. We advocate nonspanning arthrodesis as an alternative method for total wrist fusion with a high union rate and minimal risk of complications at the carpometacarpal joint. Level of Evidence Therapeutic level IV.
Collapse
Affiliation(s)
- Schneider K. Rancy
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Eugene T. Ek
- Department of Surgery, Melbourne Orthopaedic Group, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Sophia Paul
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Robert N. Hotchkiss
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
- Weill Medical College of Cornell University, New York, New York
| | - Scott W. Wolfe
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
- Weill Medical College of Cornell University, New York, New York
| |
Collapse
|
10
|
Li F, Wang SF, Li PC, Xue YH, Zou JY, Li WJ. Restoration of active pick-up function in patients with total brachial plexus avulsion injuries. J Hand Surg Eur Vol 2018; 43:269-274. [PMID: 28872413 DOI: 10.1177/1753193417728405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We designed multiple nerve transfers in one surgery to restore active pick-up function in patients with total brachial plexus avulsion injuries. Forty patients with total brachial plexus avulsion injuries first underwent multiple nerve transfers. These included transfer of the accessory nerve onto the suprascapular nerve to recover shoulder abduction, contralateral C7 nerve onto the lower trunk via the modified prespinal route with direct coaptation to restore lower trunk function and onto the musculocutaneous nerve with interpositional bridging by medial antebrachial cutaneous nerve arising from lower trunk to restore elbow flexion, and the phrenic nerve onto the posterior division of lower trunk to recover elbow and finger extension. At least three years after surgery, the patients who had a meaningful recovery were selected to perform secondary reconstruction to restore active pick-up function. Active pick-up function was successfully restored in ten patients after they underwent multiple nerve transfers combined with additional secondary functional hand reconstructions. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Feng Li
- 1 Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, PR China
| | - Shu-Feng Wang
- 1 Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, PR China
| | - Peng-Cheng Li
- 1 Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, PR China
| | - Yun-Hao Xue
- 1 Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, PR China
| | - Ji-Yao Zou
- 2 Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Wen-Jun Li
- 1 Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, PR China
| |
Collapse
|
11
|
Abstract
Free functional muscle transfer provides an option for functional restoration when nerve reconstruction and tendon transfers are not feasible. To ensure a successful outcome, many factors need to be optimized, including proper patient selection, timing of intervention, donor muscle and motor nerve selection, optimal microneurovascular technique and tension setting, proper postoperative management, and appropriate rehabilitation. Functional outcomes of various applications to the upper extremity and the authors' algorithm for the use of free functional muscle transfer are also included in this article.
Collapse
Affiliation(s)
- Emily M Krauss
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, Saint Louis, MO 63110, USA
| | - Thomas H Tung
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, Saint Louis, MO 63110, USA.
| | - Amy M Moore
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8238, Saint Louis, MO 63110, USA
| |
Collapse
|
12
|
Maldonado AA, Kircher MF, Spinner RJ, Bishop AT, Shin AY. The role of elective amputation in patients with traumatic brachial plexus injury. J Plast Reconstr Aesthet Surg 2015; 69:311-7. [PMID: 26776904 DOI: 10.1016/j.bjps.2015.10.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 07/10/2015] [Accepted: 10/19/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIM Despite undergoing complex brachial plexus, surgical reconstructions, and rehabilitation, some patients request an elective amputation. This study evaluates the role of elective amputation after brachial plexus injury. METHODS A retrospective chart review was performed for all the 2140 patients with brachial plexus injuries treated with elective amputation between 1999 and 2012 at a single institution. Analysis was conducted on the potential predisposing factors for amputation, amputation level, and postamputation complications. Patients were evaluated using pre- and postamputation Disabilities of the Shoulder, Arm, and hand scores in addition to visual analog pain scores. RESULTS The following three conditions were observed in all nine patients who requested an elective amputation: (1) Pan-plexus injury; (2) non-recovery (mid-humeral amputation) or elbow flexion recovery only (forearm amputation) 1 year after all other surgical options were performed; and (3) at least one chronic complication (chronic infection, nonunion fractures, full-thickness burns, chronic neck pain with arm weight, etc.). Pain improvement was found in five patients. Subjective patient assessments and visual analog pain scores before and after amputation did not show a statistically significant improvement in Disabilities of the Shoulder, Arm, and Hand Scores. However, four patients reported that their shoulder pain felt "better" than it did before the amputation, and two patients indicated they were completely cured of chronic pain after surgery. CONCLUSIONS Elective amputation after brachial plexus injury should be considered as an option in the above circumstances. When the informed and educated decision is made, patients can have satisfactory outcomes regarding amputation.
Collapse
Affiliation(s)
- Andrés A Maldonado
- Mayo Clinic, Department of Orthopedic Surgery, Division of Hand Surgery, 200 1st Street South West, Rochester, MN 55905, USA
| | - Michelle F Kircher
- Mayo Clinic, Department of Orthopedic Surgery, Division of Hand Surgery, 200 1st Street South West, Rochester, MN 55905, USA
| | - Robert J Spinner
- Mayo Clinic, Department of Neurologic Surgery and Department of Orthopedic Surgery, Division of Hand Surgery, 200 1st Street South West, Rochester, MN 55905, USA
| | - Allen T Bishop
- Mayo Clinic, Department of Orthopedic Surgery, Division of Hand Surgery, 200 1st Street South West, Rochester, MN 55905, USA
| | - Alexander Y Shin
- Mayo Clinic, Department of Orthopedic Surgery, Division of Hand Surgery, 200 1st Street South West, Rochester, MN 55905, USA.
| |
Collapse
|
13
|
John JR. Wrist arthrodesis following extensive brachial plexus injury. J Hand Surg Am 2013; 38:620. [PMID: 23428196 DOI: 10.1016/j.jhsa.2012.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 12/17/2012] [Indexed: 02/02/2023]
|
14
|
Giuffre JL, Bishop AT, Spinner RJ, Kircher MF, Shin AY. Wrist, first carpometacarpal joint, and thumb interphalangeal joint arthrodesis in patients with brachial plexus injuries. J Hand Surg Am 2012; 37:2557-63.e1. [PMID: 23174070 DOI: 10.1016/j.jhsa.2012.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 09/17/2012] [Accepted: 09/18/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Wrist arthrodesis, first carpometacarpal joint arthrodesis, and thumb interphalangeal joint arthrodesis can be used in conjunction with other reconstructive measures to improve function and grasp in patients with complete brachial plexus injuries. This study evaluates wrist arthrodesis, first carpometacarpal joint arthrodesis, and thumb interphalangeal joint arthrodesis as measured by fusion rate, complications, and clinical outcomes. METHODS A retrospective chart review was performed for 24 skeletally mature patients with brachial plexus injuries treated with wrist arthrodesis by a dorsal plating technique, first carpometacarpal joint arthrodesis by staples, and thumb interphalangeal joint arthrodesis by a tension band wiring technique. Nineteen patients were subjectively evaluated using prearthrodesis and postarthrodesis Disabilities of the Shoulder, Arm, and Hand scores, visual analog pain scores, and a visual analog scale assessing appearance, function, hygiene, ease of daily care, pain, and overall satisfaction. RESULTS There was 100% union rate with 1 postarthrodesis complication. One patient required wrist fusion plate removal because of painful hardware. Subjective patient assessments showed a statistically significant (P < .001) improvement in Disabilities of the Shoulder, Arm, and Hand scores (from 51 to 28) and pain scores (from 5.3 to 3.2) before and after arthrodeses. The visual analog questionnaire results revealed improvements in appearance, function, daily cares, hygiene, pain, and satisfaction. CONCLUSIONS Wrist arthrodesis, first carpometacarpal joint arthrodesis, and thumb interphalangeal joint arthrodesis had high union rates with minimal complications. Patients benefited from the improved function of their upper extremities and were satisfied with the surgery. The use of wrist, first carpometacarpal joint, and thumb interphalangeal joint arthrodeses in combination should be considered one of the reconstructive possibilities for patients with complete or nearly complete brachial plexus injuries.
Collapse
Affiliation(s)
- Jennifer L Giuffre
- Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, Rochester, MN 55906, USA
| | | | | | | | | |
Collapse
|
15
|
Wehrli L, Bonnard C, Anastakis DJ. Current Status of Brachial Plexus Reconstruction: Restoration of Hand Function. Clin Plast Surg 2011; 38:661-81. [DOI: 10.1016/j.cps.2011.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|