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Naga HI, Kim J, Dunworth K, Oleck N, Emovon E, Graton M, Mithani SK. Upper Extremity Diaphyseal Osseous Gap Reconstruction with Free Vascularized Bone Flaps: A Scoping Review. J Reconstr Microsurg 2024. [PMID: 38782026 DOI: 10.1055/a-2332-0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Reconstruction of upper extremity osseous diaphyseal defects often requires complex reconstructions. In this study, we characterized and summarized the available literature on free vascularized bone flap (VBF) reconstruction for upper extremity diaphyseal defects. METHODS A scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews was conducted. A literature search of major electronic databases was conducted to identify journal articles relating to the management of VBF reconstruction of upper limb long bone defects. Articles with patient-level data were included. Descriptive statistics were performed using Python. RESULTS Overall, 364 patients were included in this study. The most common indications for VBFs included atrophic nonunion (125, 34.3%), postoncologic resection (125, 34.3%), septic nonunion (56, 15.4%), and trauma (36, 9.9%). Mean defect size was 8.53 ± 5.14 cm. A total of 67 (18.4%) cases had defects < 6 cm, and 166 cases (45.6%) had defects > 6 cm. The fibula was the most utilized VBF (272, 74.73%), followed by the medial femoral condyle flap (69, 18.96%). Overall, primary union rate was 87.1%. Subsequent flap fracture rate was 3.3%. There were only two (0.6%) VBF losses reported in the included cases, and donor-site complications were similarly rare (17, 4.7%). CONCLUSION VBF reconstruction is often utilized for postoncologic defects and recalcitrant nonunions. The fibula is the most utilized VBF, but the medial femoral condyle flap is used frequently for smaller defects. VBF reconstruction demonstrates high union rates and low flap fracture rate across indications.
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Affiliation(s)
- Hani I Naga
- Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina
- Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina
| | - Joshua Kim
- Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina
- Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina
| | - Kristina Dunworth
- Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina
- Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina
| | - Nicholas Oleck
- Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina
- Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina
| | - Emmanuel Emovon
- Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina
- Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina
| | - Margaret Graton
- Department of Medical Library, Duke University Hospital, Durham, North Carolina
| | - Suhail K Mithani
- Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina
- Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina
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Lubelski D, Halsey J, Suk I, Tuffaha S, Osgood G, Belzberg AJ. Novel Approach of Femur Shortening With Insertion of Expandable Rod to Achieve End-to-End Repair of Sciatic Nerve Laceration. Oper Neurosurg (Hagerstown) 2023; 24:455-459. [PMID: 36701656 DOI: 10.1227/ons.0000000000000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/29/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Sciatic nerve injuries are challenging for diagnosis and treatment. Particularly in proximally located high-grade injuries, neurorrhaphy often has poor outcomes. Most advocate autologous grafting and some more recently have suggested the value of knee flexion braces to facilitate end-to-end repair. OBJECTIVE To describe a case of femur shortening to facilitate tension-free, end-to-end sciatic nerve neurorrhaphy. METHODS The patient was a 17-year-old man who was injured by the propeller of a motor boat and suffered a series of lacerations to both lower extremities including transection of his right sciatic nerve in the proximal thigh. After extensive mobilization of the nerve, a greater than 7-cm gap was still present. The patient was treated with femur shortening to facilitate end-to-end coaptation. He subsequently had an expandable rod placed which was lengthened 1 mm per day until his leg length was symmetric. RESULTS Within 7 months postoperatively, the patient had an advancing Tinel sign and paresthesias to the dorsum of his foot. Nine months postoperatively, he had early mobility in his plantarflexion. CONCLUSION We present a novel method of femur shortening with insertion of an expandable rod to facilitate direct end-to-end and tension-free sciatic nerve neurorrhaphy in a proximally located injury. Furthermore, larger scale and comparative studies are warranted to further explore this and other techniques.
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Affiliation(s)
- Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jordan Halsey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Ian Suk
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sami Tuffaha
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Greg Osgood
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allan J Belzberg
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Dheenadhayalan J, Vembanan K, Devendra A, Perumal R, Nagashree V, Kumar AH, Rajasekaran S. Consistent Protocol-Based Management of Humerus Shaft Nonunion: An Analysis of 100 Cases. Indian J Orthop 2023; 57:552-564. [PMID: 37006739 PMCID: PMC10050540 DOI: 10.1007/s43465-023-00819-4] [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: 11/16/2022] [Accepted: 01/06/2023] [Indexed: 01/28/2023]
Abstract
Introduction Humerus shaft nonunions are very disabling and challenging to treat. The current study aims to analyse the rate of union and the incidence of complications following a consistent protocol in treating humerus shaft nonunion. Methodology We did a retrospective analysis of 100 patients with humerus shaft nonunion treated over an eight-year period from 2014 to 2021. The mean age was 42 years (range 18-75 years). There were 53 male and 47 female patients. The average time interval from injury to nonunion surgery was 23 months (range 3 months to 23 years). The series included 12 recalcitrant nonunions and 12 patients with septic nonunion. All patients underwent freshening of fracture edges to increase the contact surface area, stable fixation with a locking plate and intramedullary iliac crest bone grafting. Infective nonunions were treated in a staged manner, following a similar treatment protocol after the elimination of infection in the first stage. Results Complete union was achieved in 97% of the patients with a single procedure. One patient achieved union after an additional procedure, while two patients were lost to further follow-up. The mean time to union was 5.7 months (range 3-10 months). Three patients (3%) had postoperative radial nerve palsy, which recovered completely within 6 months. Three patients (3%) had a superficial surgical site infection, while one patient (1%) developed a deep infection. Conclusion Intramedullary cancellous autologous grafts combined with stable fixation by compression plating achieve a high union rate with minimal complications. Level of Evidence III. Level of Clinical Care Level I Tertiary trauma centre.
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Affiliation(s)
- Jayaramaraju Dheenadhayalan
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, Tamil Nadu India
- No.3, Gandhinagar, Behind Cheran Nagar, GN Mills Post, Coimbatore, 641029 Tamil Nadu India
| | - Kavinkumar Vembanan
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, Tamil Nadu India
| | - Agraharam Devendra
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, Tamil Nadu India
| | - Ramesh Perumal
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, Tamil Nadu India
| | - Vasudeva Nagashree
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, Tamil Nadu India
| | - Aditya H. Kumar
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, Tamil Nadu India
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, Tamil Nadu India
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Management of the Mangled Extremity. CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00349-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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5
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Pareatumbee P, Zainul-Abidin S, Yew A, Chou SM, Howe TS, Koh JSB, Tan MH. Effect of implant length variations on stress shielding in proximal humeral replacement after tumor excision under torsion: Finite element study. J Orthop Res 2022; 41:1139-1147. [PMID: 36200541 DOI: 10.1002/jor.25456] [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: 06/19/2022] [Revised: 09/01/2022] [Accepted: 10/01/2022] [Indexed: 02/04/2023]
Abstract
The proximal humerus is the most common site of occurrence of primary bone tumors in the upper limb. Endoprosthetic replacement is deemed as the preferred reconstructive option following primary resection of bone tumors. However, it has been also associated with complications such as stress shielding and aseptic loosening compromising prosthetic survival. Our objective was to conduct a finite element (FE) study to investigate the effect of varying endoprosthesis length on bone stresses as well as to quantify the extent of stress shielding across the bone length (BL) in a humerus-prosthesis assembly for proximal humeral replacement after tumor excision thereby allowing us to identify the optimal implant length with best biomechanical performance. FE models of the intact humerus and humerus-prosthesis assemblies were established where they were loaded at the elbow joint under torsion with the glenohumeral joint fixed to represent twisting. After dividing the bone into individual slices consisting of 5% BL, the maximum cortical and cancellous principal, von Mises and shear bone stresses were calculated. To measure the level of stress shielding, the percentage stress change from the intact state was evaluated across each slice. Similar stress patterns were observed between the intact state and shorter endoprosthesis compared to the longer endoprostheses. Our findings illustrated the possibility of stress shielding occurring under torsional forces with its effect increasing with implant lengthening. To conclude, we believe that using a shorter prosthesis may substantially diminish the risk of potential implant failure due to stress shielding.
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Affiliation(s)
- Pivatidevi Pareatumbee
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore
| | - Suraya Zainul-Abidin
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore.,Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore.,Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore, Singapore
| | - Andy Yew
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore.,Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore, Singapore
| | - Siaw M Chou
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Tet Sen Howe
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore.,Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore.,Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore, Singapore
| | - Joyce S B Koh
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore.,Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore.,Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore, Singapore
| | - Mann Hong Tan
- Singhealth-Duke NUS Musculoskeletal Sciences Academic Clinical Program, Singapore General Hospital, Singapore, Singapore.,Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore.,Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore, Singapore
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6
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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.
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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.
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7
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Sabapathy SR, Del Piñal F, Boyer MI, Lee DC, Sebastin SJ, Venkatramani H. Management of a mutilated hand: the current trends. J Hand Surg Eur Vol 2022; 47:98-104. [PMID: 34632847 DOI: 10.1177/17531934211047760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Mutilated upper limbs suffer loss of substance of various tissues with loss of prehension. The most important factor in salvage of a mutilated hand is involvement of a senior surgeon at the time of initial assessment and debridement. A regional block given on arrival helps through assessment and investigations in a pain-free state. Infection still remains the important negative determinant to outcome and is prevented by emergent radical debridement and early soft tissue cover. Radical debridement and secure skeletal stabilization must be achieved on day one in all situations. Dermal substitutes and negative pressure wound therapy are increasingly used but have not substituted regular soft tissue cover techniques. Ability to perform secondary procedures and the increased use of the reconstructed hand with time keeps reconstruction a better option than prosthesis fitting. Toe transfers and free functioning muscle transfers are the two major secondary procedures that have influenced outcomes.
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Affiliation(s)
- S Raja Sabapathy
- Department of Plastic, Hand and Microsurgery and Burns, Ganga Hospital, Coimbatore, India
| | | | - Martin I Boyer
- Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Dong Chul Lee
- Plastic and Reconstructive Surgery and Hand Surgery, Gwangmyeong Sungae General Hospital, Gyeonggi-do, Republic of Korea
| | | | - Hari Venkatramani
- Department of Plastic, Hand and Microsurgery and Burns, Ganga Hospital, Coimbatore, India
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8
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Andrew Koman L. Management of upper extremity arterial penetrating vascular trauma. Injury 2021; 52:3573-3579. [PMID: 34756412 DOI: 10.1016/j.injury.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 02/02/2023]
Abstract
Penetrating vascular injuries in the upper extremity are relatively uncommon; suboptimal treatment may result in significant morbidity including amputation. Arterial trauma accounted for 68% of amputations (24% in the upper extremity) during World War II. Although surgical techniques including microsurgical principles have matured, results vary secondary to the mechanism of injury, systemic factors, anatomic considerations and physiologic events. This annotated review article is based upon the literature and the author's 42 years of vascular trauma experience including over 1500 revascularizations and replantations. It discusses the complex interplay of associated injuries; the mechanism of injury, the location of the injury; the collateral circulation; the extent of soft tissue damage; the adequacy of debridement; the significance of pre-existing conditions; and magnitude of wound contamination. Based upon this evaluation, a guide to indications for arterial reconstruction is provided and a comprehensive management plan for vascular trauma may be derived.
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Affiliation(s)
- L Andrew Koman
- Department Orthopaedic Surgery and Rehabilitation, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist, Medical Center Boulevard, Winston-Salem, North Carolina, USA 27157.
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9
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Chowdhury JMY, Wilks DJ, Bhat W, Vollans S, Foster N, Wiper J, Harwood PJ. Wrist fusion using an induced membrane technique for forearm salvage in a patient with an infected open injury with segmental bone loss: A case report. Trauma Case Rep 2021; 36:100550. [PMID: 34786448 PMCID: PMC8579149 DOI: 10.1016/j.tcr.2021.100550] [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: 08/15/2021] [Accepted: 10/23/2021] [Indexed: 11/09/2022] Open
Abstract
This case report describes the management of a 27-year-old male who, after a quadbike accident, presented with an open, infected, segmental both bone forearm injury with significant bone and soft tissue loss including the radio-carpal joint. Limb salvage was accomplished in the form of a single bone forearm fusion utilising Masquelet's two-stage induced membrane technique to reconstruct the segmental bone defect. The patient proceeded to uneventful bony union by 6 months and returned to driving and riding a quadbike. Despite significant deep infection, successful salvage was achieved using the induced membrane technique. Critical to success was aggressive, repeated debridement alongside restoration of vascular supply and reconstruction of soft tissue defects. We highlight the multidisciplinary approach to management including relevant specialists with a particular interest in limb reconstruction.
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Affiliation(s)
- James M Y Chowdhury
- Department of Trauma & Orthopaedics, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Daniel J Wilks
- Department of Trauma & Orthopaedics, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Waseem Bhat
- Department of Trauma & Orthopaedics, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Sam Vollans
- Department of Trauma & Orthopaedics, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Nicholas Foster
- Department of Trauma & Orthopaedics, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Jay Wiper
- Department of Trauma & Orthopaedics, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
| | - Paul J Harwood
- Department of Trauma & Orthopaedics, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom
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10
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Ferreira N, Saini AK, Birkholtz FF, Laubscher M. Management of segmental bone defects of the upper limb: a scoping review with data synthesis to inform decision making. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:911-922. [PMID: 33674937 DOI: 10.1007/s00590-021-02887-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/26/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Injuries to the long bones of the upper limb resulting in bone defects are rare but potentially devastating. Literature on the management of these injuries is limited to case reports and small case series. The aim of this study was to collate the most recent published work on the management of upper limb bone defects to assist with evidence based management when confronted with these cases. METHODS Following a preliminary search that confirmed the paucity of literature and lack of comparative trials, a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) was conducted. A literature search of major electronic databases was conducted to identify journal articles relating to the management of upper limb long bone defects published between 2010 and 2020. RESULTS A total of 46 publications reporting on the management of 341 patients were reviewed. Structural autograft, bone transport, one-bone forearm and the induced membrane technique were employed in an almost equal number of cases. The implemented strategies showed similar outcomes but different indications and complication profiles were observed. CONCLUSION Contemporary techniques for the management of post-traumatic upper limb bone defects all produce good results. Specific advantages, disadvantages and complications for each modality should be considered when deciding on which management strategy to employ for each specific patient, anatomical location, and defect size.
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Affiliation(s)
- Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa.
| | - Aaron Kumar Saini
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa
| | - Franz Friedrich Birkholtz
- Walk-A-Mile Centre and Department of Orthopaedics, University of Pretoria, Pretoria, 0002, South Africa
| | - Maritz Laubscher
- Orthopaedic Research Unit (ORU), Division of Orthopaedic Surgery, Department of Surgery, University of Cape Town, Cape Town, 7505, South Africa
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11
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Riccelli V, Pontell M, Gabrick K, Drolet BC. Outcomes Following Mangling Upper Extremity Trauma. CURRENT TRAUMA REPORTS 2020. [DOI: 10.1007/s40719-020-00194-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Schnapp L, Colakoglu S, Couceiro J, Oron A, Brock G, Banegas RN. Forearm Shortening Impact on Pronation and Supination. J Hand Surg Asian Pac Vol 2019; 24:289-296. [DOI: 10.1142/s242483551950036x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Shortening has been described to treat severely mangled extremities, replantations and nonunions. Outcomes after this procedure in the forearm are vaguely described. This study addresses how the forearm rotation is affected by: (1) location of the shortening; (2) the amount of the shortening at different locations. Methods: Nine fresh cadaveric forearms were dissected preserving intact proximal and distal radio ulnar joints and interosseous membrane. The widest point of the interosseous space and its location over the ulna were measured, defining the peak interosseous distance (PID) and the peak interosseous distance level (PIDL). Stabilization and fixation of the specimens were performed by using a platform and external fixators. Consecutive ostectomies were performed within one centimeter intervals at the distal, middle and proximal forearm thirds. A repeated measures mixed-effects (RMME) specific model was designed for the statistical analysis. Results: Before intervention, the average full forearm rotation was 157° (101–185), supination 80° (56–90)/pronation 77° (45–95). The average PID was 15.6 mm in supination and 12.5 mm in pronation. The PIDP were 52.2% and 58.3% of the ulna length in supination and pronation, respectively. The rotation lost were: middle third 5.31°/cm in supination and 6.12°/cm in pronation, distal third 1.62°/cm in supination and 2.20°/cm in pronation, the proximal third was not affected by up to 5 cm of shortening. Conclusions: These data suggest that shortening of the middle and distal third of the forearm might have more significant adverse effect on forearm rotation compared with the proximal third.
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Affiliation(s)
- Luis Schnapp
- Christine M. Kleinert Institute, University of Louisville, Hand and Microsurgery, Louisville, KY, USA
| | - Salih Colakoglu
- University of Colorado Hospital, Plastic and Reconstructive Surgery, Aurora, CO, USA
| | - Jose Couceiro
- Christine M. Kleinert Institute, University of Louisville, Hand and Microsurgery, Louisville, KY, USA
| | - Amir Oron
- Christine M. Kleinert Institute, University of Louisville, Hand and Microsurgery, Louisville, KY, USA
| | - Guy Brock
- The Ohio State University, Biomedical informatics, Columbus, OH, USA
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Pierrie SN, Gaston RG, Loeffler BJ. Current Concepts in Upper-Extremity Amputation. J Hand Surg Am 2018; 43:657-667. [PMID: 29871787 DOI: 10.1016/j.jhsa.2018.03.053] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 03/30/2018] [Indexed: 02/02/2023]
Abstract
Advances in motor vehicle safety, trauma care, combat body armor, and cancer treatment have enhanced the life expectancy and functional expectations of patients with upper-extremity amputations. Upper-extremity surgeons have multiple surgical options to optimize the potential of emerging prosthetic technologies for this diverse patient group. Targeted muscle reinnervation is an evolving technique that improves control of myoelectric prostheses and can prevent or treat symptomatic neuromas. This review addresses current strategies for the care of patients with amputations proximal to the wrist with an emphasis on recent advancements in surgical techniques and prostheses.
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Affiliation(s)
- Sarah N Pierrie
- Department of Orthopaedic Surgery, Atrium Health, Charlotte, NC
| | - R Glenn Gaston
- Department of Orthopaedic Surgery, Atrium Health, Charlotte, NC; OrthoCarolina Reconstructive Center for Lost Limbs, Charlotte, NC.
| | - Bryan J Loeffler
- Department of Orthopaedic Surgery, Atrium Health, Charlotte, NC; OrthoCarolina Reconstructive Center for Lost Limbs, Charlotte, NC
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ERRATUM. Orthop Surg 2016; 8:260. [PMID: 27384738 DOI: 10.1111/os.12251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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