bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Treatment Protocol for the Advanced Articular Lesion of Osteochondritis Dissecans of the Elbow
Authors: Shimada Kozo , Temporin Ko , Oura Keiichiro , Tanaka Hiroyuki
Published: September 2016

Hypothesis: Advanced lesion of osteochondritis dissecans (OCD) of the elbow should be treated surgically by the protocol “arthroscopic debridement with or without reconstruction according to the lesion size.” Materials and Methods: In total, 131 advanced OCD patients (International Cartilage Research Society [ICRS] OCD III or IV) were treated and followed more than 18 months (18-140 with mean of 36 months). Most of the patients were young boys such as baseball players, gymnasts, boxers, and judo athletes. The elbow OCD lesions were evaluated by preoperative x-ray, computed tomography (CT), or magnetic resonance imaging (MRI), and classified into 3 types by lesion size: small (articular lesion diameter [ALD] smaller than 10 mm), medium (ALD 10-15 mm), and large (ALD larger than 15 mm). For a small lesion, it was shaved arthroscopically (AS, n = 32). For a medium lesion, it was reconstructed by a local anconeus muscle–pedicled bone graft (BG) covered with periosteum flap (n = 16). For a large lesion, it was completely shaved and reconstructed by osteochondral autograft transplantation (OAT) from the patient’s knee (n = 16) or reconstructed by cylindrical costal-rib osteochondral autograft (CCOA, n = 67). Totally, 159 patients were operated in 1998 to 2014 and 131 were enrolled in this follow-up study (follow-up rate, 82.4%). Clinical findings (pain, range of motion [ROM], and physical activity) were reviewed. Timmerman and Andrews score was evaluated before and after surgery. Results: Overall Findings—Preoperative symptoms were pain, elbow catching in their activities, and limitation of motion. Their sports activities were limited. Pain and catching were improved after surgery. ROM (flexion/extension) was 126/–14 preoperatively and improved to 134/–4 at final follow-up. More than 90% of the patients returned to their former activities. Timmerman and Andrews score was 130 preoperatively and improved to 186 at final follow-up. Each procedure showed equally good end results (ROM: preoperative and at follow-up, 125/–9 improved to 132/–4 in AS, 128/–13 improved to 135/1 in BG, 125/–11 improved to 134/–5 in OAT, and 126/–17 improved to 134/–4 in CCOA; Timmerman and Andrews: 144 improved to 185 in AS, 141 improved to 193 in BG, 134 improved to 180 in OAT, and 121 improved to 186 in CCOA). Twenty-one additional minor surgeries such as hardware removal or arthroscopic removal of free bodies were performed in 21 cases in the follow-up. Conclusions: Complete resection of the damaged articular lesion is recommended for the advanced OCD of the elbow. For a large articular lesion, several types of reconstruction were possible. This protocol will serve good functional recovery to some extent for the damaged young athletes’ elbow.
Minimally Invasive Plate Osteosynthesis of Comminuted One Bone Fractures of Forearm Shaft
Authors: Je Kang Hong , Sejin Kim , Woong Choi Ji , Hee Kim Dong
Published: September 2016

Objective: Due to rotatability of the forearm, open reduction and internal fixation with plate is a gold standard treatment of forearm fracture. Our hypothesis was that if it does not make any problems on alignment and rotation, minimally invasive plate osteosynthesis (MIPO) technique could be also applied for forearm fracture. It is easy to align when only one of forearm bone is fractured because reference point exists. The purpose of this study is to introduce MIPO technique for comminuted one bone fracture of forearm shaft. Methods: Between May 2011 and January 2014, 17 patients with fractures of forearm shaft were treated by MIPO technique. MIPO technique was applied to single forearm bone shaft fractures or to the more severe comminuted bone when both forearm bones are fractured. The other less sever bone fracture is treated with open reduction and internal fixation. There were 5 cases of forearm both bone fracture (radius 3, ulna 2), 5 cases of radius shaft fracture, and 7 cases of ulnar shaft fracture. MIPO technique was applied in total 8 cases of radius fracture and 9 cases of ulna fracture. The mean follow-up period was 26 months (range, 24-44 months). Bone union period was determined by radiographs taken upon follow up, and clinical function was evaluated by range of movement, Grace and Eversmann criteria measured at the last follow up. Results: Bony union was achieved in all patients. The mean time to bone union was 10.8 weeks in radius and 13.4 weeks in ulna. The average range of motion of forearm was 80.6° in supination and 83.2° in pronation. Both groups showed mean percentage of 97 compared with the contralateral side. Functional results assessed by Grace and Eversmann criteria were rated excellent in 11 cases and good in 6 cases. Conclusion: In our series, MIPO technique for comminuted one bone fractures in forearm shaft fracture was safe and effective, which had advantages, including a small skin incision, in bone biology.
Hand Injuries in the Elder Population
Authors: Rosberg Hans-Eric , Ohlsson Olof , Hazer Derya Burcu , Dahlin Lars B
Published: September 2016

Objective/Hypothesis: Hand injuries occur at all ages, and with a globally aging population, an increasing number of hand injuries among the elderly can be expected. The aim was to describe the health characteristics and detailed injury patterns for elderly with hand injuries and study if any changes were noticed in the number of hand injuries over time. Materials and Methods: All patients with an age of more than 65 years and admitted to a hand surgery ward with a hand injury were retrospectively collected at 4 different 2-year periods over 30 years (1980-1981 to 2010-2011). Also all patients, older than 65 years, who had been treated at the department of hand surgery for a traumatic hand injury that occurred between July 1, 2013, and June 31, 2014, were included. Data were collected retrospectively. Results: The number of injuries increased over the 30-year study period. The incidence was 21.3/10 000 inhabitants/year. Two hundred eighty-six patients were included (145 women and 141 men). One patient was injured twice, resulting in 287 injuries; 188 (65%) were minor, 72 (25%) moderate, 16 (6%) severe, and 11 (4%) major according to the Modified Hand Injury Severity Score (MHISS). Men had a higher MHISS than women ( P < .01). Fracture was the most common injury among women, 97/287 (66%), and the mechanism was usually a fall. Wound was the most common among men, 69/141 (49%), inflicted by cut/saw/crush/avulsion. Men were younger than women at injury ( P < .01) and required more surgery ( P = .02) and more admissions ( P = .03). Thirty-six of two hundred eighty-six patients (13%) were healthy, while 78 of 286 (27%) patients took 5 or more medicines, mainly due to cardiovascular disease. Conclusions: We found an increased number of hand injuries over a 30-year period in combination with a decrease in patient-reported health treated at a hand surgery ward. Compared with younger patients, older men and women do not injure their hands as often. Men, at time of injury younger than women, sustain more wounds from hazardous equipment, thus, more severe injuries, while women usually fall and fracture their hands. Fall injury prevention seems to be most important to reduce the injuries among older women, while spreading of a safety philosophy might reduce the injuries among men. A minority of the elderly are healthy, which may complicate the treatment. Further studies regarding hand trauma in the elder population will be valuable for future prevention and rehabilitation of this patient group.
Technical Note About Using Temporary Bridge Plate for Comminuted Interphalangeal Joint Fracture
Authors: Oh Jin-Rok , Lee Jun-Pyo
Published: September 2016

Background: Dynamic external fixation has been mainly used for treatment of comminuted interphalangeal joint fracture; however, maintaining the fixation through this method has been difficult and uncomfortable. Based on the principle of ligament taxis, we introduce a novel method of inserting pre-bent metal hand mini-plate through minimal invasive technique for fixation and bony reunion of fragments resulted by intra-articular comminuted fracture. Patients and Methods: Fixation technique with pre-bent hand mini-plate was used in 7 cases of comminuted fracture of proximal interphalangeal joint (PIP) and 1 case of first carpo metacarpal (CMC) joint fracture. Temporary fixation was applied for 6 weeks, followed by plate removal and brisement manipulation and then passive continuous range of motion (ROM) exercise. The patients were followed up for a mean duration of 17 weeks, and simple radiographs recorded the degree of bony reunion and the ROM of interphalangeal joints measured with protractor. Results: An overall satisfactory result was achieved in all patients, with the mean ROM of 7 cases of PIP joint fracture being 2° of extension and 95.5° of flexion and that of 1 case of CMC fracture being 0° of extension and 58.5° of flexion. Furthermore, no serious complication was noted in any patient. Conclusion: Bridge plating method using ligament taxis may be a viable method in treating comminuted interphalangeal joint fracture.
NORSE
Authors: Nizar Bafiq , Yim Guang , Bella Husam , Deall Ciara , Foster Mark
Published: September 2016

Introduction: The health care sector has been rapidly incorporating the developments in the information technology infrastructure and also driven the development of many cutting-edge technologies such as telemedicine, electronic patient records, and digital radiology. Currently, emergency and urgent referrals by health professionals to specialist centers are conducted by telephone. This requires the referrer to wait for the operator to locate a specialist doctor who may be busy with another call or attending to a patient. If any investigations are to be done before a management plan is finalised the referrer has to re-enter this cycle again. This approach is inefficient and poses clinical governance concerns regarding the accurate communication and recording of clinical findings, management plans, and appropriate onward transfer plans. Materials and Methods: Our team has developed the Network of On-Call Referral Service in Hand Trauma (NORSE) referral system as a highly secure web-based system accessible only to medically qualified professionals. This allows the referrer and the specialist unit to engage in contemporaneous 2-way dialogue. When a referral is made, the on-call phone is alerted, and clinicians access NORSE via their on-call smartphone or PC. They can request further information and view attached images until there is enough information to reach a clear definitive management plan. The communication also forms a contemporaneous medical record. Results: We audited the response time since the incorporation of the NORSE referral system in January 2016. The unit received an average of 7 referrals on NORSE each day with over 90% of the referrals being responded within 30 minutes. The quickest response was found to be within 2 minutes. NORSE has avoided lengthy telephone conversations during referrals and has helped junior doctors as well as advanced nurse practitioners to deal with emergency workload with ease. The contemporaneous record of the referral also serves to promote accuracy of clinical details and drive up the standard of care. Conclusion: The quality and accuracy of clinical information on the referrals have improved significantly. Junior doctors have been unburdened by telephone conversations, thus allowing them to focus on honing their clinical experience. The junior doctor morale has also improved since the introduction of NORSE. We recommend that NORSE may be of benefit if used in other UK centers to promote efficiency, accuracy, and contemporaneous record of health care interaction.
Comprehensive Rehabilitation Management for Children With Burn Injury on Hand
Authors: Li-Tsang Cecilia W. P. , Zhang Walei , Zhang Yuting , Zhang Yingying
Published: September 2016

Background: Children are of the most susceptible groups for burn injuries, and hand injuries are prevailing among all sites of injuries. Due to the unique role of hands in children’s normal development, pediatric hand burn injuries may result in permanent disabilities that severely affect the functioning and quality of life of the child and the family. Therefore, other than proper wound care and timely surgery, rehabilitation management for children with burn injury on hand is essential. Objective: This presentation aims to propose a comprehensive rehabilitation management strategy for children with burn injuries on hands. Materials and Methods: Pediatric cases admitted to our university rehabilitation clinic with bilateral hand injuries due to second-degree burn are presented as case series. Tailor-made intervention regime was provided for each case. New methods of pressure therapy intervention was introduced, including innovative products of the Smart Pressure Monitored Suit and the Smart Pressure Monitored Padding, which were developed and patented by our research team. Splints were provided and monitored. Functional activities, parent education, and counseling, as well as home programs were also delivered. The state of preservation of the pressure intervention products, the splint condition and the rehabilitation progress of the children were monitored on a regular basis. The treatment outcomes are presented by comparing the pre- and post-intervention photos and functioning of the patients. Results: Cases with pediatric bilateral hand injuries demonstrated satisfactory recovery on both hand functions and scar appearances. Several features have been identified from the cases as key elements in successful management of pediatric burnt hand. The proper adoption of the concept of pressure therapy played an important role, and the therapists should not limited pressure intervention to pressure garment only. Proper splinting of hands prevented and corrected contracture and deformation effectively. Engaging children into age-appropriate activities should be also considered. Suitable environment that promotes participation and reduces psychological stress should be established. Moreover, the psychosocial well-being of the children and the caregiver should be addressed in order to achieve maximum compliance to the intervention regime. Finally, regular long-term follow-ups guarantee the effectiveness of the rehabilitation intervention. Conclusions: To achieve the optimal functional recovery that enables participation and engagement, individualized, comprehensive and early rehabilitation management is advocated. Rehabilitation on pediatric burns is a long-term process that requires not only collaboration and understanding among different parties but also persistent effort.
Microsurgical Digital Reconstruction by Vascularized Free Toe Pulp Transfer
Authors: Villanueva A. García , de Oña I. Roger , de Oya A. Studer , López J. I. García
Published: September 2016

Background: Restoring the aesthetic appearance and sensibility of the fingers, specially the fingertip, after traumatic amputation has an essential role in the functional recovery of the hand. Advances in microsurgery have allowed better coverage of defects with low morbidity of the donor site. Purpose: Our purpose is to present the clinical and functional outcomes achieved by vascularized free toe pulp transfer for fingertip reconstruction in hand labor patients with medium to high functional demand. Method: Between March of 2011 and August of 2015, 18 patients underwent free toe pulp transfer to restore finger pulp defects. All were manual workers, 16 men and 2 women, and their average age was 39 (25-53) years. Fourteen patients suffered from traumatic partial amputations and 4 patients had high-pressure injection injury. The average time from the accident to surgery was 18 (8-30) days. Overall results were evaluated in terms of survival flap rate, complications, and additional surgical procedures. Static 2-point discrimination (s2-PD), satisfaction, and time to return to work were also assessed with a mean follow-up more than 1 year postoperatively. Results: The survival rate was 100%. Donor site required a split-thickness skin graft (STSG) in 11 cases. Good functional results and a high degree of satisfaction were obtained. Average s2-PD over the flap area was 9.1 (8-11) mm. All patients returned to heavy manual work. Conclusion: In our opinion, the use of free toe pulp transfer provides the best aesthetic and functional outcomes in digital pulp reconstruction. It provides not only a satisfactory appearance but also excellent functional results and allows patients to return to heavy manual works.
Great Occipital Nerve as a Motor Donor Nerve in Brachial Plexus Palsy
Authors: Daroda Sergio , Zabaljauregui Facundo , Menvielle Fernando , Pereira Paul , Cosentino Rodolfo
Published: September 2016

Objective: The main purpose of this study is to evaluate the great occipital nerve (GON) as a possible donor nerve in brachial plexus reconstruction. The secondary objectives are to describe the path, the relations, and peripheral nerve length and its mobilization to reach the suprascapular nerve. Materials and Methods: Eight cadaveric specimens were used with dissections of the 2 GONs with a total of 16 GONs. They were dissected from the outlet at the rachis up to its surface emergence. Length measurements were registered between these points; the topographic point of its emergence in the nape skin was identified. Also the mobilization from this point to the inner scapula angle was recorded. Finally, the number of axons before and after the exit of the motor branches for the nape muscles was histologically studied. Results: Six and 2 of 8 specimens were males and females, respectively. The length from its exit between the first and second cervical vertebrae and its emergence in the nape skin was 62 mm average. With lateral nerve mobilization, a distance of 27 mm to the medial border and superior angle of the scapula was reached. Also, the length to the suprascapular notch was measured obtaining an average distance of 73 mm. Conclusions: The amount of motor nerve donors to transfer in preganglionic brachial plexus palsy is very low and the GON can be a new option. Using the mobilization, the GON can be reached close to the suprascapular notch. This is an alternative to neurotize the suprascapular nerve without graft and to free the accessory nerve for another transfer. Although the sample is very low, we believe the GON can be a new source of nerve donor motor for brachial plexus reconstruction.
Thumb Amputations in Children
Authors: Jones Neil , Clune James
Published: September 2016

Hypothesis: Traumatic amputations of the thumb are fortunately rare in children compared with adults, but hand surgeons remain reticent to consider microsurgical reconstruction. Materials and Methods: Nineteen thumb amputations in 17 children (13 boys and 4 girls) between the ages of 2 and 16 years were referred for secondary reconstruction. Nine were isolated thumb amputations (R1 classification) and 10 were combined thumb and multiple finger amputations (R2-R5 classification). Two children had bilateral thumb amputations due to burns. Of the unilateral thumb amputations, 8 were left thumbs and 7 were right thumbs. Three thumbs were amputated just distal to the carpometacarpal (CMC) joint, 4 through the metacarpal head or metacarpophalangeal (MCP) joint, 7 through the base of the proximal phalanx, 3 through the head of the proximal phalanx, and 2 through the base of the distal phalanx. Three children had previously undergone soft tissue coverage with a pedicled groin flap (2) and a reverse radial forearm flap (1), and 2 children underwent a reverse radial forearm flap simultaneously with their toe transfer. Results: Nineteen toe-to-thumb transfers were performed: 12 second toe transfers and 7 great toe transfers (3 great toe and 2 trimmed and 2 Morrison wrap-around variations). There were no immediate postoperative re-explorations of the microsurgical anastomoses and all toe transfers were successful. All children rapidly regained pinch and grasp function and sensibility. There were no gait problems in the donor foot/feet. Conclusions: Microsurgical toe-to-thumb transfers are the optimal technique for post-traumatic thumb reconstruction in children for any level of amputation from just distal to the CMC joint out to the distal proximal phalanx. Second toe transfers are preferred for younger children because of better growth potential and an inconspicuous donor site, but great toe transfers become more favored for older children because of the better cosmetic appearance and for combined thumb and multiple finger amputations.
Normal Range of Motion of Thumb Metacarpophalangeal Joint
Authors: Ebata Tatsuki , Nakai Ikuo , Kogure Akira , Goto Kenichiro
Published: September 2016

Objective: The range of motion (ROM) of the thumb metacarpophalangeal (MCP) joint varies widely among individuals. Because of this variability, the normal angles of flexion and extension of the MCP joint are difficult to determine. If the ROM of the thumb MCP joint is sufficiently similar between the right and left sides, the contralateral normal side can be used for outcome assessment in hand surgery. The purpose of this study was to define the difference between right and left ROM of the thumb MCP joint in the normal population and assess the utility of the normal side value as a normal indicator. Materials and Methods: Three hundred hands of 150 participants (75 men, 75 women; average age, 36.2 years) without a history of injuries or diseases of the thumb were included in this study. To exclude participants with degenerative joint disease, the age range was limited to 20 to 49 years. The angles of flexion and extension of the MCP joints were measured with a goniometer at an interval of 1°. Statistical analyses of flexion angle, extension angle, differences between men and women, and differences between the right and left sides of individuals were carried out. The Mann-Whitney U tests were used. A P value of < .05 was considered statistically significant. Results: The average flexion angle was 59.1° (16°-90°). The average extension angle was 7.9° (−32°-58°). Both the flexion and extension angles were greater in women than in men. The average difference in the flexion angle between right and left was 4.8°. The range was from 0° to 28°. The average difference in the extension angle between right and left was 6.4°. The range was from 0° to 38°. For a P value of .05, the one-sided 100th percentile of the flexion angle was 10.6° and that of the extension angle was 14.3°. For a P value of .01, the one-sided 100th percentile of flexion angle was 15.1° and that of the extension angle was 20.1°. Conclusions: The difference between the maximum flexion angle of 90° and the minimum flexion angle of 16° was 74°. The difference between the maximum extension angle of 58° and the minimum extension angle of −32° was 90°. Due to these large differences in the flexion and extension angles, it appeared that some angles could not be determined as normal. However, the average flexion and extension differences between the right and left sides of the same individual were 4.8° and 6.4°, respectively. These differences are small enough for the contralateral normal side to be a useful indicator of the normal ROM of the MCP joint. After rounding up the decimals to a unit, the one-sided 100th percentile results indicated that flexion loss of more than 11° and extension loss of more than 15° were suspicious for contracture of the MCP joint, and that flexion loss of more than 16° and extension loss of more than 21° strongly suggested contracture of the MCP joint.
Assessment of Motor Function Using Ultrasound Quantification of Abductor Pollicis Brevis in Carpal Tunnel Syndrome
Authors: Kim Jong-Pil , Shin Won-Jeong , Shin Young-Eun , Kang Hong J.
Published: September 2016

Background: Besides characterizing pain and sensory disturbance along the distribution of the median nerve, carpal tunnel syndrome (CTS) presents with motor disturbance that can range from weakness of the thenar muscles to complete paralysis and atrophy which is hardly recovered regardless of surgical procedure. Quantification of abductor pollicis brevis (APB) strength can be used as a functional measure of motor function of the thenar muscle, but correlation between the muscle strength and clinical, electrophysiological, and radiological data was not clearly proved. Purpose: The primary purpose of this study was to assess that strength and muscle thickness (MT) of APB were associated with clinical presentation, electrophysiological testing, and sonographic parameters for CTS. The secondary purpose was to determine the most adequate cutoff point of APB strength and MT for APB weakness. Patients and Methods: Fifty-two wrists from consecutive 38 CTS patients, who required carpal tunnel release, and 56 wrists from 38 asymptomatic volunteers were prospectively evaluated. The mean age was 53.6 years (range = 37-70) in the patient and 49.4 years (range = 24-68) in the control group. APB strength, grip and tip pinch strength, and sonographic parameters including cross-sectional area (CSA) and circularity of the median nerve, depth of carpal tunnel inlet, APB MT were evaluated in both groups. Correspondence between clinical and sonographic measures of the APB and the CTS-6, Levine scale, electrophysiological data was determined in the patient group. Results: APB strength and MT in CTS group were decreased compared with the control group (2.6 vs. 6.7 kg, P < .001; 3.56 vs. 5.1 mm, P = .003, respectively). APB strength was significantly correlated with symptom severity and functional status score of the Levine scale ( r = −.454, P = .004; r = −.361, P = .024, respectively). In addition, APB strength were significantly correlated with MT and distal motor latency ( r = .330, P = .040; r = −.289, P = .047, respectively). MT of the APB of 4.44 mm had 83% sensitivity, 81% specificity, 80% positive predictive value, 83% negative predictive value, and 82% accuracy for CTS. There was no correlation between grip and pinch strength and clinical, electrophysiological, and sonographic measures in either CTS or control group. Conclusion: APB strength favorably represents clinical presentation, electrophysiology of the median nerve, and MT of the APB in CTS. The data of this study suggest that MT of the APB cutoff point of 4.4 mm is considered as thenar atrophy.
Clinical Study of Sensory Recovery of Artificial Nerve Grafts (Nerbridge®)
Authors: Matsui Hirotada , Tsui Hideki , Saka Matsumi
Published: September 2016

Purpose: To examine postoperative sensory recovery of patients who used Nerbridge® for sensory nerves, and the indications. Subjects and methods: We investigated length of the transplanted nerve, postoperative sensory evaluation, and Disabilities of Arm, Shoulder and Hand (DASH) score in patients who underwent surgery at our center and could be followed up for at least 6 months. The participants were 11 patients (8 men and 3 women) with 17 nerves for study whose mean age at the time of injury was 48 years (15-64 years) and mean follow-up period was 14.4 months (6-28 months). We used the Semmes Weinstein (SW) test for postoperative sensory evaluation. Results: Mean length of the transplanted nerve was 17.3 mm (3-41 mm); the sensory evaluation had 8 patients in the blue range, 6 in the purple range, and 3 in the red range; and the mean DASH score was 16.3 points (1.7-37.5 points). The results tended to be unfavorable for patients with severe injuries such as an amputated finger and those with relatively long transplanted nerves. The results of this study indicated that Nerbridge® worked well with digital nerve deficits on the order of 20 mm. Discussion: When the results following artificial nerve transplants were as good as or better than nerve autografts, the donor site was not problematic and the transplantations with artificial nerves were clearly useful. The product would be decomposed and absorbed in vivo in approximately 3 months. Although the product can be used for a maximum length of 50 mm, in a deficit over 30 mm, the regenerating nerve might be metabolized before reaching its distal nerve stump; thus, a nerve autograft would be preferred in that situation.
The Effect of Neuronal Growth Factor on the Early Recovery After Experimental Sciatic Nerve Defect in Rabbits
Authors: Móricz Otto , Nöt Laszlo G. , Pfund Zoltan , Wiegand Norbert
Published: September 2016

Objective/Hypothesis: The facilitation of early functional recovery after peripheral nerve damage is a key component in the treatment of severe nerve traumas. The regeneration of peripheral nerves is determined by multiple factors. The nerve growth factor (NGF) plays an important role in the recovery process by facilitating the Schwann cell proliferation and helping to prepare the reception of the regenerating axon. The purpose of the study was to evaluate the rate of early nerve regeneration in the presence or absence of NGF treatment, using either silicon tubes or autolog veins as a bridge for the neuron defect in a rabbit model of nerve injury. Materials and Methods: White Canadian rabbits were used in the study. Animals were divided into 4 groups (n = 10 in each group). Under general anesthesia, 1 cm long part of the sciatic nerve was removed and the ends were connected with either silicon tube or autolog vein. In case of 10-10 rabbits, NGF was added into the connecting tubes or veins. For another 10-10 rabbits (Control animals), only plasma was added. Electrophysiological examination was performed 2, 4, 6, and 8 weeks following surgery. Histological examination was done on the postoperative second, fourth, and sixth week on 2-2 animals and on the postoperative eighth week on 4-4 animals. Results: The regeneration analyzes demonstrated that the NGF-treated nerves had already become more mature and organized by the postoperative fourth week. The rest of the fibers were still demyelinated; however, there were more myelinated fibers in the NGF-treated group. On the sixth week, the regenerated parts formed into small fascicules, showing a diffuse pattern of myelinated and demyelinated fibers. On the eighth week, the fascicules were strengthened with the signs of longitudinal vascularization. We found significantly higher number of myelinated fibers in the NGF containing tubes, compared with the Controls. Conclusion: Here, we demonstrated that the NGF-treated regenerating nerves show more maturity and neuronal organization on the fourth and sixth week, compared with the Control groups. This effect could facilitate the early functional recovery after peripheral nerve injuries. While NGF has a significant effect on the early regeneration of the rabbit sciatic nerve, based on our results, the endogen NGF has no significant effect on the late nerve regeneration process.
Does MR Neurography Parameters Predict or Correlate With Clinical Recovery in Severe Carpal Tunnel Syndrome
Authors: Garg Bhavuk , Kotwal Prakash , Srivastav Deep , Das Chandan , Vibha Deepti , Manhas Vikrant , Vardhan Anand , Malhotra Rajesh
Published: September 2016

Hypothesis: Does magnetic resonance (MR) neurography parameters predict or correlate with clinical recovery in severe carpal tunnel syndrome (CTS). Methods: Subjects were prospectively collected 22 hands from 22 CTS patients, with abductor pollicis brevis-compound muscle action potential (APB-CMAP) of 2 mV or less and evaluated preoperatively and postoperatively for clinical, electrophysiological, and MR neurography findings to find out potential risk factors and predictors of thumb opposition recovery. Parameters observed in MR neurography were morphological changes in median and thenar branch of median nerve, median nerve diameter and width, carpal tunnel diameter, denervation edema, and bowing ratio. We considered more than 0.5 mV improvement in APB-CMAP postoperatively significant. Results: Two groups were made and compared for all postoperative variables. Group 1 had patients with less than 0.5 mV improvement and group 2 had more than 0.5 mV improvement. Demographic, MR neurogram variables, and functional score had better results in group 2 comparing with group 1 but were not statistically significant. Thumb opposition showed poor results in group 2 comparing with group 1 may be because clinical recovery lags electrophysiological recovery. We did not find any significant difference for duration of symptoms in 2 groups. Conclusion: In practical terms, we did not find any predictor in clinical and MR neurography variables that correlate with recovery of thumb opposition.
The Role of Venous Return on the Survival of Arterialized Venous Flaps
Authors: Weng Weidong , Zhang Feng , Li Zhijie , Gao Weiyang , Yan Hede
Published: September 2016

Objective: The objective of this study is to evaluate the role of venous return on venous congestion and flap survival of the arterialized venous flaps (AVFs). Materials and Methods: A 10×8-cm skin flap was designed symmetrically in the rabbit abdomen. Four groups were included: the conventional arterial perfusion flap as the control group and 3 experimental groups. The experimental groups I, II, and III were designed based on the number of drainage veins (1 drainage vein for experimental group I, 2 for group II, and 3 for group III). The thoracoepigastric arteries and veins and 1 femoral artery were used as vascular sources. Levels of epidermal metabolite, water content, status of vascular perfusion, and flap viability in each group were observed and analyzed. Results: In contrast to the control group, significant venous congestion assessed by water content was noted in all the 3 experimental groups and the most severe one was found in the experimental group I, while no statistical difference was observed between the experimental groups II and III. Similar results regarding blood perfusion state, epidermal metabolite levels, and flap survival status were obtained among the 3 experimental groups. Conclusions: Venous return is vital in the survival of AVFs, but the problem of venous congestion can only be partially solved by increasing the number of draining veins. Further studies are warranted to gain insight into this complicated issue.
A New Surgical Technique for Mallet Finger With Bone Anchor and Reverse Lateral Band Slips
Authors: Tan Jun , Ye Ming , Chen Jing , Tang Jinbo
Published: September 2016

Objective: A large number of surgical techniques have been applied in the attempt to find an ideal method in treating the mallet finger after failure of conservative treatment. However, the optimal method is still unknown. The aim of this study is to evaluate a new reliable surgical technique for tendinous mallet finger repaired by Massachusetts General Hospital (MGH) method with a bone anchor followed by reverse lateral band slips in vitro. Materials and Methods: Sixteen fingers were obtained from 10 fresh-frozen cadaver hands and made into mallet finger models by terminal tendon laceration. All the lacerations were repaired by MGH method with a bone anchor fixed in distal phalanx and then divided into 2 groups. Reverse bilateral band slips were further used to supplement the repair for half of the 16 fingers (group 2). The tendon slips were carefully harvested from the bilateral band of proximal one-third of middle phalanx. The width of the slip was no more than one-fourth of the lateral band (about 1 mm for index, middle, and ring finger, and for little finger, it is about 0.8 mm). Then the harvested bilateral band slips were reversely sutured close to the extensor tendon insertion with cruciate path to cover the repair site, suture, and knots. After the procedure, all the repaired tendons with the distal phalanx were collected to detect the repair strength. Ultimate strength was evaluated as biomechanical performance for two groups. Rupture pattern was also recorded for each specimen. Results: The MGH repair with reverse bilateral band slips had a significantly higher ultimate tensile strength (43.9 N; SD, 7.9 N) than the MGH repair only (33.1 N; SD, 3.7 N). One rupture was found at partial lacerated lateral band in one initial specimen of reverse lateral band slips, due to improper operation. All the other ruptures occurred at the suture or the knots. Conclusions: Supplement with the reverse bilateral band slips can enhance the tensile strength of extensor tendon injury repaired by MGH method. Slip with no more than one-fourth width of lateral band carefully harvested cannot increase the risk of lateral band rupture. Usage of the reverse lateral band slip can cover the repair site and reduce the exposure of the stitches. It is a useful, reliable, and alternative technique for the treatment of tendious mallet finger using reverse lateral band slips after MGH repair with a bone anchor.
Nonconventional Tendon Advance for Injuries in Zones 1 and 2
Authors: Garay Alberto Luis , Martínez Carlos Eugenio , Bustos Francisco Lopez , Patiño Juan Martín , Tonetto Germán
Published: September 2016

Objective: Two techniques for reconstruction of tendon flexor injuries in zones 1 and 2 of Verdan in which primary suture cannot take place are presented. These techniques consists in carrying out a zetaplasty of the injured tendon in zone 5 to slide the proximal stump of the original rupture toward the distal stump of the tendon, suture both stump, and then perform the suture of the zetaplasty with the required tension. Another option, in case the end to end suture is unable, is to suture the lengthened tendon to an uninjured superficial flexor tendon. Methods: Thirteen patients with an average of 29 years of age were operated on with these two techniques. Diagnoses included 3 failures in primary suture of profundus flexor tendon, 7 tendon injuries treated 4 weeks after the trauma, and 3 injuries with shortening of the distal stump greater than 3 cm. In 7 cases, zetaplasty was performed with an end to end suture of the same flexor tendon, and in the remaining 6 zetaplasty was carried out with a suture of the proximal stump to an uninjured flexor tendon. Results: Average follow-up was 17.23 months. Assessment with the Strickand’s evaluation system yielded the following results: 8 excellent, 4 good, and 1 poor. Conclusions: The encouraging results in the short term with these techniques of shorter operating time and less surgical requirement motivate further development. A larger number of cases are necessary to obtain more reliable conclusions about their advantages and side effects.
Restoration of Pronation and Radial Deviation in “The Beggar’s Hand” Deformity by Switch Technique
Authors: Ozkan Turker , Berkoz Omer , Aydin H. Utkan , Ozkan Safiye , Kozanoglu Erol
Published: September 2016

Objective/Hypothesis: In this study, our aim is to present our results with the “switch technique” in the dynamic restoration of forearm pronation and wrist radial deviation in patients with “the beggar’s hand” caused by obstetric brachial plexus palsy. In the “switch technique,” the tendons of two functional muscles are sectioned at two different levels, and the proximal muscular units are transposed to the presectioned distal tendon ends in a cross fashion. This technique enables the dynamic restoration of the paralytic and complex deformity. Materials and Methods: Eleven obstetric palsy patients (6 male, 5 female) with ages ranging between 5 and 10 years (mean age of 7.6 years) were operated for the correction of supination deformity and ulnar deviation of the wrist. Soft tissue releases were performed at the forearm and the wrist. Extensor carpi ulnaris (ECU), brachioradialis (BR), abductor pollicis longus (APL), and the flexor carpi ulnaris (FCU) muscles were prepared. The ECU tendon was sectioned and disinserted from its insertion whereas the BR tendon was sectioned just distal to the myotendinous junction. The distal end of the BR tendon was rotated around the radius from the dorsal to the volar, and then, it was advanced proximally along the interosseous membrane after being passed through a pulley that was prepared from the distal end of the FCU tendon. The ECU tendon was advanced from the dorsal to the volar, and it was sutured to the BR tendon as a pronator. The APL tendon was sectioned from a proximal level, and the distal end of this tendon was sutured to the proximal end of the BR tendon as a wrist radial deviator. The mean follow-up time was 14 months (4-31 months). Forearm pronosupination, wrist flexion-extension, and ulnar-radial deviation were assessed by goniometric measurements. Results: Mean active forearm pronation was −42.5° preoperatively. After the surgery, 38.75° degrees of active forearm pronation was achieved. Preoperative and postoperative mean active radial deviation values were −7.5° and 10.75°, respectively. All patients reported that they became more capable in activities such as turning pages and holding a mug. Conclusions: The tendons that are used in the “switch technique” are not paralytic, and they are functional. In fact, this is a major difference with classic tendon transfers. With this technique, the original muscle bellies and the routes of the tendons are switched. They are used for impaired targets, and they are reorganized for the restoration of insufficient functions. Correction of the deformity improves the appearance of the limb and the self-confidence of the child and allows the patients to integrate well into the society. These results suggest that selected cases may benefit from restoration of “the beggar’s hand” deformity with the “switch technique” that may produce a critical improvement in functional capabilities.
Extensor Carpi Ulnaris Tendon Dislocation
Authors: Pereira Eduardo , Pereira Luciano , Imoto Fabio
Published: September 2016

Objective: Extensor carpi ulnares (ECU) has a stabilizing role at distal radioulnar joint, and besides the extensor retinaculum coverage, it is held tight to the ulnar groove by the ECU subsheath. Graham (2012) described a reinforced insertion of the ECU subsheath at medial edge of ulnar sulcus that creates a labrum, a critical barrier for ECU subluxation. Forced supination, palmar flexion, and ulnar deviation can rupture or attenuate the ECU subsheath and the ECU tendon can dislocate, causing ulnar side wrist pain. We present our experience dealing with diagnostic (special test for ECU instability, dynamic ultrasound, and wrist MRI) and treatment details of ulnar side wrist pain related to ECU tendon dislocation. Material and Methods: From 2010 to 2015, we treated 9 patients with ulnar side wrist pain related to ECU dislocation. All patients had a failed conservative treatment (Immobilization + Physical Therapy) for at least 3 months. Diagnostic was confirmed by clinical examination, dynamic ultrasound, and magnetic resonance imaging (MRI) in supination/pronation. Patients were evaluated in terms of ECU instability tests, wrist range of motion, grip strength, analogic scale of pain, and return to sports activities. Results: There were 8 male and 1 female, average age of 34.5 year-old, and 7 of 9 dominant wrists were affected. Of all, 5 were tennis players, 2 basketball players, and 1 soccer goalkeeper. Minimum follow-up was 12 months. Seven of 9 patients had type A (Inoue & Tamura) injury, with subsheath rupture at ulnar side, and 2 out of 9 had type C (one had a tumor inside the subsheath that became redundant). All cases with ECU instability were submitted to labral reattachment to medial wall of ulnar sulcus with mini-anchor and retinacular subsheath sling reconstruction. All players had resolution of wrist pain, recovery wrist motion, and strength and went back to sport activity. Conclusion: The ECU dislocation must receive special attention because, probably, it is more common than we expected. Based on our small experience, we believe that surgical labrum reattachment is a good option to solve ECU recurrent dislocation.
Photography-based Method for Measuring Wrist Range of Motion
Authors: Trehan Samir K. , Rancy Schneider K. , Johnsen Parker H. , Lee Steve K. , Wolfe Scott W.
Published: September 2016

Hypothesis: We hypothesized that at-home photography-based wrist range of motion (WROM) measurements would be as reliable as traditional physician-performed goniometry. Methods: Sixty-nine postoperative patients who had wrist surgery greater than 3 months prior were enrolled in this study according to an approved institutional review board protocol. Active and passive wrist flexion/extension and radial/ulnar deviation were recorded by 1 of 2 attending surgeons with a 1° resolution goniometer at the last postoperative office visit. Patients were then provided an illustrated instruction sheet detailing how to take digital photographs at home in 6 wrist positions (active and passive flexion/extension and radial/ulnar deviation). Photographs were reviewed by both attending surgeons in a randomized, blinded fashion on 2 separate occasions greater than 2 weeks apart using the same goniometer. Reliability analysis was performed using the intraclass correlation coefficient (ICC) to assess agreement between clinical and photography-based goniometry, as well as intraobserver and interobserver agreement. Results: Out of 69 enrolled patients, 30 patients sent digital images (43% response rate). Of the 180 digital photographs taken by patients at home, only 9 (5%) were missing or deemed inadequate for WROM measurements. Agreement between clinical and photography-based measurements was “almost perfect” for passive wrist flexion/extension (ICC > .80, P < .01) and “substantial” for active wrist flexion/extension and radial/ulnar deviation (.60 < ICC = .80, P < .01). Interobserver and intraobserver agreement for the 2 attending surgeons for all 6 photography-based measurements was “almost perfect” (ICC > .80, P < .01). Conclusion: This study validates a photography-based goniometry protocol allowing accurate and reliable range of motion (ROM) measurements without direct physician contact. Passive ROM was more accurately measured from photographs than active ROM. This study builds on previous photography-based goniometry literature by validating a protocol in which patients take their own photographs. Patient-performed photography-based goniometry represents an alternative to traditional clinical goniometry with the potential to enable longer term patient follow-up, overcome travel or distance impediments to office visits, improve patient convenience, and increase cost savings.