ISSN:1089-3393    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Palliative tendon transfer procedures for radial nerve palsy are continuing to evolve. The main modifications have concerned the operative techniques and the choice of procedures to adapt surgery to the needs of the patient. A study of all the elements of tendon transfer has been undertaken and has gradually led us to describe two basic methods of transfer either using or not using the flexor carpi ulnaris for transfer. The essential consideration is the avoidance of radial deviation of the wrist by centralizing the insertion of the extensor carpi radialis longus.

ISSN:1089-3393    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The polyester patch made from Bard-DeBakey Woven Fabric (C.R. Bard, Inc., Haeverhill, MA, U.S.A.) was used as the core of the interlacing suture. This new technique was applied mainly to extensor tendon transfers on the dorsum of the hand. The end-to-end interlacing suture technique with polyester patch was applied to seven patients with rupture of the extensor pollicis longus tendon, and the end-to-side transfer with a patch was applied to three patients with ruptures of the finger extensor tendon. Evaluation was performed using % total amount of motion. All seven patients who received the end-to-end interlacing suture with a patch were evaluated as good. Of the three patients who received the end-to-side transfer with a patch, two cases had a good result, and one case had a fair result. With this technique, active motion exercise may be started immediately after surgery without cast immobilization.

ISSN:1089-3393    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

We investigated 52 consecutive patients (53 wrists) with suspected scaphoid fracture using MRI (0.2 T) within 7 days after the injury. We performed two sequences for the wrist: (1) coronal T1-weighted spin-echo and (2) T2-weighted turbo spin-echo. We also performed four sequences specific for the scaphoid with the plane parallel to the longitudinal axis of the scaphoid: (1) coronal T1-weighted, (2) coronal T2-weighted, (3) sagittal T1-weighted, and (4) sagittal T2-weighted images. In these projections, only one section is enough to cover the scaphoid fracture that definitely eased the diagnosis. In 18 (33%) wrists, the scaphoid fracture was detected on MRI. Computed tomograms (CT) were also taken with angled sagittal and coronal projections in 16 of the 18 wrists in which the scaphoid fracture was detected on MRI. CT revealed ten nondisplaced fractures, three displaced fractures, and three occult fractures. Bone contusion was found in no patients. MRI is a useful modality as a screening for occult scaphoid fracture.

ISSN:1089-3393    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The wrap-around flap became the most popular technique for reconstruction of an amputated thumb, because it can create an aesthetic and functional replica of missing thumb without losing any toes. It provides length, stability, and adequate sensibility for a functional pinch and grasp. Nevertheless, long-term results revealed complications of donor site and reconstructed thumb. In this article, we describe our recent version of the wrap-around flap technique and discuss its complications and ways of preventing them.

ISSN:1089-3393    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Chronic instability of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb can cause significant functional disability due to pain and weakness of pinch and grasp. In the absence of adequate ligament to repair, stability of the joint can be restored by reconstruction using a free tendon graft. The technique described here routes the tendon graft through two holes in the proximal phalangeal base and one hole in the metacarpal neck in a triangular configuration, which recapitulates the normal anatomy of the ulnar collateral ligament. The results of reconstruction are good. Stability and strength are restored without sacrificing significant range of motion and with minimal donor site morbidity.

ISSN:1089-3393    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Identification of motor and sensory fascicles to correctly match the motor and sensory fascicles helps surgeons to correctly align nerve stumps. Motor fibers, with their high cholinesterase activity, can be differentiated from sensory fibers. I developed a new modification that requires less than 1 hour and shows clearer differentiation compared with other histochemical techniques. In my clinical research, proximal stumps can be stained as long as 16 months after injury, however, distal stumps cannot be stained after 5 days. After 5 days, this staining could provide useful proximal information and distal fascicles may be identified by anatomic or topographical knowledge. I think this staining is especially useful in proximal nerve lesions and nerve injuries that require nerve graft within 4 days after injury. Also, this technique is useful in functioning muscle transfer to find motor fascicles and, in a sensate flap, to identify the sensory fascicle.

ISSN:1089-3393    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A technique is described for internal decompression of dorsal wrist ganglions without first rupturing the cyst, including documentation of the ganglion's relation to the scapholunate interosseous ligament. Critical evaluation of the stalk's true origin indicates that dorsal wrist ganglions originate primarily at the synovial-capsular interface between the dorsal scaphoid ridge and the overlying extensor carpi radialis brevis tendon. Although the ultimate etiology of dorsal wrist ganglions still remains unproven, arthroscopic techniques allow a thorough evaluation of the carpal intrinsic and extrinsic ligaments for any associated carpal instability. Despite differences between various arthroscopic methods, the clinical advantages over open techniques remain minimal scarring, avoidance of stiffness after surgery, and a comprehensive joint evaluation.

ISSN:1089-3393    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A pronator teres (PT) tendon transfer is used to treat patients with multiple pathologies, including radial nerve palsy, cerebral palsy, and tetraplegia. Identification of the tendon at time of surgery may involve a random search for its insertion site along the radius. Efficient location of the PT is essential to expedite the procedure and limit unnecessary tissue dissection. This paper describes a succinct method of identifying the tendon using a systematic and anatomic approach. The radial sensory nerve is identified at its exit point from beneath the brachioradialis (BR) muscle. The fascia surrounding the BR muscle and tendon is incised, and the radial artery is visualized. The radial sensory nerve is traced in a proximal direction under the BR muscle. The BR is retracted medially and the ECRL laterally. The PT tendon and insertion site are found just proximal to the emergence site of the radial sensory nerve from the BR. This method of identification of the PT insertion saves tourniquet time and avoids unnecessary dissection.

ISSN:1089-3393    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Nonunion of the fractured scaphoid can present a difficult surgical problem, especially in fractures near the proximal pole. The incidence of nonunion is greater in this region, in which the vascularity of the proximal fracture segment is compromised and the proximal fragment is small and resists rigid fixation. Recent development of better vascularized bone grafting techniques has provided a tool with which to address this vexing problem. Because many authors had previously shown the advantage of rigid fixation in obtaining scaphoid union, it seemed advantageous to us to combine these two methods—rigid fixation and improved vascularity. In this article, we present in detail our technique for treating patients with very small proximal pole fractures in which the proximal fragment makes up less than 20% of the scaphoid. For practical purposes, all of these fractures have a proximal fragment that is avascular. We use a vascularized bone graft as described by Zaidemberg et al. in combination with more rigid fixation of proximal pole fractures using the Herbert mini screw. Although the technique presented requires the surgeon to use precise surgical technique, early results have been encouraging, and patients with very small fracture fragments can be treated successfully.

ISSN:1089-3393    

出版商:OVID    

年代:2002

数据来源: OVID