Objective To investigate the effectiveness of the terminal extensor tendon reconstrution by palmaris longus tendon graft for the treatment of old mallet finger deformity. Methods Between February 2009 and February 2011, 32 patients with old mallet finger deformity were treated with palmaris longus tendon graft. There were 28 males and 4 females with an average age of 32.5 years (range, 22-58 years). The injury causes included sports injury in 26 cases and punctured injury in 6 cases. The index finger was involved in 8 cases, the middle finger in 3 cases, the ring finger in 16 cases, and the little finger in 5 cases. According to the Rockwell’s classification, all patients were classified as type I. The time from injury to operation was 4-16 weeks (mean, 6 weeks). Results Primary healing was obtained in all incisions; no necrosis, infection, or nail bed injury occurred. All patients were followed up 12-20 months (mean, 14 months). The patients had no pain or paresthesia of volar finger. According to Patel’s functional assessment system, the results were excellent in 8 cases, good in 21 cases, fair in 2 cases, and poor in 1 case at last follow-up, with an excellent and good rate of 90.6%. Conclusion Reconstruction of the terminal extensor tendon by palmaris longus tendon graft is a reliable method to treat old mallet finger deformity.
Objective To evaluate the results of thumb opposition function by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons. Methods Between March 2006 and August 2009, 35 patients with dysfunction of thumb opposition were treated and the thumb opposition function was reconstruced by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons. There were 25 males and 10 females with an average age of 33.5 years (range, 20-53 years); 20 had median nerve injury in the wrist and 15 had median nerve injury with ulnar nerve injury. The causes were sharp instrument injury in 24 cases, blunt injury in 9 cases, and hot crush injury in 2 cases. Six cases complicated by shaft fractures of radius and ulna. All the patients underwent an operation of nerve repair at 1 to 3 hours after injury (mean, 2 hours). The time from injury to reconstructing operation was 6-14 months (mean, 7.5 months). Two cases was able to abduct thumb sl ightly, the others had no functions of thumb abduct and thumb opposition. Results All the wounds gained the primary healing. The patients were followed up 12-18 months (mean, 14 months). The wrist joint angle and thumb dorsal extension were satisfactory. Thumb abduct and thumb opposition function returned to normal in 20 patients with simple median nerve injury; in 15 patients with median nerve injury and ulnar nerve injury, thumb abduct and thumb opposition function returned to normal in 15 and 13, respectively. According to ZHAO Shuqiang’s standard, the results of thumb opposition function were normal in all patients at 12 months after operation. Conclusion It is a convenient and efficient procedure to reconstruct thumb opposition function by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons.
Objective To evaluate the effectiveness of flexor hallucis longus tendon harvested using a minimally invasive technique in reconstruction of chronic Achilles tendon rupture. Methods Between July 2006 and December 2009, 22 patients (22 feet) with chronic Achilles tendon rupture were treated, including 16 males and 6 females with a median age of 48 years (range, 28-65 years). The disease duration was 27-1 025 days (median, 51 days). Twenty-one patients had hoofl ikemovement’s history and 1 patient had no obvious inducement. The result of Thompson test was positive in 22 cases. The score was 53.04 ± 6.75 according to American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system. MRI indicated that the gap of the chronic Achilles tendon rupture was 4.2-8.0 cm. A 3 cm-long incision was made vertically in the plantar aspect of the midfoot and a 1 cm-long transverse incision was made in a plantar flexor crease at the base of the great toe to harvest flexor hallucis longus tendon. The flexor hallucis longus tendon was 10.5-13.5 cm longer from tuber calcanei to the end of the Achilles tendon, and then the tendon was fixed to the tuber calcanei using interface screws or anchor nail after they were woven to form reflexed 3-bundle and sutured. Results Wound healed by first intention in all patients and no early compl ication occurred. Twenty-two patients were followed up 12-42 months (mean, 16.7 months). At 12 months after operation, The AOFAS ankle and hindfoot score was 92.98 ± 5.72, showing significant difference when compared with that before operation (t= —40.903, P=0.000). The results were excellent in 18 cases, good in 2 cases, and fair in 2 cases with an excellent and good rate of 90.9%. No sural nerve injury, posterior tibial nerve injury, plantar painful scar, medial plantar nerve injury, and lateral plantar nerve injury occurred. Conclusion Chronic Achilles tendon rupture reconstruction with flexor hallucis longus tendon harvested using a minimally invasive technique offers a desirable outcome in operative recovery, tendon fixation, and complications.
Three cases of common peroneal nerve injuries from sports were reported. All of the three cases were overlooked in their early treatment. The diagnosis was clarified 5 months to 33 years after injury. Because the chance of early repair was lost, they all were treated by tendon transfer with the hope to improve the function of foot. The mechanism of this type of injury and the problems related to the diagnosis and treatment were discussed.
The reconstruction of the extension function of wrist and fingers in 35 patients with radial nerveinjury was reported, The indications of oporation and the main management during and after operationwere discussed.It was thought that the tendon transfer was an effective method to reconstructextension functions of wrist and fingers after the injury of radial nerves and could be served as asupplementary means after radial nerve repair.
In order to understand the influence of the free tendon graft and the tendon transfer on their blood supply, histological and biochemical changes during healing following repair of the damaged tendon after the alteration of the nourishing environment, an experiment was carried on 36 New Zealand white rabbits. In the front paws of the rabbits, the free tendon graft was sutured in the tendon defect of flexor of the fourth toe and the flexor tendon of the third toe was transferred to the second toe to reconstr...
ObjectiveTo evaluate the effectiveness of the median nerve constrictive operation combined with tendon transfer to treat the brain paralysis convulsive deformity of the hand. MethodsThe clinical data from 21 cases with brain paralysis convulsive deformity of the hand were analyzed retrospectively between August 2009 and April 2012. Of them, there were 13 males and 8 females with an average age of 15 years (range, 10-29 years). The causes of the convulsive cerebral palsy included preterm deliveries in 11 cases, hypoxia asphyxia in 7, traumatic brain injury in 2, and encephalitis sequela in 1. The disease duration was 2-26 years (mean, 10.6 years). All the 21 patients had cock waists, crooking fingers, and contracture of adductors pollicis, 12 had the forearm pronation deformity. According to Ashworth criteria, there were 2 cases at level Ⅰ, 5 cases at level Ⅱ, 8 cases at level Ⅲ, 4 cases at level IV, and 2 cases at level V. All patients had no intelligence disturbances. The forearm X-ray film showed no bone architectural changes before operation. The contraction of muscle and innervation was analyzed before operation. The median nerve constrictive operation combined with tendon transfer was performed. The functional activities and deformity improvement were evaluated during follow-up. ResultsAfter operation, all the patients' incision healed by first intension, without muscle atrophy and ischemic spasm. All the 21 cases were followed up 1.5-4.5 years (mean, 2.3 years). No superficial sensory loss occurred. The effectiveness was excellent in 13 cases, good in 6 cases, and poor in 2 cases, with an excellent and good rate of 90.4% at last follow-up. ConclusionThe median nerve constrictive operation combined with tendon transfer to treat brain paralysis convulsive deformity of the hand can remove and prevent the recurrence of spasm, achieve the orthopedic goals, to assure the restoration of motor function and the improvement of the life quality.