Hand surgery & rehabilitation
-
This study was a retrospective evaluation of 18 patients with traumatic bone loss affecting the fingers, hand and wrist who were treated using the induced-membrane technique. Sixteen men and two women, mean age 54years (27-74) presented a hand injury including bone loss. Sixteen patients were treated on an emergency basis and two following nonunion of their fractures. ⋯ Grip strength reached 21kg/F and pinch strength was 5kg/F; these values were 50% of those in the healthy hand. The induced-membrane technique is simple and can be used to treat traumatic bone loss in an emergency, thus avoiding amputation and limb shortening, while preserving limb function. It provides immediate stability and allows early mobilization.
-
Observational Study
Use of the entire flexor carpi radialis tendon for basal thumb ligament reconstruction interposition arthroplasty.
Recent studies seem to show that ligament reconstruction with tendon interposition (LRTI) does not provide any benefit over trapezium excision alone; however dorsal subluxation was not measured in these studies. We believe it is logical to perform ligamentoplasty in order to obtain long-term stability and therefore treat dorsal subluxation. Our aim is to verify this hypothesis in an observational prospective study of LRTI using the entire flexor carpi radialis (FCR) tendon. Patients who had failed to respond to nonoperative treatment for advanced thumb basal joint arthritis were recruited prospectively between 2007 and 2011. They all received the same surgical treatment, which consisted of LRTI using the entire FCR tendon. Pre- and postoperative pain, range of motion, strength, stability of the base of the first metacarpal and DASH scores were evaluated. Forty-three patients (49 thumbs) were included with a mean follow-up of 37months (range: 29-72months). Patients showed significant improvements in pain, range of motion and pinch strength. The dorsoradial subluxation was no longer present in any of the thumbs, and the grind test was positive in only three thumbs. The DASH score was improved from 49/100 preoperatively to 22/100 postoperatively. No ulnar deviation of the wrist was observed at the longest follow-up and grip strength was not altered by the procedure. This study showed that the use of the full FCR tendon for LRTI in combination with trapeziectomy is an efficient and safe treatment for advanced carpometacarpal osteoarthritis as it provides a strong ligamentoplasty with a bulky interposition. ⋯ Clinical study, Therapeutic Study: Level IV.
-
The aim of this study was to describe the mechanisms involved in stretch injuries of the brachial plexus. One hundred and fifty consecutive patients with supraclavicular brachial plexus injuries (BPI) were asked about the mechanism of injury during the actual injury event, particularly about the type of trauma to their shoulder, shoulder girdle and head. Fifty-seven of the patients provided enough information about their accident to allow for analysis of the shoulder trauma. ⋯ The injury mechanism for the lower root palsy cases (n=11) was variable. The most frequent mechanism was forceful anterior shoulder compression by a car seat belt. We found that injury mechanisms differed significantly from the ones commonly discussed in published studies.