The Journal of hand surgery
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Comparative Study
The effect of flexor tendon repair bulk on tendon gliding during simulated active motion: an in vitro comparison of two-strand and six-strand techniques.
The gliding function of 2-strand (Tajima) and 6-strand (Savage) techniques of flexor tendon repair were compared in an in vitro biomechanical model. Stainless steel beads were inserted directly into the metacarpals, phalanges, and flexor digitorum profundus tendons of 22 human cadaver specimens. The FDP tendons were loaded from 5 to 25 N using a pneumatic actuator. ⋯ There was no significant difference in angular rotation or linear excursion between the 2-strand and 6-strand techniques of flexor tendon repair. The addition of the epitendinous suture to the core suture improved the angular rotation and linear excursion for the 2-strand technique. Although the 6-strand repair tended to increase the repair site bulk more than the conventional 2-strand technique, the gliding function of the repair techniques was equivalent.
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The purpose of this study was to estimate the frequency and describe the epidemiology of hand and forearm fractures in the United States. We extracted cases with ICD-9-CM diagnostic codes of 813.0 to 817.1 from the 1998 National Hospital Ambulatory Medical Care Survey. In 1998 there were 1,465,874 estimated cases of hand/forearm fractures, accounting for 1.5% of all emergency department cases. ⋯ Most of the fractures occurred at home (30%); the street/highway was the second most likely fracture location (14%). Accidental falls caused the majority (47%) of fractures. Large database analysis provides important information that can be used to target interventions toward vulnerable populations and to allocate adequate resources for treating upper extremity fractures.
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The use of conjoint flaps based on the dorsalis pedis artery enabled a transfer of 3 free flaps-dorsalis pedis flap, fillet flap of the second toe, and trimmed large toe-to reconstruct a severely traumatized hand in a 12-year-old girl. High-voltage electrical burn injury had caused a large wound over the volar wrist and exposed the flexor tendons and median/ulnar nerves. In addition, she suffered a partial loss of the thumb and had an open wound at the base of the index finger. The application of the conjoint flaps restored hand function in a one-stage procedure.
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The effect of the A3 pulley and adjacent sheath integrity on tendon function at the proximal interphalangeal (PIP) joint was investigated in 21 fingers in 7 fresh-frozen cadaver hands. Excursions of the flexor digitorum profundus (FDP) tendons were measured when the tendons were pulled to produce PIP joint flexion of 110 degrees from a resting position of 0 degrees. Excursions of the FDP tendons in 10 fingers were tested within the intact sheath and after incision of the A3 pulley, of the A3 pulley with its proximal sheath up to the distal border of the A2 pulley, and of the sheath between the A2 and A4 pulleys. ⋯ Tendon bowstringing was 0.3 mm after incision of the A3 pulley, 0.6 mm after incision of the A3 pulley with its distal sheath, 0.8 mm after incision of the pulley with its proximal sheath, 1.4 mm after incision of the sheath from the A3 to A4 pulleys, and 1.6 mm after incision of the sheath between the A2 and A4 pulleys. The results suggest that the sheath adjacent to the A3 pulley plays an important role in restraining tendon bowstringing at the PIP joint, whereas the A3 pulley alone is of little importance. This study elucidates the role of individual parts of the sheath around the PIP joint in maintaining tendon function and may guide decisions regarding the area and length of the sheath feasible for surgical release or requiring repair in the treatment of tendon lacerations.