Operative Orthopädie und Traumatologie
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Oper Orthop Traumatol · Aug 2013
Clinical Trial[Restoration of thumb flexion at the interphalangeal joint by transposition of the flexor digitorum superficialis tendon from the ring finger].
Restoration of active thumb flexion at the distal joint. ⋯ In this study 10 patients with FDS IV transposition to reconstruct an isolated rupture of the FPL tendon could be followed for an average of 4.1 years postoperatively. The active range of motion of the IP joint of the thumb averaged 65° (10-100°), 8/10 patients achieved an equal active and passive range of motion of the IP joint of the thumb, in 2 patients some flexion insufficiency remained, 9 patients could reach the fingertip of the small finger with the thumb and 1 patient lacked 3 mm. Contracture of the proximal thumb joint developed in two patients. After removal of the FDS IV tendon two patients developed contracture of the PIP joint of the ring finger. The grip force was reduced to 81 %, lateral grip to 83 % and pinch grip to 77 %. The DASH score averaged 18 (0-31) and 8/10 patients would choose to undergo this surgery again.
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Oper Orthop Traumatol · Aug 2013
Clinical Trial[Operative treatment of claw deformity by lassoplasty].
The aim is correction of claw deformity of the fingers by intrinsic paralysis. ⋯ From April 2003 to June 2012 a total of 17 patients, 8 female and 9 male were surgically treated for claw deformity. The dominant hand was affected in seven patients. The average age was 46 ± 15 (22-80) years, the average interval from onset of ulnar palsy to lassoplasty was 61 ± 91 (3-288) months. The final follow-up was performed after an average of 42 ± 32 (2-112) months. Claw deformity was resolved in 14 out of the 17 patients. The grip strength was on average 58 ± 28 % (11-96 %) of the unaffected hand, the mean disabilities of the arm, shoulder and hand (DASH) score was 32 ± 18 (5-68) points and the degree of patient satisfaction 7 ± 2 (0-10). According to own results and those in the literature lassoplasty can be recommended for the treatment of claw deformity.
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Oper Orthop Traumatol · Aug 2013
Clinical Trial[Abductor digiti minimi muscle flap for defect coverage of the hand].
Defect coverage of the ulnar aspect of the hand, wrist and hypothenar with an abductor digiti minimi muscle flap and split skin graft. ⋯ In total, 9 patients showed good results with a reliable defect coverage due to a constant anatomy and easy preparation.
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Oper Orthop Traumatol · Aug 2013
Clinical Trial[Brachioradialis rerouting for restoration of forearm supination or pronation].
Improvement of active forearm supination or pronation. Reduction of paralytic pronation or supination posture. ⋯ Özkan et al. performed brachioradialis rerouting to restore supination in 5 children between 4 and 14 years with pronation deformity and to restore pronation in 4 children aged 5-9 years with supination deformity. Mean active gain for supination was 81° (40-140°). Active pronation improved from 28 to 49° (30-75°; Özkan et al., J Hand Surg Br 29:263-268, 2004; Özkan et al., J Hand Surg Am 29:22-27, 2004). Between April 2006 and January 2011 we used this technique in 4 patients aged 7-26 years (mean 14 years). Three patients could be followed up. One patient had preoperative a fixed pronation deformity of the forearm in 80° pronation. In this case active range of motion could be improved to 80/30/0° pronation/supination. One patient improved from preoperative 0/0/90° pronation/supination to 30/0/90° postoperatively. In one case no functional improvement of forearm rotation could be achieved in long-term follow-up. No functional loss in forearm rotation to the opposite direction or of the elbow function was observed. Mean follow-up time was 51 months (21-77 months).
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Oper Orthop Traumatol · Jun 2013
Reinforcement of lumbosacral instrumentation using S1-pedicle screws combined with S2-alar screws.
Increasing construct stability of lumbosacral instrumentations using S2-ala screws as an alternate to iliac screws. ⋯ Retrospective review of 80 patients undergoing S2-ala screw fixation. Main diagnosis was degenerative lumbar instability, adult scoliosis, high-grade listhesis, and nonidiopathic scoliosis. In 66% of patients, the instrumentation using S2-ala screws was part of a major lumbosacral revision surgery. Follow-up averaged 26 months. There were no deaths or major neurovascular complications. First time fusion rate at L5-S1 was greater than 90%. Eight patients (10%) experienced a complication which could be related to the S2-ala screws. Out of 160 S2-ala screws, 16 screws were judged to cause focal irritation and were removed, indicating a survival rate of 90% for the S2-ala screw.