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Flexor tendon repair

Richard M Hinds, Nicole Montero-Lopez, Kenneth Brock, Ronald Adler, Anthony Sapienza, John T Capo, Nader Paksima
BACKGROUND: Previous work evaluating the pronator quadratus (PQ) muscle following volar plate fixation (VPF) of distal radius fractures (DRF) suggests that PQ repair often fails in the postoperative period. The purpose of this investigation was to assess PQ repair integrity following VPF of DRF using dynamic musculoskeletal ultrasonography. METHODS: Twenty adult patients who underwent VPF of DRF with repair of the PQ with a minimum follow-up of 3 months underwent bilateral dynamic wrist ultrasonography...
July 1, 2018: Hand: Official Journal of the American Association for Hand Surgery
Sara Edsfeldt, Martin Eklund, Monica Wiig
STUDY DESIGN: Observational cohort study. INTRODUCTION: Investigating prognostic factors using population-based data may be used to improve functional outcome after flexor tendon injury and repair. PURPOSE OF THE STUDY: The aim of this study is to investigate the effect of concomitant nerve transection, combined flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendon transection and the age of the patient, on digital range of motion (ROM) more than 1 year after FDP tendon transection and repair in zone I and II...
July 5, 2018: Journal of Hand Therapy: Official Journal of the American Society of Hand Therapists
Gabriel Halát, Lukas L Negrin, Ewald Unger, Thomas Koch, Johannes Streicher, Jochen Erhart, Patrick Platzer, Stefan Hajdu
The purpose of this study was to determine the biomechanical characteristics of an innovative surgical technique based on a tension banding principle using a suture anchor in the repair of bony avulsions of the flexor digitorum profundus tendon. After injury simulation in 45 fresh frozen distal phalanges from human cadavers, repair was performed with minifragment screws, interosseous sutures and the innovative technique (15 per group). All repairs were loaded for a total of 500 cycles. Subsequently the specimens were loaded to failure...
July 2, 2018: Scientific Reports
Nikolaos Anastasopoulos, George Paraskevas, Nikolaos Lazaridis, Konstantinos Natsis
Isolated rupture of the flexor hallucis longus tendon is an unusual injury. We present the case of a neglected flexor hallucis longus tendon closed traumatic rupture at the plantar aspect of the first phalangeal head of the great toe in a middle-age male. The injury occurred while he was dancing. Because end-to-end tendon suture was impossible, the ensuing gap was repaired using a free plantaris tendon graft. We present the operative repair benefit of the flexor hallucis longus tendon rupture to regain the function and strength of the interphalangeal joint of the hallux, avoid extension of the distal phalanx, and maintain the longitudinal arch of the foot...
June 21, 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
N Bigorre, F Delaquaize, F Degez, S Celerier
The repair of flexor tendon lesions in zone 2 remains a highly controversial subject in hand surgery. Currently, there is no consensus about the management of these lesions intra- and postoperatively, but the literature suggests that a solid suture will allow early active motion. We hypothesized that the management of flexor tendon injury in zone 2 varies widely. Two online surveys were conducted with surgeons and hand therapists. The questions captured the demographics of the surveyed population, surgical technique, common complications, postoperative management (duration of immobilization, type of splint, rehabilitation techniques and principles of self-rehabilitation)...
June 19, 2018: Hand Surgery and Rehabilitation
Jeremy Truntzer, Kevin Mertz, Sara Eppler, Kevin Li, Michael Gardner, Robin Kamal
BACKGROUND: In distal radius fracture repair, complications often lead to reoperation and increased cost. We examined the trends and complications in open reduction internal fixation of distal radius fractures across hand specialist and non-hand specialist surgeons. METHODS: We examined claims data from the Humana administrative claims database between 2007 and 2016. International Classification of Disease, 9th Edition and Current Procedural Terminology codes were searched related to distal radius fractures repaired by open reduction internal fixation...
June 19, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Mohammad R Khan, Jayesh Dudhia, Frederic H David, Roberta De Godoy, Vedika Mehra, Gillian Hughes, Stephanie G Dakin, Andrew J Carr, Allen E Goodship, Roger K W Smith
BACKGROUND: Intra-synovial tendon injuries display poor healing, which often results in reduced functionality and pain. A lack of effective therapeutic options has led to experimental approaches to augment natural tendon repair with autologous mesenchymal stem cells (MSCs) although the effects of the intra-synovial environment on the distribution, engraftment and functionality of implanted MSCs is not known. This study utilised a novel sheep model which, although in an anatomically different location, more accurately mimics the mechanical and synovial environment of the human rotator cuff, to determine the effects of intra-synovial implantation of MSCs...
June 19, 2018: Stem Cell Research & Therapy
Masato Ohara, Ryo Oda, Shogo Toyama, Yusei Katsuyama, Hiroyoshi Fujiwara, Toshikazu Kubo
INTRODUCTION: Closed flexor tendon rupture after a malunited distal radius fracture is rare and usually becomes apparent early after the fracture. Most cases are accompanied by a severe distal radio-ulnar joint capsule injury, wherein bone protrusion (as a spur) directly stresses the tendons. We experienced a nonspecific flexor tendon rupture associated with an old fracture and the presence of collagen disease. PRESENTATION OF CASE: A 63-year-old woman presented with delayed complete rupture of the flexor digitorum profundus (FDP) of the fifth digit...
May 29, 2018: International Journal of Surgery Case Reports
Derek T Bernstein, Jamie J Alexander, Nancy J Petersen, Bradley S Lambert, Philip C Noble, David T Netscher
PURPOSE: To evaluate the impact of suture caliber and looped configurations on the integrity of 4-strand modified Kessler zone II flexor tendon repairs during progressive cyclic loading. METHODS: Seventy-two flexor digitorum profundus tendons from 18 fresh human cadaver hands were divided into 4 repair groups. Thirty-six matched tendons underwent repair using either a 4-0 looped or 4-0 single-stranded suture, and an additional 36 tendons underwent 3-0 looped or 3-0 single-stranded repairs...
June 8, 2018: Journal of Hand Surgery
James Williams, Rupert Wharton, Peter Peev, Maxim Horwitz
Delayed rupture of the extensor and flexor tendons are recognised complications of distal radius fractures. However, acute flexor tendon rupture in the context of forearm fractures is rare. A twelve-year-old female sustained midshaft fractures of the radius and ulna. Intra-operatively the flexor pollicis longus (FPL) was found to be stripped from its musculotendinous junction at the level of the fracture fragment. The ruptured tendon was repaired using a modified Krackow technique at the time of fracture fixation...
June 2018: Trauma Case Reports
Hai Li, Chengliang Deng, Zairong Wei, Wenhu Jin, Kaiyu Nie, Xiujun Tang, Dali Wang, Shusen Chang, Shujun Li
Objective: To evaluate the effectiveness of anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap for repairing extremities soft tissue defect. Methods: Between January 2014 and January 2017, 24 patients with extremities soft tissue defects were treated by anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap. There were 15 males and 9 females, with a median age of 33.5 years (range, 5-64 years). Wounds located in upper limb in 8 cases, complicated with radial styloid fracture in 1 case, extensor tendon exposure in 3 cases, and brachioradialis muscle tendon exposed in 1 case...
August 1, 2017: Chinese Journal of Reparative and Reconstructive Surgery
Yanqing Hu, Hai Jiang, Qi Li, Jian Li, Xin Tang
Objective: To evaluate the biomechanical property of tendons repaired with the modified Kessler suture combined with " 8" suture, and to provide evidence for the clinical application of this suture methods in repairing acute Achilles tendon rupture. Methods: Forty frozen flexor digitorum longus tendons from fresh pork hind leg were randomly assigned into 4 groups, 10 specimens each group. In group A, the tendons were dissected transversely at the midpoint to forming the model of tendon with transversely cutting injury...
October 1, 2017: Chinese Journal of Reparative and Reconstructive Surgery
Hamza Ozer, Yilmaz Ergisi, Gulcan Harput, Mehmet S Senol, Gul Baltaci
Flexor hallucis longus (FHL) tendon transfer to the calcaneus in the repair of delayed or neglected Achilles tendon (AT) injuries is a viable and dynamic option. Nineteen patients (18 males, 1 female; mean age 47.4 ± 12.4, range 24 to 74, years; body mass index 27.5 ± 4.5, range 23.2 to 38.9, kg/m2 ; interval from injury to surgery 40.8 ± 11.6, range 28 to 60, days) with delayed or neglected repair of AT rupture were included in the present study. FHL transfer to the calcaneus through a single incision and repair of the defect with native tendon lengthening or a tendinous turndown flap was performed...
May 18, 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Yoke Rung Wong, Austin Mun Kitt Loke, Shian Chao Tay
BACKGROUND: To propose a new term ('construct efficiency') for the evaluation of multi strands flexor tendon repairs using different suture materials. METHODS: A total of twenty specimens from 4-0 braided polyblend sutures (FiberLoop/FiberWire; Arthrex, Naples, FL) and 4-0 nylon sutures (Supramid Extra II; S. Jackson, Inc., Alexandria, VA) were subjected to tensile testing using Pneumatic Cord-and-Yarn Grips (Instron Corp., Canton MA, USA). The ultimate tensile strengths of the suture materials were measured...
June 2018: Journal of Hand Surgery Asian-Pacific Volume
Renita Sirisena, Amitabha Lahiri, Alphonsus Khin-Sze Chong, Tun-Lin Foo
BACKGROUND: Attaining competency in placement of core suture with adequate distance from juncture is a key skill for learners of tendon repair. Currently, this is most commonly practiced on animal models in wet laboratory environment. To improve accessibility and availability, we developed a tendon repair trainer that aims to guide learners in obtaining this key competency. METHODS: A customized tendon dock was designed and manufactured with additive method that permits insertion of 6mm silicon tendon rods to simulate flexor tendon repair along a digit...
June 2018: Journal of Hand Surgery Asian-Pacific Volume
Takuya Uemura, Tadashi Okano, Ema Onode, Takuya Yokoi, Kosuke Shintani, Mitsuhiro Okada, Hiroaki Nakamura
Flexor pollicis longus (FPL) tendon rupture is a major complication of volar locking plate fixation for distal radius fractures. The tendon rupture is usually caused by friction between the distal edge of the plate and the FPL tendon, and has been well detected recently with ultrasonography. Rarely, the volar locking plate itself entraps the FPL tendon, leading to its rupture. A 63-year-old man was consistently unable to flex his right thumb after previous surgery for a distal radius fracture at another hospital...
April 27, 2018: Journal of Medical Ultrasonics
Jin Bo Tang
This article reviews some recent advancements in repair and rehabilitation of the flexor tendons. These include placing sparse or no peripheral suture when the core suture is strong and sufficiently tensioned, allowing the repair site to be slightly bulky, aggressively releasing the pulleys (including the entire A2 pulley or both the A3 and A4 pulleys when necessary), placing a shorter splint with less restricted wrist positioning, and allowing out-of-splint active motion. The reported outcomes have been favourable with few or no repair ruptures and no function-disturbing tendon bowstringing...
June 2018: Journal of Hand Surgery, European Volume
Jian Yin, Zhaoyang Yin, Ge Gong, Chao Zhu, Chao Sun, Xinhui Liu
PURPOSE: This study was designed to compare the surgical outcomes of a hook plate with double-tunnel coracoclavicular (CC) ligament reconstruction by conjoined tendon transfer versus single hook plate surgery for the repair of acute type of Rockwood type III and V acromioclavicular (AC) joint dislocations. METHODS: The study cohort included 62 patients with acute (within 6 weeks after trauma) Rockwood type III and V AC joint dislocations who underwent surgery from February 2012 to September 2015...
June 2018: International Journal of Surgery
Yuk Wa Lee, Sai Chuen Fu, Tsui Yu Mok, Kai Ming Chan, Leung Kim Hung
Background: Hand flexor tendon injuries are compromised with tendon adhesion. Tendon adhesion forms between flexor tendon and tendon sheath, reduces the range of motion of fingers, and affects their function. Oxidative stress is increased in flexor tendon after injury and might play a role in tendon adhesion formation. Trolox (6-hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid), a water-soluble analog of vitamin E, is antioxidative. Trolox reduced oxidative stress and the expression of fibrotic cytokines in the bile gut ligation animal model...
July 2017: Journal of Orthopaedic Translation
Daniel Marsland, Joanna M Stephen, Toby Calder, Andrew A Amis, James D F Calder
PURPOSE: To assess whether early rehabilitation could be safe after flexor digitorum longus (FDL) tendon transfer, the current biomechanical study aimed to measure tendon displacement under cyclic loading and load to failure, comparing a traditional tendon-to-tendon (TT) repair with interference screw fixation (ISF). METHODS: 24 fresh-frozen cadaveric below knee specimens underwent FDL tendon transfer. In 12 specimens a TT repair was performed via a navicular bone tunnel...
April 7, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
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