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Flexor digitorum profundus

Nathan T Morrell
The reconstruction of chronic flexor tendon injuries remains one of the more challenging injuries facing the hand and upper extremity surgeon. In the setting of an intact flexor digitorum superficialis (FDS), there are few indications for isolated flexor digitorum profundus (FDP) reconstruction. Because of the interplay of the FDP system, the reestablishment of normal tension of the FDP tendons and lumbricals is particularly challenging, and postoperative stiffness, quadriga, or lumbrical plus phenomena can actually lead to a deterioration of digital function with surgery...
December 5, 2018: Techniques in Hand & Upper Extremity Surgery
R Srikanth, Koteswara Rao Rayidi, Subha Kakumanu
Introduction: The main deformity following an adult lower brachial plexus injury is the loss of finger flexion. Distal nerve transfers have been used to restore finger and thumb flexion followed by tendon transfers for intrinsic replacement for opening of the fingers. When patients present beyond 6 months, only tendon transfers are applicable. Since the brachioradialis (BR) is always spared in such injuries, it is the ideal muscle to provide finger flexion. Wrist extensor power may not be normal for the use of the radial wrist extensor to serve as donor...
May 2018: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Satoshi Kamihata, Takashi Oda, Takuro Wada
We experienced a rare case of carpal tunnel syndrome and rupture of the flexor digitorum profundus tendon to the index finger with a scapholunate advanced collapse wrist. We speculated that the lunate that had extruded into the carpal tunnel compressed the median nerve and caused wear of the flexor tendon following neglected perilunate subluxation. Carpal tunnel release, opponensplasty by palmaris longus tendon transfer, and a bridge graft by a half-slip of the flexor carpi radialis tendon resulted in recovery of pinch function and improvement in numbness of the hand...
December 2018: Journal of Hand Surgery Asian-Pacific Volume
Yoke-Rung Wong, Ita Suzana Mat Jais, Min-Kai Chang, Beng-Hai Lim, Shian-Chao Tay
BACKGROUND: This study evaluated the feasibility of using a low-profile titanium (Ti) plate implant, also known as the Ti-button, for Zone II flexor tendon repair. We hypothesize that the use of the Ti-button can distribute the tensile force on the digital flexor tendons to achieve better biomechanical performance. METHODS: Twenty lacerated porcine flexor tendons were randomly divided into two groups and repaired using Ti-button or 6-strand modified Lim-Tsai technique...
December 2018: Journal of Hand Surgery Asian-Pacific Volume
Min Kai Chang, Shian Chao Tay
BACKGROUND: Although flexor tendon injuries cause significant morbidities and socio-economic implications, there have been limited data on patient demographics, injury characteristics and surgical details. The aim of this study is to describe our experience in flexor tendon injuries and repairs. METHODS: We performed a retrospective study of all digital flexor tendon injuries that were repaired from January 2011 to December 2014. The collected data included patient demographics, injury characteristics and surgical details...
December 2018: Journal of Hand Surgery Asian-Pacific Volume
Matthew J Zdilla, Paula Pacurari, Tyler J Celuck, Reed C Andrews, H Wayne Lambert
Gantzer muscles are variant muscles in the anterior forearm inserting into the flexor pollicis longus or, less often, the flexor digitorum profundus. The presence of Gantzer muscles can cause a compressive neuropathy affecting the anterior interosseous nerve (Kiloh-Nevin syndrome). These muscles must also be considered when anterior forearm fasciotomies are performed for the management of acute compartment syndrome. In this case report, a novel Gantzer muscle originated from the flexor digitorum superficialis as well as the investing fascia of the brachialis muscle; the latter site is a novel proximal attachment not previously reported...
October 31, 2018: Anatomical Science International
Harry Whitehouse, Jeffrey C Y Chan, Matthew James
We present a case of spontaneous closed flexor digitorum profundus (FDP) tendon rupture of the fifth finger occurring in the carpal tunnel region (Zone IV) of the hand. A review of literature illustrates that spontaneous rupture of FDP in Zone IV is extremely rare and we wish to highlight this.
2018: Case Reports in Plastic Surgery & Hand Surgery
Elizabeth M Polfer, Jennifer M Sabino, Ryan D Katz
We present an all-inside technique for zone I flexor tendon repair that combines suture anchor fixation with buried back-up fixation. The back-up fixation uses transosseous tunnels and a dorsal counterincision to allow a suture tied dorsal to the distal phalanx and buried. This technique is strong and permits early active range of motion. The dorsal tie-over does not require a suture button and, therefore, does not imperil the nail matrix. The surgical technique is herein described including the proposed anesthesia (wide awake), the incisions (midlateral), the exposures, and the repair itself...
October 8, 2018: Journal of Hand Surgery
Eliana B Saltzman, Schneider K Rancy, Darryl B Sneag, Joseph H Feinberg Md, Dale J Lange, Scott W Wolfe
BACKGROUND: Acute flaccid myelitis is associated with enterovirus D68 -induced inflammation and destruction of cervical anterior horn cells. To date, no medical intervention has altered the disease course. METHODS: We report two pediatric patients who were treated with nerve transfer in three limbs with sustained upper extremity neuropathy. Postoperative outcomes included muscle strength, graded on the British Medical Research Council (BMRC) scale, range of motion, and electromyography...
November 2018: Pediatric Neurology
Susumu Yoneda, Hirotaka Okubo, Stephen W Linderman, Nozomu Kusano, Matthew J Silva, Stavros Thomopoulos, Fuminori Kanaya, Richard H Gelberman
The failure rate of intrasynovial tendon repair is high due to substantial elongation at the repair site and to the development of adhesions between the tendon's surface and the surrounding digital sheath. To minimize these complications, we sought to reduce the incidence of gapping and to facilitate the initiation of early motion by improving the time zero structural properties of repair. The Winters-Gelberman 8-strand repair technique was modified by adding surface lock loops and by using Fiberwire suture material...
2018: PloS One
Kanit Sananpanich, Jirachart Kraisarin, Wuttipong Siriwittayakorn, Siam Tongprasert, Songkiet Suwansirikul
PURPOSE: To explore the feasibility of restoring all finger flexion after a cervical spinal cord injury. METHODS: Double nerve transfer was conducted in 22 cadaver upper extremities. Donor nerves were the brachialis branch of the musculocutaneous nerve and the extensor carpi radialis brevis (ECRB) branches of the radial nerve. Recipient nerves were the anterior interosseous nerve (AIN) and the flexor digitorum profundus (FDP) branch of ulnar nerve (ulnar-FDP). Nerve transfers were evaluated on 3 parameters: surgical feasibility, donor-to-recipient axon count ratio, and distance from the coaptation site to the muscle entry of recipient nerve...
October 2018: Journal of Hand Surgery
Jae-Hwi Nho, Sang-Woo Lee, Mi-Ae Nam, Byung-Sung Kim, Ki Jin Jung
Avulsion fracture of the volar base of the distal phalanx is a rare injury. Zone 1 flexor tendon injuries can be treated with either internal or external fixation techniques. Pull-out suture repairs are often used for FDP tendon avulsion injuries. However, the pull out suture technique is associated with a number of well documented complications including nail bed injury and pressure necrosis. Despite the variety of techniques available for the repair of acute distal zone 1 flexor tendon injuries, no one technique has proven to be superior to all others...
September 2018: Journal of Hand Surgery Asian-Pacific Volume
Deepak Samson, Manish Gupta
BACKGROUND: The terminal phalanx of the fingers carries the attachment of the Flexor Digitorum Profundus (FDP) on the volar surface and the extensor on the dorsal surface. Avulsion of these tendons has traditionally been repaired with pull-through sutures. Recently, bone anchor sutures have been found to be of comparable biomechanical strength but with the added advantage of technical ease and fewer complications. However, the dimensions of the bone, at the site of insertion of the anchors, have never been studied...
September 2018: Journal of Hand Surgery Asian-Pacific Volume
M Ettinger, R Karkosch, H Horstmann, P Savov, T Calliess, T Smith, M Petri
BACKGROUND: Reliable biomechanical data about the strength of different tibial extracortical graft fixation devices is sparse. This biomechanical study compares the properties of tibial graft fixation in ACL reconstruction with either the ACL Tight Rope™ or the Rigid Loop Adjustable™ device. The hypothesis was that both fixation devices would provide comparable results concerning gap formation during cyclic loading and ultimate failure load. METHODS: Sixteen sawbone tibiae (Sawbones™) underwent extracortical fixation of porcine flexor digitorum profundus grafts for ACL reconstruction...
September 29, 2018: Journal of Experimental Orthopaedics
Mantu Jain, Chandrakanta Nayak, Barada Prasana Samal, Amit Tirpude
Fracture humerus may be associated with nerve injuries. However, among them median nerve is uncommonly involved and clinical affection of the anterior branch of median nerve is rare which can be easily missed and could be under-reported. A 42-year-old man presented with closed fracture of shaft of humerus right sided following fall. He had isolated weakness of flexor pollicis longus and flexor digitorum profundus of index finger without any other sensorimotor dysfunction. The findings were consistent with isolated palsy of anterior interosseous nerve (AIN)...
September 28, 2018: BMJ Case Reports
Edie Benedito Caetano, Luiz Angelo Vieira, João José Sabongi Neto, Maurício Benedito Ferreira Caetano, Rodrigo Guerra Sabongi
Objective: The goal of this study was to describe anatomical variations and clinical implications of anterior interosseous nerve. In complete anterior interosseous nerve palsy, the patient is unable to flex the distal phalanx of the thumb and index finger; in incomplete anterior interosseous nerve palsy, there is less axonal damage, and either the thumb or the index finger are affected. Methods: This study was based on the dissection of 50 limbs of 25 cadavers, 22 were male and three, female...
September 2018: Revista Brasileira de Ortopedia
Andrew Schannen, Samuel Cohen-Tanugi, Matthew Konigsberg, Peter Noback, Robert J Strauch
Introduction: The quadriga phenomenon results from excessive shortening of the flexor digitorum profundus (FDP) tendon to the middle, ring, or small finger. Methods: Five cadaveric specimens were used to create a model for quadriga. The FDP tendons to the middle, ring, and small fingers were shortened in 5-mm increments, and the tip-to-palm (TTP) distance of adjacent fingers was recorded. Results: Shortening of the middle finger FDP by 10 mm resulted in an average TTP distance of 6 mm in the ring finger and 5 mm in the small finger...
November 2017: Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews
Paul J Choi, Chidinma Nwaogbe, Joe Iwanaga, Georgi P Georgiev, Rod J Oskouian, R Shane Tubbs
Introduction A reoperation for a cubital tunnel syndrome is not uncommon. Patients often complain of sensorimotor symptoms in the ulnar nerve distribution after their primary surgery. The documented etiologies for such a phenomenon include a "new" kinking of the distal ulnar nerve and a "new" compression of the ulnar nerve by the fascial septum in between or tendinous bands over the muscles of the forearm. The deep fascial plane along which the ulnar nerve travels in the forearm has had scant attention...
June 19, 2018: Curēus
M Le Hanneur, A Walch, T Gerosa, A Grandjean, E Masmejean, T Lafosse
We aimed to assess the rate and type of postoperative motor deficits that might be encountered following elbow flexion reanimation using ulnar- and/or median-based side-to-end nerve transfers in patients with brachial plexus injuries. All patients who underwent elbow flexion reanimation between November 2015 and October 2017 at our facility by nerve transfer based on partial harvests of the median and/or ulnar nerves were included. Postoperative clinical assessment was conducted the day after surgery to identify motor deficits in the territory of the harvested nerves...
August 2, 2018: Hand Surgery and Rehabilitation
Marion Mühldorfer-Fodor, Angela Reger, Thomas Pillukat, Thomas Mittlmeier, Jörg van Schoonhoven, Karl-Josef Prommersberger
BACKGROUND: Due to the functional coupling of adjacent finger joints and the quadriga effect of the flexor digitorum profundus an influence of the grip pattern of the hand after fusion of a distal interphalangeal joint (DIPJ) is assumed. PATIENTS AND METHODS: Two patients with DIPJ II- fusion and 8 patients with DIPJ III- fusion due to a posttraumatic osteoarthritis, but without any other pathology of both hands were assessed on average 55 (17-121) months postoperatively by manugraphy...
June 2018: Handchirurgie, Mikrochirurgie, Plastische Chirurgie
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