hand injury tendons

Fractures of the hook of the hamate are traditionally thought to be caused by direct trauma. A review of the anatomy and function of the hamate hook suggests that fracture is more likely as a result of a fatigue response that develops in the hook from repetitive load applied by the adjacent deep flexor tendons. Additional vascular compromise, from direct pressure of the tendons on critical local vessels, reduces blood flow leading to both mechanical and vascular effects that create pathological osseous change and weakening...

OBJECTIVE: The reconstruction of complex soft tissue defects with exposure of bones and tendons represents an increasing challenge in wound care, especially in large extremity wounds. The aim of this study was to detect the clinical efficacy of combined use of negative pressure wound therapy (NPWT), artificial dermis (ADM), platelet-rich plasma (PRP) and split-thickness skin grafting (STSG) in the reconstruction of large traumatic extremity skin defects. METHOD: In this study, eight cases were treated with combined therapies for repairing complex extremity wounds and the results were reviewed retrospectively...

Tendon injuries resulting from accidents and aging are increasing globally. However, key tendon functional parameters such as microvascularity and oxygen perfusion remain inaccessible via the currently available clinical diagnostic tools, resulting in disagreements on optimal treatment options. Here, a new noninvasive method for anatomical and functional characterization of human tendons based on multispectral optoacoustic tomography (MSOT) is reported. Healthy subjects are investigated using a hand-held scanner delivering real-time volumetric images...

INTRODUCTION: Wide-awake local anesthesia and no tourniquet (WALANT) represents a revolutionary technique for hand surgeons who dismiss tourniquets and sedation. In this study, we present our experience with the WALANT technique in primary flexor tendon injuries of the hand. PATIENT AND METHODS: This prospective research was carried out on 30 patients undergoing hand primary, flexor tendon repair surgery. Flexor tendon injury zones 2, 3, 4, and 5 were included. WALANT was prepared and injected...

BACKGROUND: The loss of soft tissue coverage of tendons is a challenging reconstructive problem after acute hand trauma. Subsequent tendon adhesions and the loss of range of movement in addition to the poor aesthetic outcome and donor site scarring should be avoided when deciding the plan of management. Pelnac is one of the commonly used skin substitutes in reconstructive surgery that can be used for coverage of exposed tendons, but the postoperative functional outcome needs to be addressed in detail...

The management of flexor tendon injury has seen many iterations over the years, but more substantial innovations in practice have been sadly lacking. The aim of this study was to investigate the current practice of flexor tendon injury management, and variation in practice from the previous reports, most troublesome complications, and whether there was a clinical interest in potential innovative tendon repair technologies. An online survey was distributed via the British Society for Surgery of the Hand (BSSH) and a total of 132 responses were collected anonymously...

BACKGROUND: Many studies have described hamate hook fractures resulting from direct force from sporting tools. However, several authors have reported fractures that did not occur during swing-related activities. This study aimed to understand the injury mechanism of fractures by investigating their morphologies. METHODS: We selected patients with hamate hook fractures and collected data on computed tomography scans, injury causes, and how athletes handled sporting tools...

INTRODUCTION: The Galeazzi fracture is a fracture of the middle to distal one-third of the radius associated with dislocation or subluxation of the distal radioulnar joint (DRUJ) associated with high energy trauma. Injury to the dynamic and static stabilizers of DRUJ if unnoticed or poorly treated may lead to chronic instability which in turn can cause chronic pain and disability due to stiffness, decreased grip strength, forearm rotation, and symptomatic osteoarthritis. CASE REPORT: A 35-year-old gentleman sustained trauma after fall from a motorcycle presented after 2 months with radiology suggestive of midshaft radius fracture with dorsal DRUJ dislocation treated with open reduction, internal fixation with DRUJ reconstruction using a novel technique not described before in any literature...

Objective: To explore the effect of accurately localized mini anterolateral thigh perforator flap in repairing medium-sized skin and soft tissue defects in fingers. Methods: The study was a retrospective observational study. From December 2019 to September 2022, 15 patients with medium-sized skin and soft tissue defects who met the inclusion criteria in fingers were admitted to the Second Affiliated Hospital of Wenzhou Medical University, including 12 males and 3 females, aged 23 to 62 years. After debridement, the wounds were all accompanied by exposed tendons, bones, vessels and nerves, with an area from 4...

SURGICAL INDICATIONS FOR HAND WOUNDS. Hand injuries are common, with potentially severe consequences. When a patient is seen in the emergency department, a lesion assessment must be carried out to distinguish between extreme emergencies such as amputation or devascularization, which require immediate treatment in a specialized centre. If there is no immediate indication of seriousness, a clinical examination, possibly combined with meticulous exploration, helps to identify the lesions. The presence of tendon, nerve or vascular damage requires surgical management in the operating theatre...

BACKGROUND: Percutaneous pinning has been the predominant technique for fixation of proximal phalanx fractures, but stiffness is a reported complication. The introduction of intramedullary (IM) nail fixation of proximal phalanx fractures provides a stronger biomechanical fixation for amenable fracture patterns with the added benefit of not tethering the soft tissue. The goal of this study was to compare the surgical outcomes of IM nail and percutaneous pin fixation in isolated proximal phalanx fractures...

Improving upper extremity function in high cervical spinal cord injury (SCI) patients with tetraplegia is a challenging task owing to the limited expendable donor muscles and nerves that are available. Restoring active wrist extension for these patients is critical because it allows for tenodesis grasp. This is classically achieved with brachioradialis (BR) to extensor carpi radialis brevis (ECRB) tendon transfer, but outcomes are suboptimal because BR excursion is insufficient and its origin proximal to the elbow further limits the functionality of the tendon transfer, particularly in the absence of elbow extension...

Traumatic adult brachial plexus injuries typically cause immediate loss of upper limb function. Timely multidisciplinary treatment in specialized centres often results in a useful helper arm. Both the patient and the surgical team can benefit from an open discussion to set realistic expectations. Surgical reconstruction is customized for each patient, considering their injury factors and functional objectives. Optimizing pain control, adherence to procedure indications and using meticulous surgical techniques help minimize the risk of failing to meet the patient's goals...

Functional electrical stimulation (FES) is an option to restore function in individuals after high cervical spinal cord injury (SCI) who have limited available options for tendon or nerve transfer. To be considered for FES implantation, patients must possess upper motor neuron (UMN) type denervation in potential recipient muscles, which can be confirmed by response to surface electrical stimulation during clinical evaluation. Lower motor neuron (LMN) denervated muscles will not respond to electrical stimulation and, therefore, are unavailable for use in an FES system...

An emergency cesarean surgery resulted in extensor tendon lacerations in a 27-week-old preterm fetus. This injury is unique because fetal hand lacerations rarely occur, and to the best of our knowledge, this is the youngest case of hand injury during cesarean delivery reported in the literature. This case report sets the framework for a more in-depth investigation of the incidence and treatment options for fetal lacerations, with an emphasis on the less common but clinically important hand lacerations that can occur during cesarean section...

Nerve grafting, tendon transfer and joint fusion are routinely used to improve the upper limb function in patients with brachial plexus palsies. Newer techniques have been developed that provide additional options for reconstruction. Nerve transfer is a tool for restoring upper limb function in total root avulsions where nerve grafting is not possible. In partial brachial plexus injuries, nerve transfers can greatly improve shoulder, elbow, wrist and hand function. Intraoperative electrical stimulation can be used to diagnose precisely which nerve is injured and to choose which nerve fascicles should be transferred...

In adults, partial rotator cuff injuries can frequently be the root cause of pain in the shoulder. One recurrent pathology that may significantly impact a broad spectrum of individuals, including athletes, laborers, and sedentary people, is partial rotator cuff tears (RCTs). Physical therapy, anti-inflammatories, painkillers, rest or activity modifications, and corticosteroid injections are a few nonoperative treatment options for partial RCTs. We report a case of a 27-year-old male who sustained a rotator cuff injury of the right shoulder...

BACKGROUND: Several surgical techniques have been reported for flexor tendon zone 1a-b lacerations without a clear consensus on the gold standard treatment. The purpose of this multicentre study was to measure the outcomes of zone 1a-b flexor tendon injuries treated with a pull-out suture (POS) versus direct suture (DS) technique. PATIENTS AND METHODS: Fifteen patients were treated with the pull-out technique and 22 patients with a direct suture technique between 2014 and 2020...

BACKGROUND: The flexor pronator slide is an effective treatment option for ischemic contracture and contracture related to spastic cerebral palsy, but little is known about the use of the flexor pronator slide in other non-ischemic contractures. I propose a flexor pronator slide to simultaneously correct wrist and finger flexor contractures and preserve the muscle resting length. To avoid overcorrection of the deformity, I propose the use of a wide-awake local anesthesia with no tourniquet (WALANT) procedure, in which the patient is able to continually assist the surgeon in assessing the contracture release and improvement in finger movement...

Finger stiffness may arise from injuries, surgeries, or hand-related medical conditions, impacting hand function and overall well-being in daily life. Rehabilitation and hand therapy play a crucial role in restoring optimal range of motion, strength, and functionality. This article introduces the Self-Assisted Finger Stiffness Splint (SFSS), a dynamic splint designed for active finger movement applicable in post-trauma or postoperative rehabilitation. SFSS empowers patients to perform self-administered stretching exercises, expediting recovery and improving compliance...