Normal tendon substance is strong and is unlikely to break before the muscle origin, muscle, musculotendinous junction or the insertion yield. In almost all the cases, closed ruptures of the flexor tendon within the t...Normal tendon substance is strong and is unlikely to break before the muscle origin, muscle, musculotendinous junction or the insertion yield. In almost all the cases, closed ruptures of the flexor tendon within the tendinous portion have been described in association with distinct underlying pathologies. We report a case of flexor tendon rupture of the index finger which seems to be associated with previous trauma occurred more than 40 years ago and abnormal healing.展开更多
BACKGROUND Closed rupture of the little and ring finger flexor tendons caused by the hamate is mostly associated with a fracture or nonunion of the hamate hook.Only one case of a closed rupture of the finger flexor te...BACKGROUND Closed rupture of the little and ring finger flexor tendons caused by the hamate is mostly associated with a fracture or nonunion of the hamate hook.Only one case of a closed rupture of the finger flexor tendon caused by osteochondroma in the hamate has been reported.Here,we present a case study to highlight the possibility of hamate osteochondroma as a rare cause of finger closed flexor tendon rupture based on our clinical experience and literature review.CASE SUMMARY A 48-year-old man who had been a rice-field farmer for 7–8 h a day for the past 30 years visited our clinic due to the loss of right little finger and ring finger flexion involving both the proximal and distal interphalangeal joints.The patient was diagnosed with a complete rupture of the ring and little finger flexors because of the hamate and was pathologically diagnosed with an osteochondroma.Exploratory surgery was performed,and a complete rupture of the ring and little finger flexors due to an osteophyte-like lesion of the hamate was observed,which was pathologically diagnosed as an osteochondroma.CONCLUSION One should consider that osteochondroma in the hamate may be the cause of closed tendon ruptures.展开更多
Flexor tendon repair has conventionally been done by suturing techniques. However, in recent times, there have been attempts of using fibrous braided structures for the repair of ruptured tendons. In this regard, the ...Flexor tendon repair has conventionally been done by suturing techniques. However, in recent times, there have been attempts of using fibrous braided structures for the repair of ruptured tendons. In this regard, the numerical analysis of the flexural stiffness of a braided structure under bending moments is vital for understanding its capabilities in the repair of flexor tendons. In this paper, the bending deflection, curvature, contact stresses and flexural bending stiffness in the braided structure due to bending moments are simulated using Finite Element (FE) techniques. Three dimensional geometry and FE models of five sets of biaxial braided structures were developed using a python programming script. The FE models of the hybrid biaxial braids were imported into ABAQUS (v17) for post-processing and analysis. It was established that the braided fabric with largest braid angle, <em>θ</em> = 52.5<span style="white-space:nowrap;">°</span> had the highest flexural deflection while the lowest deflection was seen in the results of the braided structure with the least braid angle, <em>θ</em> = 38.5<span style="white-space:nowrap;">°</span>. The results in this study also portrayed that the curvature in biaxial braids will increase with a decrease in the angle between the braided yarns. This was also consistent with the change of bending angle of the biaxial structures under a bending moment. The deformation of the structures increased with increase in the braid angles. This implies that the flexural bending stiffness decreased with increase in braid angle. The stress limits during bending of the braided structures were established to be within the range that could be handled by flexor tendons during finger bending.展开更多
Despite early cautions against the primary repair of zone II flexor tendon injuries, recent advances in surgical technique and suture materials have allowed such repairs to become commonplace. The 6-strand repair tech...Despite early cautions against the primary repair of zone II flexor tendon injuries, recent advances in surgical technique and suture materials have allowed such repairs to become commonplace. The 6-strand repair technique is rarely applied to the young pediatric population, however, to our knowledge, no English-language articles have described this method of primary repair in zone II of children less than 2 years old. A 13-month-old male presented flexor digitorum profundus repair after lacerating it in zone II on a sharp aluminum can. The tendon was repaired with a 6-strand technique, using a 4.0 Fiberloop for the core suture and 6.0 Prolene for the epitendinous suture. Approximately four months after surgery, the patient developed a palmar collection at the level of his middle phalanx and a serosanguinous sinus tract at the distal interphalangeal crease. During the revision surgery, the inspection of the repaired tendon revealed a small gap filled with scar tissue. There was no evidence of new fistula formation at his final visit one month after the second procedure. After the revision, the patient could move his digit with minimal loss of range of motion at the distal interphalangeal joints. Unfortunately, he was subsequently lost to follow up. This surgical technique was selected to provide a strong repair that would allow the early postoperative movement. In retrospect, a 6-strand repair with braided suture is not ideal in young children as the bulky suture can cause a foreign-body reaction and possibly extrude through the skin. Additionally, the immobilization with a long-arm cast remains a valuable tool after tendon repair in infants who cannot voluntarily restrict their movements.展开更多
Objective:To explore the application effect and clinical value of musculoskeletal ultrasound in the rehabilitation of hand function after flexor tendon rupture repair.Methods:In this study,72 patients were selected fr...Objective:To explore the application effect and clinical value of musculoskeletal ultrasound in the rehabilitation of hand function after flexor tendon rupture repair.Methods:In this study,72 patients were selected from among patients who underwent flexor tendon rupture repair of the hand in Yancheng Third People’s Hospital from May 2018 to May 2020;the patients were randomly divided into the control group(routine hand rehabilitation training)and the experimental group(musculoskeletal ultrasound and targeted hand rehabilitation training based on examination results)by die roll,with 34 cases in each group;the hand rehabilitation of the two groups were compared.Results:The excellent and good rate of the total active motion(TAM)of the experimental group(94.44%)was significantly higher than that of the control group(69.44%)(P<0.05);before treatment,there was no significant difference in the diameter and degree of stenosis of the artery in the finger between the two groups(P>0.05);after treatment,the degree of stenosis and the diameter of the artery of the experimental group were significantly better than those of the control group(P<0.05).Conclusion:For patients treated with flexor tendon rupture repair of the hand,the use of musculoskeletal ultrasound in the rehabilitation process can significantly improve the functional recovery of the hand;therefore,it is worthy of in-depth research,promotion,and application in clinical rehabilitation.展开更多
Aim: The ideal flexor tendon repair should be reliable, simple and strong enough without impairing the tendon healing. Based on these requirements, we have imagined the use of a single barbed intra-tendinous suture fo...Aim: The ideal flexor tendon repair should be reliable, simple and strong enough without impairing the tendon healing. Based on these requirements, we have imagined the use of a single barbed intra-tendinous suture for stumps connection. The aim of our research is to quantify the stress that the suture and barbs should withstand in order to ensure perfect stumps connections. Methods: Seven different cross-section sutures were selected for the research study. One circular and 6 different elliptical shapes were defined according to the ratio of their minor and major axes (ρ = b/a). Barbs were designed with 3 different depths and 3 different cut angles. Thus, 9 different situations were considered for each suture geometry. Finally, 2 loading conditions were applied on each barb and tested in ANSYS Workbench using a finite element analysis technique. Results: Studies showed that a barbed suture with 0.18-mm depth, 150° cut angle and ρ = 3 produced the lowest stresses within the barb itself, while a barbed suture with 0.18-mm depth, 160° cut angle and ρ = 4 demonstrated lowest stress within the entire suture. Conclusion: The stress values in these two configurations are observed to be very close and both can fit a single barbed suture for tendon insertion and repair.展开更多
BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of t...BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.展开更多
文摘Normal tendon substance is strong and is unlikely to break before the muscle origin, muscle, musculotendinous junction or the insertion yield. In almost all the cases, closed ruptures of the flexor tendon within the tendinous portion have been described in association with distinct underlying pathologies. We report a case of flexor tendon rupture of the index finger which seems to be associated with previous trauma occurred more than 40 years ago and abnormal healing.
文摘BACKGROUND Closed rupture of the little and ring finger flexor tendons caused by the hamate is mostly associated with a fracture or nonunion of the hamate hook.Only one case of a closed rupture of the finger flexor tendon caused by osteochondroma in the hamate has been reported.Here,we present a case study to highlight the possibility of hamate osteochondroma as a rare cause of finger closed flexor tendon rupture based on our clinical experience and literature review.CASE SUMMARY A 48-year-old man who had been a rice-field farmer for 7–8 h a day for the past 30 years visited our clinic due to the loss of right little finger and ring finger flexion involving both the proximal and distal interphalangeal joints.The patient was diagnosed with a complete rupture of the ring and little finger flexors because of the hamate and was pathologically diagnosed with an osteochondroma.Exploratory surgery was performed,and a complete rupture of the ring and little finger flexors due to an osteophyte-like lesion of the hamate was observed,which was pathologically diagnosed as an osteochondroma.CONCLUSION One should consider that osteochondroma in the hamate may be the cause of closed tendon ruptures.
文摘Flexor tendon repair has conventionally been done by suturing techniques. However, in recent times, there have been attempts of using fibrous braided structures for the repair of ruptured tendons. In this regard, the numerical analysis of the flexural stiffness of a braided structure under bending moments is vital for understanding its capabilities in the repair of flexor tendons. In this paper, the bending deflection, curvature, contact stresses and flexural bending stiffness in the braided structure due to bending moments are simulated using Finite Element (FE) techniques. Three dimensional geometry and FE models of five sets of biaxial braided structures were developed using a python programming script. The FE models of the hybrid biaxial braids were imported into ABAQUS (v17) for post-processing and analysis. It was established that the braided fabric with largest braid angle, <em>θ</em> = 52.5<span style="white-space:nowrap;">°</span> had the highest flexural deflection while the lowest deflection was seen in the results of the braided structure with the least braid angle, <em>θ</em> = 38.5<span style="white-space:nowrap;">°</span>. The results in this study also portrayed that the curvature in biaxial braids will increase with a decrease in the angle between the braided yarns. This was also consistent with the change of bending angle of the biaxial structures under a bending moment. The deformation of the structures increased with increase in the braid angles. This implies that the flexural bending stiffness decreased with increase in braid angle. The stress limits during bending of the braided structures were established to be within the range that could be handled by flexor tendons during finger bending.
文摘Despite early cautions against the primary repair of zone II flexor tendon injuries, recent advances in surgical technique and suture materials have allowed such repairs to become commonplace. The 6-strand repair technique is rarely applied to the young pediatric population, however, to our knowledge, no English-language articles have described this method of primary repair in zone II of children less than 2 years old. A 13-month-old male presented flexor digitorum profundus repair after lacerating it in zone II on a sharp aluminum can. The tendon was repaired with a 6-strand technique, using a 4.0 Fiberloop for the core suture and 6.0 Prolene for the epitendinous suture. Approximately four months after surgery, the patient developed a palmar collection at the level of his middle phalanx and a serosanguinous sinus tract at the distal interphalangeal crease. During the revision surgery, the inspection of the repaired tendon revealed a small gap filled with scar tissue. There was no evidence of new fistula formation at his final visit one month after the second procedure. After the revision, the patient could move his digit with minimal loss of range of motion at the distal interphalangeal joints. Unfortunately, he was subsequently lost to follow up. This surgical technique was selected to provide a strong repair that would allow the early postoperative movement. In retrospect, a 6-strand repair with braided suture is not ideal in young children as the bulky suture can cause a foreign-body reaction and possibly extrude through the skin. Additionally, the immobilization with a long-arm cast remains a valuable tool after tendon repair in infants who cannot voluntarily restrict their movements.
文摘Objective:To explore the application effect and clinical value of musculoskeletal ultrasound in the rehabilitation of hand function after flexor tendon rupture repair.Methods:In this study,72 patients were selected from among patients who underwent flexor tendon rupture repair of the hand in Yancheng Third People’s Hospital from May 2018 to May 2020;the patients were randomly divided into the control group(routine hand rehabilitation training)and the experimental group(musculoskeletal ultrasound and targeted hand rehabilitation training based on examination results)by die roll,with 34 cases in each group;the hand rehabilitation of the two groups were compared.Results:The excellent and good rate of the total active motion(TAM)of the experimental group(94.44%)was significantly higher than that of the control group(69.44%)(P<0.05);before treatment,there was no significant difference in the diameter and degree of stenosis of the artery in the finger between the two groups(P>0.05);after treatment,the degree of stenosis and the diameter of the artery of the experimental group were significantly better than those of the control group(P<0.05).Conclusion:For patients treated with flexor tendon rupture repair of the hand,the use of musculoskeletal ultrasound in the rehabilitation process can significantly improve the functional recovery of the hand;therefore,it is worthy of in-depth research,promotion,and application in clinical rehabilitation.
文摘Aim: The ideal flexor tendon repair should be reliable, simple and strong enough without impairing the tendon healing. Based on these requirements, we have imagined the use of a single barbed intra-tendinous suture for stumps connection. The aim of our research is to quantify the stress that the suture and barbs should withstand in order to ensure perfect stumps connections. Methods: Seven different cross-section sutures were selected for the research study. One circular and 6 different elliptical shapes were defined according to the ratio of their minor and major axes (ρ = b/a). Barbs were designed with 3 different depths and 3 different cut angles. Thus, 9 different situations were considered for each suture geometry. Finally, 2 loading conditions were applied on each barb and tested in ANSYS Workbench using a finite element analysis technique. Results: Studies showed that a barbed suture with 0.18-mm depth, 150° cut angle and ρ = 3 produced the lowest stresses within the barb itself, while a barbed suture with 0.18-mm depth, 160° cut angle and ρ = 4 demonstrated lowest stress within the entire suture. Conclusion: The stress values in these two configurations are observed to be very close and both can fit a single barbed suture for tendon insertion and repair.
文摘BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.
