This article reviewed the principles and outcomes of tendon transfer procedures described in the literature to restore function following injuries delivered in a workshop as a way of improving basic science and anatom...This article reviewed the principles and outcomes of tendon transfer procedures described in the literature to restore function following injuries delivered in a workshop as a way of improving basic science and anatomical knowledge in surgical trainees preparing for surgical examinations. Post intervention surveys showed an improvement in trainees’ familiarity with musculoskeletal anatomy and engagement in learning with improved readiness for surgical examinations.展开更多
Background:The radial nerve is one of the most common war-related injury sites due to penetrating cutting tool injuries or gunshot wounds,resulting in drop-hand syndrome.The aim of this study was to evaluate the outco...Background:The radial nerve is one of the most common war-related injury sites due to penetrating cutting tool injuries or gunshot wounds,resulting in drop-hand syndrome.The aim of this study was to evaluate the outcomes of tendon transfer in patients with drop-hand syndrome who had been injured in the Syrian Civil War.Methods:This level-II,prospective,comparative study included 13 civilians injured in the Syrian Civil War 2015 and 2017.The palmaris longus tendon was used for transfer to the extensor pollicis longus for thumb extension.The pronator teres was transferred to the extensor carpi radialis brevis for wrist extension.The flexor carpi radialis was transferred to the extensor digiti communis for 2 nd,3 rd,4 th,and 5 th finger extension.All outcomes of thumb abduction and extension,wrist extension,wrist flexion,and finger extension were assessed.Results:There was a high level of radial nerve injury in all patients included in the study.The time from injury to treatment ranged from 1.5 months to 9 months.The mechanism of injury most commonly observed was a gunshot wound,which was observed in 8 patients(61.5%),followed by a penetrating cutting tool injury(n=3;23.1%)and humerus fracture(n=2;15.4%).Conclusions:In radial nerve injuries,successful results can be achieved with tendon transfer.All patients regained thumb abduction of up to approximately 60°.All the patients were able to bend the wrist,grip,and extend the fingers while in wrist flexion,neutral wrist and wrist extension positions.Although the reason for the radial injury varied,the postoperative outcomes were good for all patients,and the rehabilitation period progressed successfully in patients who underwent tendon transfer repair within 90 days of injury.展开更多
BACKGROUND The extensor indicis proprius(EIP)tendon is a frequently used donor for a variety of tendon transfers,most commonly for reconstruction of the extensor pollicis longus(EPL).EIP is known to have frequent anat...BACKGROUND The extensor indicis proprius(EIP)tendon is a frequently used donor for a variety of tendon transfers,most commonly for reconstruction of the extensor pollicis longus(EPL).EIP is known to have frequent anatomic variants including split tendons and variations in tendon arrangement.AIM To characterize the anatomy of the EIP at the level of the extensor retinaculum,where tendon harvest is often performed,and share our preferred technique for EIP to EPL transfer.METHODS Twenty-nine fresh-frozen cadaveric forearms without history of forearm or hand injury or surgery were dissected.Tendon circumference and relationship of the EIP and extensor digitorum communis to the index(EDCI)at the metacarpophalangeal(MCP)joint and the distal extensor retinaculum were recorded.Distance from the distal extensor retinaculum to the EIP myotendinous junction was measured.RESULTS EIP was ulnar to the EDCI in 96.5%of specimens(28/29)at the distal edge of the extensor retinaculum.In the remaining specimen,EIP was volar to EDCI.Tendon circumference at the distal extensor retinaculum averaged(9.3 mm±1.7 mm)for EDCI and 11.1 mm(±2.7 mm)for EIP(P=0.0010).The tendon circumference at the index MCP joint averaged 11.0 mm(±1.7 mm)for EDCI and 10.6 mm(±2.1 mm)for EIP(P=0.33).EIP had a greater circumference in 76%(22/29)of specimens at the distal extensor retinaculum whereas EIP had a greater circumference in only 31%(9/29)of specimens at the MCP joint.CONCLUSION The EIP tendon is frequently ulnar to and greater in circumference than the EDCI at the distal extensor retinaculum,which can be taken into consideration for tendon transfers involving EIP.展开更多
Background Recurrence of hallux valgus is considered to be the most common problem experienced postoperatively.We designed and caried out operations to correct hallux valgus by transferring the extensor hallucis long...Background Recurrence of hallux valgus is considered to be the most common problem experienced postoperatively.We designed and caried out operations to correct hallux valgus by transferring the extensor hallucis longus （EHL） tendon to reduce the likelihood of recurrence.Methods Twenty-five patients （38 feet） with the average age of （46.3±12.3） （range, 22 to 60） years underwent the operation. The American Orthopaedic Foot and Ankle Society score and weight-bearing radiographs of the foot were applied to assess the feet pre- and postoperatively with a mean duration of follow-up of （38.2±3.2） months. The surgical procedure includes the release of the distal soft tissues, excision of the medial eminence, plication of the medial part of the capsule, and transfer of the EHL tendon, and reconstructing its insertion.Results At follow-up, 35 feet （23 patients, 85%） were free from pain at the first metatarsophalangeal （MTP） joint. In three feet （two patients）, the pain was alleviated but persisted. The mean hallux valgus angle decreased significantly from a preoperative 38.3°±8.0° to 7.3°±2.0° at the time of the most recent follow-up （P 〈0.0001）, and the mean intermetatarsal （IM） angle decreased significantly from preoperative 12.5°±3.4° to postoperative 6.5°±2.4° （P 〈0.0001）. The mean score according to the American Orthopaedic Foot and Ankle Society had increased from 46.5 to 84.8 points （P 〈0.0001）.Conclusions Hallux valgus can be corrected by transferring the EHL tendon medially and reconstructing its insertion.The technique can achieve stress balance of metatarsophalangeal joints and therefore prevent the recurrence of hallux valgus.展开更多
Fracture of an ossification of the Achilles tendon(OAT)is a rare entity,and its etiology,pathology,and treatment remain unclear.We reviewed and scrutinized 18 cases(16 articles)of the fracture of an OAT.The most commo...Fracture of an ossification of the Achilles tendon(OAT)is a rare entity,and its etiology,pathology,and treatment remain unclear.We reviewed and scrutinized 18 cases(16 articles)of the fracture of an OAT.The most common etiologies of the ossifications include previous surgery and trauma.The fractures often occur without any trigger or with minimal trigger.The long,>5 cm,ossification in the body of the Achilles tendon may have a higher risk of fracture.The OAT itself is often asymptomatic;however,its fracture causes severe local pain,swelling,and weakness of plantar flexion,which forces patients to undergo aggressive treatments.Regarding the treatments of the fractures,nonoperative treatment by immobilizing ankle joint could be an option for elderly patients.However,because it often cannot produce satisfactory results in younger patients,surgical treatment is typically recommended.Excision of the fractured mass and repairing the tendon is applicable if the remnant is enough.If there is a defect after the excision,reconstruction with autologous grafts or adjacent tendon transfer is performed.Gastrocnemius fascia turndown flap,hamstring tendon and tensor fascia lata are used as autologous grafts,whereas peroneus brevis and flexor hallucis longus tendons are used for the tendon transfer.If the fracture of an OAT is treated properly,the functional result will be satisfactory.展开更多
Dynamic supination of the foot is a common residual deformity in children with clubfeet treated with the Ponseti method. Transfer of the anterior tibialis tendon (ATT) to the lateral cuneiform is an effective method f...Dynamic supination of the foot is a common residual deformity in children with clubfeet treated with the Ponseti method. Transfer of the anterior tibialis tendon (ATT) to the lateral cuneiform is an effective method for correcting this deformity when the cuneiform is ossified in children who are 3 to 5 years of age. We describe two cases of a previously unreported method of ATT transposition for correction of bilateral residual dynamic supination in a 26-month-old and a 19-month-old patient. Both patients presented shortly after birth with bilateral congenital idiopathic clubfoot and were initially treated with the Ponseti method. Both had residual deformity following initial treatment that included posterior contracture and metatarsus adductus with dynamic forefoot supination. This was surgically corrected with a posterior release and medial release of the 1st metatarsal/1st cuneiform joint. To correct dynamic supination, the ATT was transplanted laterally into the released midfoot joint. These two patients were followed post-operatively for 7.5 years and have correction of their residual deformity in both feet based on subjective functioning, appearance, range of motion, strength, and gait. Both have excellent lateral pull of their ATT, which functions as a strong foot dorsiflexor. No residual supination is present. This is the first report of lateral transposition of the ATT as an interposition graft at the released 1st metatarsal/1st cuneiform joint in patients with relapsed clubfoot. We suggest that this method should provide a high level of functioning in children with relapsed supination deformity and whose 3rd cuneiform has not yet ossified.展开更多
Background: Spontaneous tendon rupture of hand is not frequent. These ruptures can occur after a fracture. Aim: We report a case of spontaneous rupture of extensor pollicis longus tendon, and describe the treatment. C...Background: Spontaneous tendon rupture of hand is not frequent. These ruptures can occur after a fracture. Aim: We report a case of spontaneous rupture of extensor pollicis longus tendon, and describe the treatment. Case presentation: We report the case of a 63-year-old woman who had extensor pollicis longus tendon rupture after non-displaced extra-articular distal radius fracture, treated by wrist circular cast immobilization. Extensor indicis proprius tendon transfer was performed, with an excellent functional result. Conclusion: Extensor pollicis longus tendon rupture can occur after non-displaced extra-articular distal radius fracture. Its treatment by tendon transfer helps to restore function of hand.展开更多
Background:?Disabling internal rotation contractures are frequently experienced in children with unresolved birth brachial plexus palsies. Multiple surgical options like muscle release, tendon transfer, or humeral ost...Background:?Disabling internal rotation contractures are frequently experienced in children with unresolved birth brachial plexus palsies. Multiple surgical options like muscle release, tendon transfer, or humeral osteotomy are available to treat such cases. Purpose:?Evaluation of the outcome of subscapularis release and latissimus dorsi and teres major tendon transfer in the management of obstetric brachial palsies in Mansoura University neurosurgical department. Study type: Retrospective observational study. Patients and Methods: Twenty-five cases who underwent subscapularis release and latissimus dorsi and teres major transfer were included in the study. All patients were subjected to complete history taking, through clinical examination. The degree of shoulder movement and disability was assessed via Modified Gilbert shoulder evaluation scale. Results: The least follow up period for our patients was 9 months. There was a clear improvement of shoulder function evaluated using Modified Gilbert shoulder evaluation scale as there were 73% of postoperative group between GIV and GV while about 84% of preoperative group were between GII and GIII. Conclusion: Tendon transfer is a valid easy procedure for correction of shoulder deformities in patients with obstetrical brachial plexus palsy. It is considered a very good option for patients who missed the chance of microsurgical repair or patients with poor shoulder recovery after surgery. Although some authors reported deterioration of shoulder function with log time follow up after tendon transfer, it is still better than those who were not operated.展开更多
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
文摘This article reviewed the principles and outcomes of tendon transfer procedures described in the literature to restore function following injuries delivered in a workshop as a way of improving basic science and anatomical knowledge in surgical trainees preparing for surgical examinations. Post intervention surveys showed an improvement in trainees’ familiarity with musculoskeletal anatomy and engagement in learning with improved readiness for surgical examinations.
文摘Background:The radial nerve is one of the most common war-related injury sites due to penetrating cutting tool injuries or gunshot wounds,resulting in drop-hand syndrome.The aim of this study was to evaluate the outcomes of tendon transfer in patients with drop-hand syndrome who had been injured in the Syrian Civil War.Methods:This level-II,prospective,comparative study included 13 civilians injured in the Syrian Civil War 2015 and 2017.The palmaris longus tendon was used for transfer to the extensor pollicis longus for thumb extension.The pronator teres was transferred to the extensor carpi radialis brevis for wrist extension.The flexor carpi radialis was transferred to the extensor digiti communis for 2 nd,3 rd,4 th,and 5 th finger extension.All outcomes of thumb abduction and extension,wrist extension,wrist flexion,and finger extension were assessed.Results:There was a high level of radial nerve injury in all patients included in the study.The time from injury to treatment ranged from 1.5 months to 9 months.The mechanism of injury most commonly observed was a gunshot wound,which was observed in 8 patients(61.5%),followed by a penetrating cutting tool injury(n=3;23.1%)and humerus fracture(n=2;15.4%).Conclusions:In radial nerve injuries,successful results can be achieved with tendon transfer.All patients regained thumb abduction of up to approximately 60°.All the patients were able to bend the wrist,grip,and extend the fingers while in wrist flexion,neutral wrist and wrist extension positions.Although the reason for the radial injury varied,the postoperative outcomes were good for all patients,and the rehabilitation period progressed successfully in patients who underwent tendon transfer repair within 90 days of injury.
文摘BACKGROUND The extensor indicis proprius(EIP)tendon is a frequently used donor for a variety of tendon transfers,most commonly for reconstruction of the extensor pollicis longus(EPL).EIP is known to have frequent anatomic variants including split tendons and variations in tendon arrangement.AIM To characterize the anatomy of the EIP at the level of the extensor retinaculum,where tendon harvest is often performed,and share our preferred technique for EIP to EPL transfer.METHODS Twenty-nine fresh-frozen cadaveric forearms without history of forearm or hand injury or surgery were dissected.Tendon circumference and relationship of the EIP and extensor digitorum communis to the index(EDCI)at the metacarpophalangeal(MCP)joint and the distal extensor retinaculum were recorded.Distance from the distal extensor retinaculum to the EIP myotendinous junction was measured.RESULTS EIP was ulnar to the EDCI in 96.5%of specimens(28/29)at the distal edge of the extensor retinaculum.In the remaining specimen,EIP was volar to EDCI.Tendon circumference at the distal extensor retinaculum averaged(9.3 mm±1.7 mm)for EDCI and 11.1 mm(±2.7 mm)for EIP(P=0.0010).The tendon circumference at the index MCP joint averaged 11.0 mm(±1.7 mm)for EDCI and 10.6 mm(±2.1 mm)for EIP(P=0.33).EIP had a greater circumference in 76%(22/29)of specimens at the distal extensor retinaculum whereas EIP had a greater circumference in only 31%(9/29)of specimens at the MCP joint.CONCLUSION The EIP tendon is frequently ulnar to and greater in circumference than the EDCI at the distal extensor retinaculum,which can be taken into consideration for tendon transfers involving EIP.
文摘Background Recurrence of hallux valgus is considered to be the most common problem experienced postoperatively.We designed and caried out operations to correct hallux valgus by transferring the extensor hallucis longus （EHL） tendon to reduce the likelihood of recurrence.Methods Twenty-five patients （38 feet） with the average age of （46.3±12.3） （range, 22 to 60） years underwent the operation. The American Orthopaedic Foot and Ankle Society score and weight-bearing radiographs of the foot were applied to assess the feet pre- and postoperatively with a mean duration of follow-up of （38.2±3.2） months. The surgical procedure includes the release of the distal soft tissues, excision of the medial eminence, plication of the medial part of the capsule, and transfer of the EHL tendon, and reconstructing its insertion.Results At follow-up, 35 feet （23 patients, 85%） were free from pain at the first metatarsophalangeal （MTP） joint. In three feet （two patients）, the pain was alleviated but persisted. The mean hallux valgus angle decreased significantly from a preoperative 38.3°±8.0° to 7.3°±2.0° at the time of the most recent follow-up （P 〈0.0001）, and the mean intermetatarsal （IM） angle decreased significantly from preoperative 12.5°±3.4° to postoperative 6.5°±2.4° （P 〈0.0001）. The mean score according to the American Orthopaedic Foot and Ankle Society had increased from 46.5 to 84.8 points （P 〈0.0001）.Conclusions Hallux valgus can be corrected by transferring the EHL tendon medially and reconstructing its insertion.The technique can achieve stress balance of metatarsophalangeal joints and therefore prevent the recurrence of hallux valgus.
文摘Fracture of an ossification of the Achilles tendon(OAT)is a rare entity,and its etiology,pathology,and treatment remain unclear.We reviewed and scrutinized 18 cases(16 articles)of the fracture of an OAT.The most common etiologies of the ossifications include previous surgery and trauma.The fractures often occur without any trigger or with minimal trigger.The long,>5 cm,ossification in the body of the Achilles tendon may have a higher risk of fracture.The OAT itself is often asymptomatic;however,its fracture causes severe local pain,swelling,and weakness of plantar flexion,which forces patients to undergo aggressive treatments.Regarding the treatments of the fractures,nonoperative treatment by immobilizing ankle joint could be an option for elderly patients.However,because it often cannot produce satisfactory results in younger patients,surgical treatment is typically recommended.Excision of the fractured mass and repairing the tendon is applicable if the remnant is enough.If there is a defect after the excision,reconstruction with autologous grafts or adjacent tendon transfer is performed.Gastrocnemius fascia turndown flap,hamstring tendon and tensor fascia lata are used as autologous grafts,whereas peroneus brevis and flexor hallucis longus tendons are used for the tendon transfer.If the fracture of an OAT is treated properly,the functional result will be satisfactory.
文摘Dynamic supination of the foot is a common residual deformity in children with clubfeet treated with the Ponseti method. Transfer of the anterior tibialis tendon (ATT) to the lateral cuneiform is an effective method for correcting this deformity when the cuneiform is ossified in children who are 3 to 5 years of age. We describe two cases of a previously unreported method of ATT transposition for correction of bilateral residual dynamic supination in a 26-month-old and a 19-month-old patient. Both patients presented shortly after birth with bilateral congenital idiopathic clubfoot and were initially treated with the Ponseti method. Both had residual deformity following initial treatment that included posterior contracture and metatarsus adductus with dynamic forefoot supination. This was surgically corrected with a posterior release and medial release of the 1st metatarsal/1st cuneiform joint. To correct dynamic supination, the ATT was transplanted laterally into the released midfoot joint. These two patients were followed post-operatively for 7.5 years and have correction of their residual deformity in both feet based on subjective functioning, appearance, range of motion, strength, and gait. Both have excellent lateral pull of their ATT, which functions as a strong foot dorsiflexor. No residual supination is present. This is the first report of lateral transposition of the ATT as an interposition graft at the released 1st metatarsal/1st cuneiform joint in patients with relapsed clubfoot. We suggest that this method should provide a high level of functioning in children with relapsed supination deformity and whose 3rd cuneiform has not yet ossified.
文摘Background: Spontaneous tendon rupture of hand is not frequent. These ruptures can occur after a fracture. Aim: We report a case of spontaneous rupture of extensor pollicis longus tendon, and describe the treatment. Case presentation: We report the case of a 63-year-old woman who had extensor pollicis longus tendon rupture after non-displaced extra-articular distal radius fracture, treated by wrist circular cast immobilization. Extensor indicis proprius tendon transfer was performed, with an excellent functional result. Conclusion: Extensor pollicis longus tendon rupture can occur after non-displaced extra-articular distal radius fracture. Its treatment by tendon transfer helps to restore function of hand.
文摘Background:?Disabling internal rotation contractures are frequently experienced in children with unresolved birth brachial plexus palsies. Multiple surgical options like muscle release, tendon transfer, or humeral osteotomy are available to treat such cases. Purpose:?Evaluation of the outcome of subscapularis release and latissimus dorsi and teres major tendon transfer in the management of obstetric brachial palsies in Mansoura University neurosurgical department. Study type: Retrospective observational study. Patients and Methods: Twenty-five cases who underwent subscapularis release and latissimus dorsi and teres major transfer were included in the study. All patients were subjected to complete history taking, through clinical examination. The degree of shoulder movement and disability was assessed via Modified Gilbert shoulder evaluation scale. Results: The least follow up period for our patients was 9 months. There was a clear improvement of shoulder function evaluated using Modified Gilbert shoulder evaluation scale as there were 73% of postoperative group between GIV and GV while about 84% of preoperative group were between GII and GIII. Conclusion: Tendon transfer is a valid easy procedure for correction of shoulder deformities in patients with obstetrical brachial plexus palsy. It is considered a very good option for patients who missed the chance of microsurgical repair or patients with poor shoulder recovery after surgery. Although some authors reported deterioration of shoulder function with log time follow up after tendon transfer, it is still better than those who were not operated.
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.
