Biceps-to-Triceps Transfer in Tetraplegia

Eight tetraplegic patients (13 elbows) were treated by biceps-to-triceps transfer. To avoid the risk of radial nerve injury, we chose a medial routing of the biceps. The mean follow-up after surgery was 17.8 months (range, 4–47 months). No complications were encountered. Active extension of the elbow was achieved in each case. The mean postoperative active range of motion of the elbow was 6° extension and 137° flexion. After the biceps-to-triceps transfer mean extension torque of the elbow was 3.7 Nm and mean flexion torque was 10 Nm. In eight elbows in which it was measured, there was a 47% reduction in elbow flexion power. Nevertheless no patient complained about that reduction, and all of them were satisfied.

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Delayed Single Kirschner Wire Compression Technique for Mallet Fracture

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2004.10.012 ◽

2005 ◽

Vol 30 (2) ◽

pp. 180-184 ◽

Cited By ~ 32

Author(s):

D. FRITZ ◽

M. LUTZ ◽

R. ARORA ◽

M. GABL ◽

M. WAMBACHER ◽

...

Keyword(s):

Range Of Motion ◽

Articular Surface ◽

Kirschner Wire ◽

Compression Technique ◽

Active Range Of Motion ◽

Mallet Fracture ◽

Strenuous Work ◽

Distal Interphalangeal ◽

The Mean

Twenty-four mallet fractures which involved at least one third % of the articular surface of the distal interphalangeal joint were treated by open reduction and internal fixation using a single double-ended Kirschner wire at a mean of 9 days after injury (range 4–15). At a mean follow-up of 43 (range 12–18) months the active range of motion, pain and the Warren and Norris criteria were evaluated. The mean active range of motion was from −2° extension (range 0–10°) to 72° flexion (range 50–90°). Nineteen patients were pain free and five suffered from mild pain during strenuous work. The Warren and Norris results were successful in 22 and improved in two cases. Radiographs showed, that all the fractures united in a near-anatomic position but with joint narrowing in six digits.

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Tuberculosis of the Elbow Region in Pediatric Age Group – Experiences from a Single Centre

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s0218810417500502 ◽

2017 ◽

Vol 22 (04) ◽

pp. 457-463 ◽

Cited By ~ 1

Author(s):

Anil Agarwal ◽

Anuj Rastogi

Keyword(s):

Range Of Motion ◽

Ice Cream ◽

Elbow Flexion ◽

Joint Involvement ◽

Functional Evaluation ◽

Duration Of Symptoms ◽

Proximal Ulna ◽

Clinical Series ◽

The Mean

Background: Clinical series of tuberculosis of elbow region in children are few. The purpose of our study was to retrospectively review the presentation, healing response and functional results of 30 children. Methods: The pretreatment disease presentation was studied from patient’s case records. Serial radiographs of the patients were studied to see remineralization and healing of radiological lesions. For elbow’s functional evaluation, pain, range of motion and recurrence were observed at final follow up. Results: The mean patient age was 8.2 years. The mean duration of symptoms before presentation was 47 days. A discharging sinus was present in 6 patients. Multifocal presentation was found in 7 patients. The lesion was most commonly localized in proximal ulna or lower humerus. The classical ‘ice cream scoop’ appearance of proximal ulnar metaphysis was noted in 5 elbows. Most elbows were in Martini stage 2 (70%) at the time of presentation. All patients were treated non-operatively. Average follow up after completion of antitubercular therapy was 18.97 months. The resolution of regional osteopenia, sclerosis of lytic lesions, reappearance of bony trabeculae and decrease in size of cavities was the usual sequence of radiological healing. End average elbow flexion arc deteriorated with increasing Martini stage. ‘Ice cream scoop lesions’ resulted in a worse functional outcome with formation of an irregular proximal ulnar articular surface. Conclusions: Restriction of elbow range of motion, early discharging sinus formation and radiological ‘ice cream scoop’ appearance indicated a tubercular pathology. Late presentation with advanced disease, total joint involvement, and ‘ice cream scoop appearance’ resulted in decreased elbow flexion arc.

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Analysis of human acellular nerve allograft combined with contralateral C7 nerve root transfer for restoration of shoulder abduction and elbow flexion in brachial plexus injury: a mean 4-year follow-up

Journal of Neurosurgery ◽

10.3171/2019.2.jns182620 ◽

2020 ◽

Vol 132 (6) ◽

pp. 1914-1924 ◽

Cited By ~ 2

Author(s):

Liang Li ◽

Jiantao Yang ◽

Bengang Qin ◽

Honggang Wang ◽

Yi Yang ◽

...

Keyword(s):

Brachial Plexus ◽

Nerve Root ◽

Functional Outcomes ◽

Elbow Flexion ◽

Shoulder Abduction ◽

Allograft Reconstruction ◽

Acellular Nerve Allograft ◽

The Mean ◽

Monofilament Test

OBJECTIVEHuman acellular nerve allograft applications have increased in clinical practice, but no studies have quantified their influence on reconstruction outcomes for high-level, greater, and mixed nerves, especially the brachial plexus. The authors investigated the functional outcomes of human acellular nerve allograft reconstruction for nerve gaps in patients with brachial plexus injury (BPI) undergoing contralateral C7 (CC7) nerve root transfer to innervate the upper trunk, and they determined the independent predictors of recovery in shoulder abduction and elbow flexion.METHODSForty-five patients with partial or total BPI were eligible for this retrospective study after CC7 nerve root transfer to the upper trunk using human acellular nerve allografts. Deltoid and biceps muscle strength, degree of shoulder abduction and elbow flexion, Semmes-Weinstein monofilament test, and static two-point discrimination (S2PD) were examined according to the modified British Medical Research Council (mBMRC) scoring system, and disabilities of the arm, shoulder, and hand (DASH) were scored to establish the function of the affected upper limb. Meaningful recovery was defined as grades of M3–M5 or S3–S4 based on the scoring system. Subgroup analysis and univariate and multivariate logistic regression analyses were conducted to identify predictors of human acellular nerve allograft reconstruction.RESULTSThe mean follow-up duration and the mean human acellular nerve allograft length were 48.1 ± 10.1 months and 30.9 ± 5.9 mm, respectively. Deltoid and biceps muscle strength was grade M4 or M3 in 71.1% and 60.0% of patients. Patients in the following groups achieved a higher rate of meaningful recovery in deltoid and biceps strength, as well as lower DASH scores (p < 0.01): age < 20 years and age 20–29 years; allograft lengths ≤ 30 mm; and patients in whom the interval between injury and surgery was < 90 days. The meaningful sensory recovery rate was approximately 70% in the Semmes-Weinstein monofilament test and S2PD. According to univariate and multivariate logistic regression analyses, age, interval between injury and surgery, and allograft length significantly influenced functional outcomes.CONCLUSIONSHuman acellular nerve allografts offered safe reconstruction for 20- to 50-mm nerve gaps in procedures for CC7 nerve root transfer to repair the upper trunk after BPI. The group in which allograft lengths were ≤ 30 mm achieved better functional outcome than others, and the recommended length of allograft in this procedure was less than 30 mm. Age, interval between injury and surgery, and allograft length were independent predictors of functional outcomes after human acellular nerve allograft reconstruction.

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Z-osteotomy in hallux valgus: clinical and radiological outcome after Scarf osteotomy

Orthopedic Reviews ◽

10.4081/or.2009.e4 ◽

2009 ◽

Vol 1 (1) ◽

pp. 4 ◽

Cited By ~ 1

Author(s):

Marcus Jaeger ◽

Michael Schmidt ◽

Alexander Wild ◽

Bernd Bittersohl ◽

Susanne Courtois ◽

...

Keyword(s):

Range Of Motion ◽

Hallux Valgus ◽

Metatarsophalangeal Joint ◽

Mean Value ◽

Surgical Approaches ◽

Radiological Outcome ◽

Scarf Osteotomy ◽

Post Surgery ◽

The Mean

Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22-90 years) were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months-5 years). Surgical indications were: intermetatarsal angle (IMA) of 12-23°; increased proximal articular angle (PAA>8°), and range of motion of the metatarsophalangeal joint in flexion and extension >40°. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM) of the great toe post-surgery was 0.8±1.73 points (0: full ROM, 10: total stiffness). The mean subjective cosmetic result was 2.7±2.7 points (0: excellent, 10: poor). The overall post-operative patient satisfaction with the result was high (2.1±2.5 points (0: excellent, 10: poor). The mean hallux valgus angle improvement was 16.6° (pre-operative mean value: 37.5°) which was statistically significant (p<0.01). The IMA improved by an average of 5.96° from a pre-operative mean value of 15.4° (p<0.01). Neither osteonecrosis of the distal fragment nor peri-operative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. 筻

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Reduction and Association of the Scaphoid and Lunate: A Functional and Radiographical Outcome Study

Journal of Wrist Surgery ◽

10.1055/s-0038-1668154 ◽

2018 ◽

Vol 08 (01) ◽

pp. 037-042

Author(s):

William Aibinder ◽

Ali Izadpanah ◽

Bassem Elhassan

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

High Rate ◽

Salvage Procedure ◽

Level Of Evidence ◽

Long Term Follow Up ◽

The Mean ◽

Ligament Disruption

Background Management of scapholunate (SL) ligament disruption is a challenging problem. The reduction and association of the scaphoid and lunate (RASL) procedure has been described with varying results. This study assessed the outcomes of the RASL procedure. Purpose The objective of this study was to assess the outcomes of patients undergoing the RASL procedure at our institution in regard to pain relief, range of motion, radiographic and functional outcomes, complications, and reoperations. Materials and Methods Twelve patients with symptomatic chronic SL instability underwent the RASL procedure. The mean age was 35 years. The mean time from injury to surgery was 40 weeks. The mean follow-up was 89 months. Outcomes included visual analog score for pain, wrist range of motion, grip strength, and Mayo Wrist Scores. Preoperative and postoperative radiographs were reviewed. Results Pain scores improved in 10 wrists. Range of motion and grip strength worsened. The average Mayo Wrist Score was 63.3. The mean SL diastasis and angle improved, but seven wrists developed progressive degenerative changes, with two requiring a salvage procedure. Symptomatic progressive screw lucency occurred in eight wrists requiring screw removal. Conclusion The RASL procedure can improve SL widening but has a high rate of early failure and reoperation. Following reoperation, long-term follow-up demonstrates reasonable long-term durability in some cases. Level of Evidence This is a Level IV, therapeutic case study.

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Intraoperative radial nerve injury during coronary artery surgery – report of two cases

Journal of Brachial Plexus and Peripheral Nerve Injury ◽

10.1186/1749-7221-1-7 ◽

2014 ◽

Vol 01 (01) ◽

pp. e44-e47 ◽

Cited By ~ 1

Author(s):

Marianna Papadopoulou ◽

Konstantinos Spengos ◽

Apostolos Papapostolou ◽

Georgios Tsivgoulis ◽

Nikolaos Karandreas

Keyword(s):

Coronary Artery ◽

Nerve Injury ◽

Radial Nerve ◽

Coronary Artery Surgery ◽

Radial Nerve Injury

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The below elbow cast: a cause of median and radial nerve injury after coronary bypass surgery

Injury ◽

10.1016/s0020-1383(00)00106-6 ◽

2001 ◽

Vol 32 (1) ◽

pp. 78-79

Author(s):

J.J Candal-Couto ◽

A McCaskie ◽

P.J Briggs ◽

S Ledingham

Keyword(s):

Nerve Injury ◽

Radial Nerve ◽

Bypass Surgery ◽

Coronary Bypass ◽

Coronary Bypass Surgery ◽

Radial Nerve Injury

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Location of the radial nerve along the humeral shaft between the prone and lateral decubitus positions at different elbow positions

Scientific Reports ◽

10.1038/s41598-021-96458-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sitthiphong Suwannaphisit ◽

Wachirakorn Aonsong ◽

Porames Suwanno ◽

Chaiwat Chuaychoosakoon

Keyword(s):

Radial Nerve ◽

Minimum Distance ◽

Posterior Approach ◽

Elbow Flexion ◽

Lateral Decubitus Position ◽

Full Extension ◽

Posterior Aspect ◽

Lateral Epicondyle ◽

Lateral Decubitus ◽

The Mean

AbstractIdentification of the radial nerve is important during the posterior approach to a humerus fracture. During this procedure, the patient can be placed in the prone or lateral decubitus position depending on the surgeon’s preference. The distance from the radial nerve to the osseous structures will be different in each position. The purpose of this study was to identify the safety zones in various patient and elbow flexion positions. The distances from the olecranon to the center of the radial groove and intermuscular septum and lateral epicondyle to the lateral intermuscular septum were measured using a digital Vernier caliper. The measurements were performed with cadavers in the lateral decubitus and prone positions at different elbow flexion angles. The distance from where the radial nerve crossed the posterior aspect of the humerus measured from the upper part of the olecranon to the center of the radial nerve in both positions at different elbow flexion angles varied from a mean maximum distance of 130.00 mm with the elbow in full extension in the prone position to a minimum distance of 121.01 mm with the elbow in flexion at 120° in the lateral decubitus position. The mean distance of the radial nerve from the upper olecranon to the lateral intermuscular septum varied from 107.13 to 102.22 mm. The distance from the lateral epicondyle to the lateral edge of the radial nerve varied from 119.92 to 125.38 mm. There was not significant contrast in the position of the radial nerve with osseous landmarks concerning different degrees of flexion, except for 120°, which is not significant, as this flexion angle is rarely used.

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