Long-term follow-up of three different nerve repair strategies (repair, autografting and allografting) in one-stage replantation to treat upper extremity amputation

2021 ◽  
Vol 53 (06) ◽  
pp. 534-542
Author(s):  
Hao Wu ◽  
Xuejun Wu ◽  
Shibei Lin ◽  
Tian Lai
Keyword(s):  
Upper Extremity ◽  
Nerve Repair ◽  
Dash Score ◽  
Allograft Transplantation ◽  
Group A ◽  
Nerve Anastomosis ◽  
Direct Nerve ◽  
Group B ◽  
Nerve Autograft ◽  
Extremity Amputation

Abstract Objective To examine the efficacy of three different nerve repair methods for one-stage replantation to treat complete upper extremity amputation and long-term postoperative functional recovery. Methods Twenty-five patients underwent direct nerve anastomosis (Group A), for patients with nerve defects greater than 3 cm, nerve autograft transplantation be used (Group B), or patients with nerve defects less than 3 cm, nerve allograft transplantation be used (Group C) based on the severity of injury. The Disabilities of the Arm, Shoulder, and Hand (DASH) score (higher score means poorer function-less than 25 means good effect) and visual analogue scale (VAS) scores for pain at rest and under exertion were measured. Sensation recovery time and grip function were recorded. Results The mean follow-up time was 78 ± 29 months. Group A had the lowest DASH score, while Group C had the highest DASH score. DASH score differed significantly between the three groups (P < 0.001). Sensation was not restored in two patients in Group B and two patients in Group C, and there were significant between-group differences in sensation recovery (P = 0.001). Group C had the lowest VAS score, while Group A had the highest, and there were significant differences between groups (P = 0.044). Only one patient in Group C recovered grip function. Conclusion Direct nerve anastomosis should be performed whenever possible in replantation surgery for complete upper extremity amputation, as the nerve function recovery after direct nerve anastomosis is better than that after nerve autograft transplantation or nerve allograft transplantation. Two-stage nerve autograft transplantation can be performed in patients who do not achieve functional recovery long after nerve allograft transplantation.

scholarly journals End-to-side nerve repair using fibrin glue in rats

2010 ◽  
Vol 25 (2) ◽  
pp. 158-162 ◽  
Author(s):  
Daniel Nunes e Silva ◽  
Julice Coelho ◽  
Fabrício de Oliveira Frazílio ◽  
Alexandre Nakao Odashiro ◽  
Paulo de Tarso Camillo de Carvalho ◽  
...  
Keyword(s):  
Fibrin Glue ◽  
Axonal Regeneration ◽  
Nerve Repair ◽  
Control Group ◽  
Morphometrical Analysis ◽  
Walking Pattern ◽  
Group A ◽  
Nerve Anastomosis ◽  
Group B ◽  
Control Group Group

PURPOSE: To evaluate axonal regeneration after end-to-side nerve repair with fibrin glue in rats. METHODS: Forty-five Wistar rats were divided into three groups: group A (n=15), were not submitted to surgery (control group); group B (n=15) were submitted to fibular transection without repair; and group C (n=15), were submitted to fibular transection with end-to-side nerve anastomosis using fibrin glue, in the lateral surface of an intact tibial nerve. The three groups were submitted to walking track (30 and 90 days) and posterior morphometrical analysis (90 days). RESULTS: The functional tests demonstrated that there was no difference in the walking track during the study in group A (p>0.05). The group B had walking pattern impairment in the two tests (p>0.05). The group C had walking pattern impairment in the first test, with important recovery in the second test (p<0.05). The morphometrical assessment revealed significantly higher number of regenerated mielinates axons in group C, compared to group B (p<0.05). CONCLUSION: The end-to-side nerve repair with fibrin glue shows axonal recovery, demonstrated through functional and morphometrical ways in rats.

scholarly journals Best technique for fixation of displaced transverse olecranon fractures: tension band wiring or plate fixation?

2020 ◽  
Vol 6 (5) ◽  
pp. 1012
Author(s):  
Lokesh Kumar Yogi ◽  
Gagandeep Mahi ◽  
C. R. Thorat ◽  
Moti Janardhan Naik
Keyword(s):  
Functional Outcome ◽  
Large Scale ◽  
Plate Fixation ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Clinical Event ◽  
Dash Score ◽  
Group A ◽  
Group B ◽  
Olecranon Fractures

<p><strong>Background:</strong> Fractures of olecranon are common fractures in upper limb. Tension band wiring (TBW) and plate fixation (PF) are mostly used techniques but choice is based on type of fracture and surgeon’s preference.</p><p><strong>Methods:</strong>  A study assessed functional results in 28 patients that were enrolled after the clinical event of trauma has occurred. Patients were divided into two groups- Group (A) for TBW and Group (B) for PF; here gender, age and side of fracture were ignored. Post-operative functional outcome were evaluated by using the Mayo Elbow Performance (MEP) and the Disabilities of the Arm, Shoulder and Hand (DASH) score parameters.</p><p><strong>Results:<em> </em></strong>Mean (SD) union time as determined by postoperative radiographs was 8.5 (1.48) weeks for group (A) and 9 (2.08) weeks for group (B). Mean (SD) MEP score at 9 months in group (A) 84.28 (7.28) and 80.71 (10.92) in group (B). Mean (SD) DASH at 9 months in group (A) 12.2 (8.8) and 11.7 (10.4) in group (B). Complications were reported in group (A) 6 patient (42.85%) out of 14 patients and in group (B) 1 patient (7.14%) out of 14 patients.</p><p><strong>Conclusions:<em> </em></strong>The current study shows that there are no significant differences in functional outcome between both the study groups. Due to lesser complications, we recommend the plate fixation approach as the better choice for transverse displaced olecranon fractures. More large scale studies are required to further confirm our results.</p>

Evaluating Nerve Repair Outcomes in Upper Extremity Nerve Injuries Utilizing Processed Nerve Allografts, Tube Conduit, and Nerve Autograft

2015 ◽  
Vol 40 (9) ◽  
pp. e5 ◽  
Author(s):  
Gregory M. Buncke ◽  
Brian Rinker ◽  
Wesley P. Thayer ◽  
Jason Ko ◽  
Dmitry Tuder ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Nerve Repair ◽  
Nerve Injuries ◽  
Nerve Autograft

scholarly journals Effect of Teriparatide in Fracture Healing in Lower Limbs- An Interventional Study

2021 ◽  
Author(s):  
Sanjeev Kumar ◽  
Girish Sahni ◽  
Harjit K Singh Chawla ◽  
Daljinder Singh
Keyword(s):  
Functional Outcome ◽  
Adverse Reactions ◽  
Weight Bearing ◽  
Test Group ◽  
Control Group ◽  
Dash Score ◽  
Early Weight Bearing ◽  
Group A ◽  
Group B ◽  
Radiological Union

Introduction: Many of the trauma patients presenting to the orthopaedic departments suffer from lower limb fractures. This often leads to prolonged period of morbidity and absence from work. Fracture healing can be delayed in elderly patients, postmenopausal women and in communited fractures. Teriparatide (TPH) given subcutaneously for 6 to 9 months, in such cases, may promote clinical and radiological union of bone. Aim: To know the effect of TPH in improving clinical and radiological union and also to evaluate early weight bearing, improvement in pain and functional outcome. Materials and Methods: In this prospective interventional study, a total of 125 patients were initially enrolled for the study and then after meeting inclusion criteria total 104 patients were selected for the study. They were allocated into two groups by randomisation by 1:1 method-group A was test group of 52 cases in which subcutaneous injection TPH 20 mcg daily (for six months) was given along with standard dosage of calcium and vitamin D; while in 52 cases in group B (control group) only calcium and vitamin D were given. Injection TPH was started within 10 days of fracture and given for six months. No placebo injection was given in control group. Time to weight bearing, time to clinical and radiological union and pain by Visual Analogue Score (VAS) were noted at regular follow-up at one month, three months, six months and 12 months and were compared in both the groups. Functional outcome by Disabilities of the Arm, Shoulder and Hand (DASH) score was noted as an additional tool, as DASH score questionnaire shows many activities of daily living that require mobility and stability of lower limb too. Adverse reactions were noted and compared within test and control groups. The collected data were analysed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 22.0 software and Mann-Whitney U test was used to calculate p-value. Results: Average time period for full weight bearing with or without support for test group A was 11±2.7 weeks and 16±1.8 weeks in control group B (p-0.001). Average time to clinical union in test group was 12±1.9 weeks and in control group 16±2.2 weeks (p-0.001). Average time to radiological union was 13±1.4 weeks in test group while 22±2.2 weeks in control group (p-0.001). Pain score by VAS and functional outcome by DASH were improved in test group (p-0.001). There was no difference in adverse reactions in both the groups (p>0.05). Conclusion: Regular intake of TPH 20 mcg subcutaneous daily for six months can reduce time to clinical and radiological fracture union, promote early weight bearing and provide better pain control. Hence, better functional outcome and prefracture ambulatory status can be achieved with no significant adverse events.

A Comparison of Immediate and Delayed Nerve Repair Using Autologous Freeze-Thawed Muscle Grafts in a Large Animal Model

1995 ◽  
Vol 20 (5) ◽  
pp. 663-700 ◽  
Author(s):  
G. M. LAWSON ◽  
M. A. GLASBY
Keyword(s):  
Animal Model ◽  
Nerve Repair ◽  
Large Animal Model ◽  
Large Animal ◽  
Nerve Reconstruction ◽  
Nerve Blood Flow ◽  
Nerve Grafts ◽  
Group A ◽  
Group B ◽  
The Right

Freeze-thawed muscle grafts (FTMG) have been suggested as an alternative to nerve grafts in reconstruction of peripheral nerve defects. This study compares the results of immediate and delayed nerve repair with freeze-thawed muscle graft in a large animal model. Under general anaesthesia, ten adult sheep underwent excision of 3 cm of the right median nerve. Five had immediate nerve reconstruction with FTMGs (Group A) and five were repaired after 4 weeks (Group B). At 6 months, both the right (repaired) and left (“control”) median nerves of each sheep were assessed. Nerve blood flow distal to the graft in both groups of repaired nerves was approximately 60% of that in their respective control nerves. Peak nerve conduction velocities were significantly slower in the repaired nerves. The mean fibre diameters of the immediate and delayed repairs were 5.06 and 3.90 μ respectively compared to a control mean of 8.58 μ. G-ratios confirmed that the repaired nerves in both groups were well myelinated. The authors conclude that the FTMG can be used in delayed as well as immediate nerve reconstruction with minimal impairment of final results.

Impaired Regeneration in Rat Sciatic Nerves Exposed To Short-Term Vibration

1996 ◽  
Vol 21 (6) ◽  
pp. 746-749 ◽  
Author(s):  
T. STRÖMBERG ◽  
G. LUNDBORG ◽  
B. HOLMQUIST ◽  
L. B. DAHLIN
Keyword(s):  
Hind Limb ◽  
Nerve Repair ◽  
Control Group ◽  
Short Term ◽  
Short Term Exposure ◽  
Group A ◽  
Sciatic Nerves ◽  
Distal Nerve ◽  
Group B ◽  
End Group

We have studied the effects of vibration on the regeneration capacity of the peripheral nerve. A rat model was used where one hind limb was subjected to vibration of defined magnitude and duration while the contralateral hind limb was not exposed to vibration. Seven days later, the sciatic nerves were transected bilaterally and cross-joined giving the following groups: group A, a proximal vibrated nerve end sutured to a non-vibrated distal nerve end; group B, a non-vibrated proximal nerve end sutured to a distal vibrated nerve end, and group C, non-vibrated proximal nerve end sutured to a non-vibrated distal nerve end. The regeneration distances were measured 3, 6 and 8 days after surgery. The control group showed a normal linear outgrowth. The outgrowth in the two experimental groups was initially not different to controls but later became significantly different, indicating a retardation of outgrowth in these groups. It is concluded that short-term exposure to vibration can impair nerve regeneration after transection and nerve repair.

scholarly journals Proprioceptive elbow training reduces pain and improves function in painful lateral epicondylitis—a prospective trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
B. Schiffke-Juhász ◽  
K. Knobloch ◽  
P. M. Vogt ◽  
L. Hoy
Keyword(s):  
Grip Strength ◽  
Prospective Trial ◽  
Lateral Epicondylitis ◽  
Dash Score ◽  
Level Of Evidence ◽  
Link Type ◽  
Significant Difference ◽  
Proprioceptive Training ◽  
Group A ◽  
Group B

Abstract Background In painful epicondylitis, previous studies reported deficiencies in elbow proprioception. In line, proprioceptive training of the lower limb has been reported substantial beneficial in a number of indications. Therefore, we have asked if a specified proprioceptive training using training devices that are capable of activating the deep musculature in the upper limb is able to reduce the symptoms of epicondylitis. Materials and methods We included 71 patients with painful lateral epicondylitis > 3 months. Interventions: Group A: Proprioceptive training intervention with a Flexibar® (9 min daily for 12 weeks). Group B: at least 40 min running or walking/week with the XCO® in addition to the proprioceptive training with the Flexibar® (9 min daily for 12 weeks), follow-up for 12 weeks. Primary end point: Pain on visual analogue scale (VAS, 0-10); secondary end points: DASH-Score (0 = very good, 100 = very poor), grip strength according to Jamar dynamometer (kg), vibration sensation measured with a 128 Hz tuning fork. Results The pain on VAS in group A was reduced significantly. 3.6 ± 2.0 to 2.4 ± 2.1 (−33%, p = 0.013), and from 3.7 ± 2.4 to 2.2 ± 1.9 (−41%, p = 0.004) in group B after 12 weeks. There was no significant difference between A and B (p = 0.899). In both groups, there was a significant improvement of the DASH-Score (A: 32 ± 15 to 14 ± 12, −56%, p < 0.001; B: 27 ± 12 to 12 ± 11, −55%, p = 0.001) without any difference between groups A and B (p = 0.339). Grip strength improvement in group A from 24 ± 12 to 33 ± 11 kg (+38%, p < 0.001), and from 29 ± 14 to 34 ± 11 kg (+15%, p < 0.001) in group B. In line, vibration sensation improved in both groups (A: 6.3 ± 0.6 to 6.5 ± 0.5, p = 0.0001; B: 6.3 ± 0.7 to 6.6 ± 0.5, p = 0.003). Conclusion A 12-week proprioceptive training with the Flexibar® improves pain, quality of life, grip strength and vibration sensation in patients with painful lateral epicondylitis. Level of evidence Ib, randomised clinical trial Trial registration German Clinical Trials Register, DRKS00024857, registered on 25 March 2021—retrospectively registered, http://apps.who.int/trialsearch/

scholarly journals Platelet-Rich Plasma versus Corticosteroid Intra-Articular Injections for the Treatment of Trapeziometacarpal Arthritis: A Prospective Randomized Controlled Clinical Trial

Cartilage ◽  
2018 ◽  
Vol 12 (1) ◽  
pp. 51-61 ◽  
Author(s):  
Michael-Alexander Malahias ◽  
Leonidas Roumeliotis ◽  
Vasileios S. Nikolaou ◽  
Efstathios Chronopoulos ◽  
Ioannis Sourlas ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Platelet Rich Plasma ◽  
Symptomatic Relief ◽  
Controlled Clinical Trial ◽  
Dash Score ◽  
Ultrasound Guided ◽  
Radiographic Osteoarthritis ◽  
Group A ◽  
Group B

Various systematic reviews have recently shown that intra-articular platelet-rich plasma (IA-PRP) can lead to symptomatic relief of knee osteoarthritis for up to 12 months. There exist limited data on its use in small joints, such as the trapeziometacarpal joint (TMJ) or carpometacarpal joint (CMCJ) of the thumb. A prospective, randomized, blind, controlled, clinical trial of 33 patients with clinical and radiographic osteoarthritis of the TMJ (grades: I-III according to the Eaton and Littler classification) was conducted. Group A patients (16 patients) received 2 ultrasound-guided IA-PRP injections, while group B patients (17 patients) received 2 ultrasound-guided intra-articular methylprednisolone and lidocaine injections at a 2-week interval. Patients were evaluated prior to and at 3 and 12 months after the second injection using the visual analogue scale (VAS) 100/100, shortened Disabilities of the Arm, Shoulder, and Hand Questionnaire (Q-DASH), and patient’s subjective satisfaction. No significant differences between the baseline clinical and demographic characteristics of the 2 groups were identified. After 12 months’ follow-up, the IA-PRP treatment has yielded significantly better results in comparison with the corticosteroids, in terms of VAS score ( P = 0.015), Q-DASH score ( P = 0.025), and patients’ satisfaction ( P = 0.002). Corticosteroids offer short-term relief of symptoms, but IA-PRP might achieve a lasting effect of up to 12 months in the treatment of early to moderate symptomatic TMJ arthritis.

COMPARISON BETWEEN PERINEURAL DEXAMETHASONE AND INTRAVENOUS MAGNESIUM SULPHATE AS ADJUVANT IN SUPRACLAVICULAR BLOCK

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Nagah El-Shaer ◽  
Ahmed Kamal Mohamed Ali ◽  
Farouk Kamal Eldeen Abd El-Aziz ◽  
Mostafa Samir El-Sayed
Keyword(s):  
Upper Extremity ◽  
Magnesium Sulphate ◽  
Regional Anaesthesia ◽  
Motor Block ◽  
Sensory Block ◽  
University Hospital ◽  
Study Patient ◽  
Rescue Analgesia ◽  
Group A ◽  
Group B

Abstract   Background: Upper extremity surgeries are commonly performed under regional anaesthesia. Regional anaesthesia of the upper extremity has several advantages over general anaesthesia such as improved postoperative pain management, decreased postoperative narcotic consumption, and reduced recovery time. Objectives: The aim of the study was to compare between dexamethasone and magnesium sulphate as adjuvants in supraclavicular brachial plexus block as regards the onset and duration of sensory and motor block as well as side effects. Patients and Methods: This prospective double-blinded comparative study was carried out in Faculty of Medicine, Ain-Shams University Hospital on 120 adult patients between 21-50 years of both sexes with ASA classification 1&2 who were scheduled for elective upper limb orthopaedic surgeries. A written informed consent was obtained from all patients. Every patient received an explanation about the purpose of the study. Procedures had been approved by the institutional and the regional ethical committee. Total 120 patients are enrolled in the study and divided into 3 groups A and B and C (40 for each one). Results From aspect of increasing the duration of sensory &motor block magnesium sulphate group (group A) showed higher prolongation of sensory & motor block with recovery of pin prick sensation in median time 313 mins ± when compared with group B &C even with longer time taken for patient to request rescue analgesia after 5 hours. In group (B) by adding dexamethasone with bupivacaine the blood pressure rate are increased after 20 min of injection and return normal after 240 min, heart rate are normal, but in case of sensory and motor block about 77.5% of study patient in this group have full motor and sensory block, in case of increasing time of motor and sensory block the dexamethasone success increasing time for motor and sensory block to reach 278 min sensory and 314 min in motor block, first call of Analgesic are after 4 hr. Conclusion: Group A (Magnesium sulphate with bupivacaine) were more effective and increasing affected time in motor and sensory block than Group B (Dexamethasone with Bupivacaine) and Group C (Control).

scholarly journals Nerve growth factor with fibrin glue in end-to-side nerve repair in rats

2012 ◽  
Vol 27 (4) ◽  
pp. 325-332 ◽  
Author(s):  
Daniel Nunes e Silva ◽  
Andréia Conceição Milan Brochado Antoniolli da Silva ◽  
Ricardo Dutra Aydos ◽  
Fausto Viterbo ◽  
Elenir Rose Jardim Cury Pontes ◽  
...  
Keyword(s):  
Nerve Growth Factor ◽  
Growth Factor ◽  
Fibrin Glue ◽  
Tibial Nerve ◽  
Nerve Repair ◽  
Nerve Section ◽  
Nerve Growth ◽  
Group A ◽  
Group B ◽  
Group D

PURPOSE: To determine the effects of end-to-side nerve repair performed only with fibrin glue containing nerve growth in rats. METHODS: Seventy two Wistar rats were divided into six equal groups: group A was not submitted to nerve section; group B was submitted to nerve fibular section only. The others groups had the nerve fibular sectioned and then repaired in the lateral surface of an intact tibial nerve, with different procedures: group C: ETS with sutures; group D: ETS with sutures and NGF; group E: ETS with FG only; group F: ETS with FG containing NGF. The motor function was accompanied and the tibial muscle mass, the number and diameter of muscular fibers and regenerated axons were measured. RESULTS: All the analyzed variables did not show any differences among the four operated groups (p>0.05), which were statistically superior to group B (p<0.05), but inferior to group A (p>0.05). CONCLUSION: The end-to-side nerve repair presented the same recovery pattern, independent from the repair used, showing that the addition of nerve growth factor in fibrin glue was not enough for the results potentiating.

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