OPPONOPLASTY WITHOUT POSTOPERATIVE IMMOBILIZATION

Hand Surgery ◽  
2011 ◽  
Vol 16 (03) ◽  
pp. 295-300 ◽  
Author(s):  
Ichiro Okutsu ◽  
Ikki Hamanaka ◽  
Aya Yoshida
Keyword(s):  
Muscle Function ◽  
Tendon Transfer ◽  
Proximal Phalanx ◽  
Ring Finger ◽  
Outpatient Basis ◽  
Reconstructive Procedure ◽  
Thenar Muscle ◽  
Pneumatic Tourniquet ◽  
Palmaris Longus Tendon ◽  
Flexor Digitorum

Opponoplasty using tendon transfer is a useful reconstructive procedure that restores lost thenar muscle function. Tendon transfers, however, require postoperative immobilization periods of up to four weeks before the sutured tendons reach required strength. We developed an opponoplasty procedure using α-TCP (alpha-tricalcium phosphate) cement that does not require postoperative immobilization and was applied to nine hands out of nine cases. The procedure is performed under local anesthesia without a pneumatic tourniquet and on an outpatient basis. In this procedure, the flexor digitorum superficialis of the ring finger is used as the donor tendon and the palmaris longus tendon is used as a dynamic pulley. The distal end of the transferred tendon is anchored to the inside of a newly formed bone hole in the thumb's proximal phalanx using α-TCP cement. Our opponoplasty procedure was uneventful postoperatively and produced satisfactory results in all nine cases. The α-TCP cement procedure shows potential for other tendon transfer applications.

Influence of the flexor digitorum superficialis tendon transfer on grip strength

2021 ◽  
pp. 175319342110612
Author(s):  
Angelina Garkisch ◽  
Stefanie Schmitt ◽  
Nicole Kim ◽  
Dagmar-C. Fischer ◽  
Karl-Josef Prommersberger ◽  
...  
Keyword(s):  
Grip Strength ◽  
Tendon Transfer ◽  
Ring Finger ◽  
Flexor Digitorum Superficialis ◽  
Force Transmission ◽  
Finger Forces ◽  
Middle Ring ◽  
Flexor Digitorum

The flexor digitorum superficialis tendon of the ring finger can be transferred to the thumb flexor. We followed ten patients after such a transfer for 5–128 months and measured grip strength and force transmission of the fingers and individual phalanges while the patients gripped 10-cm or 20-cm diameter cylinders. The grip strength of the middle, ring and little fingers was reduced when gripping the 10-cm cylinder, with a significantly larger decrease in the ring finger. With the 20-cm cylinder, grip forces of all fingers were almost identical, with slightly lower force of the ring finger and slightly higher forces in the index and small fingers. We conclude that after transfer of flexor digitorum superficialis tendon from a ring finger, grip strength of the ring finger is reduced. Finger forces are more hampered while gripping objects with smaller circumferences than large ones.

Advantages and Drawbacks of Proximal Interphalangeal Joint Fusion Versus Flexor Tendon Transfer in the Correction of Hammer and Claw Toe Deformity. A Finite-Element Study

2010 ◽  
Vol 132 (5) ◽  
Author(s):  
Javier Bayod ◽  
Marta Losa-Iglesias ◽  
Ricardo Becerro de Bengoa-Vallejo ◽  
Juan Carlos Prados-Frutos ◽  
Kevin T. Jules ◽  
...  
Keyword(s):  
Finite Element ◽  
Tendon Transfer ◽  
Proximal Phalanx ◽  
Delayed Union ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
The Finite Element Method ◽  
Flexor Digitorum Brevis ◽  
Flexor Digitorum ◽  
Toe Deformity

Correction of claw or hammer toe deformity can be achieved using various techniques, including proximal interphalangeal joint arthrodesis (PIPJA), flexor digitorum longus tendon transfer (FDLT), and flexor digitorum brevis transfer. PIPJA is the oldest technique, but is associated with significant complications (infection, fracture, delayed union, and nonunion). FDLT eliminates the deformity, but leads to loss of stability during gait. Flexor digitorum brevis tendon transfer (FDBT) seems to be the best surgical alternative, but it is a recent technique with still limited results. In this work, these three techniques have been analyzed by means of the finite-element method and a comparative analysis was done with the aim of extracting advantages and drawbacks. The results show that the best technique for reducing dorsal displacement of the proximal phalanx is PIPJA (2.28 mm versus 2.73 mm for FDLT, and 3.31 mm for FDBT). However, the best technique for reducing stresses on phalanges is FDLT or FDBT (a reduction of approximately 35% regarding the pathologic case versus the increase of 7% for the PIPJA in tensile stresses, and a reduction of approximately 40% versus 25% for the PIPJA in compression stresses). Moreover, the distribution of stresses in the entire phalanx is different for the PIPJA case. These facts could cause problems for patients, in particular, those with pain in the surgical toe.

Opponensplasty by Extensor Indicis and Flexor Digitorum Superficialis Tendon Transfer

1992 ◽  
Vol 17 (6) ◽  
pp. 611-614 ◽  
Author(s):  
G. A. ANDERSON ◽  
V. LEE ◽  
G. D. SUNDARARAJ
Keyword(s):  
Median Nerve ◽  
Tendon Transfer ◽  
Ring Finger ◽  
Flexor Digitorum Superficialis ◽  
Nerve Paralysis ◽  
Lateral Incision ◽  
Oblique Incision ◽  
Flexor Digitorum

From 1977 to 1988, 166 patients with median nerve paralysis of varied aetiology underwent opponensplasty. In 50 of these the extensor indicis was used, and in 116 the flexor digitorum superficialis of the ring finger. An analysis of these hands showed that the EI opponensplasty was best in supple hands and FDS opponensplasty was more suitable for less pliable hands. There were fewer complications seen after FDS opponensplasty if the detachment of the donor tendon was done through a volar oblique incision rather than the conventional lateral incision.

Proximal Phalanx and Flexor Digitorum Longus Tendon Biomechanics in Flexor to Extensor Tendon Transfer

2015 ◽  
Vol 36 (5) ◽  
pp. 585-590 ◽  
Author(s):  
Zachary J. DiPaolo ◽  
Matthew S. Ross ◽  
Richard T. Laughlin ◽  
Greg Gould ◽  
Katie Flower ◽  
...  
Keyword(s):  
Tendon Transfer ◽  
Proximal Phalanx ◽  
Extensor Tendon ◽  
Flexor Digitorum Longus ◽  
Longus Tendon ◽  
Tendon Biomechanics ◽  
Flexor Digitorum

Outcome of flexor digitorum superficialis opponensplasty for Type II and IIIA thumb hypoplasia

2015 ◽  
Vol 41 (3) ◽  
pp. 258-264 ◽  
Author(s):  
M. de Kraker ◽  
R. W. Selles ◽  
J. M. Zuidam ◽  
H. M. Molenaar ◽  
H. J. Stam ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Transfer ◽  
Ring Finger ◽  
Metacarpophalangeal Joint ◽  
Pinch Strength ◽  
Type Ii ◽  
Flexor Digitorum Superficialis ◽  
Joint Stability ◽  
Type Iiia ◽  
Flexor Digitorum

This study reports on outcomes of the flexor digitorum superficialis tendon transfer from the ring finger in Type II and IIIA hypoplastic thumbs. We included 22 patients with 27 involved hands: 16 Type II thumbs and five Type IIIA treated by transfer and six non-operated Type II thumbs. The outcomes were assessed by range of motion, strength, sensibility, joint stability and patient/parent satisfaction. Compared with normative data, the range of motion was diminished in all patient groups. Opposition strength in operated Type II thumbs was significantly better than in non-operated thumbs. Grip strength, pinch strength, tripod strength and key pinch strength were approximately 50% of normal in Type II thumbs and 35% in Type IIIA thumbs. Metacarpophalangeal joint stability was restored in all operated Type II thumbs and in 40% of Type IIIA thumbs. We conclude that the flexor digitorum superficialis tendon transfer of the ring finger is a good functioning opponensplasty in both Type II and IIIA thumbs. The transfer provides excellent stability of the metacarpophalangeal joint in Type II thumbs. Level of Evidence: Level IV

Transfer of Extensor Carpi Radialis Longus or Brevis for Opponensplasty

1999 ◽  
Vol 24 (1) ◽  
pp. 50-53 ◽  
Author(s):  
G. H. BAEK ◽  
J. M. JUNG ◽  
W. J. YOO ◽  
M. S. CHUNG
Keyword(s):  
Tendon Transfer ◽  
Ring Finger ◽  
The Other ◽  
Flexor Digitorum Superficialis ◽  
Flexor Muscles ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis

For the restoration of thumb opposition many types of tendon transfer techniques have been described. The flexor digitorum superficialis (FDS) of the ring finger is commonly selected as a motor. On occasion, however, the quality of the flexor muscles of the fingers or wrist is not good enough for tendon transfer and another available muscle must be selected. In this situation, we have preferred to use an extensor carpi radialis longus (ECRL) or brevis (ECRB) transfer to restore opposition of the thumb. Follow-up examination, at an average 5 years and 10 months after operation, showed that the results of ten of 11 transfers were excellent and the other was good.

scholarly journals Wide-Awake Approach for Flexor Digitorum Superficialis Tendon Transfer Followed by Early Active Mobilization

2021 ◽  
Author(s):  
Takuma Kuroda ◽  
Koji Moriya ◽  
Naoto Tsubokawa ◽  
Hiroko Narisawa ◽  
Yutaka Maki ◽  
...  
Keyword(s):  
Tendon Transfer ◽  
Ring Finger ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Active Motion ◽  
Standard Clinical Practice ◽  
Closed Rupture ◽  
Active Mobilization ◽  
Flexor Digitorum ◽  
Wide Awake

Abstract Background The standard clinical practice to treat closed ruptures of the flexor digitorum profundus (FDP) tendons includes free tendon grafting; however, it is not suitable when the muscle amplitude of the ruptured FDP is not sufficient. We report outcomes of six patients who underwent flexor digitorum superficialis (FDS) tendon transfer of the ring finger using the wide-awake approach to repair the closed rupture of the FDP tendon of the little finger in zone 3 or 4. Methods The patients were identified by reviewing our institutional billing records from January 2012 to October 2019 for the International Classification of Disease 10 code M66.3 that describes the diagnosis as “spontaneous rupture of flexor tendons.” Results The patients comprised two men and four women with an average age of 72.2 years (standard deviation [SD], 8.4 years). All patients were hospitalized after surgery to undergo early active mobilization. The average total active motion at the final evaluation was 201.8° (range: 85–248°). According to Strickland’s criteria, outcomes were excellent for two, good for three, and poor for one patient. No patients complained about the ring finger. Conclusion These results suggest that FDS tendon transfer is recommended when the muscle amplitude of the ruptured FDP is insufficient. We believe that the wide-awake approach and early active mobilization may contribute to satisfactory outcomes.

scholarly journals Hand tumors: A review of 186 patients at a single institute

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199399
Author(s):  
Taketsugu Fujibuchi ◽  
Hiroshi Imai ◽  
Joji Miyawaki ◽  
Teruki Kidani ◽  
Hiroshi Kiyomatsu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Clinical Features ◽  
Malignant Tumors ◽  
Proximal Phalanx ◽  
Delayed Diagnosis ◽  
Ring Finger ◽  
Soft Tissue Tumors ◽  
Body Parts ◽  
Maximal Diameter ◽  
Benign Soft Tissue Tumors

Purpose: The spectrum of diagnoses and clinical features of hand tumors differ from those of tumors in other body parts. However, only a few reports have comprehensively referenced the diagnosis and clinical features of hand tumors. This study aimed to elucidate the diagnostic distribution and the clinical features of hand tumors undergone surgery in our institute. Patients and methods: A total of 235 lesions in 186 patients diagnosed with hand tumors between 1978 and 2020 were reviewed. Age at surgery, gender, chief complaint, tumor location, and pathological diagnosis were analyzed. Results: There were 121 benign bone tumors, 98 benign soft tissue tumors, and 16 malignant tumors. Chondroma and tenosynovial giant cell tumor were common benign bone and soft tissue tumors at the proximal phalanx of the ring finger and the palm, respectively. Meanwhile, chondrosarcoma and synovial sarcoma were common malignant tumors at the dorsal part of the hand. Local pain and painless mass were the chief complaints in patients with benign bone and soft tissue tumors, respectively. Most patients with malignant tumors were referred after unplanned resection. When patients were classified into two categories by tumor size according to maximal diameter, tumors larger than 19 mm had a significantly higher risk of malignant ( p = 0.031) despite being smaller than other tumors in different body parts. Conclusion: When a tumor malignancy is suspected, the patient should be referred to a specialist to avoid unplanned resection or delayed diagnosis due to misdiagnosis. Knowing the distribution and clinical features should help in diagnosing hand tumors.

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