Effect of a Flexor Digitorum Superficialis Hemitenodesis on Reducing Volar Plate Strains for Swan Neck Deformities

Hand ◽  
2021 ◽  
pp. 155894472110408
Author(s):  
Mohammad M. Haddara ◽  
Assaf Kadar ◽  
Louis M. Ferreira ◽  
Nina Suh
Keyword(s):  
Repeated Measures ◽  
Statistical Significance ◽  
Volar Plate ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Common Procedure ◽  
Motion Simulator ◽  
Significant Difference ◽  
Intact Condition ◽  
Flexor Digitorum

Background Flexor digitorum superficialis (FDS) hemitenodesis is a common procedure to treat swan neck deformity (SND). We hypothesize that this surgical technique is a biomechanically effective way to reduce strain in the volar plate at the proximal interphalangeal joint (PIPJ). Methods Fifteen digits from 5 cadaveric specimens were tested using a novel in vitro active finger motion simulator under 4 finger conditions: intact, SND, FDS hemitenodesis, and FDS hemitenodesis with distal interphalangeal (DIP) joint fusion. Tensile loads in FDS and flexor digitorum profundus (FDP) and joint ranges of motion were measured by electromagnetic tracking. In addition, strain gauges were inserted under the volar plate to measure strain during PIPJ hyperextension. Results were analyzed using 1-way repeated-measures analysis of variance tests. Results The SND condition increased volar plate strain by 176% ± 25% ( P < .001) compared with the intact condition. The FDS hemitenodesis repair relieved more than 50% of the SND strain, restoring it to within no statistical difference from intact. The DIP fusion further reduced strain with no further statistical significance. At full flexion, FDS and FDP tendon loads diverged as a function of the test condition ( P < .001). With the FDS hemitenodesis, the FDP load increased by 2.1 ± 1.5 N from the SND condition ( P < .001), whereas the FDS load decreased by 1.3 ± 1.3 N ( P = .012). Conclusion The FDS hemitenodesis repair restored strains to within 3.0 milli-strain of the intact condition with no significant difference. Application of DIP fusion did not further protect the PIPJ from increased hyperextension and further exacerbated the imbalance of flexor tendon loads.

Construct Stability of C2 Replacement Strategies

2003 ◽  
Author(s):  
Christian M. Puttlitz ◽  
Robert P. Melcher ◽  
Vedat Deviren ◽  
Dezsoe Jeszenszky ◽  
Ju¨rgen Harms
Keyword(s):  
Repeated Measures ◽  
Posterior Instrumentation ◽  
Statistical Significance ◽  
Axial Rotation ◽  
Posterior Fixation ◽  
Camera Motion ◽  
Anterior Plate ◽  
Intact Specimen ◽  
Strut Graft ◽  
Significant Difference

Reconstruction of C2 after tumor destruction and resection remains a significant challenge. Most constructs utilize a strutgraft with plate or screw fixation. A novel C2 prosthesis combining a titanium mesh cage with bilateral C1 shelves and a T-plate has been used successfully in 18 patients. Supplemental posterior instrumentation includes C0-C3 or C1-C3. Biomechanical comparisons of this C2 prosthesis with traditional fixation options have not been reported. Five fresh-frozen human cadaveric cervical spines (C0-C5) were tested intact. Next, the C2 prosthesis, and strut graft and anterior plate constructs were tested with occiput-C3 and C1-C3 posterior fixation. Pure moment loads (up to 1.5 N-m) were applied in flexion and extension, lateral bending, and axial rotation. C1-C3 motion was evaluated using 3 camera motion analysis. Statistical significance was evaluated using one-way repeated measures ANOVA with Student-Newman-Keuls post hoc pairwise comparisons. All constructs provided a statistically significant decrease in motion in this C2 corpectomy model as compared to the intact condition. There was no significant difference in C1-C3 motion between the 4 constructs, regardless of whether the occiput was included in the fixation. Under these loading conditions, both the C2 prostheisis and strut-graft-plate constructs provided initial C1-C3 stability beyond that of the intact specimen. The occiput does not need to be included in the posterior instrumentation.

OUTCOME OF TRACTION TENOLYSIS IN OPEN TRIGGER FINGER RELEASE — A RETROSPECTIVE REVIEW

Hand Surgery ◽  
2013 ◽  
Vol 18 (03) ◽  
pp. 375-379 ◽  
Author(s):  
Muntasir Mannan Choudhury ◽  
Shian Chao Tay
Keyword(s):  
Flexor Tendon ◽  
Group Versus ◽  
Trigger Finger ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Active Motion ◽  
Total Active Motion ◽  
The Mean ◽  
Flexor Digitorum ◽  
A1 Pulley

Surgical treatment for trigger finger involves division of the A1 pulley. Some surgeons perform an additional step of traction tenolysis by sequentially bringing the flexor digitorum superficialis and flexor digitorum profundus tendons out of the wound gently with a Ragnell retractor. There is currently no study which states whether flexor tendon traction tenolysis should be routinely performed or not. The objective of this study is to compare the outcome in patients who have traction tenolysis performed (A group) versus those who did not have traction tenolysis (B group) performed. It was noted that even though the mean total active motion (TAM) for the B group in our study was lower preoperatively, it was consistently higher than the A group in all the 3 post-operative visits demonstrating a better outcome in the B group. Even though it was not statistically significant, our data also showed that patients with traction tenolysis appeared to have more postoperative pain compared to those without.

Sliding Position of the Flexor Tendons Relative to the Hook of Hamate in CT Scans

2019 ◽  
Vol 24 (01) ◽  
pp. 72-75
Author(s):  
Kenji Goto ◽  
Kiyohito Naito ◽  
Yoichi Sugiyama ◽  
Nana Nagura ◽  
Ayaka Kaneko ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Injury ◽  
Ct Scans ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Ulnar Side ◽  
Flexor Tendon Injury ◽  
Hook Of Hamate ◽  
Flexor Digitorum ◽  
Little Finger

Background: The aim of this study was to assess the height of nonunion formation injuring the ulnar-side finger flexor tendon, the positional relationship between the hook of the hamate and little finger flexor tendon was evaluated on CT scans. Methods: The subjects were 20 healthy patients (40 hands) (14 males and 6 females, mean age: 28 years old). Their hands were imaged in extension and flexion of the fingers on CT. The position of the little finger flexor tendon was determined regarding the height of the hook of the hamate as 100%. Results: The heights of the flexor digitorum profundus tendons were 46 ± 6% in extension and 44 ± 9% in flexion, and those of the flexor digitorum superficialis tendons were 87 ± 8% in extension and 91 ± 9% in flexion. Conclusions: Our study suggested that 40% of the base of the hook of the hamate does not contact with the flexor tendon, suggesting that flexor tendon injury is unlikely to occur in that region.

scholarly journals Bilateral Variation of Forearm Flexor Muscles - A Case Report and Clinical Significance

2012 ◽  
Vol 01 (01) ◽  
pp. 040-043
Author(s):  
D. Malar ◽  
Keyword(s):  
Middle Finger ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Flexor Carpi Ulnaris ◽  
Close Proximity ◽  
Flexor Muscles ◽  
Male Cadaver ◽  
Forearm Flexor Muscles ◽  
Flexor Digitorum ◽  
Forearm Flexor

AbstractDuring routine dissection, bilateral multiple variations of forearm flexor muscles were observed in a male cadaver. The variations were a) an additional belly arising from the coronoid process of ulna, distal to the origin of ulnar head of flexor digitorum superficialis, passing deep to flexor digitorum superficialis and joining the tendon of flexor digitorum profundus to the middle finger; b) an additional belly arising from the distal part of flexor carpi ulnaris and passing superficial to ulnar nerve and ulnar vessels in the Guyon's canal and c) the origin of second lumbricals from the profundus tendon in the carpal tunnel. An aberrant muscle may stimulate a ganglion or a soft tissue tumor or if in close proximity to a nerve, it may cause pressure neuritis. Identification of these variations is important in defining the anatomical features for clinical diagnosis and surgical procedures.

scholarly journals Dietary Intake and Nitrogen Balance in British Army Infantry Recruits Undergoing Basic Training

Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 2125 ◽  
Author(s):  
Shaun Chapman ◽  
Alex J. Rawcliffe ◽  
Rachel Izard ◽  
Kimberley Jacka ◽  
Hayley Tyson ◽  
...  
Keyword(s):  
Dietary Intake ◽  
Nitrogen Balance ◽  
Repeated Measures ◽  
Protein Intake ◽  
Statistical Significance ◽  
British Army ◽  
Basic Training ◽  
Training Centre ◽  
Significant Difference ◽  
G 11

We assessed dietary intake and nitrogen balance during 14 weeks of Basic Training (BT) in British Army Infantry recruits. Nineteen men (mean ± SD: age 19.9 ± 2.6 years, height: 175.7 ± 6.5 cm, body mass 80.3 ± 10.1 kg) at the Infantry Training Centre, Catterick (ITC(C)) volunteered. Nutrient intakes and 24-h urinary nitrogen balance were assessed in weeks 2, 6 and 11 of BT. Nutrient intake was assessed using researcher-led weighed food records and food diaries, and Nutritics professional dietary software. Data were compared between weeks using a repeated-measures analysis of variance (ANOVA) with statistical significance set at p ≤ 0.05. There was a significant difference in protein intake (g) between weeks 2 and 11 of BT (115 ± 18 vs. 91 ± 20 g, p = 0.02, ES = 1.26). There was no significant difference in mean absolute daily energy (p = 0.44), fat (p = 0.79) or carbohydrate (CHO) intake (p = 0.06) between weeks. Nitrogen balance was maintained in weeks 2, 6 and 11, but declined throughout BT (2: 4.6 ± 4.1 g, 6: 1.6 ± 4.5 g, 11: −0.2 ± 5.5 g, p = 0.07). A protein intake of 1.5 g·kg−1·d−1 may be sufficient in the early stages of BT, but higher intakes may be individually needed later on in BT.

Flexor digitorum profundus with or without flexor digitorum superficialis tendon repair in acute Zone 2B injuries

2020 ◽  
Vol 45 (10) ◽  
pp. 1034-1044
Author(s):  
Ahmed F. Sadek
Keyword(s):  
Tendon Repair ◽  
Flexion Contracture ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Level Of Evidence ◽  
Power Grip ◽  
Contralateral Hand ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

A total of 53 patients with complete cuts of two flexor tendons in Zone 2B treated over a 9-year period was reviewed. Twenty-three patients (28 fingers) had only flexor digitorum profundus repair, while 30 patients (36 fingers) had both flexor digitorum profundus and flexor digitorum superficialis repairs, with a mean follow-up of 21 months (range 12–84). The decision to repair the flexor digitorum superficialis was made according to intraoperative judgement of ease of repair and gliding of the flexor digitorum profundus tendon. Two groups of patients showed no significant differences in total range of active or passive digital motion and power grip percentage to the contralateral hand. However, the values of power grip were statistically superior in the patients with both tendons repaired. The patients after flexor digitorum profundus-only repairs showed significantly greater but still mild flexion contracture (mean 20 °) of the operated digits. The Tang gradings were the same with 89% good and excellent rates in both groups. The conclusion is that although repair of both flexor digitorum profundus and flexor digitorum superficialis tendons is slightly more preferable based on increased grip strength, the repair of the flexor digitorum superficialis together with flexor digitorum profundus is not mandatory. Whether or not to repair flexor digitorum superficialis is an intraoperative decision based on the ease of gliding of the repaired tendon(s). Level of evidence: III

Effect of Presurgical Nasoalveolar Molding on Nasal Symmetry in Unilateral Complete Cleft Lip/Palate Patients after Primary Cheiloplasty without Concomitant Nasal Cartilage Dissection

2018 ◽  
Vol 55 (7) ◽  
pp. 935-940 ◽  
Author(s):  
Zhigang Liang ◽  
Jinfeng Yao ◽  
Philip K.T. Chen ◽  
Cangshang Zheng ◽  
Jiying Yang
Keyword(s):  
Repeated Measures ◽  
Cleft Lip ◽  
Early Stage ◽  
Statistical Significance ◽  
Deformity Correction ◽  
Nasal Cartilage ◽  
Significant Difference ◽  
Cleft Lip Palate ◽  
Nasoalveolar Molding

Objective: The objective of this study was to assess the efficacy of presurgical nasoalveolar molding (PNAM) on long-term nasal symmetry and shaping after primary cheiloplasty in patients with unilateral complete cleft lip/palate (UCL/P). Design: This was a two-group, parallel, retrospective, randomized clinical trial. Setting: The setting for this study was the Chang Gung Craniofacial Center in Taoyuan, Taiwan. Patients: Patients were divided into one of the following two groups: infants with UCL/P who underwent PNAM (PNAM group, n = 42) and infants with UCL/P who did not undergo PNAM (non-PNAM group, n = 42). Interventions: Interventions included PNAM and primary cheiloplasty without nasal cartilage dissection. Main Outcome Measures: In this study, 4- to 5-year postoperative full-face and submental oblique photographs were taken of all patients and scored from 1 to 5 points by 10 medical evaluators. The scores were statistically analyzed using repeated-measures analysis of variance, and P < .05 was considered to represent statistical significance. Results: After 1 to 3 months of PNAM but before primary cheiloplasty, the displaced nasal and alveolar cartilage showed obvious improvement. However, the scores in the PNAM and non-PNAM groups at 4 to 5 years postoperatively were 66.62 ± 14.25 and 66.31 ± 15.08, respectively. There was no significant difference between the two groups ( F = 0.009, P = .923). Conclusion: PNAM as an early-stage adjunctive therapy for nasal deformity correction is beneficial before primary cheiloplasty, but it is insufficient to maintain long-term nostril symmetry after primary cheiloplasty without nasal cartilage dissection.

Comparison of Muscle Activity during Use of Computer Pointing Devices in Cad Operators

2000 ◽  
Vol 44 (37) ◽  
pp. 633-636 ◽  
Author(s):  
Pat Tittiranonda ◽  
Bernard Martin ◽  
Stephen Burastero
Keyword(s):  
Muscle Activity ◽  
Index Finger ◽  
Neck Muscles ◽  
Electromyographic Activity ◽  
Flexor Digitorum Superficialis ◽  
Upper Trapezius ◽  
Extensor Indicis Proprius ◽  
Significant Difference ◽  
Experimental Mouse ◽  
Flexor Digitorum

This study examined the use of four different computer pointing devices on surface electromyographic activity of the index finger, forearm and shoulder/neck muscles among CAD operators in the workplace. Subjects were randomly assigned to use their own mouse, a trackball, a joystick mouse or an experimental mouse. Results showed that there was a statistically significant difference in muscle load for the upper trapezius, extensor indicis proprius, and extensor carpi ulnaris across pointing devices for CAD operations. The flexor digitorum superficialis muscle load remained relatively constant when all pointing devices were compared.

Accessory Roles of the Vinculum Breve of the Flexor Digitorum Profundus and Check-Rein Ligaments at the Distal Interphalangeal Joint

1991 ◽  
Vol 16 (3) ◽  
pp. 305-310 ◽  
Author(s):  
EMMA FLINDALL ◽  
D. A. McGROUTHER
Keyword(s):  
Interphalangeal Joint ◽  
Volar Plate ◽  
Flexor Digitorum Profundus ◽  
Distal Interphalangeal Joint ◽  
Distal Interphalangeal ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

The vinculum breve of the flexor digitorum profundus tendon was found to apply traction to the volar plate on flexion of the distal interphanageal joint. It was also observed that the check-rein ligaments of the joint only became taut in the hyperextended position. This may account for the greater amount of passive hyperextension that can be achieved at the distal than the proximal interphanageal joint.

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