The tension band principle and angular testing of extensor tendon repairs

2011 ◽  
Vol 36 (4) ◽  
pp. 297-302 ◽  
Author(s):  
J. Henderson ◽  
M. Sutcliffe ◽  
P. Gillespie
Keyword(s):  
Extensor Tendon ◽  
Tension Band ◽  
Curved Surfaces ◽  
Full Extension ◽  
Testing Apparatus ◽  
Extensor Tendons

Extensor tendons in the finger are flat and not amenable to repair by core and epitendinous sutures. Mattress sutures and Kessler repairs without epitendinous stitching are often used for extensor tendon divisions in the fingers. Except when in full extension, the finger presents a series of curved surfaces (at each joint) to the tendon. It was hypothesized that extensor tendons are subject to the ‘tension band’ principle and that they might be amenable to repair by dorsal-only epitendinous sutures. A Silfverskiöld dorsal-only repair was compared with mattress and Kessler repairs in vitro on a curvilinear testing apparatus. The epitendinous technique was found to be significantly more resistant to gapping and rupture, as well as more resistant to deformation (i.e. stiffer) than the conventional techniques.

Tendon Entrapment in Distal Radius Fractures

2009 ◽  
Vol 34 (4) ◽  
pp. 479-482 ◽  
Author(s):  
M. OKAZAKI ◽  
K. TAZAKI ◽  
T. NAKAMURA ◽  
Y. TOYAMA ◽  
K. SATO
Keyword(s):  
Clinical Features ◽  
Distal Radius ◽  
Flexor Tendon ◽  
Extensor Tendon ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Extensor Tendons ◽  
Epiphyseal Fracture ◽  
Tendon Entrapment

We retrospectively defined the rate and clinical features of tendon entrapment in 693 consecutive patients with 701 distal radius fractures treated in a single hospital. Eight extensor tendons and one flexor tendon were entrapped. All fractures with extensor tendon entrapment were palmarly displaced (Smith type) or epiphyseal. Flexor tendon entrapment was seen in dorsally angulated (Colles type) epiphyseal fracture. The rate of tendon entrapment in acute distal radius fractures was 1.3%. Extensor tendon entrapment in palmarly displaced fractures is more common.

scholarly journals BIOMECHANICAL COMPARATIVE STUDY BETWEEN TENSION BAND WIRING, DOUBLE ENDO BUTTON AND HOOK PLATE FOR ACROMIOCLAVICULAR JOINT INJURY

2019 ◽  
Vol 7 (1) ◽  
pp. 65
Author(s):  
Erwin Ramawan ◽  
Jifaldi Afrian MDS
Keyword(s):  
Acromioclavicular Joint ◽  
Scientific Basis ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Hook Plate ◽  
Joint Injury ◽  
Joint Reconstruction ◽  
Ac Joint Reconstruction ◽  
Acromioclavicular Joint Injury

Background: The treatment for acromioclavicular joint injury are debatable, there are fixation options include tension band wiring, AC joint reconstruction and hook plate These fixations are capable of providing a stable fixation, but controversy still exists that mentions the superiority of each of these fixationsPurpose: To compare biomechanical stability of 3 fixation include tension band wiring, double endo button, and hook plate to provide a scientific basis of the fixation.Methods: This research is an experimental in vitro. Using 27 acromioclavicular joints cadaver divided into three groups that performed tension band wiring fixation, double endo button and hook plate. Each fixation evaluated with 10, 20, 50 and 100 times repetitions with 100N traction force.Results: Tension band wiring gives the smallest displacement. In 10 times repetition average displacement of tension band wiring 0.056 mm (p = 0.000) compared to double endo button 1.622 mm and hook plate 0.867 mm. In 20 times repetitions, tension band wiring 0.1667 mm (p = 0,000) compared to double endo button 3.1778 mm and hook plate 1.1111 mm. In 50 times repetition, tension band wiring 0.3111 mm (p = 0.000) with double endo button 4.7778 mm and hook plate 1.3556 mm. In 100 times repetitions, tension band wire 0.556 mm (p = 0.000) while double endo button 5.4444 mm and hook plate 1.4556 mm.Conclusion: Tension band wiring have a good stability compared to double endo button and hook plate. But all of fixation provide stability for acriomioclavicular joint motion.

scholarly journals In vitro evaluation of the tension band suture method for proximal humerus fracture treatment

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Hideaki Ishii ◽  
Takanori Shintaku ◽  
Shu Yoshizawa ◽  
Misato Sakamoto ◽  
Takao Kaneko ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Proximal Humerus Fracture ◽  
Tension Band ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Suture Materials ◽  
Loading Test ◽  
Cyclic Loading Test ◽  
Mechanical Durability

Abstract Background Proximal humeral fractures are common, and more than half occur in patients over 65 years of age. Operative treatment may be recommended for displaced, complicated fractures; however, surgery may lead to displacement of the greater tuberosity or humeral head. Supplemental tension band sutures have been recommended to prevent such a complication. In this study, we investigate the best combination of suture, washer, and threading angle for proximal humeral fractures from a mechanical view. Methods The mechanical durability of 18 combinations of suture materials (Fiberwire, Ethibond, and Surgilon), threading washers (ring washer, disc washer), and threading angles (15 or 45°) were examined via a cyclic loading test. Results The most durable combination in the cyclic loading test consisted of threading the Fiber Wire to the washer ring using only one hole (ring washer-1) at 45°. In contrast, the most vulnerable combination was threading Ethibond to the washer disc at 15°. Breakage of all suture materials occurred at the suture-washer interface, and no failure or loosening of the knots was observed. FiberWire gradually eroded until the loss of equilibrium; whereas the rupture of Ethibond and Surgilon occurred suddenly. Conclusions From a mechanical viewpoint, we demonstrated that applying a supplemental tension band suture using FiberWire with a single-hole ring washer threaded at a wider angle is recommended.

Right–Left Differences in Knee Extension Stiffness for the Normal Rat Knee: In Vitro Measurements Using a New Testing Apparatus

2016 ◽  
Vol 138 (4) ◽  
Author(s):  
Keith L. Markolf ◽  
Denis Evseenko ◽  
Frank Petrigliano
Keyword(s):  
Joint Stiffness ◽  
Knee Extension ◽  
Angular Rotation ◽  
Joint Injury ◽  
Surgical Interventions ◽  
Testing Apparatus ◽  
Knee Stiffness ◽  
Flexion Extension ◽  
Normal Rat

Knee stiffness following joint injury or immobilization is a common clinical problem, and the rat has been used as a model for studies related to joint stiffness and limitation of motion. Knee stiffness measurements have been reported for the anesthetized rat, but it is difficult to separate the contributions of muscular and ligamentous restraints to the recorded values. in vitro testing of isolated rat knees devoid of musculature allows measurement of joint structural properties alone. In order to measure the effects of therapeutic or surgical interventions designed to alter joint stiffness, the opposite extremity is often used as a control. However, right–left stiffness differences for the normal rat knee have not been reported in the literature. If stiffness changes observed for a treatment group are within the normal right–left variation, validity of the results could be questioned. The objectives of this study were to utilize a new testing apparatus to measure right–left stiffness differences during knee extension in a population of normal rat knees and to document repeatability of the stiffness measurements on successive testing days. Moment versus rotation curves were recorded for 15 right–left pairs of normal rat knees on three consecutive days, with overnight specimen storage in a refrigerator. Each knee was subjected to ten loading–unloading cycles, with the last loading curve used for analysis. Angular rotation (AR), defined here as the change in flexion–extension angle from a specified applied joint moment, is commonly used as a measure of overall joint stiffness. For these tests, ARs were measured from the recorded test curves with a maximum applied extension moment of 100 g cm. Mean rotations for testing days 2 and 3 were 0.81–1.25 deg lower (p < 0.001) than for day 1, but were not significantly different from each other. For each testing day, mean rotations for right knees were 1.12–1.30 deg greater (p < 0.001) than left knees. These right–left stiffness differences should be considered when interpreting the results of knee treatment studies designed to alter knee stiffness when using the opposite extremity as a control.

A Comparison of Results of Extensor Tendon Repair Followed by Early Controlled Mobilisation Versus Static Immobilisation

1989 ◽  
Vol 14 (1) ◽  
pp. 18-20 ◽  
Author(s):  
J. A. Chow ◽  
S. Dovelle ◽  
L. J. Thomes ◽  
P. K. Ho ◽  
J. Saldana
Keyword(s):  
Tendon Repair ◽  
Extensor Tendon ◽  
Functional Results ◽  
Consecutive Series ◽  
Extensor Tendons ◽  
Dynamic Splinting ◽  
Tendon Surgery ◽  
Tendon Ruptures ◽  
Controlled Motion ◽  
Extensor Lag

To compare the functional results of early controlled mobilisation and static immobilisation following repair of extensor tendons, we conducted a comparative study between two centres. In one, a consecutive series of tenorrhaphy patients was treated post-operatively by the dynamic splinting technique. In the other, a consecutive group was treated by static splinting. All patients treated by dynamic splinting were graded excellent within six weeks following surgery; no tendon ruptures occurred and no secondary corrective tendon surgery was required. After static splinting, 40% were graded excellent, 31% good, 29% fair, and none poor; six fingers treated by static splintage subsequently required tenolysis. Following surgical repair of extensor tendons of the hand, patients treated by early controlled motion regain better flexion function in terms of grip strength and pulp-to-palm distance. Dynamic splinting is a more effective technique than static splinting in the prevention of extensor lag.

SPONTANEOUS ULNAR DISLOCATION OF THE INDEX, LONG, RING AND SMALL FINGER EXTENSOR TENDONS AT THE METACARPOPHALANGEAL JOINTS: A CASE REPORT

Hand Surgery ◽  
2011 ◽  
Vol 16 (02) ◽  
pp. 193-196 ◽  
Author(s):  
Katsuhisa Tanabe ◽  
Takaya Nakajima ◽  
Eiji Sogo
Keyword(s):  
Rheumatoid Arthritis ◽  
Congenital Anomaly ◽  
Case Report ◽  
Extensor Tendon ◽  
Metacarpophalangeal Joint ◽  
Extensor Digitorum ◽  
Extensor Digitorum Communis ◽  
Metacarpophalangeal Joints ◽  
Extensor Tendons

Finger extensor tendon dislocation at the metacarpophalangeal joint is caused by various etiologies, such as trauma, congenital anomaly, or rheumatoid arthritis. When the dislocation occurs with no etiology, this is called spontaneous dislocation. Although spontaneous extensor tendon dislocation in one, two or three fingers has been described, to our knowledge, simultaneous dislocation in four fingers has not been reported. In this paper, we report a spontaneous ulnar dislocation of all the extensor tendons in the index, long, ring, and small fingers. Repair of the radial sagittal bands of the extensor digitorum communis of the middle and ring fingers reduced dislocation of all the extensor tendons in four fingers.

Measuring Dynamic In-Vivo Elbow Kinematics: Description of Technique and Estimation of Accuracy

2012 ◽  
Vol 134 (12) ◽  
Author(s):  
Colin P. McDonald ◽  
Vasilios Moutzouros ◽  
Michael J. Bey
Keyword(s):  
Full Extension ◽  
X Ray ◽  
Tracking Technique ◽  
Model Based ◽  
Flexion Extension ◽  
Full Flexion ◽  
Position And Orientation ◽  
Elbow Motion

Background: The objectives of this study were to characterize the translational and rotational accuracy of a model-based tracking technique for quantifying elbow kinematics and to demonstrate its in vivo application. Method of Approach: The accuracy of a model-based tracking technique for quantifying elbow kinematics was determined in an in vitro experiment. Biplane X-ray images of a cadaveric elbow were acquired as it was manually moved through flexion-extension. The 3D position and orientation of each bone was determined using model-based tracking. For comparison, the position and orientation of each bone was also determined by tracking the position of implanted beads with dynamic radiostereometric analysis. Translations and rotations were calculated for both the ulnohumeral and radiohumeral joints, and compared between measurement techniques. To demonstrate the in vivo application of this technique, biplane X-ray images were acquired as a human subject extended their elbow from full flexion to full extension. Results: The in vitro validation demonstrated that the model-based tracking technique is capable of accurately measuring elbow motion, with reported errors averaging less than ±1.0 mm and ±1.0 deg. For the in vivo application, the carrying angle changed from an 8.3 ± 0.5 deg varus position in full flexion to an 8.4 ± 0.5 deg valgus position in full extension. Conclusions: Model-based tracking is an accurate technique for measuring in vivo, 3D, dynamic elbow motion. It is anticipated that this experimental approach will enhance our understanding of elbow motion under normal and pathologic conditions.

scholarly journals Review of Use of Amniotic Membrane Allograft in Total Ankle Replacements

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0022
Author(s):  
Andrew Horn ◽  
Jeremy Saller ◽  
Daniel Cuttica ◽  
Steven Neufeld
Keyword(s):  
Soft Tissue ◽  
Amniotic Membrane ◽  
Wound Dehiscence ◽  
Extensor Tendon ◽  
Total Ankle Replacement ◽  
Wound Complications ◽  
Split Thickness Skin Graft ◽  
Medical Comorbidities ◽  
Extensor Tendons ◽  
Ankle Replacement

Category: Ankle Arthritis Introduction/Purpose: Wound complications after total ankle replacement (TAR) lead to increased postoperative morbidity with lasting consequences. Previous studies demonstrate delayed wound healing in 6.6% to 28% of all TARs. Soft tissue breakdown along the anterior incision can cause exposure of anterior tendons and the implants. In addition, adhesions of the extensor tendons can develop causing significant morbidity. Recent publications advocate for the use of dehydrated human amnion/chorion membrane allograft (dHACM) during closure of anterior ankle incisions during TAR. dHACM is shown to promote increased epithelial cell proliferation, recruitment, and differentiation and reduce the likelihood of tendon adhesions. The goal of this study was to review the use of dHACMs in TARs and to investigate the number and type of postoperative wound complications including extensor tendon adhesions. Methods: We retrospectively reviewed 92 TARs performed between April, 2016 through August, 2018 by two board certified, fellowship trained foot and ankle orthopaedic surgeons. A standard anterior approach was done in all cases. All TARs had dHACM graft placed deep to the tibialis anterior and extensor longus tendon and along the extensor retinaculum prior to final closure of the wound. Upon data review, we identified the subset of patients who had anterior wound dehiscence postoperatively requiring an additional procedure(s) for wound coverage. We compared the demographics, medical comorbidities, and operative characteristics of those with and without perioperative wound complications. Results: 12 patients who underwent TARs sustained wound dehiscence below the subcutaneous tissue and required operative intervention (13%). Of these 12 cases, 5 required bipedical or rotational fasciocutaneous flap coverage (5.4%), 6 required less extensive soft tissue surgery (6.5%) and one case involved a deep periprosthetic infection that resulted in explant and antibiotic spacer placement (1.1%). 6 of the 12 cases required a split thickness skin graft application (6.5%) and 2 cases required tenolysis of extensor tendon adhesions (2.2%). Normal excursion of extensor tendons was seen in 90 patients (97.8%). Except for the one infected ankle, there were no cases with wound dehiscence that communicated with the joint. There were no statistically significant differences in medical comorbidities/operative characteristics between patients with wound complications and those without. Conclusion: Wound complications after total ankle replacements often lead to poor long-term outcomes for patients. Our data suggests that the application of the amniotic membrane allograft and its inherent healing potential decreases postoperative tendon adhesions and significant wound dehiscence. This may lead to less deep wound infections that communicate with the joint and may be protective against total ankle replacement failures due to these complications.

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