scholarly journals Recovery of rock climbing performance after surgical reconstruction of finger pulleys

2016 ◽  
Vol 41 (4) ◽  
pp. 406-412 ◽  
Author(s):  
M. Bouyer ◽  
A. Forli ◽  
A. Semere ◽  
B. J. Chedal Bornu ◽  
D. Corcella ◽  
...  
Keyword(s):  
Sport Performance ◽  
Rock Climbing ◽  
Surgical Reconstruction ◽  
Pinch Strength ◽  
Level Of Evidence ◽  
Active Motion ◽  
Significant Difference ◽  
Total Active Motion ◽  
The Mean ◽  
High Level

This study evaluated recovery of sport performance and correction of bowstringing after surgical reconstruction of closed finger pulley rupture in high-level rock climbers. A total of 38 patients treated with an extensor retinaculum graft were assessed. The mean follow-up time was 85 months, and 30 patients returned to their previous climbing level. The mean total active motion score was 96% of the opposite side. All patients had an excellent Buck-Gramcko score. There was no significant difference in grip strength and tip pinch strength in the crimp position between the injured side and the opposite side. A total of 31 patients were examined with ultrasonography. In 18, flexor bowstringing effects had returned to near-normal values. There was an association between rock climbing level recovery and the flexor bowstringing correction (odds ratio, 6.9; 95% confidence interval, 1.1–42.8). If flexor bowstringing was corrected, patients were more likely to regain their preinjury sport performance. The ultrasonography measurement was a useful tool for predicting functional recovery. Level of evidence: 4

Outcomes of flexor tendon repairs in zone 2 subzones with early active mobilization

2017 ◽  
Vol 42 (9) ◽  
pp. 896-902 ◽  
Author(s):  
K. Moriya ◽  
T. Yoshizu ◽  
N. Tsubokawa ◽  
H. Narisawa ◽  
S. Matsuzawa ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Level Of Evidence ◽  
Active Motion ◽  
Risk Of Rupture ◽  
Total Active Motion ◽  
A2 Pulley ◽  
Active Mobilization ◽  
The Mean ◽  
Difficult Area

We report on the outcomes of flexor tendon repair in zone 2 subzones with early active mobilization in 102 fingers in 88 consecutive patients. There were 28, 53, 15, and six fingers with repairs in zones 2A to 2D, respectively. Rupture of the repair occurred in four fingers, all in zone 2B. Excluding those with repair ruptures, the mean total active motion was 230° (range 143°–286°). Evaluated with Tang’s criteria, the outcomes were ranked excellent in 39 fingers, good in 46, fair in ten, poor in three, and failure in four. The outcomes in zone 2C were significantly inferior to those in zones 2B and 2D ( p = 0.02). Our results suggest that the tendon laceration in the area covered by the A2 pulley (zone 2C) is the most difficult area to obtain satisfactory active digital motion and tendon repair in zone 2B is the area where the risk of rupture is highest. Level of evidence: IV

Joint sparing Kirschner-wire fixation for displaced proximal phalangeal neck fractures: randomized prospective comparative study

2019 ◽  
Vol 45 (6) ◽  
pp. 560-566 ◽  
Author(s):  
Ahmed Fathy Sadek
Keyword(s):  
Comparative Study ◽  
Kirschner Wire ◽  
Level Of Evidence ◽  
Active Motion ◽  
Kirschner Wire Fixation ◽  
Group I ◽  
Wire Fixation ◽  
Total Active Motion ◽  
Prospective Comparative Study ◽  
The Mean

The aim of this study was to compare two joint sparing Kirschner-wire fixation techniques for displaced proximal phalangeal neck fractures. Forty-six patients with proximal phalangeal neck fractures managed by either percutaneous antegrade flexible intramedullary nailing (Group I) or crossed Kirschner-wires (Group II) were recruited for a randomized prospective comparative study. Clinical and radiological assessment of all patients was done in addition to the Kang scoring system, Disability of Arm, Shoulder and Hand score and total active motion. The mean time for radiological union for both groups was 5.8 weeks. The mean postoperative total active motion, Kang and the Disability of Arm, Shoulder and Hand scores were better in Group I patients, but without any statistically significant differences. Closed reduction and percutaneous Kirschner-wire fixation by a joint sparing approach will yield good functional results with no or minimal complications in proximal phalangeal neck fractures. Level of evidence: II

scholarly journals A new technique to determine the tension in extensor pollicis longus reconstruction

2019 ◽  
Vol 44 (8) ◽  
pp. 790-794 ◽  
Author(s):  
Fumiki Kamoi ◽  
Makoto Kondo ◽  
Masanori Hayashi ◽  
Shigeharu Uchiyama ◽  
Hiroyuki Kato
Keyword(s):  
Tendon Graft ◽  
Level Of Evidence ◽  
Active Motion ◽  
Extensor Pollicis Longus ◽  
Longus Tendon ◽  
Distal Edge ◽  
Total Active Motion ◽  
The Mean ◽  
A New Technique ◽  
Extensor Pollicis Longus Tendon

We present an original technique for determining the tension of the extensor pollicis longus tendon after reconstruction. We treated 20 patients using this technique for an extensor pollicis longus tendon graft or extensor indicis tendon transfer and reviewed the results. The tension of the reconstructed extensor pollicis longus was adjusted so that the centre of the distal edge of the thumbnail was elevated 2 cm above the operation table. The mean retropositional distance of the treated thumbs was 1.2 cm less than the contralateral thumbs. The mean total active motion of the thumb was 90%. This technique resulted in satisfactory thumb function. Level of evidence: IV

The Effectiveness of ADCON-T/N, a New Anti-Adhesion Barrier Gel, in Fresh Divisions of the Flexor Tendons in Zone II

2000 ◽  
Vol 25 (6) ◽  
pp. 590-592 ◽  
Author(s):  
M. MENTZEL ◽  
H. HOSS ◽  
P. KEPPLER ◽  
T. EBINGER ◽  
L. KINZL ◽  
...  
Keyword(s):  
Tendon Repair ◽  
Control Group ◽  
Adhesion Barrier ◽  
Active Motion ◽  
Traumatic Injuries ◽  
Flexor Tendons ◽  
Significant Difference ◽  
Total Active Motion ◽  
Zone Ii ◽  
The Mean

In a prospective randomized clinical trial, ADCON-T/N was investigated with regard to its effectiveness in fresh traumatic injuries of the flexor tendons in Zone II of the hand. Thirty patients participated in the trial. Following a standardized technique of tendon repair, the total active motion (TAM) and total extension lag (TEL) were determined after 12 weeks and evaluated according to the Buck-Gramcko score. Excellent results were achieved in 15 out of 16 patients in the ADCON-T/N group and 12 out of 14 in the control group. However, no statistically significant difference was found between the mean TAM and TEL in the two groups.

A randomized controlled trial comparing ketorolac and triamcinolone injections in adults with trigger digits

2018 ◽  
Vol 43 (9) ◽  
pp. 936-941 ◽  
Author(s):  
Mabel Qi He Leow ◽  
Aik Siew Robyn Hay ◽  
Shu Li Ng ◽  
Muntasir Mannan Choudhury ◽  
Huihua Li ◽  
...  
Keyword(s):  
Complete Resolution ◽  
Controlled Trial ◽  
Flexion Deformity ◽  
Short Term ◽  
Level Of Evidence ◽  
Active Motion ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Total Active Motion ◽  
To Receive

We assessed the efficacy of ketorolac trometamol injections compared with triamcinolone acetonide injections in trigger digits. Patients with trigger digits were randomized to receive either ketorolac or triamcinolone. They were followed up at 3, 6, 12 and 24 weeks, and monitored for resolution of triggering, pain and total active motion. One hundred and twenty-one patients with single trigger digits were recruited (59 ketorolac, 62 triamcinolone). At 6 weeks, 54% of patients in the triamcinolone group had complete resolution of trigger, whereas no patients in the ketorolac group had resolution. At 12 weeks, 58% of patients in the triamcinolone group had complete resolution of trigger compared with 6.7% in the ketorolac group. At 24 weeks, both groups had comparable rates of resolution at 26% and 25%, respectively. Patients in the triamcinolone group had significantly better resolution of pain at 3, 6 and 12 weeks. But at 24 weeks, there was no significant difference in pain between both groups. Significantly less flexion deformity was reported at 3 weeks and 6 weeks in the triamcinolone group. In the short term, ketorolac was less effective in relieving symptoms of trigger digit than triamcinolone. Level of evidence: I

A multicentre, randomized, double-blind trial of the safety and efficacy of mannose-6-phosphate in patients having Zone II flexor tendon repairs

2014 ◽  
Vol 40 (7) ◽  
pp. 682-694 ◽  
Author(s):  
V. C. Lees ◽  
D. Warwick ◽  
P. Gillespie ◽  
A. Brown ◽  
M. Akhavani ◽  
...  
Keyword(s):  
Standard Care ◽  
Flexor Tendon ◽  
Controlled Trial ◽  
Teaching Hospitals ◽  
Level Of Evidence ◽  
Active Motion ◽  
Significant Difference ◽  
Total Active Motion ◽  
Zone Ii ◽  
Mannose 6 Phosphate

The safety, tolerability and preliminary efficacy of mannose 6-phosphate in enhancing the outcome in Zone II flexor tendon repair was studied in a multicentre parallel double-blinded randomized controlled trial. Eight UK teaching hospitals were involved in treating repaired flexor tendons with a single intraoperative intrathecal dose of 600 mM mannose 6-phosphate, with follow-up over 26 weeks. A total of 39 patients (mannose 6-phosphate, n = 20; standard care, n = 19) were randomized. Seven were excluded from the safety and tolerability analysis because of intraoperative findings and eight were excluded due to early dropout ( n = 4) or tendon rupture ( n = 4), leaving 24 (mannose 6-phosphate, n = 13; standard care, n = 11) for assessment of total active motion. The safety, tolerability and other side effects were comparable between the groups. There was no significant difference between the two groups in the total active motion at Week 26. We concluded that mannose 6-phosphate, although safe and tolerable, had no beneficial effect on finger range of motion after Zone II tendon division. Level of evidence 1b

Outcomes of release of the entire A4 pulley after flexor tendon repairs in zone 2A followed by early active mobilization

2015 ◽  
Vol 41 (4) ◽  
pp. 400-405 ◽  
Author(s):  
K. Moriya ◽  
T. Yoshizu ◽  
N. Tsubokawa ◽  
H. Narisawa ◽  
K. Hara ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Flexor Digitorum Profundus ◽  
Level Of Evidence ◽  
Active Motion ◽  
Total Active Motion ◽  
Active Mobilization ◽  
The Mean ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

We report the outcomes of repair of the flexor digitorum profundus tendon in zone 2a in 22 fingers. The tendon was repaired with a six-strand repair method and the A4 pulley was completely released. Release of the C2 pulley combined with the A4 pulley was necessary in 12 fingers, nine fingers underwent a complete release of the A3, C2, and A4 pulleys, and one finger underwent a release of the C1, A3, C2, and A4 pulleys. The mean total active motion of the three finger joints was 234° at 5 to 12 months of follow-up. No bowstringing was noted in these fingers. The good and excellent recovery of active digital motion was in 20 (91%) out of 22 fingers according to Strickland’s criteria or Tang’s criteria. Our results suggest that release of the A3, C2, and A4 pulleys makes the repair surgery easier and does not cause tendon bowstringing. Level of Evidence: IV

scholarly journals Jones Fractures Identified at the National Football League Scouting Combine: Assessment of Prognostic Factors, Computed Tomography Findings, and Initial Career Performance

2018 ◽  
Vol 6 (8) ◽  
pp. 232596711879074 ◽  
Author(s):  
Robert C. Spang ◽  
Daniel B. Haber ◽  
Brendin R. Beaulieu-Jones ◽  
Kristen L. Stupay ◽  
George Sanchez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
National Football League ◽  
Treatment Method ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Specific Performance ◽  
Incomplete Healing ◽  
Bony Healing ◽  
The Mean ◽  
Career Performance

Background: Jones fractures result in subsequent dysfunction and remain an issue for athletes. Purpose: To (1) describe the epidemiology, treatment, and impact of Jones fractures identified at the National Football League (NFL) Scouting Combine on players’ early careers and (2) establish the value of computed tomography (CT) to determine bony healing after a fracture in prospective players. Study Design: Cohort study; Level of evidence, 3. Methods: All players who attended the combine between 2009 and 2015 were retrospectively reviewed to identify their history of Jones fractures. The playing position, treatment method, and number of missed collegiate games were recorded. The mean overall draft pick number, number of games started and played, snap percentage, and position-specific performance scores (fantasy score) over the first 2 years in the NFL were compared between players with fractures and controls. An imaging classification system was applied based on grading of each quadrant of the fifth metatarsal (plantar, dorsal, medial, lateral), with a score of 0 for not healed or 1 for healed. Results: Overall, the number of Jones fractures identified was 72 in 2285 athletes (3.2%), with all treated via intramedullary screw fixation. The mean overall draft pick number for players with fractures was 111.2 ± 67.9 compared with 99.0 ± 65.9 for controls ( P = .12). Performance scores for players with fractures were lower than those for controls across all positions, with a significant difference in running backs (2.6 vs 4.0, respectively; P < .001) and defensive linemen (1.4 vs 2.3, respectively; P = .02). The mean CT score was 2.5 ± 1.3. Of the 32 athletes who underwent imaging, 16 Jones fractures (50.0%) were healed or nearly healed, 12 (37.5%) were partially healed, and 4 (12.5%) showed little or no healing. The plantar cortex demonstrated the least healing (18/32; 56.3%), followed by the lateral cortex (15/32; 46.9%). Players with a mean score <1 were found to have fewer games started (2.7 ± 2.5) than those with 1 to 3 cortices healed (17.4 ± 10.4) or all cortices healed (8.7 ± 11.2). Conclusion: Based on CT, 50% of all players with a previous Jones fracture demonstrated incomplete healing. Moreover, position-specific performance scores over the first 2 years of a player’s career were lower across all positions for those with fractures compared with controls. Players with CT scores <1 were found to start fewer games and were drafted later than controls.

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.

scholarly journals Safety of Outpatient Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis

Neurosurgery ◽  
2019 ◽  
Vol 86 (1) ◽  
pp. 30-45 ◽  
Author(s):  
Ketan Yerneni ◽  
John F Burke ◽  
Pranathi Chunduru ◽  
Annette M Molinaro ◽  
K Daniel Riew ◽  
...  
Keyword(s):  
Safety Profile ◽  
Meta Analysis ◽  
Anterior Cervical Discectomy ◽  
Complication Rates ◽  
Outpatient Basis ◽  
Level Of Evidence ◽  
Cervical Discectomy ◽  
Significant Difference ◽  
Level I ◽  
High Level

ABSTRACT BACKGROUND Anterior cervical discectomy and fusion (ACDF) is being increasingly offered on an outpatient basis. However, the safety profile of outpatient ACDF remains poorly defined. OBJECTIVE To review the medical literature on the safety of outpatient ACDF. METHODS We systematically reviewed the literature for articles published before April 1, 2018, describing outpatient ACDF and associated complications, including incidence of reoperation, stroke, thrombolytic events, dysphagia, hematoma, and mortality. A random-effects analysis was performed comparing complications between the inpatient and outpatient groups. RESULTS We identified 21 articles that satisfied the selection criteria, of which 15 were comparative studies. Most of the existing studies were retrospective, with a lack of level I or II studies on this topic. We found no statistically significant difference between inpatient and outpatient ACDF in overall complications, incidence of stroke, thrombolytic events, dysphagia, and hematoma development. However, patients undergoing outpatient ACDF had lower reported reoperation rates (P &lt; .001), mortality (P &lt; .001), and hospitalization duration (P &lt; .001). CONCLUSION Our meta-analysis indicates that there is a lack of high level of evidence studies regarding the safety of outpatient ACDF. However, the existing literature suggests that outpatient ACDF can be safe, with low complication rates comparable to inpatient ACDF in well-selected patients. Patients with advanced age and comorbidities such as obesity and significant myelopathy are likely not suitable for outpatient ACDF. Spine surgeons must carefully evaluate each patient to decide whether outpatient ACDF is a safe option. Higher quality, large prospective randomized control trials are needed to accurately demonstrate the safety profile of outpatient ACDF.

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