An objective functional evaluation of the flexor carpi ulnaris set of triple tendon transfer in radial nerve palsy

2016 ◽  
Vol 42 (2) ◽  
pp. 170-175 ◽  
Author(s):  
L. Latheef ◽  
P. Bhardwaj ◽  
A. Sankaran ◽  
S. R. Sabapathy
Keyword(s):  
Tendon Transfer ◽  
Objective Assessment ◽  
Radial Nerve Palsy ◽  
Dash Score ◽  
Functional Evaluation ◽  
Postoperative Function ◽  
Wrist Extension ◽  
Wrist Motion ◽  
Flexor Carpi Ulnaris ◽  
The Mean

This study reports an objective assessment of postoperative function of 11 triple transfers for high radial palsies, using pronator teres for wrist extension, flexor carpi ulnaris for finger extension and palmaris longus for thumb extension. The mean follow-up was 3.3 years. Assessment was done by recording the active ranges of wrist motion, grip strength, wrist and finger strength and work simulation. The mean strength and range of wrist extension were 42% and 86%, respectively, of the contralateral wrist. Other measured movements were within the functional range and work simulation confirmed good restoration of function. The mean DASH score was 3.45, with no patient reporting any specific functional complaints. This study shows that even though the range of wrist motion and the strength of the wrist and fingers are less than normal, hand function remains good. We conclude that the flexor carpi ulnaris set of tendon transfer works well. Level of evidence: 3

scholarly journals Locking compression plate in humeral shaft nonunion: a retrospective study of 18 cases

2016 ◽  
Vol 2 (3) ◽  
pp. 86
Author(s):  
Rajesh Govindasamy ◽  
Ramkumar Gnanasundaram ◽  
Saravanan Kasirajan ◽  
Fawas Thonikadavath ◽  
Jeff Walter Rajadurai
Keyword(s):  
Bone Grafting ◽  
Locking Compression Plate ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Functional Evaluation ◽  
Postoperative Function ◽  
Non Union ◽  
Humeral Shaft Nonunion ◽  
Compression Plate ◽  
The Mean

<p class="abstract"><strong>Background:</strong> Humeral shaft nonunions are frequently seen in Orthopaedic practice. Osteosynthesis with bone grafting is the treatment of choice. Locking compression plate (LCP) is the latest implant used in treating them. We retrospectively evaluated the outcome of use of LCP in humeral shaft non-union resulted by both conservative management and following failed internal fixations.</p><p class="abstract"><strong>Methods:</strong> Eighteen patients with nonunion of humeral shaft in which ten were treated by traditional bone setters and eight followed by failed internal fixation were included in these study. The mean duration of nonunion was 18.3 months (range 8-22).  The mean follow up period was 18 months (range 12-26). The mean age of patients was 44.4 years (range 22-60). All patients underwent osteosynthesis with LCP and autologoous cortico-cancellous iliac crest graft. The outcome measures include radiographic assessment of fracture union and preoperative and postoperative function using modified constant and murley scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> All fractures united following osteosyntesis average time for union was15 weeks (range 10-24). We did not have any delayed union or non-union. The complications were superficial infection (n=1) and wound haematoma (n=1).Three patients with preoperative radial nerve palsy recovered at the end of four months. Functional evaluation using constant-murley score showed excellent result in 14, good in 3 and fair in 1. We did not have any poor results.</p><strong>Conclusions:</strong> LCP with cancellous bone grafting is a safe reliable option for all forms of humeral shaft nonunion. We recommend it.

scholarly journals FUNCTIONAL OUTCOME BY EVALUATION OF DASH SCORE ON DROP HAND PATIENT TREATED WITH JONES’ TENDON TRANSFER: A RETROSPECTIVE STUDY

2021 ◽  
Vol 10 (2) ◽  
pp. 39
Author(s):  
Tito Sumarwoto ◽  
Seti Aji Hadinoto ◽  
Adhitya Indra Pradhana
Keyword(s):  
Functional Outcome ◽  
Radial Nerve ◽  
Tendon Transfer ◽  
Nerve Repair ◽  
Average Score ◽  
Radial Nerve Palsy ◽  
Dash Score ◽  
Male Patients ◽  
The Mean ◽  
The Right

Background: Drop hands due to radial nerve injuries cause functional and structural disabilities. Tendon transfer became the last option when nerve repair could not give patients restoration. The most popular method was Jones' Tendon transfer to restore wrist dorsiflexion, extending the thumb and the fingers. The Disabilities of Arm, Shoulder, and Hand (DASH) score measures functional outcomes in patients with upper extremities injuries. This study was to acknowledge the functional outcome and evaluate the DASH score in drop hand patients who undergone surgery by Jones’ Tendon Transfer in Prof. Dr. R. Soeharso Orthopaedic Hospital Surakarta from January 2014 to June 2016.Methods: The collected data from the medical record was evaluated based on functional outcome and DASH score. Eleven patients were included, ten male patients (90.9%) and one female patient (9.1%). The mean age of patients was 27.4 years old, with the most frequently injured arm was the right arm, counted to be eight patients (72.7%), and the left arm was three patients (27.3%).Results: The result from the evaluation of the DASH score indicated ten patients (90.9%) were minimal disability, and one patient (9.1%) was moderate disability. The average score was 12.48, which means that most patients could cope with most daily living activities post-operatively.Conclusions: In conclusion, surgery for drop hand due to radial nerve palsy by Jones’ Tendon Transfer gave a satisfactory functional outcome based on the DASH score.

scholarly journals Functional outcome of locking anatomical plate in extra articular fractures of the distal humerus

2019 ◽  
Vol 5 (3) ◽  
pp. 443
Author(s):  
Amit Chandrakant Supe ◽  
Nikhil Dilip Palange ◽  
Eknath D. Pawar ◽  
Neetin P. Mahajan
Keyword(s):  
Range Of Motion ◽  
Functional Outcome ◽  
Distal Humerus ◽  
Radial Nerve Palsy ◽  
Dash Score ◽  
Articular Fractures ◽  
Early Return ◽  
Humerus Fractures ◽  
The Mean ◽  
Distal Humerus Fractures

<p class="abstract"><strong>Background:</strong> Extra articular distal humerus fractures are difficult to treat with conventional implants like intra medullary nail, 4.5 DCP and dual plate. The present study aims to study the functional outcome of the extra articular distal humerus plate (EADHP).</p><p class="abstract"><strong>Methods:</strong> 48 patients with displaced extra articular distal humerus fractures were included in the study. Inclusion criteria were age more than 18 years, closed fractures with or without radial nerve palsy and less than 3 weeks old trauma. Patients aged less than 18 years, those having open fractures, fractures more than 3 weeks old, non – unions and pathological fractures were excluded from the study. All patients were operated with EADHP. Clinically, the outcome was assessed by the disability of arm, shoulder and hand (DASH) score and elbow range of motion radiologically, union was evaluated on anteroposterior and lateral radiographs.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 48 patients, 12 had AO type 12 A1 fracture, 26 patients had type B1 fractures and remaining 10 had type C1 fractures. Mean DASH score at final follow up was 18.1; range being 12.6 to 35.7 points. The mean elbow range of motion was 0 to 130 degrees (range: 120 to 140 degrees). The mean duration for complete radiological fracture union was 14 weeks, range being 12 to 18 weeks.</p><p class="abstract"><strong>Conclusions:</strong> The extraarticular distal humerus plate is an ideal implant for the fixation of distal humerus fractures since it provides good stability of fracture and enables early return to function.</p>

Intraoperative Measurement and Biomechanical Modeling of the Flexor Carpi Ulnaris-to-Extensor Carpi Radialis Longus Tendon Transfer

1997 ◽  
Vol 119 (4) ◽  
pp. 386-391 ◽  
Author(s):  
R. L. Lieber ◽  
J. Fride´n
Keyword(s):  
Tendon Transfer ◽  
Sarcomere Length ◽  
Wrist Joint ◽  
Muscle Length ◽  
Normative Values ◽  
Radial Nerve Palsy ◽  
Biomechanical Modeling ◽  
Moment Arms ◽  
Flexor Carpi Ulnaris ◽  
Extensor Carpi Radialis

Sarcomere length was measured intraoperatively in five patients undergoing tendon transfer of the flexor carpi ulnaris (FCU) to the extensor carpi radialis longus (ECRL) for radial nerve palsy. All measurements were made with the elbow in 20 deg of flexion. Prior to tendon transfer, FCU sarcomere length ranged from 2.84 ±. 12 μm (mean ± SEM) with the wrist flexed to 4.16 ± .15 μm with the wrist extended. After transfer into the ECRL tendon, sarcomere length ranged from 4.82 ± .11 μm with the wrist flexed (the new longest position of the FCU) to 3.20 ± .09 μm with the wrist extended, resulting in a shift in the sarcomere length operating range to significantly longer sarcomere lengths (p < 0.001). At these longer sarcomere lengths, the FCU muscle was predicted to develop high active tension only when the wrist was highly extended. A biomechanical model of this tendon transfer was generated using normative values obtained from previous studies of muscle architectural properties, tendon compliance, and joint moment arms. Predicted sarcomere lengths pre- and post-tendon transfer agreed well with intraoperative experimental measurements. The theoretical wrist extension moment-wrist joint angle relationship was also calculated for a variety of values of FCU muscle length. These different lengths represented the different conditions under which the FCU could be sutured into the ECRL tendon. Variation in FCU muscle length over the range 200 mm to 260 mm resulted in large changes in absolute peak moment produced as well as the angular dependence of peak moment. This was due to the change in the region of FCU operation on its sarcomere length-tension curve relative to the magnitude of the ECRL moment arm. These data demonstrate the sensitivity of a short-fibered muscle such as the FCU to affect the functional outcome of surgery. In addition, we demonstrated that intraoperative sarcomere length measurements, combined with biomechanical modeling provide the surgeon with a powerful method for predicting the functional effect of tendon transfer surgery.

scholarly journals Evaluation of Extensor Pollicis Brevis as a Recipient of Tendon Transfer for Thumb Extension

2019 ◽  
Vol 52 (02) ◽  
pp. 171-177 ◽  
Author(s):  
Praveen Bhardwaj ◽  
Poonacha Puchimada Muddappa ◽  
Dadi Bindesh ◽  
Shanmuganathan Raja Sabapathy
Keyword(s):  
Tendon Transfer ◽  
Anatomical Variation ◽  
Excellent Result ◽  
Extensor Tendon ◽  
Interphalangeal Joint ◽  
Radial Nerve Palsy ◽  
Brachial Plexus Palsy ◽  
Extensor Pollicis Longus ◽  
Extensor Pollicis Brevis ◽  
Flexor Carpi Ulnaris

Abstract Introduction Rerouting of the extensor pollicis longus (EPL) is the standard part of tendon transfer surgery for thumb extension. It is done to overcome the ulnar vector of the EPL action. Extensor pollicis brevis (EPB), however, produces better thumb abduction and extension by virtue of its radial vector. The described anatomical variation of EPB extending the thumb interphalangeal joint (IPJ), therefore, gives the “best combination” of movements by a single-thumb extensor tendon. Materials and Methods We performed this transfer in six patients in whom the EPB was found to be extending the IPJ while checked intraoperatively. Three of these six patients were cases of radial nerve palsy and the other three presented with brachial plexus palsy. The outcome was assessed by measuring palmar and radial abduction of the thumb, Kapandji’s score, and Bincaz’s scale. Results We found satisfactory results in all the six patients. In our series, patients had an average radial extension of the thumb of 29.2 degrees and an average palmar abduction of the thumb of 65.7 degrees. On evaluation with the Bincaz score; one patient had excellent result, three patients had good results, and two patients had fair results. Conclusion In situations where EPL rerouting is not possible (as in cases where the donor tendon needs to reach the thumb from the ulnar side, for example, flexor carpi ulnaris), transfer to the EPB, provided it is extending the thumb IPJ, would produce better extension and abduction of the thumb than the transfer to the EPL.

OBJECTIVE ASSESSMENT OF THE ALTERATIONS IN WRIST MOBILITY WITH THE FASTRAKⓇ SYSTEM FOLLOWING DORSAL CAPSULODESIS

Hand Surgery ◽  
2010 ◽  
Vol 15 (03) ◽  
pp. 237-241 ◽  
Author(s):  
A. C. Jariwala ◽  
I. Scott ◽  
G. P. Arnold ◽  
R. J. Abboud ◽  
C. A. Wigderowitz
Keyword(s):  
Objective Assessment ◽  
Clinical Settings ◽  
Scapholunate Dissociation ◽  
Wrist Motion ◽  
The Mean

The treatment for scapholunate dissociation is challenging and its management is varied depending on type, severity and duration of injury, and surgeon's preferred technique. This study aimed to objectively assess the variations in the range and patterns of wrist movements using the FastrakⓇ system in patients having undergone Blatt's dorsal capsulodesis (BDC). The wrist movements were successively measured between the operated and unoperated wrists, while the patients performed set tasks. Seventeen patients agreed to participate in the study. Following BDC the mean flexion loss was 23° (range 10°–38°). However, functional tasks revealed that the BDC did not adversely affect the function of the operated wrist. This novel study demonstrates objectively the functional restrictions that patients are likely to experience postoperatively following BDC. It would be interesting to note the pattern of wrist motion using the FastrakⓇ system in various other clinical settings.

Tendon Transfer to Reconstruct Wrist Extension in Children with Obstetric Brachial Plexus palsy

2003 ◽  
Vol 28 (2) ◽  
pp. 153-157 ◽  
Author(s):  
M. M. Al-QATTAN
Keyword(s):  
Brachial Plexus ◽  
Tendon Transfer ◽  
Brachial Plexus Palsy ◽  
Wrist Extension ◽  
Obstetric Brachial Plexus Palsy ◽  
System A ◽  
Flexor Carpi Ulnaris ◽  
Obstetric Brachial Plexus ◽  
Wrist Drop ◽  
Extensor Carpi Radialis

This study reports on 20 children with obstetric brachial plexus palsy who underwent a tendon transfer to reconstruct wrist extension. The mean age at the time of tendon transfer was 8 years. There were seven patients with Erb’s palsy and the remaining 13 had total palsy. The flexor carpi ulnaris was utilized 15 times and the flexor carpi radialis five times. The transferred tendon was sutured to the tendon of the extensor carpi radialis brevis. The result of the transfer was assessed according to a modified Medical Research Council (MRC) muscle grading system. A good result was obtained in 18 patients (modified MRC grade of 4) and a fair result (modified MRC grade of 3) in two. The choice of tendon transfer to reconstruct the wrist drop deformity in various conditions including adult traumatic brachial plexus injuries is discussed.

scholarly journals No benefit for elbow blocking on conservative treatment of distal radius fractures: A 6-month randomized controlled trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252667
Author(s):  
Aldo Okamura ◽  
Vinícius Ynoe de Moraes ◽  
Jorge Raduan Neto ◽  
Marcel Jun Tamaoki ◽  
Flavio Faloppa ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Distal Radius ◽  
Primary Outcome ◽  
Dash Score ◽  
Functional Evaluation ◽  
Radius Fractures ◽  
The Mean ◽  
Objective Functional ◽  
Dash Questionnaire

Purpose For displaced distal radius fracture, this trial aimed to compare an above-elbow (AE) and below-elbow (BE) cast at the end of a 24-week follow-up using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire as a primary outcome. Methods This is a clinical trial with parallel groups (1:1) and a blinded evaluator. There are two non-surgical interventions: AE and BE. A total of 128 adult patients with acute (up to 7 days) displaced distal radius fracture of type A2-3, C1-3 by the AO classification were included. The follow-up was 24 weeks. The primary outcome was the DASH questionnaire at 24 weeks. Secondary outcomes were the maintenance of reduction by the evaluation of radiographic parameters, pain measured by VAS, PRWE, objective functional evaluation and rate of adverse effects. Results The difference between the two groups in the DASH score at 24 weeks was not significant, with the mean (95% CI) DASH score being AE: 9.44 (2.70 to 16.17) vs. BE: 9.88 (3.19 to 16.57) (p = 0.895). The above-elbow group had a significantly greater worsening of the mean DASH score from baseline to 2 weeks (p < 0.001). No statistically significant differences were found between the 2 groups in any of the other follow-up assessments. Objective functional evaluation, PRWE, radiographical measures and rates of reduction loss were similar between groups. Above-elbow casting resulted in more adverse effects (mostly shoulder pain; 19 events vs. 9 events); RR = 0.39 (0.19–0.94); p = 0.033 at the end of six-month follow-up. Conclusions This study did not demonstrate a difference between above-elbow and below-elbow cast in terms of DASH outcome at 6 months in non-surgical treatment of deviated distal radius fractures. However, below-elbow casting is less debilitating during the treatment period, has comparable performance in maintaining the reduction, and is related to fewer minor adverse effects than above-elbow casting.

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