scholarly journals Plantar Plate Reconstruction for Stage IV Plantar Plate Tear Using Flexor Tendon Tenodesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0039 ◽  
Author(s):  
Megan Reilly ◽  
Kurosh Darvish ◽  
Soroush Assari ◽  
John Cole ◽  
Eric Gokcen
Keyword(s):  
Flexor Tendon ◽  
Force Measurement ◽  
Proximal Phalanx ◽  
Measurement Instrument ◽  
Stage Iv ◽  
Extensor Tendon ◽  
Plantar Plate ◽  
Alternative Treatment Option ◽  
Stage 4 ◽  
Plate Reconstruction

Category: Lesser Toes Introduction/Purpose: Outcomes of the surgical treatment of dislocated lesser toes have improved significantly over the past few years due to the development of techniques to repair plantar plate tears through a dorsal incision. However, treatment of stage 4 tears with no reparable plantar plate can be challenging. The current treatment involves flexor to extensor tendon transfer, requiring multiple incisions and surgical time. An alternative approach is presented, using the same modern techniques of plantar plate repair, but reconstructing the plantar plate using a flexor tendon tenodesis to the plantar base of the proximal phalanx. Methods: Four fresh frozen cadaver foot and ankle specimens were used to determine the stability of this new technique. A simulated Lachman’s test was performed on the 2nd, 3 rd, and 4th metatarsophalangeal joints utilizing a force measurement instrument with displacement control on specimens with an intact plantar plate, an excised plantar plate, and following a flexor tenodesis reconstruction. Results: The intact plantar plate force was 9.0+2.6kN for 2 mm displacement, and following excision of the plantar plate, the force reduced to 1.3+0.4kN. The flexor tenodesis reconstruction improved the force to 6.0+1.9kN. Conclusion: Plantar plate reconstruction with a flexor tenodesis to the proximal phalanx resulted in stability equal to 53% of the intact plantar plate, for the shear displacements between 2 to 6 mm. This procedure may be an alternative treatment option in patients with Stage 4 irreparable plantar plate tears.

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.

Correction of Fixed Hammertoe Deformity with Resection of the Head of the Proximal Phalanx and Extensor Tendon Tenodesis

1995 ◽  
Vol 16 (7) ◽  
pp. 449-451 ◽  
Author(s):  
Shahan K. Sarrafian
Keyword(s):  
Proximal Phalanx ◽  
Extensor Tendon ◽  
Surgical Correction ◽  
Wire Fixation

A method of surgical correction of a fixed hammertoe deformity is presented. It incorporates the resection of the head of the proximal phalanx with an extensor tendon tenodesis to the dorsum of the proximal phalanx. The controlled tension in the extensor tendon provides the necessary stability. It alleviates the use of K-wire fixation.

Transthecal Digital Nerve Block

1998 ◽  
Vol 23 (4) ◽  
pp. 490-493 ◽  
Author(s):  
N. S. SARHADI ◽  
J. SHAW-DUNN
Keyword(s):  
Methylene Blue ◽  
Nerve Block ◽  
Flexor Tendon ◽  
Proximal Phalanx ◽  
Proximal Part ◽  
Tendon Sheath ◽  
Areolar Tissue ◽  
Digital Nerve ◽  
Flexor Tendon Sheath ◽  
Digital Nerve Block

Injection studies using methylene blue and latex were used in 60 digits from 40 cadavers to study how anaesthetic fluid injected into the flexor tendon sheath might spread around the proximal part of the finger. The injected solution escaped from the flexor tendon sheath around the vincular vessels which are present near the base and head of the proximal phalanx. Outside the digital canal, the dye flowed smoothly through the perivascular loose areolar tissue and spread alongside the main digital vessels and nerves and their palmar and dorsal branches.

scholarly journals The relative compliance of energy-storing tendons may be due to the helical fibril arrangement of their fascicles

2017 ◽  
Vol 14 (133) ◽  
pp. 20170261 ◽  
Author(s):  
Tom Shearer ◽  
Chavaunne T. Thorpe ◽  
Hazel R. C. Screen
Keyword(s):  
Flexor Tendon ◽  
Extensor Tendon ◽  
Mechanical Tension ◽  
Superficial Digital Flexor Tendon ◽  
Microstructural Model ◽  
And Function ◽  
Nonlinear Elastic ◽  
The Mathematical Model ◽  
The Relationship ◽  
Fitting Parameters

A nonlinear elastic microstructural model is used to investigate the relationship between structure and function in energy-storing and positional tendons. The model is used to fit mechanical tension test data from the equine common digital extensor tendon (CDET) and superficial digital flexor tendon (SDFT), which are used as archetypes of positional and energy-storing tendons, respectively. The fibril crimp and fascicle helix angles of the two tendon types are used as fitting parameters in the mathematical model to predict their values. The outer fibril crimp angles were predicted to be 15.1° ± 2.3° in the CDET and 15.8° ± 4.1° in the SDFT, and the average crimp angles were predicted to be 10.0° ± 1.5° in the CDET and 10.5° ± 2.7° in the SDFT. The crimp angles were not found to be statistically significantly different between the two tendon types ( p = 0.572). By contrast, the fascicle helix angles were predicted to be 7.9° ± 9.3° in the CDET and 29.1° ± 10.3° in the SDFT and were found to be statistically highly significantly different between the two tendon types ( p < 0.001). This supports previous qualitative observations that helical substructures are more likely to be found in energy-storing tendons than in positional tendons and suggests that the relative compliance of energy-storing tendons may be directly caused by these helical substructures.

scholarly journals Microvasculature of the Plantar Plate Using Nano–Computed Tomography

2018 ◽  
Vol 40 (4) ◽  
pp. 457-464 ◽  
Author(s):  
Fred T. Finney ◽  
Aaron McPheters ◽  
Natalie V. Singer ◽  
Jaron C. Scott ◽  
Karl J. Jepsen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Soft Tissues ◽  
Proximal Phalanx ◽  
Surgical Techniques ◽  
Phosphomolybdic Acid ◽  
Vascular Density ◽  
Plantar Plate ◽  
Tibial Arteries ◽  
Clinical Conditions ◽  
Mtp Joints

Background: Lesser toe plantar plate attenuation or disruption is being increasingly implicated in a variety of common clinical conditions. A multitude of surgical techniques and devices have been recently developed to facilitate surgical repair of the plantar plate. However, the microvascular anatomy, and therefore the healing potential in large part, has not been defined. We investigated the microvasculature of the plantar plate by employing a novel technique involving microvascular perfusion and nano–computed tomography (nano-CT) imaging. Methods: Twelve human adult cadaveric lower extremities were amputated distal to the knee. The anterior and posterior tibial arteries were perfused with a barium solution. The soft tissues of each foot were then counterstained with phosphomolybdic acid (PMA). The second through fourth toe metatarsophalangeal (MTP) joints of 12 feet were imaged with nano-CT at 14-micron resolution. Images were then reconstructed for analysis of the plantar plate microvasculature and calculation of the vascular density along the length of the plantar plate. Results: A microvascular network extends from the surrounding soft tissues at the attachments of the plantar plate on both the metatarsal and proximal phalanx. The midsubstance of the plantar plate appears to be relatively hypovascular. Analysis of the vascular density along the length of the plantar plate demonstrated a consistent trend with increased vascular density at approximately the proximal 29% and distal 22% of the plantar plate. Conclusion: There is a vascular network extending from the surrounding soft tissues into the proximal and distal attachments of the plantar plate. Clinical relevance: The hypovascular midportion of the plantar plate may play an important role in the underlying pathoanatomy and pathophysiology of this area. These findings may have significant clinical implications for the reparative potential of this region and the surgical procedures currently described to accomplish anatomic plantar plate repair.

Inoperable stage IV colorectal cancer with intact primary tumor in patients receiving palliative chemotherapy: Does the response to chemotherapy correlate between primary and metastatic sites? An Irish cancer center experience.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 136-136
Author(s):  
Ruba Hamed ◽  
Ronan Andrew McLaughlin ◽  
Hatim Ibrahim ◽  
Greg Korpanty ◽  
Nemer Osman
Keyword(s):  
Stable Disease ◽  
Primary Tumour ◽  
Stage Iv ◽  
Primary Site ◽  
First Line ◽  
Tumour Site ◽  
Response To Chemotherapy ◽  
Stage 4 ◽  
Metastatic Sites ◽  
Line Chemotherapy

136 Background: Colorectal cancer (CRC) is the 3rd most common malignancy in Ireland with over 2700 cases annually. Approximately 20% are diagnosed with stage IV disease. The aim of this study is to evaluate the response to chemotherapy at primary and metastatic sites and review the frequency of intervention required to palliate the intact primary tumour in patients with stage 4 inoperable CRC in an Irish tertiary referral centre. Methods: A retrospective review of medical records was completed, identifying stage 4 CRC patients with primary tumour in situ diagnosed between January 2014 and December 2019, treated with chemotherapy (oxaliplatin or irinotecan based +/- bevacizumab or EGFR monoclonal antibody). Data and survival analysis were obtained using Kaplan-Meier methods. Results: 50 eligible patients were identified; 60% male, 40% female with a median age of 62 years. 2% had a transverse colonic primary, 32% right and 44% left sided and 22% had a rectal primary. 36% presented with liver metastasis only, 4% lung metastasis alone and 20% both. 48% were KRAS, 4% NRAS and 4% BRAF mutation positive while 1 patient was identified as having microsatellite instability. All patient received first-line chemotherapy either oxaliplatin or irinotecan based, 18% with the addition of Bevacizumab and 24% with EGFR monoclonal antibody. Overall response to first-line chemotherapy at the primary site and metastatic sites was assessed radiologically; 42% displaying a partial response, 36% had stable disease while 18% had progression at primary site. At the metastatic sites 50% responded, 10% stable disease and 40% progressed. Complication at primary tumour site included: obstruction 12%, with perforation in 6%, bleeding 10%, pain at tumour site in 6%, and one patient developed an abscess. Overall, after chemotherapy 76% of all patients did not require further intervention to manage primary site. 6% underwent curative surgery with resection of primary and metastatic lesions. Of those who had palliative intervention; 10% underwent palliative colostomy/ileostomy, 12% palliative radiotherapy, and 2% both. Overall survival was 14 months. At time of analysis 14% were alive, 10% receiving treatment and 4% on radiological surveillance. Conclusions: This retrospective study confirms that palliative chemotherapy +/- targeted therapy is effective in controlling the primary tumour in stage 4 inoperable CRC. In addition, it reveals a nearly 80% partial response or stable disease radiologically at the primary site after first-line chemotherapy. Furthermore, progression was significantly lower at primary site compared to distant metastasis (18% vs 40%). Almost 75% did not require palliative intervention for their primary tumour. Overall survival in our centre is higher compared to internationally observed data.

Common Extensor Tendon/Common Flexor Tendon

Tendinopathy ◽  
2021 ◽  
pp. 55-70
Author(s):  
Allison Schroeder ◽  
Kentaro Onishi ◽  
Scott Joshua Szabo
Keyword(s):  
Flexor Tendon ◽  
Extensor Tendon

Relapsed stage IV adenocarcinoma with insufficient material for genotyping at diagnosis

2018 ◽  
pp. 114-120
Author(s):  
Nadza Tokaca ◽  
Sanjay Popat
Keyword(s):  
Stage Iv ◽  
Stage 4

This case study looks at Relapsed stage 4 adenocarcinoma with insufficient material for genotyping at diagnosis , and provides questions with model answers.

scholarly journals Vascularized tendon graft to the central slip using a finger fillet flap

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Jonathan Rogozinski ◽  
R Michael Johnson
Keyword(s):  
Burn Injury ◽  
Flexor Tendon ◽  
Extensor Tendon ◽  
Tendon Graft ◽  
Spare Parts ◽  
Fillet Flap ◽  
Hand Defects ◽  
Central Slip ◽  
Trauma Algorithm

Abstract Burn boutonniere deformity (BBD) treatment remains a challenge in reconstructive surgery. Severe hand defects after burn/trauma may be reconstructed with nonsalvageable or amputated tissue. The fillet flap (FF) is generally used as “spare parts” in the trauma algorithm for mangled extremities. This case study examines the use of a FF with concurrent repair of the adjacent finger extensor tendon with the amputated finger flexor tendon after burn injury. The goal is to provide adequate tissue coverage using a finger FF while concurrently reconstructing the central slip of the extensor tendon with the transposed flexor tendon from an adjacent nonfunctional digit. After reconstruction, no subluxation of the extensor tendon occurred with manipulation. Despite prolonged rehabilitation due to injuries, the surgical site healed appropriately. Single-stage FF reconstruction with vascularized tendon grafts should be considered in selected patients with BBD. This novel idea can be applied to the management of traumatized extremities.

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