scholarly journals Partial monopolar transfer of pectoralis major for elbow active flexion restoration in children with arthrogryposis

2021 ◽  
Vol 9 (4) ◽  
pp. 407-416
Author(s):  
Olga E. Agranovich ◽  
Ekaterina V. Petrova ◽  
Sergey F. Batkin ◽  
Evgeniya I. Ermolovich ◽  
Igor A. Komolkin ◽  
...  
Keyword(s):  
Biceps Brachii ◽  
Pectoralis Major Muscle ◽  
Elbow Flexion ◽  
Pectoralis Major ◽  
Software Packages ◽  
Active Flexion ◽  
Before And After ◽  
The Mean ◽  
Elbow Motion

BACKGROUND: One of the main problems that limited or made the self-ability of patients with arthrogryposis impossible is the lack of active elbow flexion due to hypoplasia (or aplasia) of the forearm flexors and, especially the m. biceps brachii. AIM: To evaluate the possibility of active forearm flexion restoration in children with arthrogryposis by partial monopolar transposition of the pectoralis major muscle. MATERIALS AND METHODS: Elbow active flexion restoration by partial monopolar transposition of the pectoralis major muscle to biceps brachii was conducted in 34 children with arthrogryposis (39 upper limbs) from 2011 to 2020. The muscle autograft included a fragment of the fascia of the m. rectus abdominis. Clinical examinations of patients were performed before and after the operation. Statistical data processing was performed using the software packages Statistica 10 and SAS JMP 11. RESULTS: The follow-up results were estimated from 6 to 99 months (44.53 31.72) postoperative. The mean age of patients was 6.24 4.24 years. The active postoperative elbow motion was 0120 (71.94 33.40). The passive postoperative elbow motion did not change and was 90130 (104.12 12.40). Muscles strength after the operation was grade 25. Elbow extension was limited in 30 cases (76.9%) from 0 to 40 (21.70 12.27) without problem in the activities of daily living. Good results were determined in 15 cases (38.5%), satisfactory in 8 (20.5%), and poor in 16 (41%). CONCLUSIONS: This study revealed that our partial monopolar transfer of pectoralis major to biceps brachii technic restored sufficient forearm flexion and improved self-ability without forming severe elbow flexor contractures of more than half of the patients with arthrogryposis.

scholarly journals Neurophysiological signals for estimation of the result of latissimus dorsii muscle transfer to biceps brachii in patients with arthrogryposis

2020 ◽  
Vol 8 (2) ◽  
pp. 151-158
Author(s):  
Olga E. Agranovich ◽  
Margarita V. Savina ◽  
Dmitry A. Ivanov ◽  
Alexey E. Boyko ◽  
Yevgeny D. Blagoveshchenskiy
Keyword(s):  
Spinal Cord ◽  
Daily Living ◽  
Biceps Brachii ◽  
Elbow Flexion ◽  
Muscle Transfer ◽  
Time Of Surgery ◽  
Active Flexion

Background. One of the leading causes of restriction in daily-living activities in patients with arthrogryposis is severe hypoplasia (or aplasia) of the biceps brachii. Latissimus dorsii muscle transfer to the biceps brachii is one of the most used methods for the reconstruction of active elbow flexion in patients with arthrogryposis. Aim. The aim of the study is to identify neurophysiological correlates for evaluating the result of the transposition of the latissimus dorsii muscle to the biceps in patients with multiple congenital arthrogryposis. Materials and methods. From 2011 to 2018, we performed monopolar latissimus dorsii muscle transfer to the biceps for the restoration of active elbow flexion in 30 patients with arthrogryposis (44 upper extremities). The follow-up results were studied in 14 cases. For this purpose, we used clinical examination, surface electromyography (sEMG), and statistical analysis. The patients were examined before and from 1 month to 96 months (7 months; 224.5 months) after the surgery. The age of patients was from 1 to 10 years at the time of surgery (4.89 2.42 years). Results. Our study showed that the age of the child at the time of surgery does not significantly change the index of activation of the latissimus dorsii muscle. A decrease of coactivation of the latissimus dorsii muscle in the long term after surgery correlates with an increase in the strength of the displaced latissimus dorsii muscle, and an improvement in active flexion in the elbow. If the value of the index of coactivation of the latissimus dorsii muscle is less 42%, the muscle strength after surgery reaches 4 points. It was found that the index of coactivation of the latissimus dorsii muscle does not depend on the level of segmental damage to the spinal cord. However, the strength of the muscle depends on the level of spinal cord damage. Conclusion. The determination of the index coactivation of the latissimus dorsii muscle after surgery can be used to evaluate the results of the latissimus dorsii muscle transfer to the biceps in patients with arthrogryposis. The index of activation of the latissimus dorsii muscle must be less than 42% for effective elbow active flexion.

scholarly journals Restoration of elbow active flexion via latissimus dorsii transfer in patients with arthrogryposis

2018 ◽  
Vol 6 (3) ◽  
pp. 5-11
Author(s):  
Olga E. Agranovich ◽  
Evgeniya A. Kochenova ◽  
Svetlana I. Trofimova ◽  
Ekaterina V. Petrova ◽  
Dmitriy S. Buklaev
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Latissimus Dorsi ◽  
Biceps Brachii ◽  
Therapeutic Option ◽  
Elbow Flexion ◽  
Upper Limbs ◽  
Latissimus Dorsi Transfer ◽  
Active Flexion

Background. Severe hypoplasia (or aplasia) of the biceps brachii is a primary cause of restriction in activities of daily living in patients with arthrogryposis. Aim. To estimate the possibility of restoring elbow active flexion via a latissimus dorsii transfer in patients with arthrogryposis. Materials and methods. From 2011 to 2018, we restored active flexion of the elbow via a latissimus dorsi transfer to the biceps brachii in 30 patients with arthrogryposis (44 upper limbs). We used different regimes including clinical examinations, EMG donor and recipient sites, and CT of the chest wall and shoulder. Results. The mean age of the patients was 4.0 ± 2.4 years, and the follow-up period was 3.2 ± 1.9 months. Follow-up results were available for 26 patients (30 upper limbs). The active postoperative elbow motion was 90.5 ± 14.9°. Elbow extension limitation occurred in 51% of cases (12.8 ± 4.3°) without any problems in activities of daily living. In total, 55.6% of patients had good results, 33.3% had satisfactory results, and 11.1% had poor results. Discussion. Our latissimus dorsi transfer results were comparable with those of other authors. Transposition of the latissimus dorsi to the biceps brachii restores sufficient flexion of the elbow without severe elbow flexion contractures. Conclusions. We suggest pedicle monopolar latissimus dorsi transfer as a reliable therapeutic option to restore active elbow flexion in patients with arthrogryposis having passive elbow flexion of 90° or higher before operation and donor muscle strain grade 4 or higher.

Analysis of human acellular nerve allograft combined with contralateral C7 nerve root transfer for restoration of shoulder abduction and elbow flexion in brachial plexus injury: a mean 4-year follow-up

2020 ◽  
Vol 132 (6) ◽  
pp. 1914-1924 ◽  
Author(s):  
Liang Li ◽  
Jiantao Yang ◽  
Bengang Qin ◽  
Honggang Wang ◽  
Yi Yang ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Nerve Root ◽  
Functional Outcomes ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Allograft Reconstruction ◽  
Acellular Nerve Allograft ◽  
The Mean ◽  
Monofilament Test

OBJECTIVEHuman acellular nerve allograft applications have increased in clinical practice, but no studies have quantified their influence on reconstruction outcomes for high-level, greater, and mixed nerves, especially the brachial plexus. The authors investigated the functional outcomes of human acellular nerve allograft reconstruction for nerve gaps in patients with brachial plexus injury (BPI) undergoing contralateral C7 (CC7) nerve root transfer to innervate the upper trunk, and they determined the independent predictors of recovery in shoulder abduction and elbow flexion.METHODSForty-five patients with partial or total BPI were eligible for this retrospective study after CC7 nerve root transfer to the upper trunk using human acellular nerve allografts. Deltoid and biceps muscle strength, degree of shoulder abduction and elbow flexion, Semmes-Weinstein monofilament test, and static two-point discrimination (S2PD) were examined according to the modified British Medical Research Council (mBMRC) scoring system, and disabilities of the arm, shoulder, and hand (DASH) were scored to establish the function of the affected upper limb. Meaningful recovery was defined as grades of M3–M5 or S3–S4 based on the scoring system. Subgroup analysis and univariate and multivariate logistic regression analyses were conducted to identify predictors of human acellular nerve allograft reconstruction.RESULTSThe mean follow-up duration and the mean human acellular nerve allograft length were 48.1 ± 10.1 months and 30.9 ± 5.9 mm, respectively. Deltoid and biceps muscle strength was grade M4 or M3 in 71.1% and 60.0% of patients. Patients in the following groups achieved a higher rate of meaningful recovery in deltoid and biceps strength, as well as lower DASH scores (p < 0.01): age < 20 years and age 20–29 years; allograft lengths ≤ 30 mm; and patients in whom the interval between injury and surgery was < 90 days. The meaningful sensory recovery rate was approximately 70% in the Semmes-Weinstein monofilament test and S2PD. According to univariate and multivariate logistic regression analyses, age, interval between injury and surgery, and allograft length significantly influenced functional outcomes.CONCLUSIONSHuman acellular nerve allografts offered safe reconstruction for 20- to 50-mm nerve gaps in procedures for CC7 nerve root transfer to repair the upper trunk after BPI. The group in which allograft lengths were ≤ 30 mm achieved better functional outcome than others, and the recommended length of allograft in this procedure was less than 30 mm. Age, interval between injury and surgery, and allograft length were independent predictors of functional outcomes after human acellular nerve allograft reconstruction.

Possibility of simultaneous transposition of segments of the pectoralis major muscle to restore flexion in the shoulder and elbow joints (clinical observation)

MedAlliance ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 61-68
Keyword(s):  
Anterior Part ◽  
Pectoralis Major Muscle ◽  
Elbow Flexion ◽  
Functional Results ◽  
Proximal Part ◽  
Deltoid Muscle ◽  
Pectoralis Major ◽  
Orthopedic Surgeons ◽  
Active Function ◽  
Head Neck

The pectoralis major is a widely used muscle in reconstruction surgery for replacement soft tissue defects of a head, neck, thorax, upper limbs and restoration of muscle active function. The peculiarities of anatomy of the pectoralis major makes it possible to divide the muscle into several segments with their own innervations and supply and use them independently from each other. This article describes the anatomy of the pectoralis major and the opportunity for clinical applications of different segments of this muscle. The authors demonstrate the result of the restoration of shoulder and elbow flexion in a patient with arthrogryposis due to simultaneous transfer of the proximal part of pectoralis major to the anterior part of the deltoid muscle and the distal part of pectoralis major to the biceps with good functional results. The article will be useful for plastic surgeons, orthopedic surgeons and physiotherapists.

scholarly journals Unilateral lateral rectus recession is an effective surgery for intermittent exotropia in young children

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Oriel Spierer ◽  
Abraham Spierer
Keyword(s):  
Young Children ◽  
Success Rate ◽  
Lateral Rectus ◽  
Intermittent Exotropia ◽  
Age At Surgery ◽  
Surgical Methods ◽  
Before And After ◽  
The Mean ◽  
Consecutive Esotropia

Abstract Background Different surgical methods have been suggested for the correction of intermittent exotropia. Unilateral lateral rectus recession has been described as a surgical alternative for small and moderate-angle exotropia. In general, previous studies did not focus on the outcomes of unilateral lateral rectus recession in young children with intermittent exotropia. The purpose of this study is to evaluate the surgical outcomes of unilateral lateral rectus recession in the treatment of moderate-angle exotropia (≤ 25 PD (prism diopters)) in children. Methods The charts of all patients younger than 12 years of age with moderate-angle exotropia (up to 25 PD) who were operated during the years 2006–2018 were retrospectively reviewed. Fifty-eight patients underwent unilateral lateral rectus recession and had a minimum follow up of 6 months. The angle of exotropia (PD) before and after surgery and the success rate were documented. Results Mean age at surgery was 6.4 ± 1.9 (range 3.5–11.0) years. Exotropia improved from a preoperative angle of 21.4 ± 4.0 PD to 3.5 ± 5.9 PD postoperatively (p < 0.001). Success rate, defined as deviation of ≤ 10 PD, was achieved in 86.2%. There were 2 (3.4%) cases of overcorrection (consecutive esotropia). There were no intra- or postoperative complications. The mean follow-up duration after surgery was 2.3 ± 1.7 years. Conclusions In children with moderate angle exotropia, good postoperative success rate was achieved by performing unilateral lateral rectus recession.

scholarly journals Pilot report: non-operative treatment of Mayo Type II olecranon fractures in any-age adult patient

2017 ◽  
Vol 9 (4) ◽  
pp. 285-291 ◽  
Author(s):  
Matthew D. Putnam ◽  
Christy M. Christophersen ◽  
Julie E. Adams
Keyword(s):  
Supportive Care ◽  
Operative Treatment ◽  
Type Ii ◽  
Post Injury ◽  
Active Motion ◽  
Non Union ◽  
The Mean ◽  
Elbow Motion ◽  
Olecranon Fractures

Background We report on the non-operative treatment of Mayo Type II olecranon fractures. Methods Fourteen isolated Mayo Type II olecranon fractures were treated non-operatively, followed to discharge, and retrospectively reviewed. Treatment was splinting in extension followed by protected active motion beginning 3 weeks to 4 weeks post-injury. Mayo Elbow Performance Index (MEPI) and Shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were available in 86% and 64% of cases, respectively. Follow-up radiographs were obtained. Results At discharge, the mean (SD) MEPI score was 95 (5). The mean (SD) elbow motion arc was 121° (21°). One patient re-fractured his elbow after discharge by falling on the ice. He recovered after open reduction and internal fixation. One patient (documented Marfan syndrome) developed an asymptomatic non-union. Excepting the patient who fell, no patient received additional care. Conclusions In this pilot report, Mayo Type II olecranon fractures were treated non-operatively to discharge. Good to excellent results were obtained in all patients according to the MEPI. Supportive care of these fractures should be comparatively studied. A downside risk to providing supportive care for these fractures was not identified.

Excitotoxic acid lesions of the primate subthalamic nucleus result in reduced pallidal neuronal activity during active holding

1992 ◽  
Vol 68 (5) ◽  
pp. 1859-1866 ◽  
Author(s):  
I. Hamada ◽  
M. R. DeLong
Keyword(s):  
Subthalamic Nucleus ◽  
Neuronal Activity ◽  
Elbow Flexion ◽  
Ibotenic Acid ◽  
Excitatory Input ◽  
Behavioral Task ◽  
Discharge Rates ◽  
Before And After ◽  
The Mean ◽  
Flexion And Extension

1. To gain a better understanding of the pathophysiology of hemiballismus in primates, and to test directly the hypothesis that the subthalamopallidal projection is excitatory, we studied the effects of lesions of the subthalamic nucleus (STN) on neuronal activity in the globus pallidus (GP) of monkeys during performance of a motor behavioral task. 2. Animals were trained to position and hold a manipulandum to which torque pulses were applied, producing elbow flexion and extension. The activity of neurons in the external (GPe) and internal (GPi) segments of GP was recorded in two monkeys during task performance before and after STN lesions. The STN was lesioned by the fiber-sparing neurotoxins ibotenic acid and/or kainic acid. 3. After lesioning, the firing rate of neurons in both segments of GP, which was measured during the period of holding before torque application, was significantly decreased in both animals. The mean of discharge rates of GPi neurons decreased (P < 0.001) from 69.8 (n = 169, SD = 21.6) to 47.4 spikes/s (n = 180, SD = 22.6) after lesioning. The mean of discharge rates of GPe neurons decreased from 63.6 spikes/s (n = 218, SD = 25.1) before lesions to 41.0 spikes/s (n = 208, SD = 18.1) after lesioning. 4. These results provide further evidence that STN gives rise to a major excitatory input to both segments of the GP and support the hypothesis that dyskinesias result from decreased GPi output.

scholarly journals Selective Arterial Embolization of Renal Angiomyolipomas with a N-Butyl Cyanoacrylate-Lipiodol Mixture: Efficacy, Safety, Short- and Mid-Term Outcomes

2021 ◽  
Vol 10 (18) ◽  
pp. 4062
Author(s):  
François-Victor Prigent ◽  
Kévin Guillen ◽  
Pierre-Olivier Comby ◽  
Julie Pellegrinelli ◽  
Nicolas Falvo ◽  
...  
Keyword(s):  
Arterial Embolization ◽  
Volume Reduction ◽  
Renal Angiomyolipoma ◽  
Cyanoacrylate Glue ◽  
Selective Arterial Embolization ◽  
Before And After ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri ◽  
Postembolization Syndrome

Selective arterial embolization (SAE) for renal angiomyolipoma (rAML) is effective to treat or prevent bleeding. We report our experience using a cyanoacrylate–Lipiodol mixture. We performed a single-center retrospective review of all rAMLs embolized with cyanoacrylate glue between July 2014 and June 2020. Demographics, tuberous sclerosis complex (TSC) status, clinical presentation, angiography features, and follow-up data were recorded. Pre- and post-procedure rAML sizes and volumes were estimated from computed tomography (CT) or magnetic resonance imaging (MRI) studies. Kidney function was assessed before and after the procedure. We identified 24 patients (22 females and 2 males, mean age 51 years) treated for 27 AMLs, either prophylactically (n = 20) or as an emergency (n = 4). Technical success was achieved for 25/27 AMLs; two patients, each with a single AML, required nephrectomy and repeated embolization, respectively. Major complications occurred in three patients and minor complications such as postembolization syndrome in 15 patients. AML volume reduction after embolization was 55.1% after a mean follow-up of 15 months (range, 1–72 months). Factors associated with greater volume reduction were a smaller percentage of fat (p = 0.001), larger initial rAML volume (p = 0.014), and longer follow-up (p = 0.0001). The mean creatinine level did not change after SAE. Embolization of rAMLs with a mixture of cyanoacrylate and Lipiodol is feasible, safe, and effective in significantly decreasing tumor volume.

scholarly journals Discharge and Sediment Transport in a River Basin. Assessment Before and After the Construction of a Dam at the Upper Basin Boundary

2021 ◽  
Author(s):  
George Paschalidis ◽  
Ilias IIordanidis ◽  
Petros Anagnostopoulos
Keyword(s):  
Sediment Transport ◽  
Meteorological Data ◽  
Climatic Data ◽  
Northern Greece ◽  
Basin Boundary ◽  
Software Packages ◽  
Before And After ◽  
The Mean ◽  
Gis Interface ◽  
Good Agreement

Abstract The purpose of this study is the evaluation of runoff and sediment transport in the basin of the Nestos River (Northern Greece) downstream of the dam of Platanovrisi, constructed in 1998. The model used for the simulation was AGNPS, which is based on the Revised Universal Soil Loss Equation (RUSLE), combined with a GIS interface. Two different simulations were conducted, one for the years 1980-1990 and another for the period 2006-2030, before and after the construction of the dam respectively. For the simulation for the period 1980-1990 existing meteorological data were employed, and the results were in good agreement with those of a different study (Hrissanthou, 2002). The simulation for the period 2006-2030 was based on rainfall and climatic data generated from the software packages GlimClim and ClimGen. The mean runoff was by 5% lower and the mean annual sediment yield by 20% lower than the corresponding values for the period 1980-1990.

scholarly journals Bipolar transfer of the pectoralis major muscle for restoration of elbow flexion in 29 cases

2018 ◽  
Vol 27 (11) ◽  
pp. e330-e336 ◽  
Author(s):  
Adeline Cambon-Binder ◽  
Arnaud Walch ◽  
Pierre-Sylvain Marcheix ◽  
Zoubir Belkheyar
Keyword(s):  
Pectoralis Major Muscle ◽  
Elbow Flexion ◽  
Pectoralis Major
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