Functional outcomes of post-traumatic metacarpal hand reconstruction with free toe-to-hand transfer

ABSTRACT Introduction: We present the functional outcomes of microvascular toe transfer to reconstruct the post-traumatic metacarpal hand deformity. Twelve toe transfers were successfully carried out in 11 patients. Materials and Methods: In each patient, the level of injury was classified according to the Wei classification system. Functional outcome was measured in seven patients using the Tamai score. Additional objective tests of function were carried out in three patients, including the Jebsen test, grip strength, pinch strength, web opening, static and moving two-point discrimination and Semmes–Weinstein monofilament testing. Observation and Results: The average Tamai score was 69 (range 60–83.5). Six patients achieved 'good' outcomes and one patient, with a double toe transfer, an 'excellent' outcome. The average follow-up time was 43 months (range 10–148 months). Conclusion: This study shows how even a single toe transfer can restore useful function to a hand that has otherwise lost all prehensile ability.

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Basilar Thumb Arthritis: The Utility of Suture-Button Suspensionplasty

Hand ◽

10.1177/1558944718798850 ◽

2018 ◽

Vol 14 (1) ◽

pp. 66-72 ◽

Cited By ~ 4

Author(s):

Brent R. DeGeorge ◽

Sagar S. Chawla ◽

Bassem T. Elhassan ◽

Sanjeev Kakar

Keyword(s):

Functional Outcomes ◽

Tendon Transfer ◽

Proximal Phalanx ◽

Pain Syndrome ◽

Pinch Strength ◽

Suture Button ◽

Radiographic Outcomes ◽

Pain Scores ◽

Joint Arthritis

Background: We sought to compare the functional outcomes, radiographic outcomes, and complications of trapeziectomy and flexor carpi radialis (FCR) to abductor pollicis longus (APL) side-to-side tendon transfer with or without suture-button suspensionplasty for thumb basilar joint arthritis. Methods: Patients treated with and without suture-button suspensionplasty were compared over a 6-year period. Data were reviewed for complications and functional outcomes, including grip and pinch strength, range of motion, and visual analog scale (VAS) pain scores. Plain radiographs were independently reviewed at initial presentation and at final follow-up, including proximal phalanx length, trapezial space height, and trapezial height ratio. Results: Seventy thumb arthroplasties were performed in 70 patients. Trapeziectomy with FCR-APL side-to-side tendon transfer was performed in 39 patients, and trapeziectomy with FCR-APL side-to-side tendon transfer with suture-button suspensionplasty was performed in 31 patients. Mean length of follow-up was 28.4 ± 3.9 and 23.8 ± 2.6 months, respectively. Postoperative grip, oppositional and appositional pinch strength, and VAS pain scores improved compared with preoperative values, but were not significantly different based on suture-button suspensionplasty. Percentage decline in trapezial space ratio was significantly different between groups at 36.7% and 20.4% for procedures with and without suture-button suspensionplasty, respectively indicating that the trapezial space was better maintained within the suture suspension cohort. The incidence of postoperative complications, including surgical site infection, paresthesias, reoperation, complex regional pain syndrome, and symptomatic subsidence, was not significantly different between groups. Conclusions: Trapeziectomy with FCR to APL side-to-side tendon transfer with and without suture-button suspensionplasty results in comparable improvement in pain, grip strength, and functional parameters. Suture-button suspensionplasty results in significantly greater preservation of trapezial space.

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Dual mobility trapeziometacarpal prosthesis: a prospective study of 107 cases with a follow-up of more than 3 years

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211024500 ◽

2021 ◽

pp. 175319342110245

Author(s):

Bruno Lussiez ◽

Cyril Falaise ◽

Pascal Ledoux

Keyword(s):

Prospective Study ◽

Functional Outcomes ◽

Pinch Strength ◽

Level Of Evidence ◽

Dual Mobility ◽

The Mean ◽

The Stability ◽

A Prospective Study ◽

Score Index

We report the results of a prospective study using a dual mobility trapeziometacarpal prosthesis (Touch®) in 107 patients with a minimum follow-up of 3 years. One-hundred and two patients (95%) were very satisfied or satisfied with the functional outcomes and the mean pain intensity in visual analogue scale decreased from 7.4 to 0.8 ( p < 0.001). Thumb opposition (Kapandji score) index increased from an average of 8.0 to 9.4, while the mean QuickDASH score improved from 38 preoperatively to 20 at follow-up ( p < 0.01). Key-pinch strength improved from 3.5 kg (range 0.5–9.5) to 5.5 kg (range 3.0–11.5). There was a 4.6% rate of complications, including cup loosening and wear of polyethylene, which required revision, but no cases of prosthetic dislocation were seen. Applying the dual mobility principle to trapeziometacarpal arthroplasty may significatively improve the stability of these prostheses. Radiolucent zones around the components of the prostheses are not systematic predictors of future loosening. Level of evidence: IV

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Toe-to-Hand Transfers: More Than 20 Years Follow-Up of Five Post-Traumatic Cases

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2005.09.017 ◽

2006 ◽

Vol 31 (1) ◽

pp. 2-8 ◽

Cited By ~ 13

Author(s):

A. GÜLGÖNEN ◽

E. GUDEMEZ

Keyword(s):

Hand Function ◽

Long Term Follow Up ◽

Post Traumatic ◽

Toe Transfer ◽

Finger Reconstruction ◽

Second Toe

In post-traumatic losses of the thumb and fingers, reconstruction can be performed with success using various combinations of toe transfers. In this study, we have presented second toe and combined toe transfers which have been followed up for more than 20 years. Second toe transfer was used in four patients for reconstruction of the thumb. Combined second and third toe transfer was performed in two patients with a metacarpal hand for finger reconstruction. Long-term follow-up results show that patients with toe-to-hand transfers have acceptable adaptation to the reconstructed hand and good hand function. Toe transfer should be individually planned and carefully executed to obtain optimal results and minimal disability in the donor foot.

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Surgery for encephalomalacias presenting with intractable epilepsy

Indian Journal of Neurosurgery ◽

10.4103/2277-9167.94368 ◽

2012 ◽

Vol 01 (01) ◽

pp. 033-037 ◽

Cited By ~ 1

Author(s):

P. Sarat Chandra ◽

Abuzer Ansari ◽

Avnish Chauhan ◽

Amandeep Kumar ◽

Ajay Garg ◽

...

Keyword(s):

Head Trauma ◽

Seizure Frequency ◽

Intractable Epilepsy ◽

Seizure Outcome ◽

Class Iii ◽

Seizure Duration ◽

Excellent Outcome ◽

Post Traumatic ◽

Class Iv

Abstract Surgery for intractable epilepsy caused by encephalomalacia (especially post-traumatic) has been reported very scarcely in the literature. 21 cases are presented who underwent resections for encephalomalacias for medically intractable epilepsy are presented from a series of 632 cases. Seizure duration pre-surgery ranged from 3 to 29 years (mean 7.8 years, median of 7 years). Seizure frequency ranged from 2 seizures/month to 7/day, with a median of 10 seizures/month. Causes included head trauma (9), encephalitis (2), peri natal ischemia (3) post abscess (3) and idiopathic (4). The postoperative follow-up was 21 months (ranging from 12 to 63 months). 17 had Engel’s Class I seizure outcome. Four patients had poor seizure outcome (two Class IV and two Class III). All post traumatic encephalomalacias had excellent outcome, and post encephalitis the worst. Encephalomalacia with intractable epilepsy have a varied outcome and depends on the pathology.

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The functional results of post-traumatic metacarpal hand reconstruction with microvascular toe transfers

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193409337958 ◽

2009 ◽

Vol 34 (6) ◽

pp. 730-742 ◽

Cited By ~ 11

Author(s):

T. KOTKANSALO ◽

S. K. VILKKI ◽

P. ELO

Keyword(s):

Hand Function ◽

Functional Results ◽

Function Test ◽

Secondary Objective ◽

Post Traumatic ◽

Secondary Operations ◽

Objective Outcomes ◽

Sollerman Hand Function Test ◽

Toe Transfer

The aim of this retrospective study was to evaluate the functional results of grip reconstruction after metacarpal amputation with microvascular toe transfer or transfers. The Sollerman hand function test and modified Tamai score were determined. Additionally, secondary objective outcomes were measured. As subjective outcomes, the patients were asked about pain, satisfaction, sensibility and activities of daily living (ADL). Complications and secondary operations were also recorded. An average of 12 years 5 months (range 11–270 months) follow-up of 8 patients (11 transfers) is presented. Sollerman hand function test averaged 54, range 36–73. The modified Tamai score averaged 63, range 54–70. All except one patient were either satisfied or highly satisfied. Patients’ perception of function in terms of ADL was generally good (average 26 out of 44) with many activities causing no difficulty or only slight difficulty. The study showed that it is possible to reconstruct a reasonable grip using microvascular toe transfers.

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Post-traumatic endophthalmitis in children

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v11i1.25419 ◽

2019 ◽

Vol 11 (1) ◽

pp. 55-63

Author(s):

Ramesh Venkatesh ◽

Abhishek Prachi Dave ◽

Prachi Gurav ◽

Manisha Agrawal

Keyword(s):

Functional Outcomes ◽

Univariate Analysis ◽

Case Series ◽

Positive Culture ◽

Gram Positive ◽

Chi Square ◽

Early Presentation ◽

Post Traumatic ◽

Anatomical Outcomes

Purpose: To study the clinico-microbiological profile and evaluate the functional and anatomical outcomes of pediatric post-traumatic endophthalmitis (PPTE). Methods: This was a retrospective interventional case series. All medical case records of patients diagnosed with PPTE over a 5-year period from January 2011 to December2015 were reviewed. Data recorded was: age, sex, type of trauma, mode of injury, interval between trauma and presentation, treatment, follow-up duration and final functional and anatomical outcomes. Results: Forty-one eyes of 41 patients diagnosed with PPTE met the inclusion criteria. There were 26 boys and 15 girls. The mean age at the time of presentation was 7.34 years (1month -16years). The median interval between trauma and presentation was 3 days (mean = 13.71 days; 1-240 days). The average follow-up period was 292.24 days (median 150 days; 30 1440 days). Injury with wooden stick (20,50%) was the most common mode of injury. Culture positivity was noted in 25(61%) cases. Staphylococcusaureus was the most common organisms identified on culture. Univariate analysis of in dependent variables was done using the Chi-square test showed patients with positive culture for gram-positive organisms had better anatomical (p=0.038) and functional outcomes (p=0.043). 35(85%) patients underwent vitrectomy along with intraocular antibiotics. Optimal anatomical and functional outcomes were noted in 23(56.1%) and12(29.3%) respectively. Conclusion: PPTE carries a significantly poor prognosis in terms of ocular integrity and visual function. PPTE is common in boys and often caused by vegetative matter. Staphylococcus aureus is the most common organism seen in PPTE. Early presentation following trauma and identification of gram-positive organisms have a better prognosis.

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Synovial Fluid Biomarkers at the Time of Arthroscopy Predict 5-Year Outcomes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00337 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0033

Author(s):

Amit Manjunath ◽

Danielle Markus ◽

Elyse Berlinberg ◽

Lena Kenny ◽

Eric Strauss ◽

...

Keyword(s):

Synovial Fluid ◽

Functional Outcomes ◽

Magnetic Bead ◽

Pain Scale ◽

Surgical Incision ◽

Cytokines And Chemokines ◽

Vas Scores ◽

Post Traumatic ◽

Fluid Biomarker

Objectives: Injury-induced molecular changes in the intra-articular microenvironment of the knee are thought to play a role in the development of post-traumatic osteoarthritis. The purpose of this study was to evaluate the association between post-traumatic synovial fluid biomarker concentrations and intermediate-term functional outcomes. Methods: Patients undergoing primary knee arthroscopy for ACL injury, meniscus injury, and/or focal chondral lesions were prospectively enrolled. Synovial fluid aspirate, collected immediately prior to surgical incision, was processed and analyzed using a multiplex magnetic bead immunoassay to determine the concentration of 10 pre-determined cytokines and chemokines. Patients with a minimum of five years of postoperative follow-up were surveyed with Visual Analog Pain Scale (VAS), Lysholm Knee Scoring Scale, and Knee Injury and Osteoarthritis Outcome Score Physical Function Shortform (KOOS-PS). Stepwise regression was used to fit a linear regression model and model accuracy was evaluated using k-fold cross validation. Results: 39 patients (mean age: 41.56 +/- 15.98 years, mean postoperative follow-up: 6.79 +/- 0.72 years) were included in the study. Mean Lysholm, KOOS-PS, and VAS scores were 83.67 +/- 17.64, 88.37 +/- 12.79, and 11.03 +/- 19.84, respectively. 11 patients had undergone further ipsilateral knee surgery during the follow-up period. Of the remaining 28 patients, a model consisting of VEGF, TIMP-2, and MMP-3 was found to most accurately predict intermediate-term functional outcomes. Regardless of the type or extent of injury, these three biomarkers were able to explain 60.35%, 34.75%, and 39.38% of the variability in Lysholm, KOOS-PS, and VAS scores, respectively. Conclusions: By measuring the concentrations of MMP-3, TIMP-2, and VEGF at the time of surgery, functional outcomes and level of pain can be predicted at 5 years postoperatively with moderate accuracy. This suggests that these biomarkers may play an important role in the development of post-traumatic osteoarthritis and may serve as potential targets for therapeutic intervention. [Table: see text]

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Functional outcomes after modified Sauve-Kapandji arthrodesis for distal radioulnar joint dysfunction

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210623 ◽

2021 ◽

Vol 7 (2) ◽

pp. 303

Author(s):

Hiranya Kumar Seenappa ◽

Karthik Narayanamurthy Mittemari ◽

Shivaraj Nadagouda ◽

Vamshikrishna Chand Nimmagadda

Keyword(s):

Range Of Motion ◽

Clinical Outcomes ◽

Functional Assessment ◽

Functional Outcomes ◽

Distal Radioulnar Joint ◽

Analog Scale ◽

Distal Ulna ◽

Excellent Outcome ◽

Radioulnar Joint

Background: The distal radioulnar joint (DRUJ) dysfunction manifests as pain, weakness and reduced range of motion. There are various treatments for DRUJ dysfunction. Modified Sauvé-Kapandji procedure involves arthrodesis of the distal radioulnar joint combined with the creation of a pseudarthrosis of the distal ulna to maintain forearm pronation and supination, and stabilization of proximal ulnar stump. This study was performed to evaluate the clinical outcomes of modified Sauve-Kapandji procedure for patients with DRUJ dysfunction.Methods: Fourteen patients with DRUJ dysfunction were treated by modified Sauve-Kapandji procedure and followed up for 2 years post-operatively. Functional assessment was evaluated according to modified mayo wrist score (MMWS) system and severity of pain by visual analog scale. Posteroanterior and lateral radiographs were used to assess fusion.Results: There was a significant improvement in VAS of wrist pain (p<0.001) and MMWS (p<0.001) at 2 years follow up. Excellent outcome was reported in 64.3% (n=9) patients. Radiographic fusion was seen in all 14 cases.Conclusions: The modified Sauve-Kapandji procedure for DRUJ dysfunction is a safe and effective procedure with excellent radiological fusion and significant improvement in functional outcomes.

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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

Journal of Neurosurgery ◽

10.3171/2019.2.jns182620 ◽

2020 ◽

Vol 132 (6) ◽

pp. 1914-1924 ◽

Cited By ~ 2

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.

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Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.6.peds18716 ◽

2019 ◽

Vol 24 (5) ◽

pp. 549-557

Author(s):

Malia McAvoy ◽

Heather J. McCrea ◽

Vamsidhar Chavakula ◽

Hoon Choi ◽

Wenya Linda Bi ◽

...

Keyword(s):

Conservative Management ◽

Functional Outcomes ◽

Pediatric Patients ◽

Clinical Presentation ◽

Case Series ◽

Csf Leak ◽

Single Institution ◽

The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

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