Showing papers in "Journal of Hand Surgery (European Volume) in 1990"
TL;DR: An experimental model using a static positioning frame, pressure-sensitive film, and a microcomputer-based videodigitizing system was used to measure contact areas and pressures in the wrist.
Abstract: An experimental model using a static positioning frame, pressure-sensitive film (Fuji), and a microcomputer-based videodigitizing system was used to measure contact areas and pressures in the wrist. Contact areas and pressures were compared in a group of wrists between the normal state and with simulated distal radius fracture malunions of varying degrees. In simulated malunions, radial shortening to any degree slightly increased the total contact area in the lunate fossa, and was significant at 2 mm of shortening. By angulating the distal radius more than 20 degrees either palmar or dorsal, there was a dorsal shift in the scaphoid and lunate high pressure areas, and the loads were more concentrated, but there was no change in the load distribution between the scaphoid and lunate. Decreasing the radial inclination shifted the load distribution so that there was more load in the lunate fossa and less load in the scaphoid fossa.
293 citations
TL;DR: In the fingers, only a small percentage of the active range of motion of the joints was required for functional tasks, and active thumb metacarpalphalangeal joint motion was found to be bimodal in the study group.
Abstract: Active ranges of motion of the joints of the hand are well documented, but there is little data reporting the functional ranges of motion required to perform activities of daily living. Electrogoniometric and standard methods were used to measure both active and functional ranges of motion of the metacarpalphalangeal and interphalangeal joints during 11 activities of daily living. In the fingers, only a small percentage of the active range of motion of the joints was required for functional tasks. Functional flexion postures averaged 61 degrees at the metacarpalphalangeal joint, 60 degrees at the proximal interphalangeal joint, and 39 degrees at the distal interphalangeal joint. In the thumb, functional flexion postures averaged 21 degrees at the metacarpalphalangeal joint and 18 degrees at the interphalangeal joint using only 32% of the available flexion. Active thumb metacarpalphalangeal joint motion was found to be bimodal in the study group.
285 citations
TL;DR: The results indicate that the procedures are technically demanding and have high early (15%) and late (35%) complication rates, including the need for further operative procedures, but patient satisfaction is very high, most patients returning to previous occupations.
Abstract: Comminuted intraarticular fractures of the distal radius present a difficult problem in management. It is well established that unreduced significant articular incongruency will result in early degenerative osteoarthritis. The technical demands of, and the results to be expected from, formal open reduction and internal fixation of these comminuted articular fractures have not been addressed in the current literature. From 1981 to 1986, 20 patients were treated by open reduction after failure of closed means. Seventeen patients were personally reviewed at an average follow-up of 3.25 years. The results indicate that the procedures are technically demanding and have high early (15%) and late (35%) complication rates. This gives an overall complication rate of 50%, including the need for further operative procedures. However, patient satisfaction is very high, most patients (89%) returning to previous occupations. Function and radiographic results are excellent. Articular congruency was restored in 88%.
266 citations
TL;DR: Using these parameters in discriminant analysis permitted correct identification of each of the 25 muscles, and in terms of size and intrinsic design, these individual muscles were highly specialized for their function.
Abstract: The architectural features of 25 wrist flexor and extensor muscles were studied. Muscles included the flexor carpi ulnaris, the flexor carpi radialis, the extensor carpi ulnaris, the extensor capri radialis brevis, and the extensor carpi radialis longus. Muscle length, mass, fiber pennation angle, fiber length, and sarcomere length (by use of laser diffraction techniques) were determined. In addition, physiological cross-sectional area and fiber length/muscle length ratio were calculated. The muscles were found to be highly specialized, with architectural features of same muscles very similar. The fiber length/muscle length ratio, muscle length, and pennation angle represented the major differences between muscles. Thus using these parameters in discriminant analysis permitted correct identification of each of the 25 muscles. In terms of size and intrinsic design, these individual muscles were highly specialized for their function.
262 citations
TL;DR: The arterial system in 141 fresh human cadavers was studied under the operating microscope using magnifications of 8 to 25 times and demonstrated a regular, repetitive distribution corresponding to: a, condylar vessel; b, metaphyseal vessel; c, dorsal skin vessel; and d, transverse palmar arch.
Abstract: The arterial system in 141 fresh human cadavers was studied under the operating microscope using magnifications of 8 to 25 times. The vascular system was injected with latex material alone for identification of the vessels during dissection, and with latex and lead for x-ray contrast studies. An overall repetitive pattern in size, location, and distribution of the vessels was noted. The dorsal branches of the paired digital vessels in each phalanx were generally 4 and demonstrated a regular, repetitive distribution corresponding to: a, condylar vessel; b, metaphyseal vessel; c, dorsal skin vessel; and d, transverse palmar arch. Proximal and middle transverse palmar arches were found always in relation to the cruciate ligaments. The distal transverse palmar arch lay just distal to the insertion of the profundus.
255 citations
TL;DR: In this paper, a simplified articulating force analysis (rigid body spring model) examined how different surgical procedures used for treating Kienbock's disease modify the force distribution across the carpus and the resulting intercarpal displacement and joint loadings were calculated for the intact wrist and for different simulated surgical procedures.
Abstract: A simplified two-dimensional articulating force analysis (rigid body spring model) examined how different surgical procedures used for treating Kienbock's disease modify the force distribution across the carpus. A two-dimensional model of a carpus was loaded through the metacarpals by forces of up to 143 Newtons. The resulting intercarpal displacement and joint loadings were calculated for the intact wrist and for different simulated surgical procedures. The predicted total amount of force transmitted through the radio-lunate joint of the intact wrist averaged a 32% of the total radio-ulno-carpal joint load. Limited intercarpal fusions were found to reduce compressive loading at the radio-lunate joint by no more than 15% of the original load. Capitate shortening was successful in relieving radio-lunate forces, however, it dramatically overloaded the adjacent scapho-trapezial and triquetral-hamate joints. By contrast, a 4 mm lengthening of the ulna (or shortening of the radius) resulted in a 45% reduction of radio-lunate load with only moderate changes in force at the midcarpal and radio-scaphoid joints. On the basis of this study, radial shortening or ulnar lengthening significantly unload the lunate and are rationale procedures in the treatment of Kienbock's disease. Limitations regarding direct clinical application of this mathematical model are also discussed.
240 citations
TL;DR: It is concluded that the hand diagram is valuable in the diagnosis of carpal tunnel syndrome among patients with upper extremity paresthesias.
Abstract: A self-administered hand diagram has been developed to assist in the evaluation of upper extremity paresthesias. A rating system was devised to classify diagrams into four categories: classic, probable, possible, or unlikely carpal tunnel syndrome. Diagram ratings of 63 patients (85 hands) evaluated in a hand clinic were compared with diagnoses established independent of diagram results by objective clinical criteria. The sensitivity of diagrams rated classic or probable was 80% and specificity was 90%. We conclude that the hand diagram is valuable in the diagnosis of carpal tunnel syndrome among patients with upper extremity paresthesias.
227 citations
TL;DR: This type II lunate, with the high incidence of associated hamate pathology, may be an unidentified cause of wrist pain on the ulnar side.
Abstract: One hundred sixty-five cadaveric wrists were dissected to assess the incidence of a medial (hamate) facet on the lunate and any associated pathologic conditions. Forty-seven of these specimens and 137 clinical patients' radiographs were reviewed to attempt to recognize and further assess the incidence of a medial (hamate) facet on the lunate. Two types of lunate were identified. Type I, in which there was no medial facet, was evident in 34.5% of the dissected specimens and type H, in which there was a medial facet, was evident in 65.5% of the dissected specimens. The medial facets in the type II lunates ranged from a shallow 1 mm facet to a deep 6 mm facet. Significant cartilage erosion with exposed subchondral bone at the proximal pole of the hamate, which was not identifiable by radiograph, was evident at dissection in 44.4%) of the type II lunates, while none (0%) of the type I lunates had such associated hamate pathologic conditions. This type II lunate, with the high incidence of associated hamate pathology, may be an unidentified cause of wrist pain on the ulnar side.
216 citations
TL;DR: The palmar radiocarpal ligaments were studied with use of fifty-four dissected adult cadaver wrists and serial sections on twenty-three wrists from fetuses ranging in size from 23 to 230 millimeters crown-rump length.
Abstract: The palmar radiocarpal ligaments were studied with use of fifty-four dissected adult cadaver wrists and serial sections on twenty-three wrists from fetuses ranging in size from 23 to 230 millimeters crown-rump length. Three palmar radiocarpal ligaments were clearly identified: the radioscaphocapitate, long radiolunate, and short radiolunate ligaments. The radioscaphocapitate ligament originates from the radial styloid process and inserts into the radial aspect of the waist of the scaphoid, hemicircumferentially around the distal pole of the scaphoid and interdigitates with fibers from the palmar aspect of the triangular fibrocartilage complex just palmar to the head of the capitate, with only a minor insertion distally into the body of the capitate. The long radiolunate ligament originates just ulnar to the radioscaphocapitate ligament, being separated from it throughout its course by the interligamentous sulcus. The long radiolunate supports, but is separate from, the palmar aspect of the scapholunate interosseous ligament, and inserts into the radial half of the palmar surface of the lunate. The short radiolunate ligament, previously not described, originates just palmar to the lunate facet of the distal radius articular surface and inserts as a flat sheet of fibers into the proximal margin of the palmar surface of the lunate. Each ligament is intracapsular, enveloped within a continuous superficial fibrous stratum and deep synovial stratum.
195 citations
TL;DR: A staging system for ulnar-sided perilunate instability is presented based on a series of cadaver dissections and load studies and evidence of dynamic or static volar intercalated segment instability deformity is presented.
Abstract: A staging system for ulnar-sided perilunate instability is presented based on a series of cadaver dissections and load studies. Stage I: partial or complete disruption of the lunotriquetral interosseous ligament, without clinical and/or radiographic evidence of dynamic or static volar intercalated segment instability deformity; stage II: complete disruption of the lunotriquetral interosseous ligament and disruption of the palmar lunotriquetral ligament, with clinical and/or radiographic evidence of dynamic volar intercalated segment instability deformity; and stage III: complete disruption of the lunotriquetral interosseous and the palmar lunotriquetral ligaments, attenuation or disruption of the dorsal radiocarpal ligament, with clinical and/or radiographic evidence of static volar intercalated segment instability deformity.
178 citations
TL;DR: Postoperative pain relief was achieved in 26 patients, allowing 24 of the 27 patients to return to their previous activity status within an average of 4.5 months after surgery, and range of motion matched or surpassed preoperative values.
Abstract: Proximal row carpectomy as a treatment of disorders of the radiocarpal joint remains controversial despite numerous reports documenting clinically successful outcomes. Criticism includes postoperative loss of grip strength, unsatisfactory range of motion, prolonged rehabilitation time, and the potential for progressive painful arthritis. Twenty-seven patients were studied to address these concerns. The average length of follow-up was 4 years. Postoperative pain relief was achieved in 26 patients, allowing 24 of the 27 patients to return to their previous activity status within an average of 4.5 months after surgery. In all cases, range of motion matched or surpassed preoperative values. Grip strength improved to an average of 80% of the contralateral side. A detailed radiographic analysis of the radii of curvature of the lunate fossa and the capitate showed that the radius of curvature of the capitate is approximately two thirds of the corresponding value of the lunate. Motion between the capitate and the radius is translational with a moving center of motion, which may dissipate load on the radius and explain the relative success of the procedure.
TL;DR: A retrospective study of 235 patients with 338 primary trigger fingers determined the efficacy and safety of steroid injection and found that 70% of all fingers showed resolution or improvement.
Abstract: A retrospective study of 235 patients with 338 primary trigger fingers determined the efficacy and safety of steroid injection. Initial treatment consisted of one to three injections of corticosteroid mixed with local anesthetic. Those fingers that failed injection therapy had conventional release of the first annular pulley. Seventy-seven percent of all fingers showed resolution or improvement; 49% after a single injection, 23% after two injections, and 5% after three injections.
TL;DR: Injection of steroids is the preferred initial treatment in de Quervain's disease, giving complete and lasting relief in 80% of cases and if injection fails, it appears likely that the extensor pollicis brevis tendon lies in a separate compartment.
Abstract: Ninety-one wrists in 82 consecutive patients with de Quervain's disease were treated by the one surgeon between 1978 and 1987. The treatment of 79 wrists in 71 patients who had received their entire treatment from this surgeon is analyzed. Uniformity of injection technique is thus ensured. Initial treatment in 63 wrists was an injection of steroids and local anesthetic into the tendon sheath, which gave complete relief in 45 cases. Seven wrists received two injections before the pain abated. Only 11 of the 63 injected wrists had an operation. In 10 of these the extensor pollicis brevis tendon was in a separate compartment. It is concluded that injection of steroids is the preferred initial treatment in de Quervain's disease, giving complete and lasting relief in 80% of cases. If injection fails, it appears likely that the extensor pollicis brevis tendon lies in a separate compartment.
TL;DR: Loss of flexion may be a more significant complication from extensor tendon injury than previously thought.
Abstract: A retrospective analysis was done in 62 patients with 101 digits having extensor tendon injury. Quality of outcome and parameters that might influence outcome were evaluated. The majority of patients were treated with conventional static splinting. Sixty percent of all fingers sustained an associated injury (fracture, dislocation, joint capsule or flexor tendon damage). Patients without associated injuries achieved 64% good/excellent results, and total active motion of 212 degrees. This difference was statistically significant (p less than 0.05). Distal zones (1 to 4) had a significantly poorer result than more proximal zones (5 to 8). The percentage of fingers losing flexion was greater than the percentage of fingers losing extension. In addition, the average degree loss of flexion was greater than the average degree loss of extension. This would seem to indicate that loss of flexion may be a more significant complication from extensor tendon injury than previously thought.
TL;DR: Carpal osteomyelitis, lunate avascular necrosis, pin-tract infection, progressive medial carpal translation, and intractable pain without arthrosis complete the spectrum of complications managed in this series.
Abstract: Goals of reducing wrist pain, allowing a stable active wrist range of motion, and retarding degenerative changes make arthrodesis of the scapho-trapezio-trapezoid joint a popular treatment for chronic static and dynamic scapho-lunate instability; however, pitfalls and complications have not been well studied. Forty-seven wrists in 46 patients over a 10-year period revealed a complication rate of 52%. Failure to attain perfect scaphoid reduction consistently resulted in persistent incapacitating pain. Radial styloid-scaphoid impingement, observed after “successful” limited wrist fusion, was effectively treated by simple styloidectomy. Carpal osteomyelitis, lunate avascular necrosis, pin-tract infection, progressive medial carpal translation, and intractable pain without arthrosis complete the spectrum of complications managed in this series. Careful preoperative patient screening and attention to detailed recommendations will assist surgeons in avoiding the many potential problems associated with this procedure.
TL;DR: Nineteen fresh cadaver wrists were divested of all dorsal and palmar tissues to the wrist capsule and extrinic and intrinsic ligaments and only when the entire palmar ligamentous structures were transected at the radius was radiopalmar tilt reestablished.
Abstract: Nineteen fresh cadaver wrists were divested of all dorsal and palmar tissues to the wrist capsule and extrinic and intrinsic ligaments. A Frykman VII type fracture was established across the radiocarpal and radioulnar joints. The dorsal and palmar wrist ligaments were left intact. The forearms were stabilized in an arm board and an external fixation device and traction applied through a Kirschner wire at the base of the third metacarpal. Three positions of wrist flexion; neutral, 15, and 30 degrees, with 10 and 20 pounds of traction were used to attempt to reestablish radiopalmar tilt. Only when the entire palmar ligamentous structures were transected at the radius was radiopalmar tilt reestablished. Ligamentotaxis alone is not a reliable method to reestablish radiopalmar tilt in intraarticular distal radius fractures.
TL;DR: Forty-three procedures on the proximal interphalangeal joint in 24 patients are retrospectively reviewed and radiographically evident bone resorption adjacent to the silicone implant was progressive over time.
Abstract: Forty-three procedures on the proximal interphalangeal joint in 24 patients are retrospectively reviewed. A diagnosis of erosive osteoarthritis accounted for 83% of the joints that had operation. Flexible silicone interposition, cemented Biomeric arthroplasty, or arthrodesis were done based on the individual functional needs of each patient and involved digit. All cemented Biomeric devices, preferentially implanted in the radial digits for optimal lateral stability, failed through the elastomer hinge at an average of 2.25 years after operation. Arthrodesis of the proximal interphalangeal joint in the radial digits provided greatest improvement in lateral pinch strength. Flexible silicone interposition arthroplasty in the ulnar digits provided an average flexion arc of 56 degrees with satisfactory pain relief. Although none required revision, radiographically evident bone resorption adjacent to the silicone implant was progressive over time; 35% of implants followed-up longer than 2 years demonstrated periarticular erosion and 20% followed-up beyond 4 years had extensive endosteal resorption along the intramedullary prosthetic stems. Surgical treatment of the osteoarthritic proximal interphalangeal joint remains an unsolved problem.
TL;DR: One hundred cases of comminuted fracture of the distal radius were treated by a simple uniform method consisting of distraction by an external fixator for 3 weeks followed by functional bracing, with excellent results after an average follow-up period of 20 months.
Abstract: One hundred cases of comminuted fracture of the distal radius were treated by a simple uniform method consisting of distraction by an external fixator for 3 weeks followed by functional bracing During the application of the external fixator, autogenous cancellous bone chips were taken from the iliac crest and packed into the fracture site to realign the juxtaarticular fragments and to fill up the bone gap. Complications have been minimal. The results, after an average follow-up period of 20 months, taking into consideration subjective assessment of pain, objective measurement of wrist motion, and radiologic angles, have been excellent
TL;DR: Successful treatment of scaphoid nonunions with screw fixation and cast-free after-treatment does not depend on the implant used but rather on careful case selection and precise surgical technique.
Abstract: The results of 20 established nonunions of the scaphoid treated with resection of the pseudoarthrosis, anterior cortico-cancellous iliac bone grafting, and conventional lag screw fixation with the ASIF 2.7 mm cortical screw are presented. Union rate was 95% and the average time off work was 8.9 weeks. Review of the relevant literature uniformly shoves that the most common reasons for failure are improper internal fixation techniques and/or the absence of bone grafting. Successful treatment of scaphoid nonunions with screw fixation and cast-free after-treatment does not depend on the implant used but rather on careful case selection and precise surgical technique.
TL;DR: An experimental study using six fresh-frozen cadaver specimens to demonstrate the radiographic changes seen on standard and stress wrist radiographs that correlate with the sequential sectioning of the scapholunate stabilizing ligaments showed significant ligamentous injury must occur before commonly used radiographic limits are exceeded.
Abstract: Although scapholunate diastasis with rotatory subluxation of the scaphoid (stage I perilunar instability determined by Mayfield's classification) has been studied by several investigators, the exact contribution of the supporting ligaments is still being defined. We designed and executed an experimental study using six fresh-frozen cadaver specimens to demonstrate the radiographic changes seen on standard and stress wrist radiographs that correlate with the sequential sectioning of the scapholunate stabilizing ligaments. The radioscapho-lunate ligament, the palmar scapholunate interosseous ligament, the dorsal scapholunate interosseous ligament, and the radiocapitate ligament were sectioned sequentially to simulate a progressive wrist injury caused by an extension, intercarpal supination and ulnar deviation force. The results showed significant ligamentous injury must occur before commonly used radiographic limits are exceeded. The lateral scapholunate angle most closely reflected the progressive nature of this injury.
TL;DR: To identify which patients are likely to respond the medical management of carpal tunnel syndrome, 331 hands in 229 patients were evaluated and a Phalen's test positive in less than 30 seconds was identified, identifying five factors which were important in predicting response to treatment.
Abstract: To identify which patients are likely to respond the medical management of carpal tunnel syndrome, 331 hands in 229 patients were evaluated. They were then treated with a wrist splint and anti-inflammatory medication. Follow-up averaged 15.4 months (minimum six months). Treatment was successful in 18.4%. Statistical evaluation identified five factors which were important in predicting response to treatment: age over 50 years, duration over ten months, constant paraesthesiae, stenosing flexor tenosynovitis, and a Phalen's test positive in less than 30 seconds. When none of these factors was present, two-thirds of patients were cured by medical therapy. 59.6% of patients with one factor, 83.3% with two factors, and 93.2% with three factors failed. No patient with four or five factors present was cured by medical management.
TL;DR: A decreased signal intensity from the proximal pole of the scaphoid may indicate a poor prognosis inasmuch as only three of the six patients had healing of the fracture even with bone grafting and internal fixation.
Abstract: In this study 12 male patients with fractures of the middle third of the scaphoid had an magnetic resonance imaging study before open reduction and internal fixation in conjunctin with bone grafting of the scaphoid. The patients' average age was 27 years (range, 17 to 37 years). At the time of surgery biopsy specimens were obtained from both the proximal and distal poles of the scaphoid. The length of time before surgery ranged from a minimum of 1½ months in recently displaced fractures to a maximum of 10 years in established nonunions. Results of the biopsy showed that six patients had avascular necrosis noted in the proximal pole fragment. In three of these six patients avascular necrosis was confirmed by the absence of tetracycline labeling despite positive uptake noted in biopsy specimens from the bone graft site; the other three patients did not receive tetracycline labeling. Magnetic resonance imaging showed that all six of the patients with biopsy specimens of the proximal poles showing avascular necrosis dcmonstrated decreased signal intensity in the proximal pole fragment, whereas the plain radiographs demonstrated changes in the proximal pole in only three of the six patients. A decreased signal intensity from the proximal pole of the scaphoid may indicate a poor prognosis inasmuch as only three of the six patients had healing of the fracture even with bone grafting and internal fixation.
TL;DR: The histologic lesions in flexor tendon synovium of 21 patients seen initially with idiopathic carpal tunnel syndrome have been studied and were typical of a connective tissue undergoing degeneration under repeated mechanical stresses.
Abstract: The histologic lesions in flexor tendon synovium of 21 patients seen initially with idiopathic carpal tunnel syndrome have been studied. The findings were similar in all biopsy specimens and were typical of a connective tissue undergoing degeneration under repeated mechanical stresses.
TL;DR: Injury to the A2 pulley of the flexor sheath, resulting in bow-stringing of the Flexor tendons, would appear to be fairly common in rock climbers performing at the present limits of difficulty.
Abstract: Injury to the A2 pulley of the flexor sheath, resulting in bow-stringing of the flexor tendons, would appear to be fairly common in rock climbers performing at the present limits of difficulty. A typical case is described.
TL;DR: Three distinct morphologic types of juncturae tendinum of the extensor tendons were identified in the dissection of 40 cadaver hands, which consisted of filamentous regions within the intertendinous fascia that attached to the ext sensor tendons on either side of the intermetacarpal space in a transverse or oblique direction.
Abstract: Three distinct morphologic types of juncturae tendinum of the extensor tendons were identified in the dissection of 40 cadaver hands. Type 1 juncturae consists of filamentous regions within the intertendinous fascia that attached to the extensor tendons on either side of the intermetacarpal space in a transverse or oblique direction. The second type, consists of much thicker and well-defined connecting bands. Type 3 juncturae consist of tendon slips from the extensor tendons and were subclassified into "y" or "r" subtypes depending on shape. Type 1 juncturae were present in 88% of the second intermetacarpal spaces and in 28% of the third intermetacarpal spaces. Type 2 juncturae were present in 40% of the third intermetacarpal spaces and in 23% of the fourth intermetacarpal spaces. Type 3 juncturae were present in 33% of the third intermetacarpal spaces and in 80% of the fourth intermetacarpal spaces. Juncturae were absent in all of the first intermetacarpal spaces and in 12% of the second intermetacarpal spaces; they were present in all other spaces. The extensor indicis proprius did not receive a junctural connection, whereas extensor digiti quinti tendons did receive junctural connections. Intertendinous fascia was present between all extensor digitorum communis tendons regardless of presence of juncturae.
TL;DR: Findings suggest that not only does early controlled passive motion not interfere with rate of early flexor tendon healing, but that earlycontrolled passive motion may improve healing efficiency.
Abstract: This study compared the effects of postoperative immobilization and early controlled passive motion on tensile properties of healing chicken flexor tendons during the initial 30 postoperative days. Results indicate (1) that controlled passive motion tendons had significantly greater values for rupture load, stress, and energy absorbed; (2) that both groups showed significant, and predictable changes, in strain, stiffness, and stress across this healing period; and (3) that there was no difference between the groups in rate of change for any of the tensile properties examined. These findings suggest that not only does early controlled passive motion not interfere with rate of early flexor tendon healing, but that early controlled passive motion may improve healing efficiency.
TL;DR: It is demonstrated that reconstruction of the tendon sheath, either by suture or autogenous graft, does not improve significantly the biomechanical, biochemical, or morphologic characteristics of repaired tendons treated with early motion rehabilitation.
Abstract: The healing response of flexor tendons treated with either sheath reconstruction or sheath excision, and early passive motion rehabilitation was investigated in a canine model. Flexor sheath repair, sheath excision, and autogenous sheath grafting were compared for biomechanical characteristics, and biochemical and ultrastructural alterations at the repair site at intervals over a 12-week period. No significant differences could be found in tendons treated with either sheath repair or sheath excision by biomechanical, biochemical, or morphologic assessments. Although ultimate load and linear slope values increased significantly in both groups at each interval ( p
TL;DR: Experimental study on human tendon specimens showed that the average tensile strength of tendon junctures was 4400 grams by double loop locking sutures and 2252 grams by Kessler's technique.
Abstract: This article describes a technique of tendon repair and two variations using double loop locking sutures. Experimental study on human tendon specimens showed that the average tensile strength of tendon junctures was 4400 grams by double loop locking sutures and 2252 grams by Kessler's technique. The study also showed that the weakest point of the tendon juncture by double loop locking sutures was the sutures.
TL;DR: The scaphoids-lunate, scaphoid- lunate-capitate, or capitate-l unate fusions, with attention to the relative carpal alignment within the limited fusion seem to offer more promise for treatment of perilunate instability biomechanically.
Abstract: An experimental model that uses a static positioning frame, pressure-sensitive film, and a microcomputer-based videodigitizing system was used to measure the contact areas and pressures in a group of wrists in their "normal" state, after ligament sectioning, which resulted in stage III perilunate instability and then following different types of simulated carpal fusions. Compared with a normal wrist, there is an overall decrease in load in the lunate fossa and a significant increase in load in the scaphoid fossa in the wrist with stage III perilunate instability. Scaphoid-trapezium-trapezoid and scaphoid-capitate fusions transmitted almost all load through the scaphoid fossa. Scaphoid-lunate, scaphoid-lunate-capitate, and capitate-lunate fusions all distributed load more proportionately through both scaphoid and lunate fossae. The positioning of the carpal bones within a limited carpal fusion was also found to affect the load distribution in the wrist. The scaphoid-lunate, scaphoid-lunate-capitate, or capitate-lunate fusions, with attention to the relative carpal alignment within the limited fusion seem to offer more promise for treatment of perilunate instability biomechanically than the scaphoid-trapezium-trapezoid or scaphoid-capitate fusions.
TL;DR: A septum is not unusual within the first dorsal compartment of the wrist and the effect of a separate compartment on the operative and nonoperative treatment of de Quervain's disease is discussed.
Abstract: A septum is not unusual within the first dorsal compartment of the wrist The right and left forearms of 50 cadavers were dissected A septum was identified 34% of the time The septum separated the abductor pollicis longus tendon from the extensor pollicis brevis tendon If the septum was present on one side, it was usually present on the other side The septum created a separate compartment for the extensor pollicis brevis tendon The effect of a separate compartment on the operative and nonoperative treatment of de Quervain's disease is discussed