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Surgery of the Hand
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Norbert Kang, Ben Miranda, Dariush Nikkhah
Zone 7: Free excursion of the repaired extensor tendon must be confirmed under the retinaculum. If necessary, the retinaculum is divided to allow free movement of the tendon but preserving as much of it as possible intact prevents later bow-stringing. The repair is now tested by passively flexing and extending the finger. There must be no gapping of the repair and it must glide freely through the full excursion of the tendon.
Fascial Anatomy
Published in David Lesondak, Angeli Maun Akey, Fascia, Function, and Medical Applications, 2020
Similar to aponeuroses, retinacula consist of collagen fibers arranged in layers with each layer oriented in a different direction. A retinaculum is a network or grid of collagen fibers arranged according to multiple lines of traction that, at the same time, slide independently from one another. Smooth sliding of retinacula layers is extremely important for proper proprioception and pain reduction.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The arterial supply from the ligamentum teres contributes more significantly in childhood. The obturator artery gives off a branch via the ligamentum teres, which provides a negligible blood supply to the femoral head in adults. Lateral and medial circumflex femoral arteries supply the femoral head via retinacula, which reflect back in longitudinal bands over the hip capsule. Vessels from the diaphysis of cancellous bone provide a significant arterial blood supply in adulthood. Fractures that are intracapsular have a high risk of resultant avascular necrosis of the femoral head, as it is separated from the trochanteric anastomosis; peritrochanteric fractures leave this anastomosis undisturbed, and thus avascular necrosis is less likely. Slipped femoral epiphysis in children may disrupt the ligamentum teres, which provides a significant arterial blood supply to the femoral head in this age group – this is seen in Perthes disease.
Quality of life and satisfaction in patients surgically treated for cubital tunnel syndrome
Published in Neurological Research, 2023
María Elena Córdoba-Mosqueda, Lukas Rasulić, Andrija Savić, Jovan Grujić, Filip Vitošević, Milan Lepić, Aleksa Mićić, Stefan Radojević, Stefan Mandić-Rajčević, Ivana Jovanović, Carlos Alberto Rodríguez-Aceves
The retinaculum forms the cubital tunnel; it straddles a gap of about 4 mm between the medial epicondyle and the olecranon. The capsule and the posterior band of the medial collateral ligament of the elbow joint create the floor of the tunnel [1] (Figure 1). Cubital tunnel syndrome (CuTS) is the second-most common nerve compression syndrome [2,3]. The incidence is 25 cases per 100,000 person-years, affecting up to 6% of the population [3]. It occurs more often at the end of the fifth decade [4]. Several factors such as gender, low or high body mass index (BMI), smoking, alcohol, occupation, repetitive arm motion, education level, sporting activities, hobbies, previous fracture around the elbow or subluxation of the elbow joint, Diabetes Mellitus (DM), hypothyroidism, and hypertension have been associated with the development of ulnar nerve compression [4,5].
Volar transfer of the lateral band with transverse retinacular ligament is effective for the correction of swan-neck deformity caused by volar plate injury of the PIP joint
Published in Modern Rheumatology Case Reports, 2020
Masahiro Sato, Taku Suzuki, Takuji Iwamoto, Noboru Matsumura, Hiroo Kimura, Kazuki Sato, Masaya Nakamura, Morio Matsumoto
Surgery was performed with digital block anaesthesia. A dorsal longitudinal incision was made on the PIP joint and both lateral bands were located dorsally (Figure 4(A)). The ulnar transverse retinacular ligaments were released from the dorsal attachment and elevated with the volar base flap (Figure 4(B)). The ulnar lateral band was released from the central slip and transferred to the volar side (Figure 4(C)). Transverse retinacular ligaments were sutured slightly volar to the original attachment to maintain the lateral band in a more volar position (Figure 4(D)). Snapping was not improved with the active motion of the finger intraoperatively. Therefore, the same procedure performed on the ulnar side was performed for the radial side. After the radial procedure, active motion of the finger confirmed disappearance of snapping with 0° of extension and full flexion of the PIP and DIP joint (Figure 4(E)).
5-year-old child with late discovered traumatic patellar tendon rupture—a case report
Published in Acta Orthopaedica, 2018
Jesper Holbeck-Brendel, Ole Rahbek
Surgery with repair of the patellar tendon was proposed due to the reduced extension force. It was performed under general anesthesia. The patellar tendon was elongated and shredded, particularly in the distal part were a complete rupture was seen. The proximal two-thirds of the tendon was macroscopically normal and was surgically exposed. The distal part was resected. The lateral and medial retinacula were intact. The periosteum on the tibial tuberosity was surgically exposed and 2 periosteal flaps were made. The patella could be repositioned to a normal position compared with the right side. 2 5.0 Mitek anchors (DePuy Synthes Sports Medicine (Mitek), Raynham, MA, USA) with screw threads were placed in the proximal epiphysis of the tibia with fluoroscopic guidance. The tendon was pulled down and sutured with Vicryl 0 (Ethicon Inc., Somerville, NJ, UA) to the Mitek anchors with appropriate tension compared with the right side. We confirmed the correct placement of the patella central in the femoral groove with fluoroscopic guidance. The strength of the repair was tested by passive knee flexion, which was possible up to 30 degrees when tension increased. A DonJoy brace (DJO Global, Vista, CA, USA) was placed allowing 0–20 degrees of flexion to protect against hyperflexion trauma. Mobilization with full loading on the operated leg was allowed immediately after surgery, but the boy was instructed to refrain from other physical activities.