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Calcaneus Deformity
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Christopher Prior, Nicholas Peterson, Selvadurai Nayagam
Increasing strength of ankle plantarflexion Tendon transfer Tibialis anterior transfer to Achilles tendon (Peabody)2Flexor digitorum longus (FDL) to Achilles tendonPlication of the over-lengthened Achilles tendonIncrease the lever arm of the gastroc-soleus by a calcaneal proximal displacement osteotomy
Peripheral Nerve Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Mohammed Tahir Ansari, Santanu Kar, Devansh Goyal, Dyuti Deepta Rano, Rajesh Malhotra
Radial nerve examination needs a systematic approach which needs to be supplemented with a battery of tests. The examination is directed not only on the diagnosis of the disease but it should help in making a decision about further management. A recovering radial nerve can be identified by diligent examination. The nerve exploration or tendon transfer is a tricky decision. The type of tendon transfer can be determined by the availability of the tendons. The palmaris longus must be examined as its absence can lead to a change in plan about the type of tendon transfer. Investigations further help as a supplement for the diagnosis and management plan. Radiographs, CT scans, EDT, HFU and MRN are usual investigations, which should be chosen on a case-by-case basis.
Hands
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Nerve injury is the most common indication for tendon transfer – tendon is attached to the parent muscle, but insertion is moved to another tendon or bone. Others include the following: Muscle/tendon injury secondary to trauma or other disease (see also ‘RA’)Spastic disorders (see also ‘cerebral palsy’)Polio – wait 6 months for any recoveryLeprosy – disease must be under control
Immediate tendon transfer for functional reconstruction of a dorsal forearm defect after sarcoma resection
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Ryo Karakawa, Hidehiko Yoshimatsu, Yuma Fuse, Kenta Tanakura, Tomohiro Imai, Masayuki Sawaizumi, Tomoyuki Yano
A 74-year-old male suffered from soft tissue sarcoma on the dorsal aspect of the left forearm (Figure 3(a)). Additional surgical wide resection followed by immediate tendon transfer was planned. Surgical wide resection, including the extensor compartment muscles (EDC, EDM, ECRL, ECRB, EPL) and posterior interosseous nerve, was performed (Figure 3(b)). A preoperatively planned tendon transfer was performed. Transfers of the FCR to the EDC and the EDM, and the PL tendon to the EPL were performed (Figure 3(c–e)). The size of the defect after tumor ablation was 11.5 × 12.5 cm. The skin defect was covered using an 11 × 18 cm superficial circumflex iliac artery perforator (SCIP) free flap (Figure 3(f)). The posterior interosseous artery and vein were used as recipient vessels. The resected mass was confirmed to be a UPS. The same rehabilitation as with case 1 was performed. Within 21 months, the patient returned to normal activity with full fist motion, pinch of the thumb and little finger, DIP joint extension of 0°, PIP joint extension of 5°, MP joint extension of 5° and thumb IP joint extension of 0°. The MSTS score was 27 (Figure 4).
Pull-in suture: a novel reconstruction technique for tendon avulsion injury at the musculotendinous junction associated with forearm open fracture
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Yuta Izawa, Yoshihiko Tsuchida, Hiroko Murakami, Tetsuya Shirakawa, Masahiro Nishida, Kentaro Futamura
While there are some reports that tendon transfer for tendon rupture at the musculotendinous junction has achieved the same range of motion as the uninjured side, there are also many reports that the range of motion has decreased by about 30 degrees compared to the uninjured side [8]. The three patients in this study had postoperative outcomes comparable to those reported for tendon transfer. Our pull-in suture method differs from that for conventional end-to-end or buried sutures, which have been reported to have poor outcomes, in that the suture on the proximal side is applied to the intact fascial part that can be firmly fixed. Avoiding damaged fascia and proximal suturing can prevent re-rupture of the muscle tendon. Givissis et al. reported a tendon reconstruction method similar to that of the pull-in suture [15]. They reported good postoperative outcomes by encapsulating the tendon stump in the proximal muscle body for an FPL avulsion injury at the musculotendinous junction. Unlike simple sutures, encapsulation is considered to have achieved the same good outcomes as the pull-in suture in terms of the repaired tendon achieving appropriate tension and strength.
Radial nerve palsy following humeral shaft fracture: a theoretical PNF rehabilitation approach for tendon and nerve transfers
Published in Physiotherapy Theory and Practice, 2022
Lauren Fader, John Nyland, Hao Li, Brandon Pyle, Kei Yoshida
This theoretical treatment approach might be effective following either tendon or nerve transfer. However, following tendon transfer, longer duration repair protection is needed, and after nerve transfer, longer duration motor re-education is needed. The axiom of neuropsychologist Donald Hebb (1949) that “if neurons fire together, they wire together” takes longer to become manifest post-nerve transfer as the peripheral nerve reinnervation and cortical neuroplasticity that improves hand-wrist function progresses more slowly with complete recovery sometimes exceeding 12–18 months (Davidge, Yee, Kahn, and Mackinnon, 2013; Mackinnon, Roque, and Tung, 2007). Rehabilitation post-nerve transfer progresses more quickly when the transferred nerve is synergistic to the recipient muscle group and when repair tension is negligible within normal upper extremity range of motion. This theoretical rehabilitation approach provides guiding principles that can help with future clinical research designs for this patient group.