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We report on the clinical history of a young male laborer with Lichtman Stage II Kienbock disease, who underwent a scaphocapitate arthrodesis after a failed silicone lunate prosthesis. After 35 years of follow-up, no further surgical intervention has been warranted despite progression of radiocarpal and ulnocarpal arthritis. [ABSTRACT FROM AUTHOR]

Background: Since the Sauvé-Kapandji procedure was introduced in 1936, many modifications were created using dynamic stabilizer, such as the ECU (extensor carpi ulnaris), the FCU (flexor carpi ulnaris), pronator teres to solve proximal ulnar stump pain. We believe that this modification is also another option for distal ulnar stump instability. Methods: From January 1998 to February 2017, there were 13 patients received the Sauvé-Kapandji (S-K) procedure with tenodesis of the ECU to the carpus and interosseous membrane. The average age at operation was 52 years (range, 28 to 63 years). Four had traumatic arthritis (two from distal radial fracture malunion, two had instability of distal radioulnar joint from Essex-Lopresti injury), four had primary osteoarthritis of the distal radio-ulnar joint, two had rheumatoid arthritis, one had gouty arthritis, two had madelung deformity. The average follow-up was 30 months (range, 15 to 72 months). Results: Postoperative pronation/supination of the forearm had significantly improved with the exception of the wrist flexion/extension. After surgery, the mean radioulnar distance was narrowed from 11 mm to 9 mm, but no significant difference in 12 patients. All patients had improved in wrist pain, 10 patients had no pain and 3 patients with mild pain over the distal ulnar stump. The mean grip strength had significantly improved from 51% of the contralateral side to 75%. The lateral and stress X-ray films showed no instability of the distal ulnar stump after surgery. Conclusions: In conclusion, the modified S-K procedure using the tenodesis of ECU provides a multi-directional stability and is a reliable surgical procedure for distal radioulnar disorders. [ABSTRACT FROM AUTHOR]

Background: The Pulvertaft weave was described more than 50 years ago and is still used in tendon transfers. The aim of this study was to evaluate the strength of a modified core suture Pulvertaft weave technique and compare it to the original Pulvertaft weave traditionally used in tendon transfer surgery. Methods: 12 extensor pollicis longus tendons and extensor indices proprius tendons were harvested from fresh frozen cadavers. Six Pulvertaft weaves were performed using FiberWire 4.0 and six core suture tendon weave were performed using FiberLoop 4.0. Biomechanical analysis was performed and stifness, first failure load and ultimate failure load were measured for both set of repairs. Results: The stiffness of the core suture tendon repair (9.5 N/mm) was greater than that of the Pulvertaft repair (2.5 N/mm) The first failure load of the core suture tendon repairs (68.9 N) was greater than the Pulvertaft repairs (19.2 N) and the ultimate failure load of the core suture tendon repairs (101.8 N) was greater than the Pulvertaft repairs (21.9 N). All of these differences were statistically significant. Conclusions: The core suture Pulvertaft weave is a modification to the Pulvertaft weave used in tendon transfers. The results of this cadaveric study suggest it is 5 times stronger than the traditional Pulvertaft repair, potentially allowing it to be used with early active motion protocols after tendon transfers. [ABSTRACT FROM AUTHOR]

We present two rare microsurgical reconstructions. A case with phocomelia was treated with lengthening of soft tissues following vascularized fibula grafting with epiphysis, and a case with cleft hand was reconstructed with spare‐part toe transfer. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to explore the potential risk factors associated with the failure of an upper extremity replantation with a focus on cigarette or tobacco use. Patients and Methods: A cohort of 102 patients with 149 replants (6 extremities, 143 digits) and a mean age of 41 years (range 5 to 72 years) was enrolled in this study. The data collected included age, gender, tobacco/cigarettes use, trauma mechanism, underlying disease (e.g., hypertension (HTN), diabetes mellitus (DM), etc.), and vein graft use. An analysis with a multivariable regression was conducted to identify the risk factors of replant failure and their respective odds ratios (ORs). Results: Multilevel generalized linear mixed models (GLMMs) with a binomial distribution and logit link showed that smoking did not increase the risk of replant failure (p = 0.234). In addition, the survival of replants was not affected by DM or HTN (p = 0.285 and 0.938, respectively). However, the replantation results were significantly affected by the age of the patients and the mechanism of injury. Patients older than 50 years and those with avulsion or crush injuries tended to have a higher risk of replant failure (OR = 2.29, 6.45, and 5.42, respectively; p = 0.047, 0.028, and 0.032, respectively). Conclusions: This study showed that the use of cigarettes/tobacco did not affect the replantation outcome. The main risks for replant failure included being older than 50 years and the trauma mechanism (avulsion or crush injuries). [ABSTRACT FROM AUTHOR]

The purpose of this study is to report the clinical results after repair of flexor tendon zone II injuries utilizing a 6-strand double-loop technique and early post-operative active rehabilitation. We retrospectively reviewed 22 patients involving 51 cases with zone II flexor tendon repair using a six strand double loop technique from September 1996 to December 2012. Most common mechanism of injuries was sharp lacerations (86.5 %). Tendon injuries occurred equally in manual and non-manual workers and were work-related in 33 % of the cases. The Strickland score for active range of motion (ROM) postoperatively was excellent and good in the majority of the cases (81 %). The rupture rate was 1.9 %. The six strand double loop technique for Zone II flexor tendon repair leads to good and excellent motion in the majority of patients and low re- rupture rate. It is clinically effective and allows for early postoperative active rehabilitation. [ABSTRACT FROM AUTHOR]

We present a case of quadrilateral space syndrome (QSS) in a patient with left arm pain. The patient sustained a trauma to his left arm, and QSS was successfully diagnosed by physical examination, magnetic resonance image, electromyographic evaluation, and nerve conduction studies. Surgery was performed to decompress the axillary nerve and the patient recovered fully with minimal residual symptoms. [ABSTRACT FROM AUTHOR]

We compared carpal tunnel release using a radial sided approach (RCTR) with a two-incision approach with regards to complications, grip strength, and functional outcomes. Retrospective chart review was done and data was collected pre-operatively, and post-operatively at six weeks and three months. A total of 32 and 26 patients were included in the two-incision and RCTR groups respectively. At six weeks, the RCTR group showed an increased grip strength (+32.24%) while the two-incision group was weaker (-6.75%). Both groups showed an increased strength at three months, RCTR at 98.4% while the two-incision group was significantly lower at 38.6% increase. Both techniques provided improvement in outcome scores, with no statistical difference. RCTR was associated with a significantly earlier return of grip strength and had better grip strength at six weeks and three months post-operatively. Both techniques provided symptom relief and good functional outcome. [ABSTRACT FROM AUTHOR]

Background: Various options exist for the surgical management of cubital tunnel syndrome. The goals of this study were to compare the outcome of four different surgical techniques: (1) simple decompression, (2) endoscopic decompression, (3) anterior subcutaneous transposition, and (4) anterior sub-muscular transposition for the treatment of cubital tunnel syndrome. Methods: One hundred ten patients (117 cases) with cubital tunnel syndrome were reviewed from 1986 to 2000. Parameters measured included signs and symptoms, medical comorbidity, other nerve compressions, and anatomical pathology. Severity was evaluated using the Dellon classification and the symptom severity score (SSS). SSS included evaluation of pain, clawing, the Froment sign, and the Wartenberg sign. Bishop's rating was measured at final follow-up. Statistical analysis included ANOVA, Kruskal-Wallis tests, and Spearman's Rho for correlation. Results: Correlation between severity of nerve compression and symptom duration was not statistically significant. A significant weak positive correlation existed between Dellon score and SSS. Bishop's rating was 46.5 % excellent, 39.5 % good, 7.9 % fair, and 6.1 % poor overall. A significant weak negative correlation existed between the Dellon score and Bishop's rating. The average Bishop score was 1.74 ± 0.85, and no significant difference existed when comparing each surgical technique to one another. No significant association was found between the severity of compression (Dellon) and the surgery type performed. A weak negative correlation existed between severity of ulnar nerve compression and clinical outcome. No significant differences were found between the type of surgeries performed in regard to outcome and Dellon score. Conclusions: We found patients with the most severe compressive symptoms benefited the least from operative intervention regardless of surgical technique used. However, for mild to moderate disease, performing any of the purposed surgical techniques in accordance with the physician's experience and comfort level is adequate in treating ulnar nerve compression at the elbow joint. Level of Evidence Level IV, therapeutic study [ABSTRACT FROM AUTHOR]

The problem of size discrepancy between vessels during microvascular procedures is well known. Inability to successfully overcome this problem can lead to turbulent flow at the anastomotic site with consequent thrombosis. Various techniques have been described to overcome this problem. We describe two techniques that have been used for over two decades in our institution. Both these techniques enable the surgeon to overcome far more significant size mismatches than other available techniques while still allowing for end-to-end anastomosis. [ABSTRACT FROM AUTHOR]

The results of three different surgical techniques used for the treatment of 46 ruptures of the distal biceps brachii tendon in 45 patients were evaluated and compared. Mean follow-up time was 14 months. The 46 ruptures were categorised according to the surgical technique used for treatment. In Group I, 17 arms were treated using two incisions and transosseous suture fixation; in Group II, 19 patients were treated using bone-anchor fixation; and in Group III, ten patients were treated using a tie-on-button technique. After treatment, 41 patients (89.1%) had full active range of motion (ROM) and 38 patients (82.6%) had excellent or good strength. The results after treatment in all three groups were satisfactory. Though the outcomes of these techniques were similar, operative time, time to return to regular activity, and time to return to work was shorter in the bone-anchor and tie-on-button groups than that in the two-incision transosseous fixation group. [ABSTRACT FROM AUTHOR]

Multiple entrapment neuropathy is compression of more than two nerves in the same extremity. In this case series, 169 patients (208 upper extremities) with this condition were identified, and 124 patients (138 upper extremities) had surgical decompression after an ineffective course of conservative treatment. There were 31 men and 93 women. Average age was 41 years (range 20-87 years). Follow-up averaged 23 months (range 12 to 60 months). Our rating system included patients' self-assessment of overall symptom improvement and return to activity and a physician assessment of strength (grip and pinch) and sensibility (recovery of two-point discrimination). A total of 92 patients (67%) achieved good to excellent results. The clinical features of multiple entrapment neuropathy in our series were presented with a variety of nerve compression syndromes and with a high incidence of regional musculotendinous syndromes. In our surgical treatment, we emphasise simultaneous release of all possible compression sites with a minimally invasive endoscopic approach to achieve better results. [ABSTRACT FROM AUTHOR]