Search

Introduction: Surgical intervention through the ‘triangle of auscultation’ is less morbid to patients, as it is devoid of muscles and provides an easy access to tumours arising on the ventral aspect of scapula especially near inferior angle. Method: Three patients presented to us with pseudo-winging of scapula and an audible thud on abduction of the arm. A bony mass, painful in two and painless in one patient, was palpable along the anterior aspect of the inferior angle of scapula. A clinical diagnosis of osteochondroma was made which was corroborated by X-rays and computed tomography (CT) imaging. Ventral scapular osteochondroma excision is challenging due to multiple muscle attachments, requiring extensive soft tissue dissection and muscular release. Numerous blood vessels and nerves in the vicinity may also add to the degree of difficulty. This necessitates the need of a minimally invasive and muscle-sparing procedure. We hereby describe a novel surgical approach to the ventral aspect of scapula through the triangle of auscultation for excision of scapular osteochondroma. Results: Pseudo-winging disappeared following surgery. Snapping of the scapula resolved with early, full shoulder range of motion. Quick disabilities of arm, shoulder and hand (DASH) score improved from mean 20.2 preoperatively to 0 postoperatively at 3 months in all the patients. Conclusion: The approach is simple with minimal blood loss as it does not involve splitting or cutting of trapezius, rhomboid major or subscapularis muscles.

Aim: Early tendon transfer has shown good outcomes in peripheral nerve injuries of upper limb. However, there is lack of knowledge on early tendon transfer for peripheral nerve palsy in lower limb. This study has been designed to study the functional outcomes of early tendon transfer in the lower limb, particularly for foot drop. Patients and Methods: We enrolled 30 cases of foot drop due to traumatic sciatic/common peroneal nerve (CPN) palsy between September 2012 and March 2016. We performed nerve exploration with repair and early tendon transfer in all patients. All patients were followed up for a minimum period of 24 months. Functional evaluation was carried out using Stanmore assessment questionnaire. Results: At the end of 24 months postoperatively, the Stanmore assessment questionnaire score showed a significant improvement from a mean preoperative score of 17.5 to mean postoperative score of 86.2. All patients were free of ankle–foot orthosis (AFO). All patients were subjectively satisfied. Time to return to original job was 5.2 months on an average. Ankle dorsiflexion of the operated limb was comparable to the normal limb in cases where there was nerve recovery. Planovalgus foot, a known complication of this procedure, was noted in 24 patients. However, it was not disabling to any patient. Conclusion: Early tendon transfer in CPN palsy/sciatic nerve palsy has a definite place in the management of the injured patient. The transfer, if appropriately carried out, acts as a helper, an internal splint, a substitute, or perhaps all of the three at varying times in the rehabilitative phase of the patient. Dorsiflexor clearance in swing phase of locomotion was quickly restored in all patients, obviating the need for AFO.

Purpose. To evaluate the outcome after single tendon transfer of the flexor carpi ulnaris (FCU) to the digital extensors for high radial nerve palsy. Methods. Records of 10 patients aged 16 to 43 (median, 27) years who underwent single tendon transfer of the FCU to the digital extensors for high radial nerve palsy secondary to closed (n=4) or open (n=4) diaphyseal humeral fractures or deltoid injection (n=2) were reviewed. Two of the patients with open fractures also underwent treatment for non-union in a staged manner. Grip strength (power grip and precision grip) was measured monthly using an automated dynamometer. The range of motion of the wrist, and metacarpophalangeal joints of the thumb and fingers was measured monthly using a goniometer. Results. All patients were followed up for at least one year. Preoperatively, the overall power grip strength of the injured hands was about 1/5 of the normal hands. At 12 months, the mean improvement was 202.5% for overall power grip strength and 43% to 57% for precision grip strength parameters. Compared with the normal hands, the mean deficit of the operated hands was 39% for overall power grip strength and 32% to 37% for precision grip strength parameters. At 12 months, mean wrist extension was 50.4°, with about 10° lag in finger and thumb extension. The mean total active motion was 86.7° in the operated wrists and 128.1° in normal wrists. The decrease in wrist flexion and ulnar deviation was 7.8° and 6.8°, respectively. Conclusion. Single tendon transfer of the FCU is a viable option to restore hand function and strength following high radial nerve injuries.