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Noratep Kulachote,1 Paphon Sa-Ngasoongsong,1 Siwadol Wongsak,1 Kulapat Chulsomlee,2 Chavarat Jarungvittayakon,1 Praman Fuangfa,3 Viroj Kawinwonggowit,1 Pornchai Mulpruek1 1Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Background and purpose: Salvage hip arthroplasty (SHA) in patients presenting with failed internal fixation after intertrochanteric fracture (FIF-ITFx) is a difficult procedure, and the incidence of perioperative mortality and complications following SHA are high. To our knowledge, no information related to the correlation between perioperative surgical factors and post-SHA perioperative complications in these patients has been demonstrated. This study aimed to identify the predictive factors for post-SHA perioperative complications in patients with FIF-ITFx.Materials and methods: A total of 32 patients with FIF-ITFx who underwent SHA between 2010 and 2017 were retrospectively reviewed. All patients had been followed for 1 year postoperatively. Perioperative data and complication details related to fracture and treatment were collected. Predictive factors for post-SHA perioperative complications were analyzed via logistic regression analysis.Results: Two (6%) patients died after SHA during the admission period. Perioperative complications were found in 16 (50%) patients, including surgical (n=3, 9%) and medical (n=15, 47%) complications, respectively. By univariate analysis, age (P=0.043), American Society of Anesthesiologist (ASA) grade 4 (P=0.016), Charlson Comorbidity Index (CCI; P=0.014), lymphocyte cell count (P=0.064), and serum albumin level (P=0.146) were correlated with the perioperative complications. However, multivariate regression analysis showed that CCI was the only significant independent predictor for post-SHA perioperative complications in these patients (OR=1.87; 95% CI, 1.14–2.07, P=0.014).Conclusion: Our study showed that post-SHA perioperative complications in patients with FIF-ITFx are very common and predictable with a simple preoperative factor CCI. Therefore, special perioperative attention must be paid to patients with FIF-ITFx undergoing SHA and having multiple severe comorbid diseases or high CCI. Keywords: salvage hip arthroplasty, failed internal fixation, intertrochanteric fracture, osteoporosis, perioperative complication, Charlson Comorbidity Index

Kulapat Chulsomlee,1,2,* Paphon Sa-ngasoongsong,1,* Noratep Kulachote,1 Norachart Sirisreetreerux,1 Panithan Tuntiyatorn,1,2 Satetha Vasaruchapong,1 Sorawut Thamyongkit,1,2 Chavarat Jarungvittayakon,1 Siwadol Wongsak,1 Viroj Kawinwonggowit1 1Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Faculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Mahidol University, Bangkok, Thailand *These authors contributed equally to this work Introduction: The early rehabilitation and mobilization after hip arthroplasty (HA) in elderly femoral neck fracture (FNF) patients significantly reduces the postoperative morbidity and mortality. The direct anterior approach (DAA) without the muscle detachment has been shown to improve the early postoperative functional outcomes in coxarthrosis patients. However, the application of DAA on elderly FNF and the most suitable surgical technique have rarely been investigated. This study aimed to report the short-term outcome after our anterior-based muscle-sparing approach (ABMS) in elderly FNF.Materials and methods: A prospective study, in 40 elderly unilateral FNF patients who underwent HA with ABMS, was conducted. The primary outcomes were hip flexion and abduction power at each follow-up period. The contralateral muscle power, measured at 3 and 6 months, was used as the control value. The perioperative data and complications were recorded. Results: Thirty-two patients underwent bipolar hemiarthroplasty (BHA), while eight other patients received total hip arthroplasty (THA). The hip abduction power returned to control value at 6 weeks (99.0%±6.1%; 95% CI: 86.1–111.8). The hip flexion power returned to control at 3 months (108.5%±5.6%, 95% CI: 96.8–120.2). No iatrogenic nerve injury was found. The intraoperative femoral fracture (IFF) was found in 7 patients (17.5%), and was significantly related to the early period of learning skill (first 11 cases; p

Patellar fracture after total knee replacement (TKR) is one of the challenging problems in periprosthetic fracture. Open reduction with internal fixation (ORIF), as tension band wiring (TBW), usually required in cases with extensor mechanism disruption. However, many studies reported a high failure rate after using this technique. In this report, we presented an interesting case of periprosthetic patellar fracture after TKR with TBW failure that was successfully treated with double non-locking reconstruction plates fixation and TBW augmentation.

Chulsomlee K, Sa-ngasoongsong P, Kulachote N, et al Orthop Res Rev. 2018;10:31–39. The authors have advised that the note “*These authors contributed equally to this work” and the accompanying asterisks on the author names Kulapat Chulsomlee and Paphon Sangasoongsong need to be removed from the author list.The updated author list should therefore read: Kulapat Chulsomlee,1,2 Paphon Sa-ngasoongsong,1 Noratep Kulachote,1 Norachart Sirisreetreerux,1 Panithan Tuntiyatorn,1,2 Satetha Vasaruchapong,1 Sorawut Thamyongkit,1,2 Chavarat Jarungvittayakon,1 Siwadol Wongsak,1 Viroj Kawinwonggowit1 Read the original article

Objectives: To examine the patient outcomes of a comprehensive health education plus village health volunteer monitoring support program on older adults with knee osteoarthritis who are overweight and have type 2 diabetes., Methods: Quasi-experimental, two-group, pretest-posttest design was applied. Using random geographic cluster sampling, older adults who met the inclusion criteria were assigned to two groups, 62 in the intervention group and 71 in the control group. The intervention group received the comprehensive health education plus village health volunteer monitoring support program. The control group received only the comprehensive health education program. Study outcomes, including blood glucose level, knee pain and range of motion, body weight, physical ability (Timed Up and Go Test), fatigue, depressive symptoms, quality of sleep, and quality of life, were assessed at baseline, 3 months, and 6 months after enrollment and analyzed using descriptive statistics and multivariate analysis of variance., Results: One hundred and ten participants completed the study (55 participants in each group). Most patient outcomes in the two groups showed general improvement with statistical significance ( P  ≤ 0.001): pain decreased, physical ability improved, less depressive symptoms and fatigue, quality of life and sleep improved. The interaction effect (the group and time) demonstrated statistically significant differences between the intervention and control groups on pain, knee range of motion, and fatigue according to each time follow-up ( P  < 0.001)., Conclusions: The comprehensive health education plus village health volunteer monitoring support program promotes good patient outcomes in this population. The integrated health education resource and support for older adults with knee osteoarthritis and type 2 diabetes is an effective, non-surgical treatment that highlights professional nursing roles and non-professional roles-village health volunteers. Nurses should consider implementing a health education plus monitoring support program to mitigate the effects of chronic diseases and improve patients' quality of life., Competing Interests: The authors have declared no conflict of interest., (© 2022 The Authors.)

Background: Periprosthetic joint infection (PJI) remains challenging since a "gold standard" for diagnosis has not yet been established. This study aimed to evaluate the accuracy of synovial fluid procalcitonin (SF-PCT) and serum procalcitonin as a diagnostic biomarker for PJI and to compare its accuracy against standard methods., Methods: A prospective cohort study was conducted during 2015-2017 in 32 patients with painful hip or knee arthroplasty who have underwent revision surgery. Relevant clinical and laboratory data were collected. PJI was diagnosed based on the 2013 international consensus criteria. Preoperative blood sample and intraoperatively acquired joint fluid were taken for PCT measurement with a standard assay. Diagnostic accuracy was analyzed by the receiver-operating characteristic curve and the area under the curve (AUC)., Results: Twenty patients (62.5%) were classified as the PJI group, and 12 (37.5%) were classified as the aseptic loosening group. The median age was 68 years (range 38-87 years). The median values of SF-PCT and serum PCT in the PJI group were both significantly higher than those in the aseptic loosening group: the median serum PCT levels (interquartile range: IQR) were 0.33 ng/mL (0.08-2.79 ng/mL) in the PJI group compared with 0.04 ng/mL (0.03-0.06 ng/mL), and the median SF-PCT levels (IQR) were 0.16 ng/mL (0.12-0.26 ng/mL) in PJI group compared with 0.00 (0.00-0.00 ng/mL) ( p < 0.001, both). SF-PCT, with a cut-off level of 0.08 ng/mL, had an AUC of 0.87, a sensitivity of 90.0%, a specificity of 83.3%, and a negative likelihood ratio (LR-) of 0.12. Serum PCT, with a standard cut-off level of 0.5 ng/mL, had an AUC of 0.70, a sensitivity of 40.0%, a specificity of 100.0%, and a LR- of 0.60., Conclusion: SF-PCT appears to be a reliable test and could be useful as an alternative indicator or in combination with standard methods for diagnosing PJI.

Background. Recently, intra-articular tranexamic acid (IA-TXA) application has become a popular method for perioperative blood loss (PBL) reduction in total knee replacement (TKR). Nevertheless, through our knowledge, no previous studies had shown the correlation perioperative factors and the risk of excessive PBL or need of blood transfusion (BT) after IA-TXA. Materials and Methods. A retrospective study was conducted in patients underwent 299 primary TKRs, using IA-TXA, during 2-year period (2013-2014). Patient's characteristic and perioperative data were reviewed and collected. PBL was measured as total hemoglobin loss (THL), estimated total blood loss (ETBL), and drainage volume per kg (DV/kg). Excessive PBL was defined as PBL that exceeded 90th percentile. Results . From multivariate analysis, low preoperative hemoglobin (Hb) level and body mass index (BMI) were the significant predictors of postoperative BT ( p < 0.0001 and 0.003, resp.). Excessive THL significant associated with preoperative Hb ( p < 0.0001). Excessive ETBL significantly associated with preoperative Hb, height, preoperative range-of-motion, and creatinine clearance ( p < 0.05 all). Low BMI and large prosthesis size were the significant predictors of excessive DV/kg ( p = 0.0001 and 0.002, resp.). Conclusions . Low preoperative Hb and BMI were the significant risks of postoperative transfusion after TKR with IA-TXA. Moreover, multiple perioperative factors could result in higher PBL., Competing Interests: All of the authors declare that they have no conflict of interests.

Background: Patented crystalline glucosamine sulfate (pCGS) and diacerein monotherapy have been recommended for treatment of mild to moderate osteoarthritis (OA), but evidence of efficacy for combined treatments is lacking. Therefore, the aim of this study was to compare clinical outcomes (i.e., pain and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] score) at 6 months as well as the safety profile of treatment with combined pCGS and diacerein versus pCGS alone., Methods: A double-blind, parallel randomized controlled superiority trial was conducted between August 2013 and August 2014 at Ramathibodi Hospital, Bangkok, Thailand. A total of 148 patients (74 patients in each group) was randomly allocated to receive pCGS plus diacerein or pCGS plus placebo daily. Adult patients with OA were eligible if they had a Kellgren-Lawrence grade of 2-3. The primary outcomes were visual analogue scale score (VAS) for pain and WOMAC subscores measured at 24 weeks after receiving treatment, using the intention-to-treat principle (nonresponder imputation)., Results: Among the 148 patients in the study, mean age and body mass index were 60 years and 28.1 kg/m 2 , respectively. Mean VAS and minimal joint space width at baseline were 5.1 and 2.5 mm, respectively. The mean VAS values measured at 24 weeks were 2.97 and 2.88 in the pCGS plus diacerein and pCGS plus placebo groups, respectively. The estimated mean difference was 0.09 (95 % CI -0.75 to 0.94), which was not statistically significant (P = 0.710). In addition, the mean WOMAC total, pain, function, and stiffness scores for both groups were not significantly different, with corresponding means of 48.59, 12.02, 32.74, and 3.85 for the pCGS plus diacerein group and 48.69, 11.76, 32.47, and 4.16 for the pCGS plus placebo group. The risk of diarrhea and dyspepsia was very similar between the two groups, with risk ratios of 1.03 (95 % CI 0.56-1.89) and 0.91 (95 % CI 0.43-1.92), respectively., Conclusions: This study did not demonstrate that coadministration of diacerein with pCGS improves pain and WOMAC score compared with pCGS monotherapy in patients with mild to moderate OA of the knee., Trial Registration: ClinicalTrials.gov identifier: NCT01906801 . Registered on 20 July 2013.

Aim: To investigate the effect of early surgical intervention on the high surgical risk elderly patients who sustained femoral neck fracture (FNF) and taking concomitant antiplatelet agents., Methods: Between 2010 and 2012, a prospective study was conducted on 49 geriatric patients, who took antiplatelet agents, sustained FNF and underwent surgery within 72 h [early surgery (ES) group], and these were compared with a retrospective consecutive case series of patients with similar characteristics (45 cases) who had delayed surgery (DS group) after 72 h during an earlier 3-year period. Postoperative outcomes were followed for one year and compared., Results: There were non-significant differences in perioperative blood loss, blood transfusion, intensive care unit requirement and postoperative mortality (P > 0.05 all). There were 2 patients (4%) in the DS group who died after surgery (P = 0.23). However, the ES group showed a significantly better postoperative outcome in terms of postoperative complications, length of hospital stay, and functional outcome (P < 0.05 all)., Conclusion: Early hip surgery in geriatric hip fracture patients with ongoing antiplatelet treatment was not associated with a significant increase of perioperative blood loss and postoperative mortality. Moreover, ES resulted in a better postoperative surgical outcome. In early hip surgery protocol, the antiplatelet agents are discontinued and the patient is operated on within 72 h after admission, which is safe and effective for the medically fit patients.

Objective: To compare the outcome of early hip surgery in intertrochanteric fracture between high surgical risk patients receiving antiplatelet and anticoagulant drugs and those who did not., Design: Retrospective study., Material and Method: One hundred and four elderly patients with intertrochanteric fracture and having American Society of Anesthesiologist grade III-IV who underwent early hip surgery (within 72 hours after admission) with proximalfemoral nail anti-rotation (PFNA), were recruited and allocated into two group: antiplatelet and anticoagulant (AA-AC) group (n = 65), and no drug group (n = 39). Perioperative and postoperative outcomes were recorded and analyzed., Results: The mean age was 81?8 years. The overall 1-year mortality was 6.7% (7 patients: 5 AA-AC group, and 2 no drug group, p = 0.7). Intra-operative blood loss in AA-AC group and No drug group were 87 ± 70 and 91 ± 65 ml, respectively (p = 0.74). There was no significant difference in blood transfusion, postoperative complications, and 1-year ambulatory status between both groups (p > 0.05 all). However, AA-AC group showed significant longer in duration of hospital stay compared with no drug group (p = 0.02)., Conclusion: Early hip fracture surgery with PFNA in patients who received antiplatelet and anticoagulant medications is safe and does not significantly increase perioperative blood loss, blood transfusion, and postoperative mortality and morbidity.

Background: Recently, combined intra-articular tranexamic acid (IA-TXA) injection with clamping drain method showed efficacy for blood loss and transfusion reduction in total knee replacement (TKR). However, until now, none of previous studies revealed the effect of this technique on pharmacokinetics, coagulation, and fibrinolysis., Materials and Methods: An experimental study was conducted, during 2011-2012, in 30 patients undergoing unilateral TKR. Patients received IA-TXA application and then were allocated into six groups regarding clamping drain duration (2-, 4-, 6-, 8-, 10-, and 12-hours). Blood and drainage fluid were collected to measure tranexamic acid (TXA) level and related coagulation and fibrinolytic markers. Postoperative complication was followed for one year., Results: There was no significant difference of serum TXA level at 2 hour and 24 hour among groups (p < 0.05). Serum TXA level at time of clamp release was significantly different among groups with the highest level at 2 hour (p < 0.0001). There was no significant difference of TXA level in drainage fluid, postoperative blood loss, blood transfusion, and postoperative complications (p < 0.05)., Conclusions: Low-dose IA-TXA application in TKR with prolonged clamping drain method is a safe and effective blood conservative technique with only minimal systemic absorption and without significant increase in systemic absorption over time.

Objective: To demonstrate the new sensory restoration technique in radial nerve injury using the first branch of dorsal ulnar cutaneous nerve as the donor sensory nerve., Material and Method: Forty formalin-preserved cadavers (18 males and 22 females) were used as the subjects of the present study. The localization of the origin of first branch of dorsal ulnar cutaneous nerve was performed. The measurement was done to determine the origin of this nerve in relation to the tip of ulnar styloid. The simulated transfer was done. The length of the superficial radial nerve that had to be cut was determined. The measurement was done by two observers to determine the reliability of measurement., Results: The mean horizontal distance (X) to the origin of first branch of dorsal ulnar cutaneous nerve measured from the tip of ulnar styloid on the right and left side were 5.22 mm and 6.51 mm respectively. The mean vertical distance (Y) to the origin of first branch of dorsal ulnar cutaneous nerve measured from the tip of ulnar styloid on the right and left side were -7.72 mm and -4.37 mm respectively. The mean length of superficial radial nerve that had to be cut to allow tension free anastomosis, measured from the tip of radial styloid on the right and left side were 68.21 mm and 65.92 mm respectively. The estimated average size of the transferred branch of ulnar cutaneous nerve was about 70% of the size of superficial radial nerve., Conclusion: The sensory restoration in radial nerve injury using sensory nerve transfer from the first branch of dorsal ulnar cutaneous nerve was technically feasible regarding to the comparable size between two nerves and anatomic consistency of the first branch of dorsal ulnar cutaneous nerve.

Background: Recently, a number of studies using intra-articular application of tranexamic acid (IA-TXA), with different dosage and techniques, successfully reduced postoperative blood loss in total knee replacement (TKR). However, best of our knowledge, the very low dose of IA-TXA with drain clamping technique in conventional TKR has not been yet studied. This study aimed to evaluate the effectiveness and dose-response effect of two low-dose IA-TXA regimens in conventional TKR on blood loss and blood transfusion reduction., Methods: Between 2010 and 2011, a triple-blinded randomized controlled study was conducted in 135 patients undergoing conventional TKR. The patients were allocated into three groups according to intra-articular solution received: Control group (physiologic saline), TXA-250 group (TXA 250 mg), and TXA-500 group (TXA 500 mg). The solution was injected after wound closure followed by drain clamping for 2 hours. Blood loss and transfusion were recorded. Duplex ultrasound was performed. Functional outcome and complication were followed for one year., Results: There were forty-five patients per groups. The mean total hemoglobin loss was 2.9 g/dL in control group compared with 2.2 g/dL in both TXA groups (p > 0.001). Ten patients (22%, control), six patients (13%, TXA-250) and none (TXA-500) required transfusion (p = 0.005). Thromboembolic events were detected in 7 patients (4 controls, 1 TXA-250, and 2 TXA-500). Functional outcome was non-significant difference between groups., Conclusions: Combined low-dose IA-TXA, as 500 mg, with 2-hour clamp drain is effective for reducing postoperative blood loss and transfusion in conventional TKR without significant difference in postoperative knee function or complication., Trial Registration: ClinicalTrials.gov NCT01850394.

Purpose: To examine the impact of an integrated health education and exercise program on knee osteoarthritis knowledge, self-efficacy expectations, behaviors, and health outcomes including severity of knee symptoms, muscle strength, joint range of motion, and body mass index in middle-aged adults with knee osteoarthritis., Design/method: Sixty-five participants were assigned to either Group 1 or Group 2. Both groups received a 1-day health education program followed by a facilities-based exercise program for Group 1 and a supervised home-based exercise program for Group 2, 3 times a week for 12 weeks., Results: Participants in each group had a significant improvement in study variables at 2-, 8- and 12-week follow-ups compared with baseline assessment. There were no significant differences in study variables between the 2 groups, except muscle strength and right knee flexion., Implication: Integrated health education with either a facilities-based or supervised home-based exercise program is beneficial for patients with knee osteoarthritis.

A high-dose local tranexamic acid has been introduced in total knee arthroplasty for bleeding control. We are not sure about the systemic absorption and side effects. The aim of this study was to evaluate the effect of low dosage of intra-articular tranexamic acid injection combined with 2-hour clamp drain in minimally bleeding computer-assisted surgery total knee replacement (CAS-TKR). A prospective randomized controlled trial was conducted in a total of 48 patients underwent CAS-TKR. The patients were randomly assigned to receive either of a mixed intra-articular solution of tranexamic acid 250 mg with physiologic saline (TXA group), or physiologic saline (control group) and then followed by clamp drain for 2 hours. Postoperative blood loss was measured by three different methods as drainage volume, total hemoglobin loss and calculated total blood loss. Transfusion requirement and postoperative complications were recorded. All patients were screened for deep vein thrombosis and the functional outcomes were evaluated at 6 months after surgery. The mean postoperative drainage volume, total hemoglobin loss and calculated total blood loss in TXA group were 308.8 mL, 2.1 g/dL and 206.3 mL compared to 529.0 mL, 3.0 g/dL and 385.1 mL in the control group (P=0.0003, 0.0005 and <0.0001 respectively). Allogenic blood transfusion was needed for one patient (4.2%) in TXA group and for eight patients (33.3%) in the control group. Postoperative knee scores were not significantly different between groups. No deep vein thrombosis, infection or wound complication was detected in both groups. In this study, low dose intra-articular tranexamic acid injection combined with 2-hour clamping drain was effective for reducing postoperative blood loss and transfusion requirement in CAS-TKR without significant difference in postoperative complications or functional outcomes.

Background: Accurate preoperative templating to predict implant size and position can facilitate precise, efficient, and reproducible knee replacement operations. Preoperative templating for total knee arthroplasty can be performed with digital images of the knee implants on digital radiographs of the knee., Objective: To determine the accuracy of knee implants sizing predicted by digital images., Material and Method: A retrospective study was done to assess the accuracy of the knee implant sizing predicted by digital images in 100 Thai adults, who had osteoarthritis of the knee. Digital anteroposterior and lateral radiographs of the knee were used in measuring the level of distal femoral resection and the level of proximal tibial resection. Anteroposterior and mediolateral diameter of femur and tibia were determined and the implant size was choosen. The results from digital images were compared with the size of actual femoral and tibial implants used at the time of surgery. All variables were analyzed. The correlation coefficients were calculated to determine interobserver and intraobserver reliability., Results: The accuracy of digital preoperative plans for femoral component was 53.1%. The accuracy of digital preoperative plans for tibial component was 59.3%. The digital preoperative planning predicted 79 of 81 (97.6%) femoral implants to within one size and predicted 77 of 81 (95.1%) measurements of the tibial implants to within one size., Conclusion: Digital images can help to focus the thoughts and plans of the operation. When planning is performed, it can identify extremes of sizes that may require special order, and planning can predict size mismatches between femoral and tibial implants. When recognized ahead of time, these limitations can be accommodated during the surgical procedure or a different implant system chosen. Predicting implant sizes to within one size allows efficient anticipation by the orthopaedic surgeon.

The purpose of this study was to translate the original English version of the Self-Efficacy and Outcome Expectations Scales for Exercise and Functional Activity and to establish their reliability in older Thai adults in geriatric rehabilitation. This study used a correlational design with repeated measures. Reliability of the Self-Efficacy for Exercise Scale (SEES), the Self-Efficacy for Functional Activity Scale (SEFAS), the Outcome Expectations for Exercise Scale (OEES), and the Outcome Expectations for Functional Activity Scale (OEFAS) developed by Resnick was measured in 20 older adults aged 60 years or older after hip or knee replacement or another orthopedic surgery of their lower extremity. All scales were translated into Thai and back translated into English according to the process described by Marin and Marin. The instruments were administered twice--the 1st and 2nd day in the participants' geriatric rehabilitation program (i.e., the 4th and 5th postoperative day). Results indicated that there was sufficient evidence for internal consistency of the SEES, SEFAS, OEES, and OEFAS with alpha coefficients of 0.84, 0.86, 0.70, and 0.86 respectively. Test-retest reliability of the tools was also demonstrated with Spearman correlation coefficients of 0.84 for the SEES, 0.87 for the SEFAS, 0.61 for the OEES, and 0.54 for the OEFAS. The findings from this study provide important information for instrument adaptation and the applicability of these scales for further studies of older Thai adults.

Background: In brachial plexus injury, elbow flexion is the first priority in reconstruction. Neglected cases need functioning free muscle transplantation that requires the donor nerve to supply the transplanted muscle. The purpose of this study was to investigate the effects and results of transferring one fascicle of the ulnar nerve to the transplanted gracilis muscle., Methods: One woman and two men with neglected avulsions of the C5,C6 roots of the brachial plexus underwent free gracilis muscle transfer for elbow flexion. One fascicle of the ulnar nerve was used as the donor nerve., Results: The mean period of follow-up was 33.3 months. The average reinnervation time of gracilis muscle was 3.7 months. At the final examination, the mean strength of elbow flexion was 4.3 kgf. The grip strength, moving two-point discrimination and the strength of the wrist volar flexion on the affected side was not worse than before surgery in any patient at the last follow-up examination., Conclusions: A fascicle of the ulnar nerve can be one of the most effective options for functioning free muscle transplantation for elbow flexion.

Five male patients with avulsions of the C5 and C6 roots of the brachial plexus underwent transfer of one fascicle of the median nerve to the motor branch of the biceps muscle. The mean period of follow-up was 32 months. The average reinnervation time of the biceps was 3.4 months. Four patients achieved biceps strength of Medical Research Council (MRC) grade 4, and one patient had strength of the biceps of MRC grade 3. The mean period of time from surgery to MRC grade 3 was 9 months. At the last follow-up examination, grip strength, pinch strength, moving two-point discrimination, and strength of wrist volar flexion on the affected side were not worse than before the operation in any patient., (Copyright 2003 Wiley-Liss, Inc.)

From 1992 to 1998, 1630 patients with trigger digits were studied. The ratio of female to male patients was 6:1. The average age of the patients was 51.8 years. The thumb was the most frequently involved digit. The index and little fingers were relatively spared. More than two trigger digits in one hand or more than four trigger digits in both hands were found only in patients whose body mass index (BMI) were obese and morbidly obese.

The association of age, sex and the number of sides of carpal tunnel syndrome were studied in 250 patients. The mean age of the patients with bilateral involvement was more than unilateral involvement (t = 2.48, p < 0.05). A statistically significant association was found between age and the number of sides of carpal tunnel syndrome (chi-square = 16.707, p < 0.05). There was also statistical significance in association of sex and the number of sides of carpal tunnel syndrome (chi-square = 10.2398, p < 0.01). The association of age, sex and the number of sides of carpal tunnel syndrome found in the study may help the prediction of diagnosis and natural history of the disease.

The prospective study was performed in 250 patients with carpal tunnel syndrome. The mean body mass index (BMI) of patients with bilateral carpal tunnel syndrome was more than that of patients with unilateral carpal tunnel syndrome (t = 6.84, p < 0.001). There was no statistically significant difference between the mean BMI of patients with right carpal tunnel syndrome and that of patients with left carpal tunnel syndrome. In conclusion, BMI may be used to predict the number of sides of carpal tunnel syndrome.

Twenty-four patients with root avulsion of brachial plexus were treated with the contralateral C7 root transfer. The area of sensory abnormalities was found on the thumb in 20 cases (83.33%), index finger in 14 cases (58.33%), middle finger in 8 cases (33.33%), ring finger in 3 cases (12.5%), little finger in 11 cases (45.83%), on the radial side of forearm in 9 cases (37.5%), thenar area in 12 cases (50%), and hypothenar area in 8 cases (33.33%). No patient had normal sensation after the seventh cervical root transfer. Sensory abnormalities disappeared within 3 months in all except one patient, who still had sensory abnormalities on the tip of index finger for more than 20 months after the operation., (Copyright 1999 Wiley-Liss, Inc.)

Twenty patients with brachial plexus injury have been treated with one fascicle nerve transfer to the bicipital branch of the musculocutaneous nerve for reconstruction of elbow flexion. The mean distance from the medial epicondyle to the origin of this branch is 17.9 centimeters. The correlation coefficient and test of statistic significance between distance and heights of patients is 0.76 and 5.07 respectively (t18, 0.995 = 2.88). There is no correlation between the arm span, weight, age and the distance.