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To avoid the extended anterior or the two-incision approach to the radius, we present a limited anterior approach for anatomical reattachment at the radial tuberosity of the distal biceps brachii tendon complete rupture using suture anchors. Our clinical experience in nine patients showed that secure fixation obtained with the suture anchors, limited surgical approach and anatomical reconstruction allow for early mobilization and rapid return of function, and provide excellent long-term results with acceptable complications. We suggest using the limited anterior approach in patients with early (less than 6 weeks) distal biceps brachii tendon rupture.

We present a series of 31 patients treated for complications following open carpal tunnel syndrome surgery over a time period of 10 years. The most frequent complications encountered were major nerve lacerations at the wrist and thenar followed by persistent and recurrent symptoms, neuroma formation and wound infection. All patients had primary treatment by a different approach, by different spectrum of training surgeons; in only one patient, the initial operating surgeon was an orthopedic surgeon in hand fellowship training. In ten patients, the typical approach to the carpal tunnel has been used at the initial operation; an excessive ulnar-directed incision and a long proximal- and radial-directed incision have been observed in ten and eight patients, respectively; a mini-open incision and an incision that crossed the wrist perpendicular to the flexion creases have been observed in one and two patients, each. Most complications of open carpal tunnel surgery can be prevented by specialized training in hand surgery of the operative surgeon and proper operative technique, including a properly placed incision and exposure under magnification and direct vision.

Purpose To compare the sensory results of patients with low median nerve complete transection and repair, with and without sensory re-education. Methods We studied 40 patients, aged 20 to 32 years, with low median nerve complete transection. Primary epineural repair using 8-0 single-strand sutures was done in all patients. Hands were immobilized in a splint for 4 weeks, followed by physical therapy for 1 month. At a mean of 3.5 months (range, 3-4 months) after surgery, when vibration sense (pallesthesia), using the 256-cycles-per-second tuning fork, was perceived at the fingertips of the 3.5 radial fingers innervated by the median nerve, the patients were randomly assigned to 2 equal groups: group A patients were rehabilitated with a sensory re-education program, and group B patients had no further treatment. Clinical evaluation at 18 months after surgery (range, 17.5-18.5 months) included locognosia (the ability to localize touch), the static and moving 2-point discrimination tests, and the Moberg pick-up test. Results All patients were included in the postoperative evaluation. Static and moving 2-point discrimination were not statistically significant between groups. Locognosia was significantly improved in group A, and a statistical trend was identified regarding the Moberg pick-up test in group A compared to group B. Conclusions Sensory re-education appeared to have significant value only in re-education of locognosia at 18 months after low median nerve complete transection and repair. (J Hand Surg 2009;34A:1210-1215. Copyright (C) 2009 by the American Society for Surgery of the Hand. All rights reserved.)

The healing and regeneration capacity of the injured tissues in childhood, adolescence, and adult life differs significantly. As a result, the prognosis of compound injuries of the upper limb in different age groups varies; therefore, the decision making and management of these cases should be age-specific. This article presents a series of 32 patients aged 1.5-14 years, with compound injuries of the upper limb that have been treated in our hospital during the period of the last 6 years. Ten of the above cases involved major vascular lesions that required revascularization or replantation. The injuries were classified according to the SATT (Severity, Anatomy, Topography, Type) classification system. This study shows that the outcome of compound upper limb injuries is age-related, while the SATT classification system is a valuable tool in the decision making process. Further research should be undertaken to determine age group-specific indications for the management of compound upper limb injuries, based on the SATT classification system. (C) 2008 Wiley-Liss, Inc.