1/37. thumb reconstruction in a bilateral upper extremity amputee: an alternative to the Krukenburg procedure.A 23-year-old man sustained traumatic loss of both hands. His left defective forearm underwent lengthening with a 3-cm segment of the ipsilateral radius; this was immediately followed by an ipsilateral second toe microvascular transfer to the stump of the radius to provide pinch. Two years after the procedure the reconstructed hand had recovery of both motion and sensibility.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/37. Optimizing the correction of severe postburn hand deformities by using aggressive contracture releases and fasciocutaneous free-tissue transfers.Severe postburn hand deformities were classified into three major patterns: hyperextension deformity of the metacarpophalangeal joint of the fingers with dorsal contracture of the hand, adduction contracture of the thumb with hyperextension deformity of the interphalangeal joint, and flexion contracture of the palm. Over the past 6 years, 18 cases of severe postburn hand deformities were corrected with extensor tenotomy, joint capsulotomy, and release of volar plate and collateral ligament. The soft-tissue defects were reconstructed with various fasciocutaneous free flaps, including the arterialized venous flap (n = 4), dorsalis pedis flap (n = 3), posterior interosseous flap (n = 3), first web space free flap (n = 3), and radial forearm flap (n = 1). Early active physical therapy was applied. All flaps survived. Functional return of pinch and grip strength was possible in 16 cases. In 11 cases of reconstruction of the dorsum of the hand, the total active range of motion in all joints of the fingers averaged 140 degrees. The mean grip strength was 16.5 kg and key pinch was 3.5 kg. In palm reconstruction, the wider contact area facilitated the grasping of larger objects. In thumb reconstruction, key-pinch increased to 5.5 kg and the angle of the first web space increased to 45 degrees. Jebsen's hand function test was not possible before surgery; postoperatively, it showed more functional recovery in gross motion and in the dominant hand. Aggressive contracture release of the bone,joints, tendons, and soft tissue is required for optimal results in the correction of severe postburn hand deformities. Various fasciocutaneous free flaps used to reconstruct the defect provide early motion, appropriate thinness, and excellent cosmesis of the hand.- - - - - - - - - - ranking = 3keywords = motion (Clic here for more details about this article) |
3/37. Use of a venous flap from an amputated part for salvage of an upper extremity injury.The authors describe a patient in whom a large arterialized venous flap was harvested from a nonreplantable part after partial hand amputation. A 9 x 6-cm segment of dorsal hand skin was transplanted acutely in an artery-vein-vein fashion to cover exposed bone, joints, and reconstructed tendons. The flap provided durable coverage, and at 1 year the patient regained 94% total active motion at the index finger and 99% total active motion at the long finger. Salvage of component parts such as a venous flap and extensor tendons avoided additional procedures for coverage and staged tendon reconstructions.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
4/37. Traumatic axial dislocation of the carpus: a case report of transscaphoid pericapitate transhamate axial dislocation.Traumatic axial dislocation of the carpus in a 20-year-old man is described. This injury was accompanied by a crushing injury to the hand. The disruption pattern was different from those of previously reported cases. Despite the restoration of painless wrist motion postoperatively, grip strength remained below normal. Early accurate reduction, fixation, and range of motion (ROM) exercise are the treatment of choice in such complex injuries.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
5/37. Effect of 3M Coban Self-Adherent Wraps on edema and function of the burned hand: a case study.edema and limited function are common acute problems associated with hand burns. This case study examined the effects of 3M Coban Self-Adherent Wraps on edema and function in a 59-year-old male (46% TBSA flame injury) with newly skin grafted dorsally burned hands. At the time of each dressing change, circumferential measurements were taken of both hands and weekly active range of motion and grip strength measurements were recorded. The nine-hole peg test was used to appraise dexterity. During the 4-week study period, there was less edema, greater active range of motion and grip strength, and greater dexterity in the hand with 3M Coban Self-Adherent Wraps as compared with the control hand. This case study suggests that 3M Coban Self-Adherent Wraps were effective in reducing edema in the skin-grafted hand after skin grafting. It further appeared that the reduced edema may have contributed to improved hand function and that 3M Coban Self-Adherent Wraps as a compressive dressing do not impede hand function- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
6/37. Pyramid of progressive force exercises to the injured flexor tendon.Postoperative rehabilitation for patients who have sustained a laceration to their flexor tendon apparatus is an important factor in maximizing functional outcome. Quality rehabilitation is characterized by the development of a tailored exercise regimen. There is currently no model available to tailor an exercise regimen for a person with an atypical physiologic response pattern. If rehabilitation protocols were classified according to the criteria of forces applied across a tendon juncture and/or excursion, and a clinical method were available to assist in the identification of optimal tendon loading and/or excursion application, then those individuals with atypical response patterns could be treated more efficiently and effectively. The author conducted a literature review and case study. A model for systematic application of progressive loading exercises to the intrasynovial flexor tendon injury and repair is conceptually developed. The model consists of a pyramidal series of eight specific rehabilitation exercises in the following sequence: passive protected extension, place and hold, active composite fist, hook and straight fist, isolated joint motion, resistive composite fist, resistive hook and straight fist, and resistive isolated joint motion. Concepts are developed to implement a three-point clinical adhesion-grading system. Clinical application of the system is highlighted. An excellent outcome was considered 112% total active motion. A model for systematic application of progressive loading exercises has been conceptually developed in concert with a method for determination of optimal tendon loading. Further substantiation is necessary to validate the proposed theory.- - - - - - - - - - ranking = 3keywords = motion (Clic here for more details about this article) |
7/37. Free vascularized joint transfer from the nonreplantable digit as a free flap for primary reconstruction of complex hand injury.We report our experience in treating a a patient with an electrical saw injury to the right hand that resulted in incomplete amputation of the ring and small fingers at the metacarpophalangeal (MCP) joint with segmental tissue loss. Ray amputation of the small finger was performed because of extensive tissue loss. The proximal interphalangeal joint of the nonreplantable small finger was transferred as a fillet flap for primary reconstruction of the severely damaged MCP joint of the ring finger after revascularization. Two years after surgery active range of motion of the reconstructed MCP joint was 35 degrees extension to 85 degrees flexion with no instability or pain.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/37. Toe-to-thumb transfer: a new technique.Our technique combines the advantages of two proven techniques of the wraparound flap and vascularized joint transfer while offering a more normal thumb, both functionally and cosmetically. Its advantages are as follows: 1. A more normal-looking thumb with good length 2. Preservation of motion through joint transfer 3. maintenance of growth potential through transfer of vascularized epiphyses 4. Minimal donor-site morbidity- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/37. Use of maxillary miniplates and screw system in the treatment of hand fractures: a preliminary report.The vast majority of hand fractures can be adequately treated with techniques such as closed reduction and external splinting or with a variety of internal fixation devices. Choice of stabilization methods depends on individual surgical preference, fracture location, and the geometry of the bony injury. Fracture stabilization that allows early mobilization is advantageous in achieving rapid bone healing and restoration of function by minimizing joint and tendon complications. Rigid internal fixation with miniplates and screws permits stabilization and compression of fracture segments, thereby permitting early bone loading and motion. Although the role of rigid internal fixation with miniplates and screws in hand fractures is well documented in the literature, in this article we present our preliminary experience with Howmedica's (Rutherford, NJ) Luhr vitallium miniplate and screw system in treating hand injuries.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/37. Traumatic segmental bone defects in the upper extremity. Treatment with exposed grafts of corticocancellous bone.We treated twenty-two consecutive patients for an open fracture and segmental loss of bone in the upper extremity by delayed insertion of a graft of iliac corticocancellous bone. All of the wounds were left open and healed by secondary intention. Sixteen patients (nineteen grafts) had long-term follow-up. Ten injuries were secondary to a gunshot wound. The ten patients (twelve grafts) who had an injury to the hand were followed for an average of 24.1 months. No patient in this group had an infection, and all had primary union after an average of 13.3 weeks. Nine had a satisfactory result. The other six patients (seven grafts) had an injury to the arm or forearm and were followed for an average of 30.2 months. There were four non-unions, one refracture, and no persistent infections. The final result was satisfactory in five and unsatisfactory in one patient. Fourteen of the nineteen grafts were inserted within seventeen days after the initial injury. All nine of the grafts in the hand that were inserted early did well, but three of the other five (in the arm or forearm) became infected. The method that was used in the patients who had an open injury of the hand allowed early active motion and quick rehabilitation. The exposed cortical bone was not prone to infection. The technique has limited application in patients who have an open injury of the arm or forearm because of a high incidence of complications.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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