Biomechanical Study Comparing Pulvertaft, Double Side-to-Side, and Locking Side-to-Side Tendon Suture Techniques.

Purpose: In this study, we present a single-sided locking side-to-side (STS) suture technique as a possible alternative for the Pulvertaft weave in tendon transfers. The aim of the study was to compare the biomechanical characteristics of the single-sided locking STS reconstruction with Pulvertaft and double-sided nonlocking STS reconstructions.

Methods: Twenty-four human cadaveric extensor digitorum communis tendons and 24 flexor digitorum superficialis tendons were randomly assigned to 1 of 3 groups, resulting in a total of 8 flexor tendons and 8 extensor tendons per group: Pulvertaft, double-sided nonlocking STS, and single-sided locking STS reconstructions.

Extensor pollicis longus rerouting for thumb-in-palm deformity in cerebral palsy: a biomechanical analysis.

Extensor pollicis longus rerouting is a common procedure to improve thumb abduction in thumb-in-palm deformity seen with spastic cerebral palsy. In 1985, Manske redirected the extensor pollicis longus tendon in this procedure through the first extensor compartment. They also proposed an alternative subcutaneous route around the extensor pollicis brevis and abductor pollicis longus tendons proximal to the extensor compartment.

Effects of Upper-Extremity Surgery on Manual Performance of Children and Adolescents with Cerebral Palsy: A Multidisciplinary Approach Using Shared Decision-Making.

Background: Little is known about the effects of upper-extremity surgery on the manual performance of children and adolescents with cerebral palsy (CP). This clinical cohort study describes our experience with patient selection based on multidisciplinary assessment and shared decision-making and the effects of upper-extremity surgery on manual performance and patient-relevant outcomes.

Methods: All patients (up to 20 years of age) with CP referred to our multidisciplinary team for evaluation for upper-extremity surgery between July 2011 and May 2017 were included.

[Complicated course of a felon: prevention is better than surgical reconstruction].

Infections of the hand can result in significant limitation of the function of the hand, and may even require partial amputation of a digit. A felon is an abscess of the distal pulp of the fingertip, which can spread rapidly through the flexor tendon sheath when not treated appropriately. Knowledge of the anatomy and the correct method of physical examination are essential when assessing a patient suspected of having a felon or flexor tendon sheath infection.

Connective Tissue Degeneration: Mechanisms of Palmar Fascia Degeneration (Dupuytren's Disease).

Dupuytren's disease is a connective tissue disorder of the hand causing excessive palmar fascial fibrosis with associated finger contracture and disability. The aetiology of the disease is heterogeneous, with both genetic and environmental components. The connective tissue is abnormally infiltrated by myofibroblasts that deposit collagen and other extracellular matrix proteins.

A microcosting study of the surgical correction of upper extremity deformity in children with spastic cerebral palsy.

Objective: Determine healthcare costs of upper-extremity surgical correction in children with spastic cerebral palsy (CP).

Method: This cohort study included 39 children with spastic CP who had surgery for their upper extremity at a Dutch hospital. A retrospective cost analysis was performed including both hospital and rehabilitation costs.

Short-term and Long-term Clinical Results of the Surgical Correction of Thumb-in-Palm Deformity in Patients With Cerebral Palsy.

Background: Thumb-in-palm deformity disturbs a functional grip of the hand in patients with cerebral palsy. Reported recurrence rates after surgical correction are contradicting and earlier studies are limited to short-term follow-up. Therefore, the aim of this retrospective clinical outcome study is to evaluate the success rate of surgical correction of thumb-in-palm deformity around 1 year and at a minimum of 5 years follow-up.

Intramuscular connective tissue differences in spastic and control muscle: a mechanical and histological study.

Cerebral palsy (CP) of the spastic type is a neurological disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks. Secondary to the spasticity, muscle adaptation is presumed to contribute to limitations in the passive range of joint motion. However, the mechanisms underlying these limitations are unknown.

Unusual radial nerve injury by a locking compression plate for humerus fracture.

The management of primary and secondary radial nerve palsy associated with humeral shaft fractures is still controversial. Radial nerve function is likely to return spontaneously after primary as well as secondary radial nerve palsy in the absence of any level of neurotmesis. Identification and protection of the radial nerve during surgery may prevent secondary nerve palsy, but is not always performed and depends on the location of the fracture, and the experience and preference of the surgeon.

Geometrical adaptation in ulna and radius of cerebral palsy patients: measures and consequences.

Background: The presence of significant forearm bone torsion might affect planning and evaluating treatment regimes in cerebral palsy patients. We aimed to evaluate the influence of longstanding wrist flexion, ulnar deviation, and forearm pronation due to spasticity on the bone geometries of radius and ulna. Furthermore, we aimed to model the hypothetical influence of these deformities on potential maximal moment balance for forearm rotation.

Biceps brachii can add to performance of tasks requiring supination in cerebral palsy patients.

The aim of this study was to assess whether cerebral palsy patients can use biceps brachii for supination during movement tasks requiring supination and pronation. 3D upper extremity kinematic and EMG-data of 12 patients (mean age 13 y 8 mo ± 36 mo) were compared to 10 healthy age-matched controls. Significant difference in biceps brachii activation between maximal isolated pronation and supination in both groups showed that it is possible for CP patients to use biceps brachii for supination.

Why is joint range of motion limited in patients with cerebral palsy?

Patients with spastic cerebral palsy of the upper limb typically present with various problems including an impaired range of motion that affects the positioning of the upper extremity. This impaired range of motion often develops into contractures that further limit functioning of the spastic hand and arm. Understanding why these contractures develop in cerebral palsy will affect the selection of patients suitable for surgical treatment as well as the choice for specific surgical procedures.

Flexor carpi ulnaris tenotomy alone does not eliminate its contribution to wrist torque.

Background: Flexor carpi ulnaris muscle tenotomy and transfer to the extensor side of the wrist are common procedures used to improve wrist position and dexterity in patients with cerebral palsy. Our aim was to determine whether this muscle still influences wrist torque even after tenotomy of its distal tendon.

Methods: Intra-operatively, we determined in vivo maximal wrist torque in hemiplegic cerebral palsy patients (n=15, mean age 17 years) in three conditions: 1) with the arm and the muscle intact; 2) after tenotomy of the flexor carpi ulnaris just proximal to the pisiform bone, with complete release from its insertion; and 3) after careful dissection of the belly of the muscle from its fascial surroundings up until approximately halfway its length.

Reliability of in vivo determination of forearm muscle volume using 3.0 T magnetic resonance imaging.

Purpose: To apply magnetic resonance imaging (MRI) as a tool for quantifying muscle volume of forearm muscles feasibility and reliability of volume estimation of the flexor carpi ulnaris (FCU) and the extensor carpi ulnaris (ECU).

Materials And Methods: Forearms of 10 subjects were scanned twice. Muscle volumes were calculated from manual outlines on axial slices, slice thickness, and the number of slices.

Long-term results of lateral band translocation for the correction of swan neck deformity in cerebral palsy.

Purpose: The aim of this study was to evaluate the long-term effect of lateral band translocation for correcting swan neck deformity in patients with cerebral palsy at a minimum follow-up of 5 years.

Methods: Swan neck deformities of 62 fingers were corrected using a modified lateral band translocation. At 1-year and 5-year follow-up, any recurrence of hyperextension was recorded through nonconstrained evaluation.

Specific volume of female subcutaneous abdominal tissue as a reference in autologous breast reconstruction.

Use of the deep inferior epigastric perforator (DIEP) flap is gaining popularity as the method of choice for breast reconstruction and replacement of prosthetic breast implants. Ideally, the volume of the prosthesis is replaced by the same volume of autologous tissue to restore shape and symmetry. Still, intraoperative tissue volumetry is not practical under sterile circumstances.

Clinical application and outcome of the segmental pectoralis major free flap in five head and neck patients.

Background: Although microsurgical transplantation of the sternocostal segment of the pectoralis major muscle shares most of the advantages of the latissimus dorsi free flap, the latter has become a workhorse of microsurgery and the segmental pectoralis major free flap has not. By presenting their clinical experience with primary transplantations of this free flap to reconstruct craniofacial defects, the authors intend to draw more attention to its application and promote its use in reconstructive surgery.

Methods: Segmental pectoralis major free flaps were used for reconstruction of craniofacial defects in four male oncologic patients and one female trauma patient with a mean age of 55 years (range, 37 to 68 years).

[Effect of surgical treatment on patients with cerebral palsy: improvement of manual dexterity but not of perceived competence].

Objective: To examine the relationship between impaired manual dexterity and perceived competence in children with cerebral palsy and the effect of surgical intervention, with the question whether the perceived competence is applicable as an outcome measure for surgical reconstruction of hand function.

Method: The Dutch version of the Michigan Hand Outcomes Questionnaire (MHQ-DLV) for perceived manual dexterity and the Dutch version of the Harter Scales for perceived competence were used in a sample of 25 children and adolescents with hemiplegic cerebral palsy of the spastic type. 10 patients underwent surgical treatment to improve hand function.

Assessment of Flexor carpi ulnaris function for tendon transfer surgery.

Active and passive length-force curves of spastic flexor carpi ulnaris (FCU) muscles were intra-operatively measured in 10 patients with cerebral palsy to study the variability in FCU muscle function. Maximum active FCU force was in general situated near the neutral position of the wrist and varied between 40 and 135 N. Passive forces varied between 1 and 8 N at maximum active force.

The results of surgical excision and adjuvant irradiation for therapy-resistant keloids: a prospective clinical outcome study.

Background: There is no consensus on the best way to treat keloids, because adequate studies on this subject are sparse. Surgical excision in combination with radiotherapy is considered the most efficacious treatment available in severe keloids following the International Clinical Recommendations on Scar Management. Unfortunately, the recommendations are mainly based on retrospective studies that do not define recurrence.

Myofascial force transmission and tendon transfer for patients suffering from spastic paresis: a review and some new observations.

The current rationale of clinical practice in spastic tendon transfer surgery is based on four assumptions: (1) changes in muscle fiber length (serial number of sarcomeres) determine the available length range and joint excursion, (2) muscle cross-sectional area determines the maximal force output, (3) fiber length and muscle force are invariable functions of muscle length, (4) there is an invariable relation between the elastic force and the active force exerted by the sarcomeres. The validity of these assumptions is discussed. Additionally, some new perspectives in muscle research are discussed and myofascial force transmission is introduced as a co-determinant for the outcome of tendon transfer by presenting some exploratory observations.

Movement patterns of the upper extremity and trunk associated with impaired forearm rotation in patients with hemiplegic cerebral palsy compared to healthy controls.

The aim of this study was to objectively assess the relationship between impaired forearm rotation and movement patterns of the upper arm and trunk in patients with hemiplegic cerebral palsy. For this purpose, 'extrinsic forearm rotation' was introduced as a parameter to quantify the cumulative result of all movements that supplement forearm rotation. The results of three-dimensional video analysis of the upper extremity and trunk in different reaching tasks in eight male and two female patients (mean age, 16 years and 2 months) were compared to those of 10 case-matched controls.