The versatility of the Supinator to Posterior Interosseus Nerve (SPIN) transfer: Indications and outcomes, a Case Series.

Background: Transfer of the supinator motor branches to the posterior interosseous nerve (SPIN) was first described as a reliable method of restoration of digit extension in cases of paralysis when there is retained function in the 5th and 6th cervical nerve roots with loss of function in the 8th cervical nerve root.

Methods: We performed a retrospective review of all the SPIN transfers that were performed in our unit which included 16 limbs in 14 patients over a 6-year period. The median age was 49 years (range 22-74).

Ten Myths in Nerve Surgery.

Background: Surgical innovation has provided new options for the management of complex peripheral nerve injuries, generating renewed interest in this field. Historic literature may be misinterpreted or misquoted, or create dogma, which is perpetuated in teaching, research publications, and clinical practice. The management of peripheral nerve injuries is based on complex decision-making, with potential lifelong ramifications for patients incorrectly receiving an expectant or surgical management plan.

Lumbosacral Plexogram: An Aid to Reconstructive Nerve Possibilities in the Lower Extremity.

The lumbosacral plexus is the network of nerves responsible for the motor and sensory function of the pelvis and lower limb. Our observation is that the anatomy of this plexus is less familiar to surgeons than that of the brachial plexus. Damage to the lumbosacral plexus and its terminal branches may have a significant impact on locomotion, posture, and stability.

The Clinical Outcomes of Spinal Accessory to Suprascapular Nerve Transfer Through a Posterior Approach.

Background: Spinal accessory nerve (SAN) to suprascapular nerve (SSN) transfer can restore function to the rotator cuff following brachial plexus injuries. The traditional anterior approach using the lateral branch of the SAN causes denervation of the lateral trapezius limiting shoulder elevation. Suprascapular nerve pathology at the suprascapular notch may be missed resulting in poor reinnervation of the rotator cuff.

Outcomes Following Surgery for Common Peroneal Nerve Intraneural Ganglion Cysts: A Case Series and Systematic Review.

Background: Intraneural ganglia are a rare cause of common peroneal nerve palsy. Although several treatment modalities exist, surgical intervention is recommended, especially in the setting of neurological dysfunction. We present a case series and systematic review on the clinical outcomes following surgical excision of common peroneal nerve intraneural ganglia.

Resect, rewire, and restore: Nerve transfer salvage of neurological deficits associated with soft tissue tumors in a retrospective cohort series at a tertiary reconstructive center.

Aims: We aimed to explore the effectiveness of nerve transfer as an intervention to restore neurological deficits caused by extremity tumors through direct nerve involvement, neural compression, or as a consequence of oncological surgery.

Methods: A retrospective cohort study of consecutive cases was conducted, including all patients who underwent nerve transfers to restore functional deficits in limbs following soft tissue tumor resection. The threshold for a successful nerve transfer was a BMRC motor grade of 4/5 and sensory grade of 3-3+/4 with protective sensation.

Tendon Transfer versus Nerve Transfer for the Reconstruction of Key Pinch and Grip Strength in Isolated High Traumatic Injuries of the Ulnar Nerve: A Systematic Review.

Primary repair for traumatic injuries to the ulnar nerve alone does not always restore satisfactory hand function, particularly in injuries above the elbow where the long distances for regeneration limit motor reinnervation. Reductions in key pinch and grip strength are some of the main complaints. Tendon transfers have traditionally been used to improve key pinch and grip strength as a late salvage where primary nerve regeneration has run its course.

Pathological findings identified during the posterior approach to the spinal accessory nerve after high-energy trauma.

The spinal accessory to suprascapular nerve transfer is a key procedure for restoring shoulder function in upper brachial plexus injuries and is typically undertaken via an anterior approach. The anterior approach may miss injury to the suprascapular nerve about the suprascapular notch, which may explain why functional outcomes are often limited. In 2014 we adopted a posterior approach to enable better visualization of the suprascapular nerve at the notch.

The effect of injurious compression on the elastic, hyper-elastic and visco-elastic properties of porcine peripheral nerves.

The aim of this study was to characterise the viscoelastic and hyper-elastic properties of the ulnar nerve before and after compression has been induced, in order to aid the understanding of how the mechanical properties of nerves are altered during nerve compression, a contributing factor to cubital tunnel syndrome. Ulnar nerves were dissected from porcine legs and tensile tested to 10% strain. The Young's modulus and Yeoh hyper-elastic model were used to evaluate the materials elastic and hyper-elastic properties respectively.

Towards viscoelastic characterisation of the human ulnar nerve: An early assessment using embalmed cadavers.

Cubital tunnel syndrome is the most prevalent neuropathy of the ulnar nerve and its aetiology is controversial. Potential replacement materials should display similar viscoelastic properties. The purpose of this study was to assess the feasibility and merit of quantifying the frequency-dependent viscoelastic properties of proximal and distal sections of the human ulnar nerve.

Scaphoid Nonunion With Poor Prognostic Factors: The Role of the Free Medial Femoral Condyle Vascularized Bone Graft.

To report on the results of free medial femoral condyle (MFC) vascularized bone graft for scaphoid nonunions with 1 or more poor prognostic factors. We have used the free MFC vascularized bone graft for scaphoid nonunions that have 1 or more factors associated with a poor prognosis. These were, a delay in presentation of over 5 years, a proximal pole nonunion, the presence of avascular necrosis (AVN), or previous nonunion surgery.

Four corner fusion using a multidirectional angular stable locking plate.

Aim: To review the results of our experience with the Medartis Aptus plating system for four corner arthrodesis of the wrist, which uses a combination of compression screws and variable angle locking screws.

Methods: We reviewed the results of 17 procedures in 16 patients that underwent scaphoid excision and four corner fusion using the Medartis Aptus system between May 2010 and June 2014. The primary outcome measure was radiographic and clinical union.

Soft tissue stabilization for palmar midcarpal instability using a palmaris longus tendon graft.

Purpose: To report the results of a technique of soft tissue stabilization for palmar midcarpal instability using a palmaris longus graft.

Methods: In patients' symptomatic wrists with palmar midcarpal instability that had failed conservative management, we used a dorsal approach and stabilized the hamate and triquetrum by reconstructing the dorsal triquetrohamate ligament. The palmaris longus tendon graft was fixed with bone anchors.

Post-traumatic false aneurysm in a digital artery of the finger.

Despite the high incidence of trauma involving the hand and digits, traumatic aneurysms in this region are rarely seen and few are reported. We describe a false aneurysm of a digital artery caused by a dog bite.

The surgical anatomy of the radial nerve and the triceps aponeurosis.

The radial nerve passes around the posterior aspect of the humerus where it is prone to injury in both humeral fractures and surgical exploration of this region. We examined 55 cadaveric limbs to determine whether the exact position of the radial nerve could be reliably predicted on the basis of superficial anatomical markings. We found that when there is considerable variability in the position of the nerve in relation to the lateral epicondyle, the nerve consistently passed adjacent to the lateral border of the triceps aponeurosis at a distance of 22-27 (+/-2) mm.