Tendon transfers in cerebral palsy: art or science?

Tendon transfers in cerebral palsy are commonly described as a method to improve function in the upper limb. The field can be considered by some to be more of an art than science due to the unique challenges involved, which include poor volitional control and spasticity. Surgical outcomes can be uncertain and, in certain circumstances, worsened.

Utilization of the web index in the measurement of web creep after syndactyly surgery.

The aim of this study was to explore the feasibility of using a web index to measure web creep after syndactyly surgery. A total of 19 hands in nine children (six preoperatively and 13 immediately postoperatively) underwent measurement of their web position. A preliminary study confirmed that the web index measured on the child's hand at the time of surgery was similar to that measured on photographs taken at the same time.

A Unit-Concentration Method to Quantify Source Contribution.

Solute migration is typically simulated to describe and estimate the fate and transport of contaminants in groundwater. The unit-concentration approach is investigated here as a method to enable solute transport simulations to expand the capabilities of groundwater flow modeling. The unit-concentration method uses a concentration value of one to identify sources of water to be assessed and a concentration of zero for all other water sources.

Use of Censored Multiple Regression to Interpret Temporal Environmental Data and Assess Remedy Progress.

Many methods to evaluate temporal trends in monitoring data focus on univariate techniques that account for changes in the response variable (e.g., concentration) by means of a single variable, namely time.

Interventions to Improve Social Climate in Acute Mental Health Inpatient Settings: Systematic Review of Content and Outcomes.

Introduction: Quantification of the social climate of mental health care environments has received considerable attention. Investigations of the resulting measures indicate that social climate is associated with individual outcomes including patient satisfaction and staff burnout. Interest has grown in developing interventions to improve social climate in anticipation of subsequent related benefits.

Simulating Groundwater Interaction with a Surface Water Network Using Connected Linear Networks.

Simulating the interaction of groundwater with surface water networks using traditional boundary packages available with MODFLOW-USG can be challenging for complex systems. Often several package types are required as they are typically purpose built. Moreover, these packages generally do not interact with one another which complicates accounting of groundwater discharge at different points within the system.

A detailed analysis of long-term outcomes following reconstruction for congenital thumb hypoplasia.

This retrospective study analyses long-term outcomes of reconstruction for congenital thumb hypoplasia Grades 2 and 3 A. In 22 thumbs (mean follow-up 9 years), instability of the metacarpophalangeal joint was found in 20 thumbs regardless of the method of reconstruction, double breasting of local tissue with or without adductor pollicis advancement or use of a slip of flexor digitorum superficialis to supplement local tissue. There was a trend towards a greater global strength, higher Kapandji score and better subjective function score when the abductor digiti minimi was used as an opposition transfer as compared with the flexor digitorum superficialis.

Thumb duplication/polydactyly.

A significant lesson for those assessing the work of others stems from the necessity to review what has been written before. It remains a common but human error to misinterpret or misrepresent the words of others and indeed, for inconsistencies in these to become apparent. This is certainly so in the field of congenital hand surgery and especially so with discussion of thumb duplication/polydactyly.

Quorum Sensing - A Stratagem for Conquering Multi-Drug Resistant Pathogens.

Quorum sensing is defined as a cell to cell communication between micro-organisms, which enables micro-organisms to behave as multicellular organisms. Quorum sensing enables many collaborative benefits such as synchronisation of virulence factors and biofilm formation. Both quorum sensing, as well as biofilm formation, encourage the development of drug resistance in micro-organisms.

It's all in the timing: The effect of a healthy food cue on food choices from a pictorial menu.

The contemporary food-rich environment has been consistently linked to unhealthy eating. Emerging research suggests that changing the presentation context of unhealthy foods by introducing a subtle nudge in the form of a healthy food cue may promote healthier dietary choices. This study investigated the effect of the timing of a healthy food cue (before or simultaneously with food options) on food choices.

The Effect of Extensor Tendon Adhesions on Finger Motion.

Purpose: To quantify the amount and pattern of finger range of motion loss at the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints with a simulated extensor tendon adhesion at the level of the proximal phalanx or metacarpal.

Methods: In 10 cadaveric specimens, traction sutures were placed in the forearm extensor digitorum communis and flexor digitorum profundus tendons of the middle and ring fingers. Active motion was simulated by suspending weights from the traction sutures via pulleys.

Congenital Great Toe Hypoplasia Equivalent to a Grade 3 Hypoplastic Thumb in a Patient with VACTERL Association.

Lower limb malformations in VACTERL patients are extremely rare and the most common anomalies are found in the tibial ray. We present the case of a 15 month old male with VACTERL and, additionally, a hypoplastic hallucal ray of the right foot in conjunction with a floating preaxial polydactyly. The great toe hypoplasia is similar to a grade 3b thumb hypoplasia with absence of the proximal two-thirds of the first metatarsal on the plain X-ray.

Cadaveric Dissection of the Axillary Nerve: An Investigation of Extra-Muscular and Intra-Muscular Branching Patterns.

Background: Variations in the axillary nerve branching patterns have been reported. The aim of the study is to investigate the extra- and intra-muscular course of the axillary nerve and quantify the regional innervation of the deltoid.

Methods: In fresh frozen specimens, the origin of the axillary nerve from the posterior cord of the brachial plexus and its extra- and intra-muscular course were identified.

The Austrian Flag - Severe Carpal Tunnel Syndrome: A Case Report.

In severe carpal tunnel syndrome a continuum of neural changes takes place depending on the degree and duration of the compression, beginning with breakdown of the blood-nerve barrier, followed by endoneurial oedema and, subsequently, perineurial thickening and ischemia. Persisting chronic compression will eventually result in axonal degeneration. We report a case of longstanding carpal tunnel syndrome with amyloid deposits and the unusual intraoperative 'Austrian flag' sign.

Surgical techniques for reconstruction of the hypoplastic thumb.

The reconstruction of a congenital hypoplastic thumb usually involves release of a tight first web space, metacarpophalangeal joint stabilization, reconstruction of intrinsic muscle function, and extrinsic tendon reconstruction, as appropriate. Numerous surgical options and combinations are available, but the approaches vary among surgeons who work in the field of congenital hand surgery and the empirical evidence that allows for evaluation of the results of techniques is scarce. Both the pre-operative assessment and intra-operative findings of all thumb elements - bone, joints, and soft tissues - should be considered in the surgical decision-making and eventually define the methods of reconstruction.