Extensor Tendon Repair
This article describes the pertinent clinical anatomy of the extensor mechanism, reviews outcomes and complications following extensor tendon repair, and provides guidance on how to avoid and manage complications when they occur. (Source: Hand Clinics)
Source: Hand Clinics - May 20, 2023 Category: Orthopaedics Authors: R Adams Cowley, Curtis M. Henn Source Type: research
Flexor Tendon Repair
This article discusses the common complications after flexor tendon repair, such as repair site rupture and adhesion formation. This article also addresses strategies to prevent and manage these complications. The foundation for preventing many of these complications is ensuring a strong repair without gapping at time zero, which will enable the accrual of tensile strength through early initiation of motion. (Source: Hand Clinics)
Source: Hand Clinics - May 16, 2023 Category: Orthopaedics Authors: Sally Jo, Christopher J. Dy Source Type: research
Complications and Revision Surgery of Forearm Fractures
Nonunion or malunion of forearm fractures may result in restricted range of motion or persistent pain, leading to limitations in activities of daily living. Complications may also present in the form of ectopic bone growth or persistent infections. A systematic method to evaluate complications resulting from forearm fractures is helpful to both determine the cause for the failure and plan for adequate reconstruction. (Source: Hand Clinics)
Source: Hand Clinics - May 11, 2023 Category: Orthopaedics Authors: Viviana M. Serra Lopez, Chia H. Wu, David J. Bozentka Source Type: research
Managing Difficult Problems in Small Joint Arthroplasty
This article addresses the management of the most common complications seen following MCP, PIP, and CMC arthroplasty. (Source: Hand Clinics)
Source: Hand Clinics - May 11, 2023 Category: Orthopaedics Authors: Steven L. Moran, Marco Rizzo Source Type: research
Revision Arthroplasty in the Challenging Elbow
Compared with hip and knee arthroplasty, total elbow arthroplasty (TEA) has a higher complication rate and lower survivorship. Modern TEA implants most commonly require revision due to implant loosening, infection, and periprosthetic fracture. Concerns with revision TEA include handling of the soft tissues and possible necessity of flap coverage, triceps management, preservation of bone stock, and management of concurrent infection or fracture. In this review, we will discuss preoperative evaluation of the failed elbow arthroplasty, surgical approaches, techniques for revision, outcomes, and complications following revi...
Source: Hand Clinics - May 11, 2023 Category: Orthopaedics Authors: Ryan C. Xiao, Zina Model, Jaehon M. Kim, Neal C. Chen Source Type: research
Management of Complex Hand and Wrist Ligament Injuries
Ligamentous injuries in the hand and wrist are often underdiagnosed and can present with significant functional limitations if there is untimely recognition of injury. Adequate repair or reconstruction is critical in restoring joint stability and mobility. The purpose of this review is to provide an overview of the metacarpophalangeal joint, scapholunate interosseous ligament (SLIL), and non-SLIL carpal ligament anatomy, diagnosis, imaging, treatment consideration and options, as well as surgical techniques encompassing repair, reconstruction, and fusion. (Source: Hand Clinics)
Source: Hand Clinics - May 11, 2023 Category: Orthopaedics Authors: Hannah C. Langdell, Gloria X. Zhang, Tyler S. Pidgeon, David S. Ruch, Christopher S. Klifto, Suhail K. Mithani Source Type: research
Tendon Transfers
Outcomes after tendon transfer to restore upper extremity function can be optimized using a standardized, multidisciplinary approach to the patient preoperatively, augmented intraoperative decision-making, and an early postoperative mobilization therapy protocol. (Source: Hand Clinics)
Source: Hand Clinics - May 11, 2023 Category: Orthopaedics Authors: Kanu Goyal, Kyle J. Chepla Source Type: research
Advanced Dupuytren Contracture
Dupuytren disease is a common pathologic condition that can be especially challenging to hand surgeons in recurrent or severe contractures. Recurrence risk may be reduced with a variety of techniques, including skin grafting, external fixator application, radiation, and many others described in this article. Management of recurrence requires special attention to anatomy at risk. Adjuvant therapy may help to prevent the progression or recurrence of severe disease. (Source: Hand Clinics)
Source: Hand Clinics - May 11, 2023 Category: Orthopaedics Authors: Jill Putnam Source Type: research
Flexor Tendon Repair Techniques
The authors present the methods and outcomes from six institutes where M-Tang repairs with early active flexion exercise are used for zone 2 digital flexor tendon repair. The authors had close to zero repair ruptures, and few digits needed tenolysis. The excellent to good results are generally between 80% and 90%. In the pandemic period, less stringent therapy supervision might have allowed some patients to move too aggressively, with repair ruptures not seen before the pandemic in one institute. In Nantong, Yixing, and Saint John, the rupture incidence is zero to 1%. In Florence and Heidelberg, the rupture incidence was 3...
Source: Hand Clinics - April 20, 2023 Category: Orthopaedics Authors: Jin Bo Tang, Zhang Jun Pan, Giovanni Munz, Inga S. Besmens, Leila Harhaus Source Type: research
Surgical Considerations for Flexor Tendon Repair
This article reviews the principles of tendon structure, function, healing, and anatomy. Repair techniques are discussed in detail for each flexor tendon zone. Postoperative rehabilitation greatly influences outcomes, and several protocols are described. (Source: Hand Clinics)
Source: Hand Clinics - April 20, 2023 Category: Orthopaedics Authors: Sarah E. Sasor, Kevin C. Chung Source Type: research
Therapy after Flexor Tendon Repair
Rehabilitation after flexor tendon repairs is a challenging process. The repaired tendon must be simultaneously protected from disruption and moved in a controlled fashion to prevent restrictive adhesion formation. Although measures are necessary to protect the repaired structures, early controlled motion is required to enhance healing and function. Appropriate intervention at the correct phase of healing is based on an understanding of tendon healing and the factors that influence it. Coordination and communication between the surgeon and therapist is essential. Tendon injuries can profoundly affect hand function, and app...
Source: Hand Clinics - April 20, 2023 Category: Orthopaedics Authors: Terri M. Skirven, Lauren M. DeTullio Source Type: research
Flexor Tendon Reconstruction
Chronic injury to the flexor tendon system of the hand remains a challenging problem for the hand surgeon to treat. Both single- and two-stage techniques remain important in the reconstruction of the flexor tendon deficient digit. Modern advances include the use of allograft composites that aim to reduce the time and donor-site morbidity compared with conventional autograft techniques. Regardless of technique, restoring a gliding tendon-pulley system with a functional arc of motion is the primary goal of flexor tendon reconstruction. (Source: Hand Clinics)
Source: Hand Clinics - April 20, 2023 Category: Orthopaedics Authors: Benjamin K. Gundlach, David S. Zelouf Source Type: research
Hand Flexor Tendon Repair
Tendon biology and anatomy are crucial to manage hand flexor tendon injuries, not only for surgical treatment but also for rehabilitation; surgeon and physical therapist have to choose zone by zone the best way to manage and restore the normal function of hand flexor tendons. (Source: Hand Clinics)
Source: Hand Clinics - April 20, 2023 Category: Orthopaedics Authors: Cristian Aletto, Rocco Aicale, Francesco Oliva, Nicola Maffulli Source Type: research
Zone 1 Flexor Tendon Repairs
In contrast to other zones of the hand, zone 1 flexor tendon injuries include laceration as well as avulsion mechanisms. Although zone 1 tendon lacerations are treated similarly to other zones, with various suture configurations and techniques, zone 1 avulsion injuries often require repair of tendon to bone. Proximity of the repair site to the distal interphalangeal joint often results in persistent flexion contracture and stiffness. Despite these differences in injury mechanism and location, zone 1 flexor tendon repairs are well tolerated and often lead to fair-high patient satisfaction. (Source: Hand Clinics)
Source: Hand Clinics - April 20, 2023 Category: Orthopaedics Authors: Saral J. Patel, Andrew J. Miller, A. Lee Osterman, Rowena McBeath Source Type: research
Principles of Tendon Structure, Healing, and the Microenvironment
Tendon is a strong viscoelastic tissue, responsible for conducting force from muscle to bone. In the hand, flexor tendons course through fibro-osseous sheaths, composed of an intricate tenosynovium and fibrocartilaginous pulley system. After flexor tendon laceration, changes occur in tendon force transduction as well as vascularity, affecting tendon healing on a tissue and cellular level. Tendon healing occurs through intrinsic and extrinsic mechanisms, which in combination with local anatomy, can predispose to adhesion formation. Understanding the relationship between microenvironmental cues and tendon healing on the cell...
Source: Hand Clinics - April 20, 2023 Category: Orthopaedics Authors: Rowena McBeath, Kevin C. Chung Source Type: research
