RESUMO
PURPOSE: Secure methods of graft attachment ensure safe early motion after flexor tendon grafting. This has been achieved at the proximal graft juncture using Pulvertaft's technique. For secure distal attachment, we investigate the results of flexor tendon grafting using the plantaris tendon with a fragment of attached bone fixed with a screw to the distal phalanx. METHODS: Thirteen digits from 10 patients with longstanding flexor tendon injuries in zone II had surgical reconstruction. A plantaris tendon-bone graft was attached to the distal phalanx using a mini-screw. This was followed by immediate active motion. At 3 and 8 months after surgery, total active motion was calculated as the sum of the degrees of active flexion in the proximal and distal interphalangeal joints minus the sum of the degrees of extension deficits for each of these joints. The results of total active motion were compared to the normal contralateral digit. RESULTS: Three months after surgery, the mean rate of recovery, relative to the normal contralateral finger, was 74%, whereas 8 months after surgery, this value was 70%. This difference was statistically significant. There were no failures or poor results (ie, less than 50% recovery). CONCLUSIONS: The tendon-bone plantaris graft employed here ensured immediate active motion and early use of the involved hand in daily activities. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Assuntos
Calcâneo/transplante , Falanges dos Dedos da Mão/cirurgia , Traumatismos dos Tendões/cirurgia , Tendões/transplante , Adulto , Parafusos Ósseos , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento ArticularRESUMO
OBJECTIVE: The pattern of triceps innervation is complex and, as yet, has not been fully elucidated. The purposes of this study were 1) to clarify the anatomy of the triceps motor branches, and 2) to evaluate their possible uses as a donor or receiver for nerve transfer. METHODS: The radial nerve and its motor and cutaneous branches were bilaterally dissected from the axilla and posterior arm regions of 10 embalmed cadavers. RESULTS: A single branch innervates the triceps long head, whereas double innervation was identified for the lateral and medial heads. The upper branch to the lateral head originated from the radial nerve, whereas the lower branch to the lateral head stemmed from the lower medial head motor branch, which ultimately innervated the anconeus muscle. Both the long head and the upper medial head motor branches originated in the axillary region in the vicinity of the latissimus dorsi tendon. CONCLUSION: Each of the triceps' motor branches might be used as a donor for transfer. The triceps long head motor branch should be used preferentially when the intention is to establish triceps reinnervation.