In this article it was reported that there were 14 patients sufferingfrom traumatic or spontaneous rupt-ure of tendon of extensor pollicislongus at the level of the 3rd comp-artment of the dorsal aspect of thewrist where repair by direct suturecould not be used of the Listertubercle which might cause adhesionand re-rupture of the repaired tendon.It was proposed that this tendonrupture could be repaired by transferof extensor indicis proprius tendon.Of the 14 cases, 10 of them werefollowed with on average of 4.5 tears. The range of flexion and extension of the thumb all returned to normal with little disturbance of the motion of the index finger.
Objective To summarize the method and the cl inical outcome of repairing both toe extensor tendon and dorsal foot wounds with anterolateral thigh flap. Methods Between February 2007 and May 2009, 11 patients with toe extensor tendon and dorsal foot defect were treated with anterolateral thigh flap. There were 8 males and 3 females with a medianage of 45 years (range, 10-60 years). The causes of injury were sharp injury in 3 cases, machine crush injury in 3 cases, and traffic accident injury in 5 cases, including 7 cases of fresh wounds with a disease duration of 2-8 hours and 4 cases of old wounds with a disease duration of 3-15 days. The size of wound ranged from 6 cm × 5 cm to 25 cm × 15 cm. All cases compl icated by toe extensor tendon defect, which were located at the 2nd-5th toes in 1 case, 3rd-5th toes in 1 case, 2nd-4th toes in 2 cases, 2nd and 3rd toes in 3 cases, 1st and 2nd toes in 1 case, and 1st toe in 3 cases. In the first stage, the anterolateral thigh flap ranged from 8 cm × 7 cm to 27 cm × 15 cm was used to repair defect and fascia lata was used to bridge two ends of digitorum longus tendon; the donor site was sutured or repaired with the skin graft. The second stage was performed after 2-3 months, tenolysis for tendon was performed, and fascia lata was spl it into tendon-l ike shape; and the toe functional exercises were done. Results All flaps survived completely after the first stage, wounds healed by first intention; the donor skin graft survived and incisions healed by first intention. At 7 days after the second stage, marginal necrosis occurred in 3 flaps (0.5-2.0 cm in width), and healed after 15-20 days of dressing change; the other flaps survived, and incisions healed by first intention. Eight patients were followed up 12-18 months (mean, 15 months). Excepts 4 sl ight bulky flaps, the other flaps had satisfactory appearance and soft texture with two points discrimination of 1-3 cm. During the follow-up, part of the dorsiflexion function recovered in 5 patients (5-40°), andflexion function was normal; 3 dorsiflexion function disappeared without effect on the function of toe flexion, and the patients could walk normally. No toe ptosis occurred. Conclusion Appl ication of the anterolateral thigh flap can repair toe extensor tendon and dorsal foot wounds with short treatment time and less damage at the donor site, so it can avoid toe ptosis after surgery and achieve excellent cl inical results.
ObjectiveTo discuss the effectiveness of operative treatments for different kinds of old injury of extensor tendon in zone II so as to choose the best surgical approach based on the classification of injury.
MethodsBetween May 2006 and May 2014, 68 cases of old injury of extensor tendon in zone II were treated. Among them, there were 50 males and 18 females with an average age of 36 years (range, 18-52 years). The causes included contusion injury in 50 cases, avulsion injury in 11 cases, and burn injury in 7 cases. The left side was involved in 21 cases and the right side in 47 cases. The injured finger involved the index finger in 18 cases, the middle finger in 21 cases, the ring finger in 24 cases, and the little finger in 5 cases. The disease duration was 1.5 months to 1 year (mean, 6.75 months). The central slip of extensor was repaired directly in 32 patients who had normal passive motion. Side cross stitch (8 cases) or Littler-Eaton (10 cases) method was used in 18 patients who can not extend actively and passively. Tendon graft was performed in 11 patients with tendon defect. Joint release was given in 7 patients with contracture after burn injury.
ResultsPrimary healing of incision was obtained in all cases. Sixty-eight cases were followed up 3-12 months (mean, 6.9 months). Three cases had tendon adhesion in varying degrees and suffered from pain, which was treated conservatively by functional exercise. Recurrence was observed in 2 cases, and extensor tendon was repaired again. According to total active motion (TAM) function assessment, the results were excellent in 52 cases, good in 11 cases, fair in 3 cases, and poor in 2 cases with an excellent and good rate of 92.6%.
ConclusionAdaptive operation method for old injury of extensor tendon in zone II should be selected based on the type of injury. The results will be satisfactory if correct method is chosen.
In order to investigate the effect of repair of paratendon in tendon healing, two different ways were performed to repair the transected extensor tendons of chick’s toe. End to end suture of the extensor tenon was performed in group 1 while the paratendon was also repaired simultaneously in addition to suture of the tendon in group 2. Gross observation and histological examination were undertaken in the 3rd and 6th week after operation. The result showed, in group 1, extensive adhesion and irregular proliferation of fibroblasts was found in the 3rd week, severe adhesion and irregular arrangement of fibroblasts with less collagen fiber was found in the 6th week; while in group 2, smooth and regular "fusiform structure" was formed, slight adhesion and regular proliferation of fibroblasts were found in the 3rd week, adhesion disappeared and the structure of paratendon and tondon recovered in the 6th week. It was concluded that repair of extensor tendon and paratendon simultaneously could promote the intrinsic tendon healing and prevent tendon adhesion.
Objective
To evaluate the short-term effectiveness of Kirschner wire (K-wire) elastic fixation in the treatment of Doyle type Ⅰ and Ⅱ mallet finger.
Methods
Between July 2016 and March 2017, 18 patients with Doyle type Ⅰ and Ⅱ mallet finger were treated. There were 12 males and 6 males, with an average age of 45 years (range, 16-61 years). The index finger was involved in 2 cases, the middle finger in 3 cases, the ring finger in 10 cases, and the little finger in 3 cases. The interval from injury to operation ranged from 2 hours to 45 days (median, 5.5 hours). There were 8 patients of closed wound and 10 patients of open wound. Fourteen patients were simply extensor tendon rupture and 4 were extensor tendon rupture complicated with avulsion fracture. The distal interphalangeal joints (DIPJ) of injured fingers were elastically fixed with the K-wire at mild dorsal extend position. The K-wire was removed after 6 weeks, and the functional training started.
Results
The operation time was 34-53 minutes (mean, 38.9 minutes). Patients were followed up 3-8 months (mean, 5 months). All incisions healed primarily and no K-wire loosening or infection happened during the period of fixation. All mallet fingers were corrected. The range of motion (ROM) in terms of active flexion of injured DIPJ was (75.83±11.15)° at 6 weeks after operation, showing significant difference when compared with the normal DIPJ of contralateral finger [(85.28±6.06)°] (t=3.158, P=0.003). The ROM in terms of active flexion was (82.67±6.78)° in 15 patients who were followed up at 8 months after operation, showing no significant difference when compared with the normal DIPJ of contralateral finger [(86.00±5.73)°] (t=1.454, P=0.157). After the removal of K-wire at 6 weeks, visual analogue scale (VAS) score of active flexion and of passive flexion to maximum angle were 1.78±0.88 and 3.06±1.06, respectively. According to the total active motion criteria, the effectiveness was rated as excellent in 10 cases, good in 5 cases, moderate in 2 cases, and poor in 1 case, and the excellent and good rate was 83.33%. The patients’ satisfaction were accessed by Likert scale, which were 3-5 (mean, 4.2).
Conclusion
K-wire elastic fixation in the treatment of Doyle typeⅠand Ⅱ mallet finger can repair the extensor effectively, correct the mallet finger deformity, and also be benefit for the flexion-extension function restoration of DIPJ.
Objective To discuss the mechanisms and clinical effect of musculus extensor hallucis longus shifting in correcting hallux valgus (HV) deformity. Methods From April 2004 to December 2006,25 cases of HV (38 feet) were treated by musculus extensor hallucis longus shifing. There were 2 men and 23 women, aging from 22-60 years (mean 46.3 years).HV angle was 21.45° (mean 31.30°), intermetatarsal(IM) angle was 7-21° (mean 12.52°). The HV were corrected by cutting osteophyma of the first metatarsal bone, cutting transverse head of adductor pollicis, transferring musculus extensor hallucis longus and reconstructing its insertion. Results The patients were followed up 6-14 months after operation. HV angle and IM angle were 7.30°±2.62° and 6.50°±2.46° respectively, showing significantdifferences when compared with before operation (Plt;0.05). According to the American Orthopaedic Foot amp; Ankle Society (AOFAS) score system, the foot function was excellent in 25 feet, good in 7 feet and poor in 6 feet,and the excellent and good rate was 84.2%. Hallux varus occurred in 2 feet after 2 months of operation, metatarsophalangeal joint limitation of motion in 2feet after 3 months of operation, no HV recurred. ConclusionThe HV deforemity can be corrected by shifting the musculus extensor hallucis longus and reconstructing its insertion. It makes stress of metatarsophalangeal joint balance and prevent recurrance of HV deformity.
