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BACKGROUND: Traumatic dislocation of sternoclavicular joint is a rare disease in orthopedics, which can cause misdiagnosis and improper treatment. Its operation technology is constantly improving, mainly because of the improvement of the internal objects. OBJECTIVE: To explore the new progress in the diagnosis and treatment of traumatic dislocation of sternoclavicular joint, and to summarize the key points and the advantages and disadvantages of operation with various implants. METHODS: The Chinese database of Wanfang and China National Knowledge Infrastructure was searched by the first author. The key words were “dislocation of sternoclavicular joint; biomechanics; implants; internal fixation; tendon reconstruction; complications; prognosis”. Simultaneously, the English database of PubMed was searched, with the search term of “dislocation of sternoclavicular joint; biomechanics; implant; internal fixation; tendon reconstruction; complications; prognosis”. The retrieval period was from July 2010 to February 2020. RESULTS AND CONCLUSION: (1) Traumatic dislocation of sternoclavicular joint is a kind of trauma which is easy to be missed and may be fatal. Computed tomograhy and B-ultrasound can be used to confirm the diagnosis. Magnetic resonance imaging can show the damage of mediastinum structure. (2) Surgical treatment methods include Kirschner wire tension band internal fixation, hook plate internal fixation, locking plate internal fixation, ligament strengthening and reconstruction technology, joint replacement and so on. The fixation strength of Kirschner wires and steel wires is unsatisfactory and its complication rate is high, but they can be used in juvenile patients. The cross joint steel plate does not meet the biomechanical requirements of the fretting joint, so it is difficult to achieve firm fixation. The hook steel plate belongs to the built-in object of elastic fixation, and the disadvantage lies in the abrasion and stimulation of the bone caused by the tail hook structure. More and more attention has been paid to ligament reconstruction technology, which not only meets the needs of strength, but also conforms to the characteristics of biomechanics.
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@#Giant cell tumour of tendon sheath is a benign soft tissue lesion most commonly found in the flexor aspect of hand and wrist. However, it is uncommon in foot and ankle and rare in bilateral achilles tendon. We report a case of 17-year-old female who presented with progressive enlargement of bilateral achilles tendon for six months. MRI findings showed that most of the tumour had intermediate to low signal intensity. Histopathology confirmed the diagnosis of giant cell tumour of tendon sheath. To help the patient regain the strength of the achilles tendon and walking abilities, a large area of tendon tumour was excised, followed by reconstruction with transfer of the peroneus brevis (PB) and posterior tibial (PT) tendon autograft. At two years followup, functional result was satisfactory.
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@#clavicular joint (ACJ) injuries remains controversial. Themodified Weaver-Dunn (WD) procedure is one of thefrequently used techniques. Recently when it was comparedwith anatomical autogenous tendon graft reconstructionprocedures, the results were inferior. However, theseanatomical procedures are technically more demanding withsmall margin of error and they have tendency forpostoperative pain because of extra donor site incision.Materials and Methods: Forty patients with type IV to VIACJ dislocations were treated by modified WD procedureusing non-absorbable synthetic suture passed through thebase of coracoid process for augmentation of transferredcoraco-acromial (CA) ligament. Functional outcome wasassessed using the Oxford Shoulder Score, NottinghamClavicular Score and Visual Analog Score (VAS) at the finalfollow-up after surgery.Results: The mean pre-operative Oxford Shoulder Scoreimproved from 25.22±2.64 (range 20 to 30) to 44.75±1.99(range 40 to 48) and mean pre-operative NottinghamShoulder Score improved from 49.25±4.91 (range 39 to 58)to 87.27±4.39 (range 79 to 96) at last follow-up after surgerywith p-value <0.001. Thirty-five (87.5%) patients hadexcellent outcomes, four (10%) patients had good outcomesand one (2.5%) patient had fair outcome. Thirty-eight (95%)patients had no pain while two (5%) had moderate painbased on VAS score.Conclusion: Modified Weaver-Dunn is a simple wellestablished technique for grade IV to VI ACJ dislocation.We cannot consider this procedure as old and outdated on theargument that the long term functional outcomes are notsubopti
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Objective To compare the clinical effect of reconstructing the anterior and posterior cruciate ligaments of knee joint with al-lografttendon and autogenous tendon transplantation. Methods 130 patients with anterior and posterior cruciate ligaments of knee fractured were randomly divided into two groups:the observation group were given allogeneic tendon transplantation while the control group were autol-ogous tendon transplantation. Observed the clinical efficacy of the two groups. Results The operation time of the observation group was ob-viously less than control group(P0. 05);the Lysholm and Tengner score of the two groups were significantly higher compared with the preoperative scores with a statistically significant difference (P0. 05). Conclusion Allogeneic tendon transplantation has similar curative effect with autologous tendon transplantation, both of them are good transplantation material for anterior and posterior cruciate ligaments reconstruction.
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Various reconstructive surgery have been performed for repair of the patellar tendon defect due to direct trauma or infected open wound. But most surgical procedure need wide skin incision and soft tissue dissection, that result in joint stiffness or muscle weakness. We carried out two-stage reconstructive surgery used bone-patellar tendon-bone allograft and bioabsorbable interference screw for skin and patellar tendon defect due to repetitive debridment for infected wound management. The result was satisfactroy and the patient achieved nearly full return of knee motion and quadriceps strength.
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Humans , Allografts , Joints , Knee , Muscle Weakness , Patellar Ligament , Skin , Wounds and InjuriesABSTRACT
PURPOSE: To analyze the final results of a two-stage flexor tendon reconstruction in the hand with the early postoperative combined protocol of controlled motion, and to identify the prognostic factors associated with the final results. MATERIALS AND METHODS: Nine cases of two-stage flexor tendon reconstructions in 9 patients, who had been unable to flex their digits due to old flexor tendon injury, were examined. Using the modified Boyes' injury severity classification, the digits were classified as grades 1, 2 and 3 in 1, 5 and 3 patients, respectively. The average follow-up period was 1 year and 8 months and the final results are expressed using the Buck-Gramcko assessment system. RESULTS: Eight out of nine hands were graded as excellent and one patient whose injury severity had been graded 3 was graded as good. Excellent results were found in patients with a more than 10-year interval between the injury and the stage I procedure. Of the 3 patients who had undergone contracture release two were excellent and one was good. All 5 patients with a pulley reconstruction had excellent results. Complications involved one infection at the distal incision site, one tendon rupture and four flexion contractures. CONCLUSION: A two-stage flexor tendon reconstruction with an early postoperative combined protocol of controlled motion is a useful procedure for restoring the flexor performance in old badly scarred digits. The excellent or good results might be due to following: the early protected rehabilitation incorporating two protocols, a pulley reconstruction and protection, flexion contracture release, an initial injury with less than moderate grade and the young age of the patients.
Subject(s)
Humans , Cicatrix , Classification , Contracture , Follow-Up Studies , Hand , Rehabilitation , Rupture , Tendon Injuries , TendonsABSTRACT
T The Flexor tendon injury caused by trauma of hand and forearm is commonly reported and earlier treatment for trauma is recommendable. But in many cases, earlier treatment is often not possible due to degree of injured tissues and infection. Specially in cases of severe trauma and damage of tendon sheath and pulley, the solution of limitation of motion is still remained as a difficult problem up to present due to scar tissue adhesion to surrounding tissues even after the primary treatment. The Department of orthopaedic surgery of National Medical Center during four years from 1981 to 1985 have treated 22 patients (27 fingers) of old flexor tendon injuries with tendon reconstruction and followed up more than for 6 months for clinieal study arrd the results ase as follows: 1. The old flexor tendon injuries are composed of 18 patients of the first decade and the second decade, especially in male. 2. The main causes of injury were deep lacerations by sharp objects (12 patients, 55.6%) and crushing injuries (9 patients, 40.8%). 3. Tendon injuries were mostly occurred in the index and ring finger. The incidence rate was equal between the 2 fingers, 25.7% representatively. Most of the injuries (21 cases, 77.8%) occurred in the zone II (Kleinert classification). 4. According to Boyes' classification, Grade 2 was 16 patients (19 cases): Grade 4, 3 patients (4 cases): Grade 3, 2 patients (3 cases): and Grade 5, 1 patient. 5. The operation method in zone II was free tendon graft in 10 cases and staged tendon graft in 7 cases. 6. The timing of operation depends on whether the open wounds were completely healed or not as well as subsidence of swelling. In case of swelling. In case of stiff fingers normal range of motions should be restored by vigorous exercise before operation. 7. According to the assessment based on strickland and Glovac, 20 cases out of 22 cases (13 cases of free tendon graft and 9 cases of staged tendon graft were satisfactory result.