Application of absorbable anchor combined with Kirschner wire in reconstruction of extension function of old mallet finger / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility and effectiveness of absorbable anchor combined with Kirschner wire fixation in the reconstruction of extension function of old mallet finger.@*METHODS@#Between January 2020 and January 2022, 23 cases of old mallet fingers were treated. There were 17 males and 6 females with an average age of 42 years (range, 18-70 years). The cause of injury included sports impact injury in 12 cases, sprain in 9 cases, and previous cut injury in 2 cases. The affected finger included index finger in 4 cases, middle finger in 5 cases, ring finger in 9 cases, and little finger in 5 cases. There were 18 patients of tendinous mallet fingers (Doyle type Ⅰ), 5 patients were only small bone fragments avulsion (Wehbe type ⅠA). The time from injury to operation was 45-120 days, with an average of 67 days. The patients were treated with Kirschner wire to fix the distal interphalangeal joint in a mild back extension position after joint release. The insertion of extensor tendon was reconstructed and fixed with absorbable anchors. After 6 weeks, the Kirschner wire was removed, and the patients started joint flexion and extension training.@*RESULTS@#The postoperative follow-up ranged from 4 to 24 months (mean, 9 months). The wounds healed by first intention without complications such as skin necrosis, wound infection, and nail deformity. The distal interphalangeal joint was not stiff, the joint space was good, and there was no complication such as pain and osteoarthritis. At last follow-up, according to Crawford function evaluation standard, 12 cases were excellent, 9 cases were good, 2 cases were fair, and the good and excellent rate was 91.3%.@*CONCLUSION@#Absorbable anchor combined with Kirschner wire fixation can be used to reconstruct the extension function of old mallet finger, which has the advantages of simple operation and less complications.

Tendinitis cálcica atraumática de tendón extensor común del dedo medio: un caso infrecuente de dolor metacarpofalángico / Atraumatic calcium tendonitis of common extensor tendon of the middle finger: a rare case of metacarpophalangeal pain

Calcific tendinitis is a pathology characterized by the deposits of periarticular hydroxyapatite. Its pathophysiology is not completely known. It is clinically characterized by important inflammatory changes with incapacitating pain. It most commonly affects the shoulder joint and it rarely affects the hand and wrist. Given the unusual nature of this localization, we present the clinical case of a woman who developed calcific tendinitis of the third metacarpophalangeal muscle. We present the clinical evolution of the case, the treatments carried out, and a review of the literature related to this unusual localization of calcific tendinitis.

Flow-through anterolateral thigh perforator flap with fascia lata for repairing dorsal wounds of the hand and foot with extensor tendon defects / 中华创伤杂志

Objective:To investigate the clinical effect of flow-through anterolateral thigh perforator flap with fascia lata for repairing dorsal wounds of the hand and foot with extensor tendon defects.Methods:A retrospective case series study was conducted to analyze the clinical date of 14 patients with hand and foot wounds associated with extensor tendon defects admitted to Ruihua Affiliated Hospital of Soochow University from January 2015 to December 2019. There were 13 males and 1 female，aged 10-57 years［（39.2±13.4）years］. The wounds were all single with the area of 10 cm×4 cm to 23 cm×12 cm，including 8 wounds on the back of the hand and 6 wounds on the back of the foot. There was 1 patient accompanied with 1 tendon defect，10 with 4 tendon defects and 3 with 5 tendon defects，with the length of tendon defects ranging from 2.0 to 6.0 cm［（3.8±1.4）cm］. The dimension of flaps ranged from 12 cm×5 cm to 23 cm×13 cm，with the fascia lata from 11 cm×5 cm to 20 cm×7 cm. The deficient extensor tendons were repaired with the fascia lata and vascular pedicles were anastomosed by flow-though. A bilobed flap was harvested in 3 patients and a single flap in 11 patients. Donor sites were sutured directly. The survival of the flap and healing of the donor area were detected after operation. The extremity revascularization and shape and sensation recovery of the flap were measured at the last follow-up. The upper extremity functional evaluation standard set up by Hand Surgery Society of the Chinese Medical Association and Maryland foot functional score were used to evaluate the hand and foot function before operation and at the cast follow-up，respectively. The donor site complications and performance of tendon release or flap thinning in the second stage were recorded.Results:All patients were followed up for 8-30 months［（15.3±6.2）months］. All flaps survived successfully，with wounds and thigh donor areas healed by first intension. No significant effect of revascularization was observed on recipient sites，and acceptable cosmetic outcomes and sensation recovery of the flap were achieved at the final follow-up. For patients with dorsal wounds of the hand，the extensor function recovered in different degrees，and the flexion activities of the fingers were not limited. The total active movement was 180°-250°［（226.3±21.7）°］at the last follow-up，compared to preoperative 110°-170°［（145.6±13.2）°］（ P<0.01）. According to the upper extremity functional evaluation standard，the function was excellent in 4 patients，good in 2 and fair in 2. For patients with wounds of the foot，the flexion and extension function was good，with no obvious deformity of toes，and the Maryland foot functional score ranged from 60 to 92 points［（76.0±12.7）points］at the last follow-up，significantly improved from preoperative 18-45 points［（27.4±7.8）points］（ P<0.01），including excellent results in 2 patients，good in 3 and fair in 1. Only linear scars were left in the thigh donor area，and there was no discomfort such as scar contracture or pain. Four patients underwent skin flap thinning at 4-8 months after operation and none underwent a tenolysis. Conclusion:Repair of dorsal wounds with extensor tendon defects of the hand and foot by flow-through anterolateral thigh perforator flap with fascia lata can reduce interference to recipient sites and repair wounds and extensor tendons simultaneously，which can obtain good flexion and extension function and minor damage to the donor area.

Application value of high-frequency ultrasound in diagnosis of finger extensor tendon olisthy / 中国医学影像技术

Objective: To explore the application value of high-frequency ultrasound in diagnosis of finger extensor tendon olisthy. Methods: A total of 32 dorsal trauma in metacarpophalangeal joint patients with clinically suspected finger extensor tendon olisthy underwent high-frequency ultrasound. Olisthy in finger extensor tendon and causes of injuries were observed, and the results were compared with those of surgical operations. Results: Among all 32 cases, surgery treatment was performed in 25 patients, including 7 patients of partial olisthy in extensor tendon and 18 patients of complete olisthy, while 7 patients were found without olisthy (only tendon hood injury) and were followed up for observation. Utrasound missed 1 case with complete olisthy in finger extensor tendon and misdiagnosed 2 cases of complete olisthy as partial olisthy. The consistency of ultrasound examination and surgery results was well (Kappa=0.85, P<0.01). Conclusion: Ultrasound can show tendon hood tear and finger extensor tendon olisthy and judge the injury degree through dynamic observation, therefore providing important evidences for clinical treatment.

Anatomical study on finger of extensor tendon in zone Ⅰ / 局解手术学杂志

Objective To discuss the effect of proximal interphalangeal joint(PIPJ) motion on the tension of the zone Ⅰ extensor tendon through measuring the extensor tendon and find the fixed position of PIPJ when the zone Ⅰ extensor tendon at minimum tension,and to provide reference for best fixed position in clinical treatment.Methods The maximal passive flexion angles of the distal interphalangeal joint (DIP J) of the index,distal,ring and little fingers were measured in 20 cadaver hands when the PIPJ flexed at 0 °,20 °,40 °,60 °,80 ° and 100 °.Making an incision over the back of the DIPJ to expose the zone Ⅰ extensor tendon.Incising the extensor tendon laterally at the level of the DIPJ with the DIPJ fixed in extension position to make a mallet finger.Pierced a Kirschner wire through and perpendicular to the distal phalangeal basement as a sign.Parallel to this sign,marked the zone Ⅰ extensor tendon and measured its relative distance to the sign as the sliding distance of the extensor.Recording the widest gap between the tendon edges and the tendon sliding distance while the PIPJ was in extension and 20°,40°,60°,80° and 100°flexion position,severally.Results The maximal passive flexion angle of the DIPJ increased with the PIPJ flexed from 0°to 100°in 80 fingers.The gap between the extensor tendon edges in zone Ⅰ was (1.322 8 ± 1.078 9) mm when the PIPJ was in extension position.The proximal extensor tendon glide distally while the PIPJ flexed to 100° with an average sliding distance of(1.540 5 ± 0.690 7) mm.Conclusion The zone Ⅰ extensor tendon has the maximal tension while the PIPJ is in extension position.Flexing PIPJ can make the tension decrease.

Spontaneous rupture of the digital extensor tendons of the hand in unrecognized carpal lunatefracture / Ruptura espontánea de los tendones extensores de los dedos de la mano en una fractura oculta del semilunar

Abstract: Spontaneous rupture of the digital extensor tendons of the hand has been reported after Kienbock's disease, rheumatoid arthritis, Vaughan-Jackson' syndrome, distal radial fracture. Rupture may also occur as a consequence of unrecognized carpal lunate fracture. We present a case report of a man affected with spontaneous rupture of the digital extensor tendons secondary to unrecognized carpal lunate fracture with partial dorsal dislocation. The edges of the tendon were debrided and sutured using a locked modified Kessler suture. A dynamic splinting cast was applied in moderate extension of the wrist. The aim of this case report is to highlight that in absence of a clear etiology for rupture of the extensor tendons of the hand, carpal lunate fracture, though rare, is an important cause of spontaneous extensor tendons rupture.

Resumen: La ruptura espontánea de tendones extensores digitales de la mano ha sido reportado después de la enfermedad de Kienböck, artritis reumatoide, síndrome de Jackson Vaughan, fractura del radio distal. La lesión del tendón también puede ocurrir como consecuencia de la fractura no reconocida de carpal semilunar. En este artículo, se presenta un caso de un hombre que sufre de rotura espontánea del tendón extensor digital secundaria a fractura semilunar no reconocida de los huesos del carpo con luxación dorsal del fragmento parcial. Los bordes del tendón se han limpiado y se sutura usando una sutura de Kessler. Un refuerzo dinámico se aplicó en extensión moderada de la muñeca. El propósito de este caso clínico es poner de relieve que, en ausencia de una etiología clara de la ruptura de los tendones extensores de la mano, una fractura de los huesos del carpo semilunar puede ser una causa importante de la ruptura espontánea de los tendones extensores de la mano.

Chronic Traumatic Sagittal Band Injury with Extensor Tendon Dislocation: Report of a Case and New Surgical Technique

Chronic sagittal band injury with tendon dislocation of the extensor digitorum communis in the hand often requires operative stabilization. Various surgical techniques have been reported to repair and reconstruct the sagittal band. Nonetheless, most of the techniques are technically demanding and require donor graft. In this case report, we report a novel surgical technique to centralize and stabilize the tendon by reattaching the radial sagittal band with anchor sutures. The advantages of this new technique are simple, no donor morbidity and stable repair to restore the normal biomechanics of the tendon. The patient was able to return to work in three months and no recurrent dislocation was noted at review two years after surgery.

A Repair of Sagittal Band for Subluxation of the Extensor Tendons at the Metacarpophalangeal Joint / 대한정형외과학회잡지

PURPOSE: Subluxation of the extensor tendon that result from sagittal band injury at the metacarpophalangeal (MCP) joint can lead to joint pain and limit the range of motion in fingers. Upon the injury mechanism, other causes except rheumatoid arthritis are relatively uncommon, and studies regarding the operative management are also sparse. We performed a direct repair of sagittal band and attempted to report clinical results of our experience in patients without application of conservative management. MATERIALS AND METHODS: Authors retrospectively reviewed the medical records of 26 patients who underwent operative treatment for extensor tendon subluxation. There were 23 males and 3 females with the mean age of 39.9 years old. All patients had an injury on the long finger, and presenting an ulnarward extensor tendon subluxation. Nine patients were injured from the direct blow, 14 patients from the flicking finger, and 3 patients from the resisted finger flexion. The mean time interval between the injury and operation was 27.5 days. The mean duration of follow-up was 14.6 months. As clinical results, authors evaluated visual analogue scale, MCP joint range of motion, total active motion (TAM), 3rd finger tip pinch power, and recurrence of extensor tendon. RESULTS: The mean final MCP joint flexion was 89.6° with 22.8° of extension. The mean TAM was 248° without a significant difference between opposite hands. The mean tip-pinch power was 3.4 kg (7.5 lb), which also did not have any significant difference with contralateral hand. Herein, we did not experience subluxation recurrence, and all but one was pain-free at the final outpatient clinic follow-up. CONCLUSION: A direct repair of the sagittal band for the extensor tendon subluxation presented a favorable clinical outcome. Therefore, we can suggest that such a method can be a treatment option for patients not undergoing conservative management.

The Estimation of the Prevalence Rate of Boxer's Knuckle by Internet Questionnaire / 대한스포츠의학회지

Boxer's knuckle has become known as rare diseases caused by trauma, congenital, idiopathic, degenerative and more. Because there is no research for specific prevalence rate, the purpose of this study is to figure out the possibility of the prevalence rate of Korean early 20's who relied on data from the Internet questionnaire about the group suspected of having Boxer's knuckle by self-diagnosis after an indirect explanation for Boxer's knuckle. The positive response rate of Boxer's knuckle analyzed by a public Internet survey questionnaire contains personal information, Boxer's knuckle symptoms, location, risk factors, family history, and so on. Total of 304 respondents include 106 males (median age, 23 years; Q1, 21–Q3, 23), 198 females (median age, 21 years; Q1, 21–Q3, 23). Thirty-three patients had severe symptoms of Boxer's knuckle (dislocation) and 42 patients had mild symptoms of Boxer's knuckle (subluxation). Sex, age, type of exercise and duration of exercise, family history, etc were analyzed. It is a result that whether or not history of severe exercise and family history are statistical significances as risk factors. Fifteen (7.7%) of 196 people who do not exercise, seven (14.0%) of 50 people with light exercise, 11 (19.0%) of 58 people with severe exercise, 28 (9.5%) of 294 people without family history and five (50.0%) of 10 people with family history showed symptoms of the Boxer's knuckle. The positive response rate of the Boxer's knuckle is 10.9%. The exercise in the possibility of injury and family history are significant predictors.

Clinical Observation on 50 Hz Frequency of Electricity Stimulating Finger Extensor Tendon for Hand Dysfunction Caused by Incident Storke / 浙江中医药大学学报

Objective] To study the effect of 50 hz frequency of electricity stimulating finger extensor tendon for hand dysfunction caused by incident storke. [Methods] 67 cases diagnosed as hand dysfunction of incident storke patients randomly divided into treatment group and control group(33 cases in treatment group, 34 cases in control group). The control group was given Bobath method for hand function recovery training. The treatment group was given 50 hz frequency of electricity stimulating finger extensor tendon on the basis of Bobath rehabilitation treatment, 5 times every week, for 4 weeks. Evaluate patients' symptoms improvement, before and after, with Fugl-Meyer grade(hand part) and modified Barthel index evaluation, and then make statistical analysis of the results. [Result] After the treatment,the grades, Fugl-Meyer grade(hand part) and modified Barthel index, of two groups both increased significantly, with statistical significance(P<0.01); Both of the grades of treatment group were significantly higher than that of control group, with statistical significance(P<0.01). [Conclusion] 50 hz electrical stimulating finger extensor tendon can significantly improve hand dysfunction caused by incident storke, improve their abilities of daily life.

Spontaneous Rupture of the Second and Third Extensor Digitorum Longus Tendons Caused by Osteophyte of the Tarsometatarsal Joint: A Case Report / 대한족부족관절학회지

Spontaneous rupture of the extensor tendon has been reported in association with predisposing inflammatory conditions including rheumatoid arthritis, diabetes, trauma, tophaceous gout, and steroid injection. The authors experienced a case of spontaneous rupture of the extensor digitorum longus tendons caused by an osteophyte of the tarsometatarsal joint in a patient with rheumatoid arthritis. The authors stress that aggressive treatment including surgery could be considered for prevention of spontaneous tendon rupture in a patient with predisposing conditions despite an asymptomatic spur.

Extensor Digiti Minimi Triggering Caused by an Anatomical Variation: A Case Report

Although flexor tendon triggering due to stenosing flexor tenosynovitis is common clinically, extensor triggering is quite rare. Known common causes are impingement between extensor tendon and extensor retinaculum, stenosis of the tendon sheath, and impingement between extensor tendon and osteophyte. We report rare case of triggering in the little finger caused by impingement between extensor digiti minimi and synovial septum.

Value of high frequency ultrasonography in acute closed mallet finger / 中华超声影像学杂志

Objective To study the clinical value of high frequency ultrasonography in acute closed mallet finger.Methods The high frequency ultrasonographic images of thirty-six patients with diagnosed acute closed mallet finger were retrospective analyzed.The ultrasonographic features were analyzed.Results The position and internal structure of extensor tendon could be showed by high frequency ultrasound,the position and injury level of acute closed mallet finger were identified.In 36 patients of acute closed mallet finger,6 cases were complete tear combined avulsion fracture,the ultrasonography showed the disruption in the extensor tendon at the level of the distal interphalangeal joint,the hyperechoic fracture fragment were found in the distal end of extensor tendon.22 cases were complete tear and no avulsion fracture,the longitudinal imaging showed the disruption in the extensor tendon at the level of the distal interphalangeal joint and the retraction of the tendon end.8 cases were partial tear,the ultrasonography showed that extensor tendons were thickened and hypoechoic,the section of extensor tendons were still continuous.Conclusions High frequency ultrasonography is the preferred imaging method for diagnosis of acute closed mallet finger,it will be important value for clinical treatment method.

Rupture of the Extensor Tendon Secondary to Advanced Kienbock's Disease / 대한정형외과학회잡지

Rupture of the extensor tendon caused by a posteriorly displaced lunate fragment is an uncommon complication of Kienbock's disease. Thirteen cases have been reported in the English literatures, but it has never been reported in the Korean literatures. We report a case of rupture of the third and fourth extensor tendons secondary to advanced Kienbock's disease that was successfully treated by excision of the lunate and a tendon transfer.

Lesões tendinosas da mão / Hand tendon injuries

As lesões tendinosas são muito frequentes nos traumatismos da mão. Vidro e arma branca são os agentes mais comuns. Classificam-se como aberta e fechada e invariavelmente estão associadas a lesões de pele, nervos e artérias. O conhecimento anatômico da mão é fundamental, pois mesmo traumas menores podem trazer sequelas se não forem tratados adequadamente. Uma anamnese e um exame físico minucioso permitirão identificar corretamente as lesões. O diagnóstico, o tratamento precoce e o seguimento pós-operatório especializado de fisioterapeuta ou terapeuta da mão serão fundamentais para o melhor resultado funcional. Este artigo revisa o diagnóstico e a conduta nas lesões tendinosas da mão.

Tendon injuries are very common in injuries in the hand. Glass and knives are the most common agents. They are classified as open and closed and are invariably associated with lesions of skin, nerves and arteries. Knowing the anatomy of the hand is crucial, because even minor trauma can bring consequences if not treated properly. A medical history and physical examination will allow the correct identification of the injuries. The diagnosis, early treatment and postoperative follow-up by a hand specialist or physical therapist will be key to a better functional outcome. This article reviews the diagnosis and management of tendon injuries in the hand.

Calcific Tendinitis of the Common Extensor Tendon: A Case Report / 대한스포츠의학회지

Calcific tendinitis is most common seen within the rotator cuff of the shoulder, although it may develop around the hip, wrist, elbow, knee, forefoot, and neck. However, there has been no report in the medical literature regarding calcific tendinitis of the common extensor tendon. We present a case of a 26-year-old woman who had calcific tendinitis of the common extensor tendon. Intraoperatively, partial rupture and calcific deposit at the insertion of the common extensor tendon were seen. We were removed calcific deposit and ruptured tissue of common extensor tendon, and then ruptured common extensor tendon was sutured. The patient showed excellent result two years postoperatively with return to range in a degree of activity levels.

Spontaneous Rupture of 3rd, 4th, and 5th Extensor Digitorum Tendons in an Amateur Golfer: A Case Report

Spontaneous rupture of extensor tendon at the wrist usually affects the extensor pollicis longus, and the etiologies include fractures of distal radius, rheumatoid arthritis and certain sports activities. Sports associated rupture of the extensor pollicis longus has been reported in a kick boxer, diver, tennis player, and downhill skier. But spontaneous rupture of extensor tendon besides extensor pollicis longus has been rarely reported in a sports player. We report spontaneous rupture of 3rd, 4th, and 5th extensor tendons because of probably overuse of the wrist in an amateur golfer.

Dislocation of the Extensor Tendon over the Metacarpophalangeal Joint

PURPOSE: We analyzed the results of treatment of dislocation of the extensor tendons over the metacarpophalangeal joints. MATERIALS AND METHODS: Thirteen patients who had received treatment for dislocation of the extensor tendons over the metacarpophalangeal joint were reviewed. Ten patients had traumatic dislocations, two had spontaneous dislocations, and one had congenital dislocation. The long finger was most frequently affected. The other fingers were affected almost equally. Displacement of the extensor tendon always occurred in the ulnar direction in the long and ring fingers. The index and little fingers exhibited different patterns of dislocation. RESULTS: Nonsurgical treatment was undertaken in two cases. Surgery was performed in 11 cases. No recurrent dislocations were reported in any of the patients. Conculsions: Based on our experience, patients seen within 2 weeks of injury initially should be treated with splinting of the involved metacarpophalangeal joint. Chronic dislocations should be treated with a primary repair of the defect in the sagittal band. When the sagittal band is absent or deficient, the tendon must be stabilized using a loop procedure with a tendon slip.

Experimental study of the injury of extended tendon through cross-finger micro-weave sutue plus sodium hyaluronate to prevent adhesion / 中国矫形外科杂志

[Objective]To observe the effect of cross-finger-like micro-weave suture plus sodium hyaluronate technology in the treatment of extensor tendon injury by the animal experiments.[Method]Twenty-eight Leghorn chickens were randomly divided into four groups,double-cross stitching was used in group A in the treatment of extensor tendon injury,double-cross stitching plus sodium hyaluronate in group B,cross-finger-like micro-braided suture in group C,cross-finger-like micro-braided suture plug sodium hyaluronate surgery in group D.Six weeks after surgery,morphological observation,histological observation and biomechanical determination were done by using the naked eye and microscope,as well as the results of the experiments were statistically analyzed.[Result]In the group of the cross-finger-like micro-weave suture plus sodium hyaluronate,tendon grew in good shape without nodules after surgery,pseudome was formed around tendon,tendon cells mostly arranged regularly in bunches,maximum load was (70.9 ? 5.68) N on average,it was significantly larger than those in other groups and there was a significant difference by the analysis of variance (P

Restorative treatment of rupture of extensor tendon / 中国矫形外科杂志

The extensor tendon rupture is a common disease.Traditional management includes "8" suture and cross suture.But second operation is commonly needed for the reason of postoperative Nodules or adhesion.So a new technique is invented by the author:micro-weave suture combined with sodium hyaluronate.The new technique has improved dynamic intensity of the tendon and avoided postoperative adhesion.In this paper,this technique is reviewed.