Multiple Flexor Tendon Ruptures with Compression Neuropathy at Neglected Volar Lunate Dislocation / 대한정형외과학회잡지

Perilunate dislocation represents approximately 3% of all carpal injuries and is diagnosed late in 25% of cases. Neglected perilunate dislocation accompanies many complications. Multiple flexor tendon rupture is a very rare complication of neglected perilunate dislocation. Three cases have been reported in the English literatures. No case has been reported in Korean literature. We report on a case of multiple flexor tendon ruptures with compressive neuropathy of median and ulnar nerve caused by neglected volar perilunate dislocation.

Clinical Outcomes of Two-stage Flexor Tendon Reconstruction in the Hand: Experience with Early Postoperative Combined Protocol of Controlled Motion / 대한정형외과학회잡지

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.

Experimental Study of the Effectiveness of Hyaluronic Acid on Adhesion Formation in Digital Flexor Tendon Injuries / 대한정형외과학회잡지

Postoperative adhesions that restrict tendon gliding are a major cause of failure after tendon repair and grafting in Zone II. Several experimental reports have claimed that exogenously administered sodium hyaluronic acid (HA) helps to prevent the adhesion formation after digital flexor tendon repair. However, some investigators reported that HA had no effect on prevention of adhesion. Effectiveness of HA was determined by using an experimental chicken model. HA and physiologic saline solution was injected into the tendon sheath after partial cut of flexor digitorum profundus tendon. On light microscopy, cut ends revealed infiltration of neutrophils with scattered monocytes, 1ymphocytes and eosinophils at the second postoperative day in both control and HA treated goup. At the sixth and eighth postoperative day, the wounds were healed with granulation tissues and adhered to the tendon sheath in control group. Two weeks after operation both control and HA treated group were adhered to the tendon sheaths, but milder in HA treated group than that of control. After three weeks, adhesion to the tendon sheath was marked in both groups. Scanning electron microscopic findings were consistent with light microscopy. As results of above experiments, HA had a significant effect on prevention of adhesion until post-operative S days, and after 2 weeks no difference between HA and control group. No histological difference in process of tendon healing was observed between HA treated and control groups.

Clinical Study on Free Tendon Graft and Staged Tendon Graft for the Flexor Tendon Injury in Zone II / 대한정형외과학회잡지

Nineteen patients with twenty six fingers were admitted to the Department of Orthopedic Surgery, Yonsei University College of Medicine with Zone II flexor tendon injury of the fingers during a period of 9 years from January 1980 to December 1988. 17 cases received free tendon graft and 9 cases received staged tendon graft. The result of long term follow-up of these patients are as follows. 1. The interval from tendon injury to tendon graft did not influence the operational result. 2. The main factor influencing operational result was flexion deformity whieh was in turn deeply related to preoperational passive range of motion. 3. Due to the relative anatomic simplicity, the thumb had better results after treatment than the other fingers. 4. Satisfactory results were obtained with free tendon graft in most of the Pre-operational Grade I group, good soft tissue without scarring or joint contracture, whereas in the Grade II group and above, complicated with scarring, joint damage or nerve injury, free tendon graft resulted only in 33 % success. 5. In Grade II group and above, free tendon graft resulted only in 33% success whereas 71% of staged tendon graft resulted in good or excellent results. This suggested that staged tendon graft had better operational results than free tendon graft in cases of severe tendon injury.

Tendon Graft in Old Flexor Tendon Injury / 대한정형외과학회잡지

The flexor tendon injuries of the finger are very difficult to treat satisfactorily. Early treatment is desirable, but not always posaible. In addition, joint stiffness and limitation in gliding of the tendon caused by adhesion, make the problem more complex. From 1978 until 1988, 13 patients (14 eases) underwent operations for free tendon graft, and 10 patients (13 eases) for staged tendon graft at the Department of Orthopaedic Surgery, National Medieal Center. They have been followed up for clinical study, and the result was summarized as follows:1. Old flexor tendon injuries were common in the teen and twenties, especially in male. 2. They occurred in the index (10 Cases, 37.0%) and middle (8 cases, 29.6%) fingers most commony, especially zone II (62.9%). 3. The result was evalusted according to the method designed by Strickland and Glovac. In 19 out of 27 cases, satisfactory result (excellent and good) was yielded. 4. In cause, deep laceration by sharp object was better in the result than crushing injury. 5. The interval between the injury and the operation ranged from 1 month through 11 years, averaging 16 months, and is supposed to have little relation to the result. 6. The preoperative state is supposed to have much relation to postoperative result, judging from 100% of satisfactory result in Grade I compared with 40% in Grade V according to Boyes preoperative classification. 7. Little difference is seen in the result between free tendon graft and staged tendon graft. And 5 cases complicated by adhesion, rupture of grafted tendon and wound infection yielded poor result.

Clinical Study of Reconstruction on Old Flexor Tendon Injuries / 대한정형외과학회잡지

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.

Clinical Study on the Staged Tendon Graft for Flexor Tendon Injury of the Hand / 대한정형외과학회잡지

The biological characteristic of the silastic rod which in vivo induce the pseudosheath formation has popularized its application in the reconstructive surgery of flexor tendon injury of the digit, especially in the zone I, no-man's-land. We performed staged tendon graft in 14 digits(9 cases) and the following were the results. Clinical results of the 13 digits were good in 10 digists(77%). One case showed the untoward ill effect postoperatively. The above study has also shown that this staged tendon graft operation is applicable even to the higher grade of injury by Boyes. For the prevention of bowstring effect, A2 and A4 pulleys seem to be more essential than A1, A2. and A3.