Biomechanical investigation of 'figure of 8' flexor tendon repair techniques.

This biomechanical study compared the original Al-Qattan repair with other modifications postulated to reduce bulk and friction, thereby potentially improving outcome. A total of 32 cadaveric digits with intact flexor apparatus were used. In each digit, the flexor digitorum profundus and flexor digitorum superficialis tendons were cut cleanly in Zone 2. We tested Al-Qattan's technique along with three modifications using stronger suture material and varying the number of strands across the repair site. Of the four repair techniques, the modified Al-Qattan's technique using two 'figure of 8' 4-0 Fiberwire core sutures (Group 4) had the best balance of ultimate tensile strength (50.9 N), 2 mm gapping force (38 N) and friction. The modified technique provided a stronger repair for early active mobilization and has less friction than the originally described repair.

Bipedicled homodigital neurovascular island flap for resurfacing dorsal digital defects amputation.

Critical defects distal to the proximal interphalangeal joint are usually treated by heterodigital or reverse-flow homodigital flaps. Drawbacks of the former are potential donor digit stiffness and scarring, while the latter might be complicated by flap congestion. A bipedicled neurovascular island transposition flap design that preserves both proximal and distal extent of digital nerve and artery was employed to treat critical dorsal skin defect in two patients with encouraging results. Technical details and cadaveric study concepts are presented.

The oblique wedge osteotomy of the metacarpal condyle for reconstructing Wassel type IV thumb duplication in older children and adults.

In reconstructing the Wassel type IV thumb duplication in infants, a deviation deformity of the retained thumb may be corrected by a closing transverse wedge osteotomy of the metacarpal neck. In older children and adults, this technique may cause avascular necrosis of the retained metacarpal condyle. We have addressed this problem by using an oblique wedge osteotomy of the metacarpal condyle. Ten patients (mean age, 18.9 years) underwent this procedure between 1993 and 2007. Patients with deviation angles of 30° or less had a closing wedge osteotomy, while those with deviation angles exceeding 30° had a rotational bone graft osteotomy. Deviation angles were corrected from a mean of 32° (range, 16° to 55°) to 0° in eight thumbs and 10° in two thumbs. There were no cases of avascular necrosis. All patients achieved good results by Tada's criteria. This technique effectively restores bony alignment of the thumb and preserves vascularity of the retained condyle.

Radionuclide synovectomy and chronic haemophilic synovitis in Asians: a retrospective study.

Radionuclide synovectomy has been identified as the procedure of choice in treating chronic haemophilic synovitis among Caucasian populations. Its effectiveness among East Asians has not been studied. A retrospective study was carried out on 12 Asian haemophiliacs who underwent 12 radionuclide synovectomies. The average follow-up was 30.7 months (range 6-55) for primary procedures. 32P chromic phosphate and 188Re-tin colloid were injected into target joints according to protocol. There was a significant 80% decrease in the median frequency of haemarthrosis from 1.4 per month (range 0.2-7.0) to 0.25 per month (range 0.0-1.8) (P<0.05). Half of the patients had excellent results by 1 year of synovectomy. The median factor usage for target joint haemarthrosis postsynovectomy was 792 units per month (range 0-3209) reduced significantly from a presynovectomy level of 1452 units per month (range 306-7125) (P<0.05). Patients also reported a reduction in joint pain scores, and an improvement in joint mobility and quality of life. The majority of patients were satisfied with the overall outcome of radionuclide synovectomy. Radionuclide synovectomy appears to be effective in reducing the incidence of target joint haemarthrosis and quantity of factor usage for such bleeds among Asians with haemophilic synovitis.