Penetrating injury to the terminal branches of the posterior interosseous nerve with nerve grafting.

We report two cases of penetrating injuries to the terminal branches of the posterior interosseous nerve in the forearm. Repair using nerve grafts in both cases were followed by complete recovery.

Primary vascularized distal radius bone graft for nonunion of the scaphoid.

A vascularized bone graft from the dorsoradial aspect of the distal radius was used with internal fixation to treat nonunion of the scaphoid in ten patients who had not received any previous surgical treatment. Five cases were classified as Lichtman type I and five as type II. The average age was 30 years (range, 18-40 years). Associated avascular necrosis was observed in five cases. Postoperatively pain was relieved and union was achieved in all cases. The mean time to union was 6.5 weeks. Range of motion, grip strength and pinch strength were also restored satisfactorily. These results suggest that this vascularized bone graft should be used as the primary procedure in Lichtman type I and II of scaphoid nonunions, regardless of the presence of avascular necrosis of the proximal pole.

Congenital pseudarthrosis of the forearm treated by free vascularized fibular graft: a report of three cases and a review of the literature.

Congenital pseudarthrosis of the forearm is a rare condition; approximately 60 cases have been reported in the English literature. We report 3 patients treated by wide excision of the pseudarthrosis and free vascularized fibular grafting. The pseudarthrosis involved the radius in 1 patient and the ulna in 2. Neurofibromatosis was present in 2 patients. The technical problems encountered during the procedures included preservation of the distal epiphysis and attaining stable fixation of the fibular graft without damaging its vascular supply. A review of 15 previously reported patients treated by free vascularized fibular grafting showed that this procedure is excellent in the treatment of congenital pseudarthrosis of the forearm and that the result is consistently reproducible.

Nerve transfer to biceps muscle using a part of the ulnar nerve in brachial plexus injury (upper arm type): a report of 32 cases.

Thirty-two patients with absent elbow flexion secondary to brachial plexus injury underwent nerve transfer using 1 or 2 fascicles of the ulnar nerve to the motor branch of the biceps muscle. Twenty-six patients had root avulsion injury of C5 and C6; 4 had root avulsion injury of C5, C6, and C7; and 2 had lateral and posterior cord injury with distal injury of the musculocutaneous nerve. The follow-up period ranged from 11 to 40 months (average, 18 months). Thirty patients had biceps strength of M4 (flexion power ranged from 0.5 to 7 kg) and 1 had biceps strength of M3. All but 1 patient demonstrated signs of recovery of the biceps muscle. No notable impairment of hand function was observed.

Anatomy and internal topography of the musculocutaneous nerve: the nerves to the biceps and brachialis muscle.

One hundred twelve musculocutaneous nerves from 56 cadavers were examined to determine branching patterns of innervation and internal neurotopography. There were 3 distinct types of branching patterns for biceps innervation: in 62%, there was 1 branch only; in 33%, 2 branches; and in 5%, 3 branches. The origin of the first branch averaged 130 mm from the acromion regardless of branching type. The maximum distance between the first and second branch was 53 mm. In 92%, there was only 1 branch to the brachialis muscle. It always emerged from the main trunk distal to the nerve to the biceps and averaged 170 mm from the acromion. Internal topography was studied from 1-mm-thick serial sections of the musculocutaneous nerve in 5 fresh cadaver arms. The group of fasciculi of the nerve to the biceps, the nerve to the brachialis, and the lateral cutaneous nerve of the forearm were constantly located from lateral to medial. The fasciculi of the nerve to the biceps traveled proximally in the musculocutaneous nerve for an average distance of 63 mm.

Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases.

Four patients with C5-C6 root avulsion after brachial plexus injury were treated with a transfer of part of a normal functioning nerve in the arm to the motor nerve of the biceps. Ten percent of the bulk of the ulnar nerve was harvested for a suture directly to the motor nerve of the biceps with no significant impairment of hand function.