ABSTRACT
The present study reports results of a metacarpal transposition technique we have developed for congenital and spontaneous extensor tendon snapping. Six patients with a mean age of 14 years (range: 12-19 years) were included and evaluated retrospectively. They had Rayan-Murray type-3 atraumatic chronic extensor tendon instability: 2 on the middle finger, 3 on the ring finger, and 1 on the index and middle fingers. In selecting the cases, preoperative examination included elevation of the metacarpals to check whether this decreased the tendon snapping, and patients in whom no snapping persisted were scheduled for surgery. Pre- and post-operative pain at rest and in activity was assessed on visual analog scale (VAS), and the QuickDASH test was administered. Pre- and post-operative active and passive ranges of metacarpophalangeal motion were measured, as was grip strength on a Jamar dynamometer. Mean follow-up was 38 months (range: 26-42 months). Postoperatively, pain during activity and QuickDASH score showed significant improvement. No wound problems or recurrence were encountered. There were no significant postoperative changes in active and passive joint range of motion. At follow-up examination, no physical therapy needed to be prescribed and no limitation of motion was observed. For tendon snapping, in which treatment is technically difficult and may lead to problems, we believe that our easily applicable minimally traumatizing technique does not restrict joint motion and is an appropriate solution for patients with positive elevation test.
Subject(s)
Metacarpal Bones , Tendon Injuries , Adolescent , Humans , Metacarpal Bones/surgery , Metacarpophalangeal Joint/surgery , Retrospective Studies , Tendon Injuries/surgery , Tendons/surgerySubject(s)
Median Neuropathy , Neoplasms, Multiple Primary , Neurilemmoma , Peripheral Nervous System Neoplasms , Adult , Diagnosis, Differential , Electromyography , Female , Humans , Magnetic Resonance Imaging , Median Neuropathy/diagnosis , Median Neuropathy/pathology , Median Neuropathy/surgery , Neoplasms, Multiple Primary/diagnosis , Neoplasms, Multiple Primary/pathology , Neoplasms, Multiple Primary/surgery , Neurilemmoma/diagnosis , Neurilemmoma/pathology , Neurilemmoma/surgery , Peripheral Nervous System Neoplasms/diagnosis , Peripheral Nervous System Neoplasms/pathology , Peripheral Nervous System Neoplasms/surgeryABSTRACT
Distal phalangeal fractures are the most common fractures of the hand but nonunions are unusual in the distal phalanx. Eleven patients were operated on for nonunions of the distal phalanx. The diagnosis of nonunion was made by the presence of the clinical (pain, deformity, instability) and radiological signs of nonunion more than 4 months after the initial injury. Three patients had developed infection and four of them had bone resorption after their initial treatments, which probably caused nonunion. Olecranon bone grafting combined with Kirschner wire fixation was done in all patients. The mean follow up was 7 months (range 5-18 months). There were no major complications at the donor or recipient sites. One patient had a haematoma formation at the donor site. There was complete radiological union of bone-grafted sites in all patients except one. There were no cases of pain, deformity, or instability after the treatment. The olecranon bone graft was found to be safe and easy to harvest. Its strong tubular structure replaced the distal phalanx successfully.
