Subject(s)
Clinical Coding , Fracture Fixation/classification , International Classification of Diseases , Organ Transplantation/classification , Replantation/classification , Surgical Flaps/classification , Education, Continuing , Humans , Medical Record Administrators/education , Nerve Transfer/classification , Tendon Transfer/classification , United StatesABSTRACT
The median nerve provides sensory innervation to the radial aspect of the hand, including the palm, thumb, index, long, and half of the ring fingers. It provides motor innervation to most of the volar forearm musculature and, importantly, to m ost of thenar musculature. The main goal of median nerve reconstructive procedures is to restore thumb opposition. There are a variety of transfers that can achieve this goal but tendon transfers must recreate thumb opposition, which involves 3 basics movements: thumb abduction, flexion, and pronation. Many tendon transfers exist and the choice of tendon transfer should be tailored to the patient's needs.
Subject(s)
Median Neuropathy , Paralysis , Postoperative Complications/prevention & control , Tendon Transfer , Tendons/surgery , Hand Strength , Humans , Median Nerve/physiopathology , Median Nerve/surgery , Median Neuropathy/etiology , Median Neuropathy/physiopathology , Median Neuropathy/surgery , Movement , Paralysis/classification , Paralysis/etiology , Paralysis/physiopathology , Paralysis/surgery , Range of Motion, Articular , Recovery of Function , Sensation , Tendon Transfer/adverse effects , Tendon Transfer/classification , Tendon Transfer/methods , Tendon Transfer/rehabilitation , Tendons/physiopathology , Thumb/physiopathology , Thumb/surgery , Treatment OutcomeABSTRACT
BACKGROUND: The purpose of this study was to introduce a novel operative technique and to evaluate the clinical outcomes in a cohort of patients with missed or neglected Achilles tendon ruptures. METHODS: Fifteen consecutive patients with missed complete Achilles tendon ruptures and 5-cm or larger gaps had reconstruction with V-Y lengthening and flexor hallucis longus tendon transfer through a single incision. The patients were evaluated at an average of 106 weeks after surgery. At the time of followup, all patients were assessed with regard to their self-reported level of satisfaction and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. Ankle strength and active range of motion were evaluated using Biodex (Biodex Medical Systems, Shirley, NY) isokinetic dynamometry. In addition, seven patients were evaluated using diagnostic ultrasound. RESULTS: We found a 7.7 N-m (-22.3%) loss of plantarflexion torque at 60 degrees/sec and a 3.5 N-m (-13.5%) loss of plantarflexion torque at 120 degrees/sec, as well as a 5 degrees loss of active range of motion. AOFAS scores were all good to excellent, with an average score of 94.1 of 100. All patients were satisfied with their outcomes (rated good or very good). Excellent exposure of the Achilles tendon repair was obtained with ultrasound. CONCLUSIONS: For patients with missed or neglected Achilles tendon rupture with a rupture gap of at least 5 cm, operative repair using V-Y lengthening and flexor hallucis longus tendon transfer through a single incision technique achieved a high percentage of satisfactory results.
