Surgical treatment of the divided flexor digitorum profundus tendon in zone 2, delayed more than 6 weeks, by tendon grafting in 50 cases.

The surgical treatment of the divided FDP tendon, more than 6 weeks old, in zone 2 is reviewed in 50 patients. The method used was the excision of the divided FDP tendon and the insertion of a thin tendon graft. There were 50 patients in this study; 36 were male and 14 female, aged from 18 to 60 years. All patients were markedly disabled because of loss of strength of the involved finger. Follow-up ranged from 1 to 25 years following tendon grafting. In 35 patients plantaris tendon was used and in 15 patients palmaris longus. Definite advantages were found in using the tendon grafting procedure; strength, dexterity, pinch and grasp were markedly improved. Functional results were evaluated by the Boyes method, with the Pulvertaft method as a secondary assessment. Among the 50 patients, 80% had excellent and good results (excellent 32%, good 48%) and 20% fair.

Management of the unbalanced wrist in cerebral palsy by tendon transfer.

Over a 25-year period, 60 children with spasticity of the upper extremity mainly resulting from cerebral palsy underwent surgical reconstruction of the unbalanced wrist. A detailed classification of the deformity is described on the basis of the functional anatomy of the unbalanced wrist in cerebral palsy, which was divided into three groups. In retrospective analysis of the long-term results, this classification has proved helpful in selecting an option for the treatment of this difficult deformity. In addition, the described classification has aided us in keeping accurate follow-up records in predicting the progress of the patient, and in coordinating the postoperative treatment.

Classification and surgical treatment of the thumb-in-palm deformity in cerebral palsy and spastic paralysis.

Over a 20-year period, 59 children with spasticity mainly due to cerebral palsy underwent surgery for correction of a thumb-in-palm deformity. A classification of the deformity based on the functional anatomy of the thumb divided the problem into four different types. A retrospective analysis of the results has shown the classification to be helpful in selecting a surgical option for treatment. In addition, the classification helps to keep accurate records, predict patient progress, and coordinate postoperative treatment.

The surgical treatment of old injuries of the collateral ligaments of the MP joint of the thumb using the extensor pollicis brevis tendon (a long-term follow-up of 100 cases).

The surgical technique is described, the literature is reviewed, and recommendations for treatment are given for acute complete and acute incomplete ruptures of these ligaments, as well as for old ruptures and all ruptures with severe degenerative changes.

Treatment of pronation contractures of the forearm in cerebral palsy by changing the insertion of the pronator radii teres.

In twenty-two patients with cerebral palsy and a pronation contracture of the forearm, transfer of the pronator radii teres posteriorly to the anterolateral border of the radius converted it from a pronator to a supinator. Of the twenty-two patients so treated and followed for two to six years, 82 per cent were judged to have a good to excellent result since they had gained an average of 46 degrees of active supination compared with their preoperative status. There was no loss of motion with the passage of time and, determined by palpation, active contract of the transferred pronator teres was evident during voluntary supination. The procedure allowed the patients to improve function significantly by giving them the ability to supinate the forearm during activities requiring axial rotation of the forearm.

The correction of rheumatoid ulnar drift by silicone prostheses with tendon transfer.

Fifty hands with rheumatoid ulnar drift treated by resection of the metacarpal heads and replacement with silicone prostheses were studied. The procedure is outlined which consists of an arthroplasty using a silicone prosthesis with tendon transfer. The complications are also studied and the results evaluated. Of the cases studied 20% were excellent, 40% were good, and 40% fair.

Instability of the metacarpophalangeal joint of the thumb. Reconstruction of the collateral ligaments using the extensor pollicis brevis tendon.

Reconstruction of the collateral ligaments of the metacarpophalangeal joint of the thumb was performed for fourteen ruptures of the ulnar and two ruptures of the radial collateral ligament, one to eighteen months after injury. The extensor pollicis brevis tendon was used to reinforce the resutured ligament. Symptoms were relieved in all cases after follow-ups ranging from one to seven years, even in two thumbs with mild degenerative arthritis of the metacarpophalangeal joint.