Does primary brachial plexus surgery alter palliative tendon transfer surgery outcomes in children with obstetric paralysis?

<p>Abstract</p> <p>Background</p> <p>The surgical management of obstetrical brachial plexus palsy can generally be divided into two groups; early reconstructions in which the plexus or affected nerves are addressed and late or palliative reconstructions in which the residual deformities are addressed. Tendon transfers are the mainstay of palliative surgery. Occasionally, surgeons are required to utilise already denervated and subsequently reinnervated muscles as motors. This study aimed to compare the outcomes of tendon transfers for residual shoulder dysfunction in patients who had undergone early nerve surgery to the outcomes in patients who had not.</p> <p>Methods</p> <p>A total of 91 patients with obstetric paralysis-related shoulder abduction and external rotation deficits who underwent a modified Hoffer transfer of the latissimus dorsi/teres major to the greater tubercle of the humerus tendon between 2002 and 2009 were retrospectively analysed. The patients who had undergone neural surgery during infancy were compared to those who had not in terms of their preoperative and postoperative shoulder abduction and external rotation active ranges of motion.</p> <p>Results</p> <p>In the early surgery groups, only the postoperative external rotation angles showed statistically significant differences (25 degrees and 75 degrees for total and upper type palsies, respectively). Within the palliative surgery-only groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. The significant differences between the early surgery groups and the palliative surgery groups with total palsy during the preoperative period diminished postoperatively (p < 0.05 and p > 0.05, respectively) for abduction but not for external rotation. Within the upper type palsy groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles.</p> <p>Conclusions</p> <p>In this study, it was found that in patients with total paralysis, satisfactory shoulder abduction values can be achieved with tendon transfers regardless of a previous history of neural surgery even if the preoperative values differ.</p

Early results of nerve surgery in obstetrical brachial plexus palsy

Amaç: Doğumsal brakiyal pleksus paralizisi nedeniyle si-nir cerrahisine başvurulan olgularda uyguladığımız cerrahi teknik ve erken dönem sonuçlar sunuldu. Çalışma planı: Belirli bir algoritma izlenerek seçilen ve spontan sinir rejenerasyonu ve kas fonksiyonları yeterli görülmeyen doğumsal brakiyal pleksus paralizili 24 bebeğe (12 kız, 12 erkek; ort. yaş 7.9 ay; dağılım 4-14 ay) sinir onanını uygulandı. Beş olguda sadece nöroliz uygulanırken, yedi olguda spinal aksesuvar sinirden supraskapular sinire ekstrapleksal nörotizasyon, 17 olguda da intrapleksal nörotizasyon yapıldı. Ameliyat edilen olguların 17'sinde (%70) total paralizi (C5, C6±C7 rüptürü ve Cg, T, avulsiyonu), dördünde (%17) C5, C6 tutulumu, üçünde (%13) C5, C6, C7 tutulumu vardı. Ortalama izlem süresi 15.8 ay (dağılım 8-31 ay) olan hastaların periyodik değerlendirmeleri Hospital for Sick Children (HSC) değerlendirme sistemine göre yapıldı. Sonuçlar: En az 12 ay izlenen hastalarda ortalama HSC sonuçlan omuz abdüksiyonu için 4, dirsek fleksiyonu için 4.5, el bileği ekstansiyonu için 2.3, parmak fleksiyonu için 3.3 bulundu. Nöroma eksizyonu ve sinir grefti uygulanan sinirlerde, sadece nöroliz yapılan sinirlere oranla daha iyi rejenerasyon geliştiği gözlendi. Ameliyat sonrasında hiçbir olguda solunum sorunu, metabolik asidoz veya hipotermi gibi sorunlarla karşılaşılmadı. Çıkarımlar: Cerrahi müdahale gerektiren, kas aktivitesi yetersiz hastalarda tanının erken dönemde konması ve sinir cerrahisi uygulanması kasların atrofisini önleyerek, daha fonksiyonel bir üst ekstremite kazandırmaktadır.Objectives: To present surgical techniques and early postoperative results of patients who underwent nerve surgery for obstetrical brachial plexus palsy. Methods: Twenty-four infants (12 girls, 12 boys; mean age 7.9 months; range 4 to 14 months) with obstetrical brachial plexus palsy underwent nerve repair following a surgical algorithm that showed inadequate spontaneous nerve regen-eration and muscle function. Neurolysis was performed in five cases, intraplexial neurotisation in 17 cases, and extraplexial transfer of the spinal accessory nerve to the suprascapular nerve in seven cases. Seventeen patients (70%) had total palsy (C5, C6 and/or C7 rupture and C8, T, avulsion), four patients (17%) had C$, Cg involvement, and three patients (13%) had C5.7 involvement. Pre- and postop-erative evaluations were made according to the grading sys-tem of the Hospital for Sick Children (HSC). The mean fol-low-up period was 15.8 months (range 8 to 31 months). Results: The mean HSC grades of the patients followed at least for 12 months were as follows: shoulder abduction 4, elbow flexion 4.5, wrist extension 2.3, and finger flexion 3.3. Compared to patients who underwent neurolysis alone, improved nerve regeneration was noted in patients who underwent neuroma excision and nerve grafting. No severe complications occurred postoperatively, including respiratory problems, metabolic acidosis, and hypothermia. Conclusion: Early diagnosis and nerve surgery in patients having insufficient muscle activity and requiring surgical intervention may prevent atrophy of the muscles and provide a more functional upper extremity

The results of digital replantations at the level of the distal interphalangeal joint and the distal phalanx

Amaç: Distal uç amputasyonlarında uygulanan replantasyonlar geriye dönük olarak değerlendirildi. Çalışma planı: Distal interfalangeal eklem distal seviyesinde total amputasyon gelişen 82 hastanın (75 erkek, 7 kadın; ort. yaş 29; dağılım 10-52) 98 parmağına uygulanan replantasyonlar incelendi. Tamai sınıflamasına göre amputasyonların 58’i zon 1, 40’ı zon 2’de idi. Yetmiş yedi (%93.9) hasta digital blok anestezisi altında ameliyat edildi. Kemik fiksasyonunu takiben arter anastomozu ve mümkün olan olgularda ven anastomozu ve nörorafi yapıldı. Ven anastomozu yapılamayan veya anastomoz yapılmasına karşın venöz yetmezlik oluşan olgularda tırnak yatağına iğneyle açılan delikler üzerine heparinize gaz konarak iki saatte bir heparin uygulandı. Hastaların fonksiyonel durumu ve kozmetik açıdan memnuniyeti değerlendirildi. Ortalama takip süresi 16 aydı (dağılım 3-46 ay). Sonuçlar: Altmış replantasyon (%61.2) başarılı, 38 replantasyon (%38.8) başarısız bulundu. Başarılı sonuç alınan olgularda, tırnağın ve parmak uzunluğunun korunması nedeniyle kozmetik olarak tatmin edici görünüm sağlandı; distal interfalangeal eklemi korunan olgularda fonksiyonel açıdan tatminkar sonuçlar alındı. Zon 1 amputasyonlardaki başarı oranının (%74.1) zon 2 amputasyonlara (%42.5) göre daha yüksek olduğu gözlendi. Çıkarımlar: Distal uç replantasyonları, teknik zorluklara karşın görünüm ve fonksiyonel açıdan tatmin edici sonuçlar verebilmektedir.Objectives: We retrospectively evaluated replantations performed for distal amputations. Methods: The study included 82 patients (75 males, 7 females; mean age 29 years; range 10 to 52 years) who underwent replantations distal to the distal interphalangeal joint for a total of 98 amputations. According to the Tamai classification, there were 58 zone 1 and 40 zone 2 amputations. Local digital anesthesia was used in 77 patients (93.9%). Arterial anastomosis was accomplished after bone fixation, and venous anastomosis and nerve repair were performed whenever possible. When venous anastomosis was not possible or in case of venous insufficiency, venous decompression was performed with heparinized gauze placed on the bleeding nail matrix. Functional results and the degree of patients&amp;#8217; satisfaction with the cosmetic outcome were evaluated. The mean follow-up was 16 months (range 3 to 46 months). Results: Replantation was successful in 60 amputations (61.2%) and unsuccessful in 38 cases (38.8%). In successful cases, cosmetic results were satisfactory due to the preservation of the nail and finger length. Functional results were satisfactory in cases in which the distal interphalangeal joint could be preserved. Replantations for zone 1 amputations (74.1%) yielded better results than those performed for zone 2 amputations (42.5%). Conclusion: Despite technical difficulties, replantations for distal finger amputations can provide satisfactory functional and cosmetic results

Evaluation of Patients Undergoing Removal of Glass Fragments From Injured Hands A Retrospective Study

WOS: 000292505600006PubMed ID: 21372675The hand is the body part most frequently injured by broken glass. Glass fragments lodged in soft tissues may result in numerous complications, such as infection, delayed healing, persistent pain, and late injury as a result of migration. Between 2005 and 2010, we removed 46 glass particles from the hands of 26 patients. The injuries were caused by the following: car windows broken during motor vehicle accidents in 11 patients (42%); fragments from broken glasses, dishes, or bottles in 9 (35%); the hand passing through glass in 5 (19%); and a fragment from a broken fluorescent lamp in 1 (4%) patient. Despite the efficacy of plain radiographs in detecting glass fragments, these are sometimes not obtained. Given the relatively low cost, accessibility, and efficacy of radiographs, and the adverse consequences of retained foreign bodies, the objections to obtaining radiographs should be few in diagnosing glass-related injuries of the hand

Olecranon bone grafting for the treatment of nonunion after distal finger replantation

Aim: Although not very popular, the olecranon bone graft is a useful option for this type of operation due to the minimal donor morbidity and its ease of use in small bone defect reconstruction and non-union therapy. To our best knowledge, few studies have evaluated the use of the olecranon bone graft as a treatment for non-union after distal finger replantation. Our aim in this report was to present our experience of using olecranon grafts in our nonunion patients undergoing distal replantations.Methods: Between 2013 and 2019, a total of 14 patients who developed nonunion or had segmental bone defects due to the injury were included in the study. Retrospectively the results were analyzed in terms of complication and union rates.Results: The mean follow-up period was 37 months (range 8-72 months). No major complications were seen in the donor region or recipient regions. One patient developed necrosis in the nail bed and one patient had a hematoma in the donor site. The minor complications were solved without any problem.Conclusion: In conclusion, we found the olecranon bone grafting for the treatment of nonunion after distal finger replantation is a safe and convenient method. It can be preferred as the first choice for nonunions of distal finger replantations