Asunto(s)

Lesiones del Manguito de los Rotadores/cirugía , Manguito de los Rotadores/cirugía , Músculos Superficiales de la Espalda/cirugía , Transferencia Tendinosa/métodos , Tenodesis/métodos , Adulto , Cuidados Posteriores , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Manguito de los Rotadores/patología , Lesiones del Manguito de los Rotadores/complicaciones , Lesiones del Manguito de los Rotadores/patología , Transferencia Tendinosa/normas , Tenodesis/estadística & datos numéricos

RESUMEN

We report a case of bilateral reversed palmaris longus muscle (PLM). The muscle was tendinous in its upper portion and muscular in its lower portion in both arms. This rare variation has been mentioned only once in the literature as a surgical finding. According to the literature, a reversed PLM may cause a compartment syndrome in the wrist area, carpal tunnel, and Guyon's syndrome. The described variation is also useful to the hand surgeon as a tendon graft, a tendon for transfer, or as an anatomical landmark for operations at this area.

Asunto(s)

Antebrazo/anomalías , Músculo Esquelético/anomalías , Anomalías Musculoesqueléticas/patología , Tendones/anomalías , Anciano , Síndrome del Túnel Carpiano/etiología , Síndrome del Túnel Carpiano/cirugía , Antebrazo/cirugía , Humanos , Húmero/anomalías , Masculino , Músculo Esquelético/cirugía , Transferencia Tendinosa/efectos adversos , Transferencia Tendinosa/normas , Tendones/cirugía , Muñeca/anomalías , Muñeca/fisiología , Muñeca/cirugía

RESUMEN

Tendon transfers are performed predominantly to restore hand function or balance due to injuries of the radial, median, and ulnar nerves. Current surgical techniques for the most common tendon transfers for reconstruction of radial, median, and ulnar nerve palsies are demonstrated. These techniques can also be applied to restore flexion and extension of the fingers and thumb after injuries to the extrinsic flexor and extensor muscles and tendons of the forearm or intrinsic muscles of the hand.

Asunto(s)

Traumatismos de la Mano/cirugía , Mano/inervación , Nervio Mediano/lesiones , Nervio Radial/lesiones , Transferencia Tendinosa/métodos , Nervio Cubital/lesiones , Mano/fisiopatología , Mano/cirugía , Traumatismos de la Mano/fisiopatología , Humanos , Nervio Mediano/fisiopatología , Nervio Mediano/cirugía , Guías de Práctica Clínica como Asunto , Nervio Radial/fisiopatología , Nervio Radial/cirugía , Rango del Movimiento Articular , Recuperación de la Función , Transferencia Tendinosa/normas , Tendones/fisiopatología , Tendones/cirugía , Resultado del Tratamiento , Nervio Cubital/fisiopatología , Nervio Cubital/cirugía

RESUMEN

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Asunto(s)

Neuropatías del Plexo Braquial/cirugía , Plexo Braquial/cirugía , Procedimientos Neuroquirúrgicos , Cuidados Paliativos , Parálisis Obstétrica/cirugía , Transferencia Tendinosa , Adolescente , Plexo Braquial/lesiones , Plexo Braquial/patología , Neuropatías del Plexo Braquial/patología , Niño , Preescolar , Femenino , Humanos , Masculino , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/normas , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Parálisis Obstétrica/patología , Estudios Retrospectivos , Transferencia Tendinosa/métodos , Transferencia Tendinosa/normas , Resultado del Tratamiento , Adulto Joven

RESUMEN

There is a trend towards the use of double-bundle techniques for the reconstruction of the anterior cruciate ligament. This has not been substantiated scientifically. The functional outcome of these techniques is equivalent to that of single-bundle methods. The main advantage of a double-bundle rather than a single-bundle reconstruction should be a better rotational stability, but the validity and accuracy of systems for the measurement of rotational stability have not been confirmed. Despite the enthusiasm of surgeons for the double-bundle technique, reconstruction with a single-bundle should remain the standard method for managing deficiency of the anterior cruciate ligament until strong evidence in favour of the use of the double-bundle method is available.

Asunto(s)

Ligamento Cruzado Anterior/cirugía , Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/cirugía , Procedimientos Ortopédicos/métodos , Transferencia Tendinosa/métodos , Tendones/trasplante , Ligamento Cruzado Anterior/trasplante , Artrometría Articular , Artroscopía/métodos , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Transferencia Tendinosa/normas

RESUMEN

BACKGROUND: Fixation of tendon transfers with a bioabsorbable interference-fit screw has several advantages over other fixation methods: decreased dissection, operative time, and blood loss; preservation of tendon length; no interference with radiographic studies; no need for implant removal; and no barrier to revision surgery. Whether strength of fixation is affected by the size of the pilot hole has not been established. The purpose of this study was to determine the effect of pilot hole size on the pullout strength of a flexor digitorum longus (FDL) tendon secured into a bone analog using a 5.5-mm bioabsorbable screw. METHODS: Thirty FDL tendons were harvested from 15 cadaver specimens and secured into predrilled 4 x 4 x 4 cm bone cubes with a 5.5-mm Arthrex bioabsorbable screw (Arthrex, Naples, FL). The use of bone analog foam cubes ensured consistent porosity at the insertion site, eliminating the variations associated with varying bone densities of cadaver specimens. Pilot hole sizes studied were 5.0 mm, 5.5 mm, and 6.0 mm. Pullout tests were done with an servohydraulic testing frame (MTS, Eden Prairie, MN). RESULTS: There was no significant difference (p = 0.4) between the pullout forces and stresses among the three pilot hole sizes. All specimens failed at the interface between the FDL and the bioabsorbable screw. In the 6.0-mm pilot hole group, there was a trend for increased pullout strength with increased tendon size. CONCLUSIONS: With a bioabsorbable 5.5-mm screw used for FDL transfer, a pilot hole the same size or a half millimeter larger or smaller than the screw had no statistically significant effect on the strength of the construct, even with tendons of different sizes.

Asunto(s)

Implantes Absorbibles , Tornillos Óseos , Transferencia Tendinosa/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Cadáver , Femenino , Humanos , Masculino , Persona de Mediana Edad , Transferencia Tendinosa/métodos , Transferencia Tendinosa/normas

RESUMEN

A follow up study was performed in the rehabilitation centre for patients with leprosy in Hôchiminhville - Vietnam. All patients had claw-hand deformity due to ulnar and median nerve intrinsic paralysis. Thirty-two affected hands (128 long fingers) were included in the study. A Bunnel-Littler tendon transfer procedure was performed using a four-tailed graft of the flexor digitorum superficialis of the third finger. Clinical evaluation included anatomical measurements of interphalangeal and metacarpal joints in complete extension and in the intrinsic position. In the open hand assessment, 48.5% reported good results, 14.8% medium results and 36.7% poor results. With the hand in the intrinsic position, 53.9% achieved good results, while 33.6% achieved medium results and poor in 12.5%. Poor functional outcome is related to a failure of this procedure and seems to be due to extensor tendon laxity, with or without stiffness of the interphalangeal joints. There were many anatomical deformities (27.3%) found at the time of follow up, notably boutonniere (51.4%) and mallet finger deformities (31.4%) The fourth and fifth fingers had the worst results. We have therefore decided to change our protocol for claw-hand correction and use the Bouvier test in deciding on our surgical indications. Preoperative physiotherapy is absolutely necessary to reduce stiffness of the interphalangeal joints.

Asunto(s)

Masculino , Femenino , Humanos , Adulto , Persona de Mediana Edad , Lepra/cirugía , Lepra/complicaciones , Lepra/rehabilitación , Metacarpo/cirugía , Metacarpo/lesiones , Transferencia Tendinosa , Transferencia Tendinosa/métodos , Transferencia Tendinosa/normas , Transferencia Tendinosa/rehabilitación

RESUMEN

A team of experts in the field of reconstructive surgery for leprosy-affected people was identified. Using the Delphi method, an exercise was undertaken to ascertain whether a consensus on essential criteria and indicators for Tibialis Posterior Transfer (TPT) could be reached among the team. This paper describes the Delphi Exercise, giving results at each stage of consensus development. The final outcome was that essential criteria, including contraindications for surgery, pre- and post- operative assessments and expected outcomes, were agreed. The criteria are presented with recommendations.

Asunto(s)

Consenso , Lepra/cirugía , Evaluación de Resultado en la Atención de Salud/normas , Procedimientos de Cirugía Plástica/normas , Transferencia Tendinosa/normas , Contraindicaciones , Técnica Delphi , Humanos , Selección de Paciente , Guías de Práctica Clínica como Asunto/normas , Resultado del Tratamiento

RESUMEN

AIM: Common peroneal nerve (CPN) injuries represent the most common nerve lesions of the lower limb and can be due to several causative mechanisms. Although in most cases they recover spontaneously, an irreversible damage of the nerve is also likely to occur. Nerve regeneration following CPN repair is poorer if compared to other peripheral nerves and this can explain the reluctant attitude of many physicians towards the surgical treatment of these patients. Among the several factors advocated to explain the poor outcome following surgery, it has been suggested that reinnervation might be obstacled by the force imbalance between the functioning flexors and the paralysed extensors that eventually results in the fixed equinism of the foot, due to the excessive contracture of the active muscles and the shortening of the heel cord. Therefore the early correction of these forces might favour nerve regeneration. Following such hypothesis, the authors treat irreversible CPN injuries performing a one-stage procedure of nerve repair and tibialis tendon transfer. We report our experience, describing the indications to surgical treatment, the operative technique and the postoperative clinical outcome correlated with the causative mechanisms of the injuries. METHODS: A 62-patient series controlled over a period of 15 years with a post-traumatic palsy of the CPN is reported. All the patients underwent surgery. In open wounds, when a nerve transection was suspected, surgery was performed at emergency (2 cases). In closed injuries, operative treatment was advised when no spontaneous regeneration occurred 3-4 months after the injury. From 1988 till 1991, 9 patients were elected for surgery : in 6 cases treatment consisted of neuroma resection and nerve repair by means of a graft. In 3 patients it was performed only a CPN decompression at the fibular neck. Since 1991, surgical treatment has always consisted of nerve repair associated with a tendon transfer during the same procedure. Fifty-three patients were elected for surgery. Nerve repair was achieved by direct suture in 1 case and by means of a graft in 46 patients. Decompression of the CPN at the fibular neck was performed in 6 patients where nerve continuity was demonstrated. RESULTS: In the first group of patients, nerve repair outcome was highly disapponting: no recovery in 5 cases, reinnervation occurred in 1 patient only (M1-2). CPN decompression was followed by complete recovery in 2 cases, no improvement was observed in 1 case. Nerve repair associated with tibialis tendon transfer dramatically improved the postoperative outcome: at 2 year follow-up, neural regeneration was demonstrated in 90% of the patients. Surgical outcome depends on the causative mechanisms of the lesion: sharp injuries and severe dislocations of the knee had an excellent recovery, while in crush injuries and gunshot wounds good recovery was less common. CONCLUSION: Surgical treatment of CPN injuries can nowadays be highly rewarding. CPN palsies in open wounds should undergo surgical exploration at emergency. In close injuries with no spontaneous recovery within 4 months after the injury, patients should be advised to seek surgical treatment regardless the causative mechanism of the lesion. According to our experience, the association of a transfer procedure to nerve repair enhances neural regeneration, dramatically improving the surgical outcome of these injuries.

Asunto(s)

Regeneración Nerviosa/fisiología , Nervio Peroneo/lesiones , Nervio Peroneo/cirugía , Neuropatías Peroneas/cirugía , Transferencia Tendinosa/métodos , Transferencia Tendinosa/normas , Trasplante de Tejidos/métodos , Adolescente , Adulto , Anastomosis Quirúrgica/métodos , Descompresión Quirúrgica/métodos , Femenino , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/prevención & control , Trastornos Neurológicos de la Marcha/cirugía , Humanos , Luxación de la Rodilla/complicaciones , Luxación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Contracción Muscular/fisiología , Músculo Esquelético/inervación , Músculo Esquelético/fisiología , Músculo Esquelético/cirugía , Neuroma/etiología , Neuroma/patología , Neuroma/cirugía , Selección de Paciente , Nervio Peroneo/fisiopatología , Neuropatías Peroneas/etiología , Neuropatías Peroneas/fisiopatología , Recuperación de la Función/fisiología , Nervio Sural/anatomía & histología , Nervio Sural/cirugía , Tendones/anatomía & histología , Tendones/fisiología , Tendones/cirugía , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

STUDY DESIGN: Tetraplegic patients were tested for hand strength before and after hand surgery. They also answered questions about how they rated the results of surgery. OBJECTIVES: Presentation of the efficacy of reconstruction of hand raising, lateral grip, and cylindrical grip in the tetraplegic hand. SETTING: The study was conducted in the Werner Wicker Clinic, Bad Wildungen, Germany, from 1991 to 1998. METHODS: The results of reconstruction surgery performed on 23 tetraplegic hands, as reflected in lifting the hand (n=3), lateral grip (n=21), and cylindrical grip (n=14), are presented. In a follow-up study in 22 patients, their management of activities of daily living 34.1 months (9-51 months) after the surgery is compared with the preoperative situation. Subjective satisfaction levels were elicited for each of the 22 patients by means of a questionnaire. RESULTS: The gain in force corresponded to 893 g (150-1500 g) for cyclindrical grip and 488 g (100-1200 g) for lateral grip, while they were able to develop grade 4 force for lifting the hand. After the operation 28 aids/appliances that patients had formerly used regularly were no longer necessary. There were 75 separate activities listed in the questionnaire, and on average the 22 patients were able to perform 8.7 (0-20) more of these. Most patients (19) said they would advise others to have the operation and 18, that they would have the operation again. There were 12 complications in nine patients. CONCLUSION: Reconstructive surgery on the hands of tetraplegic patients leads to gains in both cylindrical grip and lateral grip force and to increased manual dexterity. Patient satisfaction with the procedure is high.

Asunto(s)

Actividades Cotidianas/psicología , Vértebras Cervicales/lesiones , Deformidades Adquiridas de la Mano/cirugía , Mano/cirugía , Cuadriplejía/cirugía , Traumatismos de la Médula Espinal/cirugía , Adulto , Vértebras Cervicales/patología , Vértebras Cervicales/fisiopatología , Femenino , Mano/inervación , Mano/fisiopatología , Deformidades Adquiridas de la Mano/etiología , Deformidades Adquiridas de la Mano/fisiopatología , Fuerza de la Mano/fisiología , Humanos , Masculino , Persona de Mediana Edad , Debilidad Muscular/etiología , Debilidad Muscular/rehabilitación , Debilidad Muscular/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Cuadriplejía/fisiopatología , Cuadriplejía/rehabilitación , Calidad de Vida , Recuperación de la Función/fisiología , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/rehabilitación , Encuestas y Cuestionarios , Transferencia Tendinosa/efectos adversos , Transferencia Tendinosa/normas , Resultado del Tratamiento

RESUMEN

In the period 1969-1991, 46 extensor indicis proprius tendon transfers were performed for functional loss of extensor pollicis longus. The long-term function of the thumb was reviewed in 22 patients with an average follow-up of 7 years. Based on Geldmacher's evaluation scheme for assessment of the results of extensor tendon reconstruction, we report 5 excellent (23%), 4 good (18%), 12 satisfactory (55%) and 1 poor (4%) result. The mean loss of pinch strength was 8% compared with the contralateral, non-operated thumb. Subjectively, the majority of the patients (86%) described no limitations in their daily life activities. It is recommended that the transfer be tight enough to give full thumb extension and that the hand be immobilized with the thumb in this position for 4 weeks.

Asunto(s)

Traumatismos de los Tendones/cirugía , Transferencia Tendinosa/normas , Pulgar/lesiones , Actividades Cotidianas , Adulto , Anciano , Fenómenos Biomecánicos , Articulaciones de los Dedos/fisiología , Fuerza de la Mano , Humanos , Articulación Metacarpofalángica/fisiología , Persona de Mediana Edad , Satisfacción del Paciente , Rango del Movimiento Articular , Rotura , Resultado del Tratamiento

RESUMEN

Nos muestra las posibilidades reconstructivas, por medio de la microcirugía, reimplantes, transplantes, cirugía de los nervios periféricos y otras tecnologías de avanzada, de las diversas patologías que afectan la mano

Asunto(s)

Humanos , Mano/cirugía , Cirugía Plástica/métodos , Mano/anatomía & histología , Cirugía Plástica/instrumentación , Cirugía Plástica/normas , Colgajos Quirúrgicos/clasificación , Colgajos Quirúrgicos/instrumentación , Colgajos Quirúrgicos/métodos , Traumatismos de la Mano/cirugía , Deformidades de la Mano/cirugía , Nervios Periféricos/cirugía , Nervios Periféricos/lesiones , Síndromes de Compresión Nerviosa/cirugía , Uñas/cirugía , Uñas/lesiones , Miembros Artificiales/clasificación , Miembros Artificiales/instrumentación , Miembros Artificiales/normas , Reimplantación/instrumentación , Reimplantación/métodos , Reimplantación/normas , Distrofia Simpática Refleja/cirugía , Muñones de Amputación/cirugía , Amputación Quirúrgica/métodos , Amputación Quirúrgica/normas , Traumatismos de los Dedos/cirugía , Artritis Reumatoide/cirugía , Tendones/cirugía , Plexo Braquial/cirugía , Plexo Braquial/lesiones , Transferencia Tendinosa/instrumentación , Transferencia Tendinosa/métodos , Transferencia Tendinosa/normas , Espasticidad Muscular/cirugía , Distrofia Simpática Refleja/cirugía , Síndromes Compartimentales/cirugía , Contractura de Dupuytren/cirugía , Pulgar/cirugía , Pulgar/lesiones , Dedos del Pie/cirugía , Antebrazo/anomalías , Antebrazo/cirugía , Traumatismos por Electricidad/cirugía , Quemaduras/cirugía , Infecciones Bacterianas/clasificación , Infecciones Bacterianas/prevención & control , Infecciones Bacterianas/tratamiento farmacológico , Traumatismos por Radiación/cirugía , Traumatismos por Radiación/terapia , Congelación , /cirugía , /terapia , Quemaduras Químicas/cirugía , Quemaduras Químicas/terapia

RESUMEN

Nos muestra las posibilidades reconstructivas, por medio de la microcirugía, reimplantes, transplantes, cirugía de los nervios periféricos y otras tecnologías de avanzada, de las diversas patologías que afectan la mano

Asunto(s)

Humanos , Cirugía Plástica/métodos , Mano/cirugía , Amputación Quirúrgica/métodos , Amputación Quirúrgica/normas , Antebrazo/anomalías , Antebrazo/cirugía , Artritis Reumatoide/cirugía , Cirugía Plástica/instrumentación , Cirugía Plástica/normas , Congelación , Contractura de Dupuytren/cirugía , Muñones de Amputación/cirugía , Dedos del Pie/cirugía , Deformidades de la Mano/cirugía , Distrofia Simpática Refleja/cirugía , Espasticidad Muscular/cirugía , Infecciones Bacterianas/clasificación , Infecciones Bacterianas/prevención & control , Infecciones Bacterianas/tratamiento farmacológico , Traumatismos por Radiación/cirugía , Traumatismos por Radiación/terapia , Miembros Artificiales/clasificación , Miembros Artificiales/instrumentación , Miembros Artificiales/normas , Mano/anatomía & histología , Nervios Periféricos/cirugía , Nervios Periféricos/lesiones , Plexo Braquial/cirugía , Plexo Braquial/lesiones , Pulgar/cirugía , Pulgar/lesiones , Quemaduras Químicas/cirugía , Quemaduras Químicas/terapia , Quemaduras/cirugía , Reimplantación/instrumentación , Reimplantación/métodos , Reimplantación/normas , Colgajos Quirúrgicos/clasificación , Colgajos Quirúrgicos/instrumentación , Colgajos Quirúrgicos/métodos , Síndromes Compartimentales/cirugía , Síndromes de Compresión Nerviosa/cirugía , Tendones/cirugía , Transferencia Tendinosa/instrumentación , Transferencia Tendinosa/métodos , Transferencia Tendinosa/normas , Traumatismos de la Mano/cirugía , Traumatismos de los Dedos/cirugía , Traumatismos por Electricidad/cirugía , Uñas/cirugía , Uñas/lesiones

RESUMEN

This is a case of late-onset (6 weeks) radial nerve paralysis following open reduction and internal fixation of a comminuted distal humerus fracture. A transected radial nerve within the callus was found at reoperation. The mechanism of transection was thought to be repetitive motion of the nerve across an edge of new bone. The nerve was repaired and tendon transfers done subsequently with less than full functional recovery at 16 months. No such case has been previously reported.

Asunto(s)

Callo Óseo/diagnóstico por imagen , Fracturas del Húmero/complicaciones , Síndromes de Compresión Nerviosa/etiología , Complicaciones Posoperatorias/etiología , Nervio Radial/lesiones , Adulto , Femenino , Fijación Interna de Fracturas , Humanos , Fracturas del Húmero/diagnóstico por imagen , Fracturas del Húmero/cirugía , Síndromes de Compresión Nerviosa/cirugía , Complicaciones Posoperatorias/cirugía , Radiografía , Reoperación , Transferencia Tendinosa/normas

RESUMEN

Tendoachilles tenodesis to the fibula was performed in postpolio patients to improve their gait. The charts of 48 patients with 52 tenodeses were reviewed. The mean follow-up was 5.5 years. Gait improved in one-third. When the hindfoot was stabilized, gait improved in 40% of the patients, but when it was not stabilized, only 22% improved their gait. Excessive equinus developed in 18 patients, all of whom were less than age 12 years when operated. We conclude that it is reasonable to use this procedure to improve the gait of postpolio children with flail lower extremity, provided the hindfoot is stabilized.

Asunto(s)

Tendón Calcáneo/cirugía , Peroné/cirugía , Deformidades Adquiridas del Pie/cirugía , Marcha , Síndrome Pospoliomielitis/complicaciones , Transferencia Tendinosa/métodos , Adolescente , Adulto , Niño , Preescolar , Femenino , Estudios de Seguimiento , Deformidades Adquiridas del Pie/etiología , Deformidades Adquiridas del Pie/fisiopatología , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Transferencia Tendinosa/efectos adversos , Transferencia Tendinosa/normas

RESUMEN

We report a retrospective review of 50 consecutive patients (75 feet) with chronically symptomatic accessory tarsal naviculars that failed to improve with conservative treatment. Surgical treatment consisted of excision of the accessory tarsal navicular or medial protuberance of a prominent cornuate-shaped navicular combined with simple replication of the tibialis posterior tendon without altering its course. Good and excellent results were obtained in 45 (70 feet) of the 50 patients (90%). The procedure has a low rate of minor complications, is easy to perform, and is extremely well accepted by the patients.

Asunto(s)

Deformidades Congénitas del Pie/cirugía , Osteotomía/normas , Huesos Tarsianos/anomalías , Adolescente , Fenómenos Biomecánicos , Niño , Comportamiento del Consumidor , Femenino , Deformidades Congénitas del Pie/diagnóstico por imagen , Deformidades Congénitas del Pie/fisiopatología , Humanos , Masculino , Osteotomía/métodos , Osteotomía/psicología , Pronación , Radiografía , Estudios Retrospectivos , Encuestas y Cuestionarios , Transferencia Tendinosa/métodos , Transferencia Tendinosa/normas

RESUMEN

Since 1963, 25 patients have undergone Sever-L'Episcopo transfers for obstetrical birth palsy at the St. Louis Unit of the Shriners Hospital for Crippled Children. A follow-up of 2-6 years was possible with a retrospective review of 16 patients. Substantial improvement in shoulder external rotation as well as subjective functional improvement was obtained by all patients. Three transient and one permanent axillary nerve palsies resulting from this procedure are reported.

Asunto(s)

Traumatismos del Nacimiento/complicaciones , Plexo Braquial , Síndromes de Compresión Nerviosa/cirugía , Transferencia Tendinosa/normas , Actividades Cotidianas , Estudios de Seguimiento , Humanos , Síndromes de Compresión Nerviosa/etiología , Síndromes de Compresión Nerviosa/fisiopatología , Estudios Retrospectivos , Transferencia Tendinosa/efectos adversos , Transferencia Tendinosa/métodos

RESUMEN

Twelve patients with congenital dislocation of the patella (CDP) and 23 patients with habitual dislocation of the patella (HDP) were followed for 2-15 years after surgical stabilization of the patella. The underlying pathology in both conditions was contracture of the quadriceps mechanism, which was more severe in CDP. Surgical stabilization in most cases included an extensive lateral release, medial plication, and transfer of the lateral half of the patella tendon. Lengthening of the rectus femoris tendon was required in many cases. With appropriate operative procedures, satisfactory results were achieved in 36 of the 41 knees (87.8%).

Asunto(s)

Luxaciones Articulares/cirugía , Rótula , Transferencia Tendinosa/métodos , Actividades Cotidianas , Adolescente , Adulto , Fenómenos Biomecánicos , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Luxaciones Articulares/congénito , Luxaciones Articulares/fisiopatología , Masculino , Recurrencia , Transferencia Tendinosa/normas

Asunto(s)

Artritis/cirugía , Artroplastia/normas , Huesos del Carpo/cirugía , Osteotomía/normas , Adulto , Anciano , Artritis/patología , Artritis/fisiopatología , Artroplastia/métodos , Artroplastia/psicología , Comportamiento del Consumidor , Femenino , Estudios de Seguimiento , Humanos , Prótesis Articulares , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Osteotomía/métodos , Transferencia Tendinosa/métodos , Transferencia Tendinosa/normas

RESUMEN

The authors report the medium term results (41 months) in 88 patients submitted to surgery for reconstruction of the anterior cruciate ligament according to the method currently in use at our Clinic which uses the semitendinosus and gracilis tendons. The results were evaluated according to a score card method and in 28 patients a KT-1000 arthrometer was also used. The method gives a probability of full success in approximately 85% of cases, with significantly better results in patients not submitted to meniscectomy. A comparison with other methods of autogenous transplant and prosthetic substitution, even on the basis of the data provided by the KT-1000, still places the semitendinosus and gracilis method at the forefront.

Asunto(s)

Inestabilidad de la Articulación/cirugía , Rodilla , Ligamentos Articulares/cirugía , Transferencia Tendinosa/normas , Muslo , Comportamiento del Consumidor , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/fisiopatología , Transferencia Tendinosa/psicología