RESUMO
PURPOSE: To determine whether the triceps sling reconstruction technique is a safe and effective treatment of intraoperative ulnar nerve subluxation after in situ decompression. METHODS: Twelve patients who underwent a triceps sling reconstruction for intraoperative ulnar nerve subluxation after in situ release were retrospectively reviewed. The triceps sling technique consists of harvesting a small, distally based strip of triceps tendon and suturing the proximal end of the strip to the posterior aspect of the released Osborne ligament. Thus, a sling is created between the medial epicondyle and the olecranon, preventing the nerve from subluxating. Patients were clinically evaluated before and after surgery. Visual analog scale pain scores, static 2-point discrimination, strength, and Disabilities of the Arm, Shoulder, and Hand score were assessed. RESULTS: At a mean follow-up of 31 months (range, 24-38 months), there was a significant improvement in mean visual analog pain scores from 8.6 to 0.2. Static 2-point discrimination was improved from a mean of 9.1 mm before surgery to 5.7 mm afterward. Strength improved by a mean of 33% and 30% with grip and pinch, respectively. Mean Disabilities of the Arm, Shoulder, and Hand score improved from 45.9 to 3.7. No subluxation of the ulnar nerve was noted after surgery. No other complications were noted. No reoperations were required during the follow-up period. CONCLUSIONS: Triceps sling reconstruction is a safe treatment in patients with intraoperative ulnar nerve subluxation after in situ decompression. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Assuntos
Síndrome do Túnel Ulnar , Nervo Ulnar , Braço , Síndrome do Túnel Ulnar/cirurgia , Descompressão Cirúrgica , Humanos , Estudos Retrospectivos , Nervo Ulnar/cirurgiaRESUMO
PURPOSE: To evaluate the outcome of revision surgery for failed thumb carpometacarpal (CMC) arthroplasty. METHODS: We retrospectively analyzed 32 patients with failed thumb CMC arthroplasty. The primary reason for revision was pain caused by metacarpal subsidence. Revision surgery included soft tissue interposition and distraction pinning to address the metacarpal subsidence. Additional ligament reconstruction was performed in patients with thumb instability. Eight patients required additional metacarpophalangeal joint fusion for concomitant joint hyperextension. Eleven required additional partial excision of the trapezoid for concomitant scaphotrapezoidal joint arthritis. All patients were evaluated clinically and radiographically. RESULTS: Mean follow-up was 57 months (range, 24-121 months). Pain levels evaluated by visual analog scale were significantly reduced in all patients after revision surgery. Mean grip strength and key pinch strength significantly increased. Twenty-seven patients achieved good functional results; those for 5 patients were fair. CONCLUSIONS: This study showed that revision surgery with distraction pinning and soft tissue interposition with or without ligament reconstruction was an effective treatment for failed CMC arthroplasty of the thumb. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Assuntos
Artrite/cirurgia , Artroplastia , Articulações Carpometacarpais , Reoperação , Polegar , Adulto , Artrite/diagnóstico por imagem , Artrite/etiologia , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: To determine whether open cheilectomy and debridement of the distal interphalangeal (DIP) joint is a safe and effective alternative to joint arthrodesis for the treatment of symptomatic osteoarthritis. METHODS: Seventy-eight patients with symptomatic DIP joint osteoarthritis and with a minimum follow-up of 24 months were retrospectively reviewed. Preoperative radiographs were graded. Open cheilectomy and debridement of the DIP joint was performed in all patients. The DIP joint was immobilized for 4 weeks after surgery. Patients were evaluated clinically and radiographically. Visual analog scale pain scores and range of motion were assessed. RESULTS: At a median final follow-up of 36 months (minimum, 24 months), there was a significant improvement in mean visual analog scale pain scores from 8 to 1. Distal interphalangeal joint flexion contracture was improved by a mean of 6° and DIP joint range of motion was improved by a mean of 20°. No postoperative infections or other complication were noted. No reoperations were required/performed during the follow-up period. CONCLUSIONS: Open DIP joint cheilectomy is a safe and effective alternative to DIP joint arthrodesis in patients with symptomatic osteoarthritis who wish to preserve joint motion. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Assuntos
Articulações dos Dedos/cirurgia , Osteoartrite/cirurgia , Osteotomia/métodos , Amplitude de Movimento Articular/fisiologia , Idoso , Artrodese/métodos , Estudos de Coortes , Desbridamento/métodos , Feminino , Articulações dos Dedos/diagnóstico por imagem , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Medição da Dor , Prognóstico , Radiografia/métodos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the clinical results of revision neurolysis and wrapping with porcine extracellular matrix (AxoGuard Nerve Protector, AxoGen Inc., Alachua, FL) for cubital tunnel syndrome after one previous surgical decompression. METHODS: Twelve patients with recurrent cubital tunnel syndrome were treated with decompression, porcine extracellular matrix nerve wrap, and minimal medial epicondylectomy (if not previously performed). The average follow-up period was 41 months (range, 24-61 mo). All patients had recurrent symptoms after having previously undergone one surgical decompression. The mean patient age was 45 years (range, 30-58 y). All patients were evaluated subjectively and objectively (pain, satisfaction, static 2-point discrimination, grip strength, and pinch strength). RESULTS: A significant improvement was demonstrated in postoperative pain levels (from 8.5 to 1.7), grip strength (from 41% to 86% of the unaffected side), and pinch strength (from 64% to 83% of the unaffected side). Static 2-point discrimination improved from an average 10.4 mm preoperatively to 7.6 mm postoperatively. Eleven of 12 patients demonstrated 2 mm or more improvement in 2-point discrimination postoperatively. There were no complications related to the use of the porcine extracellular matrix for nerve wrapping. CONCLUSIONS: This study found that secondary decompression combined with porcine extracellular matrix nerve wrapping was an effective and safe treatment for patients with recurrent cubital tunnel syndrome. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.