1/17. Emergency reconstruction of a collateral ligament of a metacarpophalangeal joint using Dacron material.We present a case in which an open wound involving the ulnar collateral ligament of the metacarpophalangeal joint of the little finger was treated by ligament reconstruction using a strip of Dacron material, nerve grafting and coverage by a posterior interosseous artery pedicled flap. At a long term follow-up of 4 years, the joint was stable and had a full range of movement.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/17. Optimizing the correction of severe postburn hand deformities by using aggressive contracture releases and fasciocutaneous free-tissue transfers.Severe postburn hand deformities were classified into three major patterns: hyperextension deformity of the metacarpophalangeal joint of the fingers with dorsal contracture of the hand, adduction contracture of the thumb with hyperextension deformity of the interphalangeal joint, and flexion contracture of the palm. Over the past 6 years, 18 cases of severe postburn hand deformities were corrected with extensor tenotomy, joint capsulotomy, and release of volar plate and collateral ligament. The soft-tissue defects were reconstructed with various fasciocutaneous free flaps, including the arterialized venous flap (n = 4), dorsalis pedis flap (n = 3), posterior interosseous flap (n = 3), first web space free flap (n = 3), and radial forearm flap (n = 1). Early active physical therapy was applied. All flaps survived. Functional return of pinch and grip strength was possible in 16 cases. In 11 cases of reconstruction of the dorsum of the hand, the total active range of motion in all joints of the fingers averaged 140 degrees. The mean grip strength was 16.5 kg and key pinch was 3.5 kg. In palm reconstruction, the wider contact area facilitated the grasping of larger objects. In thumb reconstruction, key-pinch increased to 5.5 kg and the angle of the first web space increased to 45 degrees. Jebsen's hand function test was not possible before surgery; postoperatively, it showed more functional recovery in gross motion and in the dominant hand. Aggressive contracture release of the bone,joints, tendons, and soft tissue is required for optimal results in the correction of severe postburn hand deformities. Various fasciocutaneous free flaps used to reconstruct the defect provide early motion, appropriate thinness, and excellent cosmesis of the hand.- - - - - - - - - - ranking = 0.16666666666667keywords = ligament (Clic here for more details about this article) |
3/17. Is 20 years of immobilization, not sufficient to render metacarpophalangeal joints completely useless?--Correction of a 20-year old post-burn palmar contracture: a case report.This report presents a case of post-burn palmar contracture with flexion contracture of thumb of 20-year duration. The contracture was released and the raw area was covered with split thickness skin graft. Only one 'K' wire in soft tissue was needed to keep all the fingers straight and immobilized, suggestive of intermetacarpal ligamentous contracture. A static night splint was given to maintain the correction. Complete range of movement was achieved in a month with the combination of dynamic splinting and physiotherapy. It was interesting to note that even 20 years of contracted position did not render the metacarpophalangeal joints completely stiff and useless. Probable reasons are discussed.- - - - - - - - - - ranking = 0.16666666666667keywords = ligament (Clic here for more details about this article) |
4/17. Dislocation of the pisiform bone after severe crush injury to the hand.The pisiform bone dislocated in a 56-year-old worker who had a crush injury of his wrist. Open reduction and reconstruction of the ligaments resulted in proximal subluxation of the pisiform bone and post-traumatic arthritic changes. Other authors recommend that excision of the pisiform is considered to be a more appropriate method of treatment.- - - - - - - - - - ranking = 0.16666666666667keywords = ligament (Clic here for more details about this article) |
5/17. Hand lacerations of the combined interdigital-intermetacarpal region (split hand).Longitudinal lacerations involving the finger commissures and adjacent intermetacarpal clefts (including the adjacent tendons, the intrinsic muscles, the deep transverse metacarpal ligament, adjacent arteries, nerves, bones and joints), present multiple problems not seen in the unusual hand lacerations. Thorough cleansing, delayed closure, accurate repair of all injured structures with prompt appropriate rehabilitation results in excellent appearance and early function.- - - - - - - - - - ranking = 0.16666666666667keywords = ligament (Clic here for more details about this article) |
6/17. Open traumatic avulsion of the flexor pollicis longus tendon from the musculotendinous area: a case report.A traumatic avulsion of the flexor tendon at the musculotendinous junction in nonamputated digits is a very rare injury. We present a 14-year-old girl who sustained a longitudinal, tensile, injurious force directly to the flexor pollicis longus tendon after an open thenar injury resulting in its avulsion at the musculotendinous junction. In an effort to minimize soft-tissue damage and preserve the transverse ligament of the carpus the tendon was retrieved through a separate forearm incision. Direct repair was made by encapsulation of the tendon into the muscle belly. The functional result 30 months after surgery was satisfactory.- - - - - - - - - - ranking = 0.16666666666667keywords = ligament (Clic here for more details about this article) |
7/17. Isolated dislocation of the four ulnar carpometacarpal joints.Dislocation of the multiple carpometacarpal joints without associated fractures of the metacarpal and/or carpal bones is an exceedingly rare injury. An earlier belief that carpometacarpal dislocations are high-energy injuries is questioned due to an unusual case of isolated dislocation of the four ulnar metacarpals that occurred after a relatively minor hand trauma. Early recognition and anatomical reduction are essential to achieving good long-term outcomes. Massive edema, interposed volar ligaments and overlapping metacarpal bases are the usual obstacles to a successful closed reduction.- - - - - - - - - - ranking = 0.16666666666667keywords = ligament (Clic here for more details about this article) |
8/17. Distal rupture of the palmaris longus tendon and fascia as a cause of acute carpal tunnel syndrome.Acute carpal tunnel syndrome is rare compared with its more chronic presentation. Previous reports in the literature have documented the most common causes. rupture of the distal palmaris longus tendon into the palmaris fascia as a cause of an acute carpal tunnel syndrome has not been reported previous to this case report. Partial rupture of the tendon and hemorrhage around its insertion produced intrinsic compression on the transverse ligament and the underlying nerve.- - - - - - - - - - ranking = 0.16666666666667keywords = ligament (Clic here for more details about this article) |
9/17. groin flap design and versatility.The groin flap is a reliable and well-established reconstructive option for pedicled or free-tissue transfer. Concern regarding its variable vascular origin and caliber has limited its use. To overcome this, a simplified guideline based on the transverse diameter of the patient's index and long fingers at the distal interphalangeal level has been developed. Thus "rule of two finger widths" positions the origin of the vascular pedicle from the femoral vessels two finger widths below the inguinal ligament, the upper flap border two finger widths above the inguinal ligament, the lower flap border two finger widths below the vascular origin, and both parallel to the flap axis, which lies along a line from the vascular origin to the anterosuperior iliac spine. This new groin flap design provides the necessary guidelines for vascular identification, accommodates pediatric and adult stature, and ensures primary donor-site closure if flap dimensions are within the prescribed boundaries. In addition, a new sartorius-cutaneous groin flap is presented. This combines the cutaneous groin flap with the proximal sartorius muscle (up to 15 cm), which is supplied by the deep vessels of the superficial circumflex iliac system. The sartorius-cutaneous groin flap further emphasizes the concept of single-pedicle compound or combined flaps and additionally enhances the extensive reconstructive versatility of previously described groin flaps. Over 200 pedicled and free groin flaps have been performed according to the "rule of two finger widths" over the past 5 years. There have been no complications related to flap design, such as difficulty with flap elevation, marginal necrosis, or donor-site closure.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.33333333333333keywords = ligament (Clic here for more details about this article) |
10/17. carpal tunnel syndrome caused by flexor tendon sheath lipoma.Release of the transverse carpal ligament is a highly successful treatment for the majority of patients with carpal tunnel syndrome. However, carpal tunnel syndrome may also be caused by space-occupying lesions within the carpal canal that compress the median nerve. In these cases, simple release of the transverse We describe a patient with carpal tunnel syndrome whose symptoms were not relieved by simple transverse carpal ligament release. Subsequent surgery revealed a lipoma of the flexor tendon sheath.- - - - - - - - - - ranking = 0.33333333333333keywords = ligament (Clic here for more details about this article) |
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