Background:Traditionally the repaired extensor tendons have been treated postoperatively in static splints for several weeks, leading to formation of adhesions and prolonged rehabilitation. Early mobilization using dynamic splints is common, but associated with many shortcomings. We attempted to study the results of early active mobilization, using a simple static splint, and easy-to-follow rehabilitation plan.Materials and Methods:In a prospective study 26 cases of cut extensor tendons in Zone V to VIII were treated with primary or delayed primary repair. Following this, early active mobilization was undertaken, using an easy-to-follow rehabilitation plan. The results were assessed according to the criteria of Dargan at six weeks and one year.Results:All the 26 patients were followed up for one year. 20 out of 26 patients were below 30 years of age, involving the dominant hand more commonly (16 patients, 62%). Agriculture instruments were the most common mode of injury (13 patients, 50%). The common site for injury was extensor zone VI (42%, n = 11).Conclusion:Rehabilitation done for repaired extensor tendon injuries by active mobilization plan using a simple static splint has shown good results.

Background:The functional outcome of a flexor tendon injury after repair depends on multiple factors. The postoperative management of tendon injuries has paved a sea through many mobilization protocols. The improved understanding of splinting techniques has promoted the understanding and implication of these mobilization protocols. We conducted a study to observe and record the results of early active mobilization of repaired flexor tendons in zones II–V.Materials and Methods:25 cases with 75 digits involving 129 flexor tendons including 8 flexor pollicis longus (FPL) tendons in zones II–V of thumb were subjected to the early active mobilization protocol. Eighteen (72%) patients were below 30 years of age. Twenty-four cases (96%) sustained injury by sharp instrument either accidentally or by assault. Ring and little finger were involved in 50% instances. In all digits, either a primary repair (n=26) or a delayed primary repair (n=49) was done. The repair was done with the modified Kessler core suture technique with locking epitendinous sutures with a knot inside the repair site, using polypropylene 3-0/4-0 sutures. An end-to-end repair of the cut nerves was done under loupe magnification using a 6-0/8-0 polyamide suture. The rehabilitation program adopted was a modification of Kleinert’s regimen, and Silfverskiold regimen. The final assessment was done at 14 weeks post repair using the Louisville system of Lister et al.Results:Eighteen of excellent results were attributed to ring and little fingers where there was a flexion lag of < 1 cm and an extension lag of < 15°. FPL showed 75% (n=6) excellent flexion. 63% (n=47) digits showed excellent results whereas good results were seen in 19% (n=14) digits. Nine percent (n=7) digits showed fair and the same number showed poor results. The cases where the median (n=4) or ulnar nerve (n=6) or both (n=3) were involved led to some deformity (clawing/ape thumb) at 6 months postoperatively. The cases with digital or common digital nerve involvement (n=7 with 17 digits) showed five excellent, two good, four fair, and six poor results. Complications included tendon ruptures in 2 (3%) cases (one thumb and one ring finger) and contracture in 2 (3%) cases whereas superficial infection and flap necrosis was seen in 1 case each.Conclusion:The early active mobilization of cut flexor tendons in zones II–V using the modified mobilization protocol has given good results, with minimal complications.

Background:Treatment of radial clubhand has progressed over the years from no treatment to aggressive surgical correction. Various surgical methods of correction have been described; Centralization of the carpus over the distal end of the ulna has become the method of choice. Corrective casting prior to centralization is an easy and effective method of obtaining soft tissue stretching before any definitive procedure is undertaken. Moreover, it helps put the limb in a correct position. The outcome of deformity correction by serial casting / JESS distractor followed by centralization is discussed.Materials and Methods:In a prospective study, of 17 cases with 18 radial clubhands of Heikel's Grade III and IV (with average age 11 months (range 20 days – 24 months) with M:F of 2.6:1, were treated by gradual soft tissue stretching using corrective cast (14 cases) and JESS distraction (4 cases), followed by centralization (16 cases) or radialization (2 cases) and tendon transfers.Results:The average correction attained during the study was 71° of radial deviation and 31° of volar flexion. The average third metacarpal to distal ulna angle in anteroposterior and lateral view at final follow-up was 7° in both views. Angle of movement at elbow showed a small increase from 99° to 101° during the follow-up period. However, the range of movement at fingers showed increase in stiffness during the follow-up. No injury occurred to the distal ulnar epiphysis during the operative intervention. The results at the final follow-up, at the end of 2 years were graded on the basis of the criteria of F.W. Bora, and of Bayne and Klug. Considering the criteria of F.W. Bora, satisfactory result was shown by nine of the 18 hands (50%) while 16 out of 18 hands (89%) showed good or satisfactory result based on deformity criteria of Bayne and Klug.Conclusion:The management of radial clubhand by gradual corrective cast or JESS distractor followed by centralization and tendon transfers in children is an acceptable method of treatment with consistently satisfactory results, both functional and cosmetic.

Background:Distal end of radius is third most common site for GCT of long bones and 1% of these metastasize mostly to lungs. Reconstruction methods commonly used are fibula (vascularized and nonvascularized), centralization of ulna, translocation of ulna, and endoprosthetic replacement. We report the outcome of series of twenty cases where we did en bloc excision of tumor with translocation of ulna.Materials and Methods:Twenty cases of giant cell tumor (GCT) of lower end of radius were included in this retrospective study. The mean age of patients was 33.15 years (range 21-55 years). We had 14 of Campanacci Grade III and 6 of Grade II. Preoperative radiographs and magnetic resonance imaging of the involved wrist and forearm were done.Results:Of all twenty patients, 14 were males and 6 were females. Mean followup duration was 3.9 years (range 1.5–17 years). Mean grip strength of involved side as a percentage of normal side was 71% (range 42%–86%) and the actual mean value for operated side was 29 kg as compared to 40 kg for normal side. The average range of forearm movement was supination 80.25° (60°–90°) and pronation 77.5° (70°–90°). No patient was dissatisfied as far as cosmesis was concerned.Discussion:In our opinion considering the propensity to recur with more aggressiveness after recurrence, en bloc excision with translocation of ulna has become a standard treatment option for GCT of lower end of radius, with advantages of better functional outcomes, retained vascularity, and elimination of risk of donor site morbidity.