The treatment of ruptures of multiple extensor tendons at wrist level by a free tendon graft in the rheumatoid patient

Bora, F. William; Osterman, A. Lee; Thomas, Victor J.; Maitin, Ellen C.; Polineni, Subbaro

doi:10.1016/s0363-5023(87)80107-7

Cited by 46 publications

(24 citation statements)

References 7 publications

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“…The JT are also useful surgically for the proper identification of the tendons of the hand and have been used in the repair of the dorsal aponeurosis (Bora et al, 1987;Ohshio et al, 1991;Tada et al, 1991;Carr and Burge, 1992;Jebson and Blair, 1992;Zilber and Oberlin, 2004;Tanaka et al 2006). The interaction between the adjacent fingers was larger on the ulnar side of the hand than the radial side, and this was found to be associated with the type and direction of the JT connection, which was shown to be thicker on the ulnar side.…”

Section: Juncturaementioning

confidence: 99%

“…On the other hand, spontaneous rupture of the extensor tendon as EDM is common, especially in patients with rhematoid arthritis, distal radioulnar joint osteoarthritis, ulnar plus variance, and ulnar head dislocation (Bora et al, 1987;Ohshio et al, 1991;Tada et al, 1991;Carr and Burge, 1992;Jebson and Blair, 1992;Gelb, 1995;Zilber and Oberlin, 2004;Tanaka et al, 2006). Protecting the hand dynamics in human, who particularly uses his hand a lot, is only possible with successful reconstruction (Vermeylen and Monballiu, 1991;Robinson et al, 1992).…”

Section: Introductionmentioning

confidence: 99%

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The anatomical variations of the extensor tendons to the dorsum of the hand

et al. 2008

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To lead a quality life, tendon repair must be performed in a trauma causing damage to the extensor tendon of the hand. The aim of this study is to study the structures that can be used as donor tendons. Fifty-four dissected adult hands were examined to study the pattern of the extensor tendons on the dorsum of the hand. The most common distribution patterns of the extensor tendons of the fingers were as follows: a single extensor indicis proprius (EIP) tendon which inserted ulnar to the extensor digitorum (ED)-index; a single ED-index; a single ED-middle; a single ED-ring; an absent ED-little; a double extensor digiti minimi (EDM), and a single ED-ring to the little finger. The frequency of the number of tendons is as follows: a single (87.03%) EIP, a single ED-index (100%), a single (92.6%) ED-middle, a single (75.9%) ED-ring, and an absent (68.5%) or a single (24.1%) ED-little. A double (88.9%) EDM tendons were seen. The thickest type of juncturae tendinum (JT) is found primarily between the ring and little fingers (90%). Suitable excessive tendon and the thickest JT as donor tendon were found in the fourth intermetacarpal space. The present findings, especially the fourth intermetacarpal space, may explain why incisions on the dorsum of the hand should be large and performed with particular care. It is necessary to have a thorough understanding of the arrangements of the multiple extensor muscles and their junctural connections of the hand when tenoplasty or tendon transfer is required.

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Section: Juncturaementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The anatomical variations of the extensor tendons to the dorsum of the hand

et al. 2008

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“…These soft tissue grafts were not inserted into bone tunnels but rather were sutured to or screwed into the MCL insertions. These kinds of interpositional grafts, using soft tissue autografts or allografts, have also been used successfully to bridge gaps in late reconstruction of flexor tendons of the wrist and hand, 17,18 reconstruction of extensor tendons of the rheumatoid hand, 19,20 and reconstruction of the extensor tendons of the foot. 21,22 When the opposing ligament ends are separated by a large gap and medial side knee instability is a concern, an interpositional graft of the MCL may be a suitable treatment option.…”

mentioning

confidence: 99%

Healing ligament mechanical properties are improved by repair with interpositional allografts but not by concomitant treatment with hyaluronic acid

Thornton¹,

Shao²,

Kuchison³

et al. 2009

Journal Orthopaedic Research

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Healing ligaments have inferior mechanical properties compared to normal ligaments during early healing intervals. The purpose of this study was to investigate if in vivo ligament repair with an interpositional allograft and treatment with hyaluronic acid (HA) would improve the mechanical properties of a medial collateral ligament (MCL) healing from a gap injury. Twenty rabbits were assigned equally to either a donor or recipient group. A gap injury of the MCL was created in both hindlimbs of 10 recipient animals. The right hindlimb was treated with allograft plus HA while the left hindlimb was treated with allograft only. Low-load and high-load mechanical properties, including laxity, relaxation and failure, and histology were evaluated after 6 weeks of healing. Mechanical results were compared to previously published normal MCL and MCL gap scar data. MCL allografts had greater initial force during cyclic relaxation testing and maximum force during failure testing than MCL scars, but were weaker than normal MCLs. Failure stress was the only parameter to demonstrate a statistically significant effect of treatment with HA on the allografts. However, the failure stress of the HA-treated MCL allografts was not different than MCL scars and was less than normal MCLs. In conclusion, interpositional allografts could enhance some mechanical properties of ligament healing but HA, in the way we applied it, did not produce an obvious improvement. ß

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“…Meanwhile, others have shown good functional results and improved biomechanical properties using tendon grafting for the repair of extensor tendon ruptures in this patient population. 13,14 Comparative studies between tendon grafting and tendon transfer for the repair of extensor tendon ruptures in rheumatoid patients are lacking in the literature. One retrospective review comparing 11 cases of tendon transfer with 28 cases of tendon grafting noted no significant difference in clinical results.…”

Section: Diagnosismentioning

confidence: 99%

“…Palmaris longus Strips of extensor carpi radialis brevis or extensor carpi radialis longus (ECRL) Plantaris Extensor tendon to the fourth toe 8,10,13,14 …”

Section: Diagnosismentioning

confidence: 99%