- Email: [email protected]
16.7 Finger extensor aponeurosis reconstruction by dermical bandelets
ARTICLE IN PRESS 78
was assessed every 100 cycles. Samples were tested to failure at the completion of 500 cycles. Results were compared to previously published data using the same model for testing other repair techniques. Results: Mean gap formation after 500 cycles was 1.84 mm. Mean load to failure was 47.5 N. This compared favourably with data for other repair modalities. Clinical evaluation of patients following repair of distal FDP division confirmed comparable outcome to other repair modalities. Conclusion: Our results demonstrate that this repair technique is biomechanical sound and has comparable in vitro strength compared to other techniques of repair at this site. The repair can be used clinically with good results and is technically straightforward, having the advantage of not requiring suturing over a button, and not requiring suture anchor technology. 10.1016/j.jhsb.2006.03.188
16.7 FINGER EXTENSOR APONEUROSIS RECONSTRUCTION BY DERMICAL BANDELETS
A. Georgescu, B. Baldea, S. Axinte, I. Matei, I. Capota and F. Ardelean University of Medicine ‘‘Iuliu Hatieganu’’-Spitalul Clinic de Recuperare, Romania Introduction: The lesions of the distal extensor aponeurosis (Mallet finger) due to various types of injuries represent an intruding and disabling disease of the fingers. This can lead, despite treatment, to joint modifications and movement impairment. Various methods of repair were recommended from splint immobilization for long periods to tendon reconstruction by different techniques. We describe possible new method consisting in reconstruction by dermical bandelets. Material and methods: Our technique is based on a long and narrow (2–3 cm/2–3 mm) de-epithelized skin bandelet harvested from one border of the longitudinal incision made to explore the lesion. This bandelet remains pedicled on its proximal end. It is reinserted distally at the base of the distal phalanx through a transosseous hole using a steel wire 4/0-5/0 and is also sutured to the remnants of the aponeurosis. The bandelet is then buried subcutaneous. The DIP joint is maintained in extension by a intramedullary K-wire. The DIP joint is also immobilized using a splint. The Kwire is removed after 3 weeks and the steel wire after 4 weeks. The splint is maintained one more week, followed by controlled mobilization. Results: We used this method in 97 cases. We had recurrence of the deformity in 10 cases, from which three cases required arthrodesis. The functional restoration is 75% to 90% in DIP stability and mobility, with an extension deficit of 5 to 10 degrees.
THE JOURNAL OF HAND SURGERY VOL. 31B No. S1 JUNE
2006
Conclusions: This simple and effective method avoids an extended and uncertain period of immobilization and has a significantly higher percentage of success. The method uses local tissues and avoids the rejection of allograft materials. The distal transosseous reinsertion and intramedullary wiring are important technical aspects and improve the final results. 10.1016/j.jhsb.2006.03.189
16.8 DOES LENGTH MATTER? TESTING THE BITE SIZE
P. Smitham, D. Stewart, P. Stephens and W. Walsh Surgical and Orthopedic Research Lab, Sydney, Australia Background: Injuries to the flexor tendons of the hand are a major component of the workload of surgeons involved in the management of hand trauma, and an area of great controversy regarding surgical technique. While there is a large body of evidence comparing the various described techniques of suturing tendons, an accepted fact is the need for a 1 cm bite of tendon. Aim: To test this accepted rule that 1 cm is required. Using the Kessler suturing method, the Tajima modification is one of the most commonly used. We tested various lengths of bite in repairs of sheep tendons initially before continuing with a trail of human tendons. Methods: Sheep flexor tendons were harvested and dissected free from paratenon and surrounding structures. They were divided and repaired with 3-0, 4-0 Ticron or 3-0, 4-0 Prolene to compare monofilament with braided suture material and different suture strengths. A plastic surgeon and orthopedic surgeon performed five repairs each using the suture materials stated above with bite sizes of 1.5, 1.25, 0.75, 0.5 and 0.25 cm giving a total of 240 repairs performed. These were tested to failure (by pull-out of suture) at 1 mm per second using bionix MTS. Following this pilot study a further 120 repairs were performed using human flexor tendons. following the above protocols. Results: We found that below 1 cm the repairs failed at a force proportionate to the bite size. Above 1 cm, we found that there was little difference as we approached the mechanical limits of the suture material. Particularly of note, there was a significant difference between 1 and 0.75 cm repairs in human tendons and no significant difference between orthopaedic and plastic trained repairs in any group. Conclusion: Our study confirms that below 1 cm bite size, the strength of repair is compromised and therefore every effort should be made to achieve this. Without this strength of repair, early mobilization —
was assessed every 100 cycles. Samples were tested to failure at the completion of 500 cycles. Results were compared to previously published data using the same model for testing other repair techniques. Results: Mean gap formation after 500 cycles was 1.84 mm. Mean load to failure was 47.5 N. This compared favourably with data for other repair modalities. Clinical evaluation of patients following repair of distal FDP division confirmed comparable outcome to other repair modalities. Conclusion: Our results demonstrate that this repair technique is biomechanical sound and has comparable in vitro strength compared to other techniques of repair at this site. The repair can be used clinically with good results and is technically straightforward, having the advantage of not requiring suturing over a button, and not requiring suture anchor technology. 10.1016/j.jhsb.2006.03.188
16.7 FINGER EXTENSOR APONEUROSIS RECONSTRUCTION BY DERMICAL BANDELETS
A. Georgescu, B. Baldea, S. Axinte, I. Matei, I. Capota and F. Ardelean University of Medicine ‘‘Iuliu Hatieganu’’-Spitalul Clinic de Recuperare, Romania Introduction: The lesions of the distal extensor aponeurosis (Mallet finger) due to various types of injuries represent an intruding and disabling disease of the fingers. This can lead, despite treatment, to joint modifications and movement impairment. Various methods of repair were recommended from splint immobilization for long periods to tendon reconstruction by different techniques. We describe possible new method consisting in reconstruction by dermical bandelets. Material and methods: Our technique is based on a long and narrow (2–3 cm/2–3 mm) de-epithelized skin bandelet harvested from one border of the longitudinal incision made to explore the lesion. This bandelet remains pedicled on its proximal end. It is reinserted distally at the base of the distal phalanx through a transosseous hole using a steel wire 4/0-5/0 and is also sutured to the remnants of the aponeurosis. The bandelet is then buried subcutaneous. The DIP joint is maintained in extension by a intramedullary K-wire. The DIP joint is also immobilized using a splint. The Kwire is removed after 3 weeks and the steel wire after 4 weeks. The splint is maintained one more week, followed by controlled mobilization. Results: We used this method in 97 cases. We had recurrence of the deformity in 10 cases, from which three cases required arthrodesis. The functional restoration is 75% to 90% in DIP stability and mobility, with an extension deficit of 5 to 10 degrees.
THE JOURNAL OF HAND SURGERY VOL. 31B No. S1 JUNE
2006
Conclusions: This simple and effective method avoids an extended and uncertain period of immobilization and has a significantly higher percentage of success. The method uses local tissues and avoids the rejection of allograft materials. The distal transosseous reinsertion and intramedullary wiring are important technical aspects and improve the final results. 10.1016/j.jhsb.2006.03.189
16.8 DOES LENGTH MATTER? TESTING THE BITE SIZE
P. Smitham, D. Stewart, P. Stephens and W. Walsh Surgical and Orthopedic Research Lab, Sydney, Australia Background: Injuries to the flexor tendons of the hand are a major component of the workload of surgeons involved in the management of hand trauma, and an area of great controversy regarding surgical technique. While there is a large body of evidence comparing the various described techniques of suturing tendons, an accepted fact is the need for a 1 cm bite of tendon. Aim: To test this accepted rule that 1 cm is required. Using the Kessler suturing method, the Tajima modification is one of the most commonly used. We tested various lengths of bite in repairs of sheep tendons initially before continuing with a trail of human tendons. Methods: Sheep flexor tendons were harvested and dissected free from paratenon and surrounding structures. They were divided and repaired with 3-0, 4-0 Ticron or 3-0, 4-0 Prolene to compare monofilament with braided suture material and different suture strengths. A plastic surgeon and orthopedic surgeon performed five repairs each using the suture materials stated above with bite sizes of 1.5, 1.25, 0.75, 0.5 and 0.25 cm giving a total of 240 repairs performed. These were tested to failure (by pull-out of suture) at 1 mm per second using bionix MTS. Following this pilot study a further 120 repairs were performed using human flexor tendons. following the above protocols. Results: We found that below 1 cm the repairs failed at a force proportionate to the bite size. Above 1 cm, we found that there was little difference as we approached the mechanical limits of the suture material. Particularly of note, there was a significant difference between 1 and 0.75 cm repairs in human tendons and no significant difference between orthopaedic and plastic trained repairs in any group. Conclusion: Our study confirms that below 1 cm bite size, the strength of repair is compromised and therefore every effort should be made to achieve this. Without this strength of repair, early mobilization —