Objective To discuss the mechanisms and clinical effect of musculus extensor hallucis longus shifting in correcting hallux valgus (HV) deformity. Methods From April 2004 to December 2006,25 cases of HV (38 feet) were treated by musculus extensor hallucis longus shifing. There were 2 men and 23 women, aging from 22-60 years (mean 46.3 years).HV angle was 21.45° (mean 31.30°), intermetatarsal(IM) angle was 7-21° (mean 12.52°). The HV were corrected by cutting osteophyma of the first metatarsal bone, cutting transverse head of adductor pollicis, transferring musculus extensor hallucis longus and reconstructing its insertion. Results The patients were followed up 6-14 months after operation. HV angle and IM angle were 7.30°±2.62° and 6.50°±2.46° respectively, showing significantdifferences when compared with before operation (Plt;0.05). According to the American Orthopaedic Foot amp; Ankle Society (AOFAS) score system, the foot function was excellent in 25 feet, good in 7 feet and poor in 6 feet,and the excellent and good rate was 84.2%. Hallux varus occurred in 2 feet after 2 months of operation, metatarsophalangeal joint limitation of motion in 2feet after 3 months of operation, no HV recurred. ConclusionThe HV deforemity can be corrected by shifting the musculus extensor hallucis longus and reconstructing its insertion. It makes stress of metatarsophalangeal joint balance and prevent recurrance of HV deformity.
Since 1989, 17 cases ( 18 fingers) of mallet finger underwent surgical repair of the extensor tendons of the fingers combined with postoperative perpendicular pin transfixion. The follow-up was through 3 to 8 months. The results were 13 satisfactory, 4 improved and one failure. The method of pin transfixion was introduced in detail, and the classification of mallet fingers and the principles of treatment were discussed in detail, and the classification of mallet fingers and the principles of treatment were discussed.
In order to investigate the effect of repair of paratendon in tendon healing, two different ways were performed to repair the transected extensor tendons of chick’s toe. End to end suture of the extensor tenon was performed in group 1 while the paratendon was also repaired simultaneously in addition to suture of the tendon in group 2. Gross observation and histological examination were undertaken in the 3rd and 6th week after operation. The result showed, in group 1, extensive adhesion and irregular proliferation of fibroblasts was found in the 3rd week, severe adhesion and irregular arrangement of fibroblasts with less collagen fiber was found in the 6th week; while in group 2, smooth and regular "fusiform structure" was formed, slight adhesion and regular proliferation of fibroblasts were found in the 3rd week, adhesion disappeared and the structure of paratendon and tondon recovered in the 6th week. It was concluded that repair of extensor tendon and paratendon simultaneously could promote the intrinsic tendon healing and prevent tendon adhesion.
ObjectiveTo investigate the effectiveness of modified extensor indicis proprius (EIP) tendon transfer for reconstruction of spontaneously ruptured extensor pollicis longus (EPL) tendon by comparing with the traditional EIP tendon transfer. MethodsBetween January 2009 and December 2011, 11 cases of spontaneously ruptured EPL tendon were treated by modified EIP tendon transfer to reconstruct extension function (modified group). On the base of traditional procedure, the proximal end of EPL tendon was sutured with EIP tendon and the distal end of EIP tendon was crossed round extensor pollicis brevis (EPB) tendon and sutured back with EPL tendon. A specific EI-EPL evaluation method (SEEM) was used to measure the EPL tendon function after transfer. The result was compared with that of the other 18 cases undergoing traditional operation (traditional group). There was no significant difference in gender, age, disease duration, and injury causes between 2 groups (P gt; 0.05). ResultsAll incisions healed by first intention. In traditional group, 5 cases were out of follow-up, and the other 24 cases were followed up 1 year and 6 months on average (range, 8 months-2 years and 6 months). At the last follow-up, according to the evaluation of SEEM, the thumb elevation and flexion deficits of modified group were significantly less than those of traditional group (P lt; 0.05). The independent elevation deficit of the index finger of modified group was similar to that of traditional group (P gt; 0.05). The effectiveness was excellent in 9 cases and good in 2 cases with an excellent and good rate of 100% in modified group, and was excellent in 5 cases, good in 6 cases, and fair in 2 cases with an excellent and good rate of 84.6%. The effectiveness of modified group was significantly better than that of traditional group (χ2=0.03, P=0.03). ConclusionReconstruction of EPL tendon function by modified EIP tendon transfer is effective and easy. It can increase strength of the transferred tendon and obtain satisfactory results, but the long-term effectiveness needs further follow-up.
In this article it was reported that there were 14 patients sufferingfrom traumatic or spontaneous rupt-ure of tendon of extensor pollicislongus at the level of the 3rd comp-artment of the dorsal aspect of thewrist where repair by direct suturecould not be used of the Listertubercle which might cause adhesionand re-rupture of the repaired tendon.It was proposed that this tendonrupture could be repaired by transferof extensor indicis proprius tendon.Of the 14 cases, 10 of them werefollowed with on average of 4.5 tears. The range of flexion and extension of the thumb all returned to normal with little disturbance of the motion of the index finger.
Objective To evaluate the results of thumb opposition function by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons. Methods Between March 2006 and August 2009, 35 patients with dysfunction of thumb opposition were treated and the thumb opposition function was reconstruced by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons. There were 25 males and 10 females with an average age of 33.5 years (range, 20-53 years); 20 had median nerve injury in the wrist and 15 had median nerve injury with ulnar nerve injury. The causes were sharp instrument injury in 24 cases, blunt injury in 9 cases, and hot crush injury in 2 cases. Six cases complicated by shaft fractures of radius and ulna. All the patients underwent an operation of nerve repair at 1 to 3 hours after injury (mean, 2 hours). The time from injury to reconstructing operation was 6-14 months (mean, 7.5 months). Two cases was able to abduct thumb sl ightly, the others had no functions of thumb abduct and thumb opposition. Results All the wounds gained the primary healing. The patients were followed up 12-18 months (mean, 14 months). The wrist joint angle and thumb dorsal extension were satisfactory. Thumb abduct and thumb opposition function returned to normal in 20 patients with simple median nerve injury; in 15 patients with median nerve injury and ulnar nerve injury, thumb abduct and thumb opposition function returned to normal in 15 and 13, respectively. According to ZHAO Shuqiang’s standard, the results of thumb opposition function were normal in all patients at 12 months after operation. Conclusion It is a convenient and efficient procedure to reconstruct thumb opposition function by transferring the extensor carpi ulnaris and the extensor poll icis brevis muscle tendons.
Objective To summarize the method and the cl inical outcome of repairing both toe extensor tendon and dorsal foot wounds with anterolateral thigh flap. Methods Between February 2007 and May 2009, 11 patients with toe extensor tendon and dorsal foot defect were treated with anterolateral thigh flap. There were 8 males and 3 females with a medianage of 45 years (range, 10-60 years). The causes of injury were sharp injury in 3 cases, machine crush injury in 3 cases, and traffic accident injury in 5 cases, including 7 cases of fresh wounds with a disease duration of 2-8 hours and 4 cases of old wounds with a disease duration of 3-15 days. The size of wound ranged from 6 cm × 5 cm to 25 cm × 15 cm. All cases compl icated by toe extensor tendon defect, which were located at the 2nd-5th toes in 1 case, 3rd-5th toes in 1 case, 2nd-4th toes in 2 cases, 2nd and 3rd toes in 3 cases, 1st and 2nd toes in 1 case, and 1st toe in 3 cases. In the first stage, the anterolateral thigh flap ranged from 8 cm × 7 cm to 27 cm × 15 cm was used to repair defect and fascia lata was used to bridge two ends of digitorum longus tendon; the donor site was sutured or repaired with the skin graft. The second stage was performed after 2-3 months, tenolysis for tendon was performed, and fascia lata was spl it into tendon-l ike shape; and the toe functional exercises were done. Results All flaps survived completely after the first stage, wounds healed by first intention; the donor skin graft survived and incisions healed by first intention. At 7 days after the second stage, marginal necrosis occurred in 3 flaps (0.5-2.0 cm in width), and healed after 15-20 days of dressing change; the other flaps survived, and incisions healed by first intention. Eight patients were followed up 12-18 months (mean, 15 months). Excepts 4 sl ight bulky flaps, the other flaps had satisfactory appearance and soft texture with two points discrimination of 1-3 cm. During the follow-up, part of the dorsiflexion function recovered in 5 patients (5-40°), andflexion function was normal; 3 dorsiflexion function disappeared without effect on the function of toe flexion, and the patients could walk normally. No toe ptosis occurred. Conclusion Appl ication of the anterolateral thigh flap can repair toe extensor tendon and dorsal foot wounds with short treatment time and less damage at the donor site, so it can avoid toe ptosis after surgery and achieve excellent cl inical results.