AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

Unmasking the Flexor Digitorum Superficialis Decussation: Masquerading as a Supplemental Pulley
Institution where the work was prepared: Union Memorial Hospital, Baltimore, MD, USA
Michele A. Manahan, MD1; Sione Fanua, MSM2; Christina Hughes, MD2; Shaw Wilgis, MD2; (1)Johns Hopkins University School of Medicine, (2)Union Memorial Hospital
Introduction:
Flexor digitorum profundus (FDP) lacerations and ruptures of zone 1 near the distal interphalangeal (DIP) joint are common injuries but demonstrate variable
anatomy. In some cases, the vinculae hold the FDP in its anatomical position within the flexor digitorum superficialis (FDS) decussation distally, and deep to
the FDS tendon more proximally. In other cases, the FDP retracts toward the palm. Accepted repair techniques of retracted tendons and tendon grafts include
either reestablishing the FDP's anatomic positioning or allowing the FDP to travel alongside the FDS within the pulley system of the finger.
Methods:
To determine whether pursuance of the often technically more difficult placement of the FDP within its native sheath translates into clinical advantages regarding
extent of flexion of the DIP joint, we performed dissections on the four fingers of nine cadaver hands for a total of 36 digits. A laceration was created in
the FDP tendon at its insertion in the distal phalanx. The FDP's vinculae and attachments were stripped proximally to a level proximal to the A1 pulley. The
FDP tendons in half of the digits were replaced beneath the FDS and through the decussation prior to repair of the laceration with standard Bunnell's suture
technique. The other half of the digits received suture repair after placement of the FDP through the digital pulley system beside the FDS. The digits were
flexed using a standard weight system, and range of motion at the DIP joints were measured.
Results:
Average range of motion at the DIP joints of control digits prior to dissection were 37°, 60°, 57°, and 50° for the index, long, ring, and small digits, respectively,
with an overall average of 51°. Average range of DIP joint motion of the nonanatomic repairs were 43°, 59°, 62°, and 51° for the index, long, ring, and
small digits respectively, with an overall average of 54°. Average range of DIP joint motion of the anatomic repairs were 29°, 47°, 35°, and 65° for the index,
long, ring, and small digits, respectively, with an overall average of 44°.
Discussion:
Although the ranges of motion for the anatomical repairs were actually less than the nonanatomical repairs in all digits but the small finger, no results reached
statistical significance. It appears that the additional difficulty of anatomical replacement of the FDP through the FDS decussation does not improve functioning,
at least in a cadaver model.
Evaluating Fractures of the Distal Radius Articular Surface Using a CT Coordinate Grid-System—A Technique to
Describe Fracture Patterns
Institution where the work prepared: Department of Orthopedic Surgery and Rehabilitation, Texas Tech, El Paso, TX, USA
Miguel Pirela-Cruz, MD; Solange Burnette, MD; Syeda T. Nargis, MBBS, MPH
Evaluation of the fractured articular surface of the distal radius using conventional radiographs is difficult. A numbered coordinate (grid) system that is superimposed
on a CT image is introduced to help in describing the configuration and location of the fracture pattern to minimize the problems associated with
fracture interpretation. This information has potential use in clinical and investigational applications in addressing fractures of the distal radius.The specificity
of the description can be tailored to the needs of the observer. The location of fracture lines, fracture fragments, and voids involving the articular surface of
the distal radius can now be described using this system.s
Treatment of Paralysis of the Trapezius Following Injury to Spinal Accessory Nerve
Institution where the work prepared: Boston University School of Medicine, Boston, MA, USA
Harilaos T. Sakellarides, MD, Orthopaedic/Hand Service, Boston University School of Medicine, 3 Hawthorne Place (S-102), Boston, MA, USA
Ten cases with paralysis of the trapezius muscle have been treated in the past 25 years. Most cases were the results of accidental injuries. Half were of iatrogenic
origin, namely paralysis followed the removal of small lipomas from the neck area. There were ten patients, six men and four women. The right side was
involved six times, the left four times. Ages ranged from 28 to 65 years. All patients were handicapped in using their extremities, causing marked weakness in
abduction, with difficulty performing activities such as fishing, tennis, golf and other sports, as well as simple tasks like combing their hair, putting hand behind
neck and elevating the arm. The operation consisted of transferring the insertion of the levator scapulae with a fascial sling through the acromion. The fascial
sling was also used to anchor the spinal border of the scapula to the spinous processes of the upper dorsal vertebrae. The lateral transfer of the rhomboid muscle
in a double-breasted fashion, was added to this procedure. The results were as follows- excellent and good 75% and fair 25%. In this group, all patients
demonstrated much improvement compared with the preoperative status. This method has been found to be satisfactory for correcting the paralysis of the
trapezius.
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