Extensor Pollicis Brevis Research Articles

A case report: Surgical Release for De Quervain Syndrome after conservative treatment of distal radius fracture

Objective Describe the clinical and paraclinical characteristics of De Quervain Syndrome and the result of the surgery for De Quervain Syndrome after conservative treatment of distal radius fracture Subjects and methods A case report. Results De Quervain Syndrome is a condition that involves tendon entrapment affecting the first dorsal compartment of the wrist. It has been reported that De Quervain Syndrome can also develops after distal radius fracture. We report a case that the patient was diagnosed with De Quervain Syndrome after conservative treatment of distal radius fracture. During surgery we noticed that the patient had separated tendon sheaths for abductor pollicis longus (APL) and extensor pollicis brevis (EPB). EPB tendon sheath was released and reconstructed to prevent tendon subluxation. After 6 months, patient was feeling no pain and very satisfied. Conclusions De Quervain Syndrome development after distal radius fracture is rare. The successful surgery got the patient came back to work normally.

High-sensitivity acceleration sensor detecting micro-mechanomyogram and deep learning approach for parkinson’s disease classification

High-sensitivity acceleration sensors have been independently developed by our research group to detect vibrations that are > 10 dB smaller than those detected by conventional commercial sensors. This study is the first to measure high-frequency micro-vibrations in muscle fibers, termed micro-mechanomyogram (MMG) in patients with Parkinson’s disease (PwPD) using a high-sensitivity acceleration sensor. We specifically measured the extensor pollicis brevis muscle at the base of the thumb in PwPD and healthy controls (HC) and detected not only low-frequency MMG (< 15 Hz) but also micro-MMG (≥ 15 Hz), which was preciously undetectable using commercial acceleration sensors. Analysis revealed remarkable differences in the frequency characteristics of micro-MMG between PwPD and HC. Specifically, during muscle power output, the low-frequency MMG energy was greater in PwPD than in HC, while the micro-MMG energy was smaller in PwPD compared to HC. These results suggest that micro-MMG detected by the high-sensitivity acceleration sensor provides crucial information for distinguishing between PwPD and HC. Moreover, a deep learning model trained on both low-frequency MMG and micro-MMG achieved a high accuracy (92.19%) in classifying PwPD and HC, demonstrating the potential for a diagnostic system for PwPD using micro-MMG.

A new high-frequency ultrasound classification of De Quervain tenosynovitis

PurposeThis study aimed to introduce a new high-frequency ultrasound classification of De Quervain tenosynovitis based on a large group of patients. Detailed characteristics of classification are also reported. MethodsFrom January 2014 to February 2024, patients diagnosed with De Quervain tenosynovitis were retrospectively reviewed. High-frequency ultrasound (7−14 MHz) scanning was performed to identify the anatomy of the extensor pollicis brevis and abductor pollicis longus tendons, presence of intertendinous septa, and pathologic changes. The affected wrist was compared to the contralateral wrist. Results453 patients were included: 65 male and 388 female; mean age, 46 ± 27 years (range, 24–65 years). Symptom duration was 14 ± 27 weeks. Disease types were type 0 (n = 5), type 1 (n = 195), type 2a (n = 72), type 2b (n = 18), type 2c (n = 50), type 3 (n = 59), type 4 (n = 45), and type 5 (n = 9). Mean retinacular thickness was 2.1 ± 0.5 mm in affected wrists and 0.4 ± 0.1 mm in contralateral wrists (p < 0.01). The intercompartmental septum was significantly thicker on the affected side (1.2 ± 0.7 mm) than on the asymptomatic side (0.1 ± 0.4 mm) (p < 0.01). ConclusionsThis novel classification provides detailed ultrasonographic characteristics of De Quervain tenosynovitis, based on a large population of patients. It may help in selecting treatment and predicting outcome. However, relevance and therapeutic significance remain to be demonstrated. Level of EvidenceTherapeutic study, Level IV.

De Quervain's Tenosynovitis Release With Excision of the First Dorsal Compartment: Novel Surgical Technique and a Case Series.

Incision of the dorsal side of the tendon sheath in release of De Quervain's tenosynovitis has traditionally been advocated to prevent the risk of volar tendon subluxation. We describe a novel technique of complete excision, rather than simple incision, of the first dorsal compartment tendon sheath. Over a 10-year period, 147 patients (154 wrists) underwent first dorsal compartment release using this technique of complete excision of the sheath. No postoperative immobilization is used. Patients were followed for a mean of 7.0 months. Records were assessed for any complications including reoperation, tendon subluxation, recurrence, wound complications, scar tenderness, and superficial radial sensory nerve paresthesias. There were no cases of recurrence, reoperation, or tendon subluxation after release with this technique. Postoperatively, 7 (4.5%) patients had scar tenderness and 5 (3.2%) of these patients also had superficial radial sensory nerve parasthesias, which all resolved at the time of final follow-up. Mean range of motion was 73±11 degrees of flexion and 69±10 degrees of extension. In contrast to simple incision, we propose that this technique provides a more complete release of the compartment without risk of symptomatic subluxation or bowstringing and provides a complete release of a separate extensor pollicis brevis subsheath or any concomitant retinacular cysts associated with the tendonitis. There is an immediate removal of the symptomatic swelling and visible, painful bump associated with the thickened retinaculum with this technique. Furthermore, no immobilization is required after surgery.

De Quervain’s tendinitis after trapeziometacarpal arthroplasty

ObjectivesDe Quervain’s tendinitis is frequently observed after placement of a trapeziometacarpal prosthesis. The aim of this study was to investigate the relationship between De Quervain’s tendinitis, osteoarthritis of the thumb and placement of a trapeziometacarpal prosthesis. The second aim was a critical analysis of the literature in search of a cause for this postoperative event after arthroplasty or trapeziectomy. MethodsWe reviewed a series of 331 trapeziometacarpal prostheses. ResultsThere were no differences in thumb column length, gender, type of neck (straight or angled), or surgical approach between patients who developed De Quervain’s tendinitis and those who did not. However, the frequency of De Quervain’s tendinitis was much higher after arthroplasty than trapeziectomy. ConclusionsWe believe that the preoperative frequency of De Quervain’s tendinitis in trapeziometacarpal osteoarthritis is underestimated, being part of a more general pain symptomatology. More precise and specific examination is needed for a better preoperative diagnosis.Trapeziometacarpal osteoarthritis should be considered within a more global framework of peri-trapeziometacarpal pathology, including the trapeziometacarpal and triscaphoid levels, the articular ligaments and the abductor pollicis longus, extensor pollicis brevis, flexor pollicis longus, and flexor carpi radialis tendons.

Relationship to the superficial radial nerve and anatomic variations of the first extensor compartment in Thai population: a basis for successful de Quervain tenosynovitis treatment.

Knowledge of the superficial radial nerve (SRN) relationship and anatomic variations of the first extensor compartment (1st EC) will contribute to a better outcome of de Quervain tenosynovitis treatment. We dissected 87 embalmed cadaveric wrists to determine the relationship of the SRN, the 1st EC length, distance from the proximal and distal 1st EC borders to radial styloid process (RSP), abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon slip numbers, and the presence of septum. Our results revealed SRN crossing over the 1st EC in 59.5%. The lateral branch of the superficial radial nerve to the 1st EC midline in most cases (61.9%) except for one specimen, where lateral antebrachial cutaneous nerve was the closest. Distances from proximal and distal 1st EC borders to the RSP were 19.7±4.1 mm and 7.6±1.8 mm, respectively. Extensor retinaculum (ER) width over 1st EC (1st EC length) was 14.8±3.2 mm. Complete and incomplete septa were found in 17.2%, and 42.5%, respectively. The most frequent APL tendon slip number in the compartment was two in overall 47 specimens (54.0%). Almost all compartments (85 specimens; 97.7%) contained one EPB tendon slip. We detected bilateral EPB absence in one cadaver. Moreover, we recorded a tendon slip from extensor pollicis longus traveling into 1st EC bilaterally in one cadaver and observed the EPB muscle belly extension into 1st EC in 9 wrists. Awareness of 1st EC anatomic variations would be essential for successful surgical and nonsurgical outcomes.

Anatomic location of the first dorsal extensor compartment for surgical De-Quervain's tenosynovitis release: A cadaveric study.

De-Quervain's tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist. Patients who fail conservative treatment modalities are candidates for surgical release. However, risks with surgery include damage to the superficial radial nerve and an incomplete release due to inadequate dissection. Currently, there is a paucity of literature demonstrating the exact anatomic location of the first dorsal extensor compartment in reference to surface anatomy. Thus, this cadaveric study was performed to determine the exact location of the first extensor compartment and to devise a reliable surgical incision to prevent complications. To describe the location of the first dorsal compartment in relation to bony surface landmarks to create replicable surgical incisions. Six cadaveric forearms, including four left and two right forearm specimens were dissected. Dissections were performed by a single fellowship trained upper extremity orthopaedic surgeon. Distance of the first dorsal compartment from landmarks such as Lister's tubercle, the wrist crease, and the radial styloid were calculated. Other variables studied included the presence of the superficial radial nerve overlying the first dorsal compartment, additional compartment sub-sheaths, number of abductor pollicis longus (APL) tendon slips, and the presence of a pseudo-retinaculum. Distance from the radial most aspect of the wrist crease to the extensor retinaculum was 5.14 mm ± 0.80 mm. The distance from Lister's tubercle to the distal aspect of the extensor retinaculum was 13.37 mm ± 2.94 mm. Lister's tubercle to the start of the first dorsal compartment was 18.43 mm ± 2.01 mm. The radial styloid to the initial aspect of the extensor retinaculum measured 2.98 mm ± 0.99 mm. The retinaculum length longitudinally on average was 26.82 mm ± 3.34 mm. Four cadaveric forearms had separate extensor pollicis brevis compartments. The average number of APL tendon slips was three. A pseudo-retinaculum was present in four cadavers. Two cadavers had a superficial radial nerve that crossed over the first dorsal compartment and retinaculum proximally (7.03 mm and 13.36 mm). An incision that measures 3 mm proximal from the radial styloid, 2 cm radial from Lister's tubercle, and 5 mm proximal from the radial wrist crease will safely place surgeons at the first dorsal compartment.

De Quervain tendinitis after total trapeziometacarpal joint arthroplasty: Biomechanical evaluation of tendon excursion in the first extensor tendon compartment

De Quervain’s tenosynovitis is the most common complication after total trapeziometacarpal joint replacement. Etiology is unclear. Implantation of a ball-in-socket implant changes the biomechanics of the normal trapeziometacarpal saddle joint and increases its range of motion. The present study demonstrates that this procedure also significantly increases excursion of the abductor pollicis longus and extensor pollicis brevis tendons during thumb flexion-extension, and not during thumb abduction-adduction. Increased tendon gliding under the retinaculum of the first extensor tendon compartment could predispose to the development frictional tenosynovitis and play a role in the development of de Quervain’s syndrome after total trapeziometacarpal joint replacement. Level of evidenceNot applicable (laboratory study).

Opposition Transfer Using the Extensor Indicis Muscle and the Extensor Pollicis Brevis Tendon

PurposeThis study aimed to introduce a novel technique utilizing the extensor pollicis brevis and extensor indicis proprius tendons as power sources for thumb opposition reconstruction in cases of severe carpal tunnel syndrome (CTS) associated with thenar muscle atrophy. Further, the efficacy of this novel method and the traditional Camitz technique was compared. MethodsPatients with severe CTS and thumb opposition dysfunction who underwent surgery using the novel technique (n = 7, 9 surgeries) or the Camitz technique (n = 8, 8 surgeries) were included in the analysis. The pre- and postoperative palmar abduction angle, thumb–ring finger opposition (T–R) angle, and Kapandji score were assessed. The repeated measures ANOVA and the Mann–Whitney U test were used for statistical analysis. ResultsThe novel technique was associated with a significant postoperative improvement in palmar abduction angle, T–R angle, and Kapandji score. In particular, the T–R angle of patients who underwent surgery using this technique was superior to that of patients who underwent surgery using the Camitz technique. Therefore, the novel technique was highly effective in improving thumb pronation. ConclusionThe novel technique using the extensor pollicis brevis and extensor indicis proprius tendons is promising for thumb opposition reconstruction in severe CTS cases. Unlike the traditional Camitz technique, this approach promotes stable thumb opposition function without requiring a pulley, thereby yielding satisfactory outcomes. Nevertheless, further studies with a larger sample size should be conducted to validate these findings.

The place of B-mode ultrasonography, shear-wave elastography, and superb microvascular imaging in the diagnosis of De Quervain tenosynovitis.

Superb microvascular imaging (SMI) and Shear wave elastography (SWE) are newly developed ultrasonographic diagnostic tools used to support the diagnosis of De Quervain tenosynovitis (DQT). The aim of this study was to examine the capacity to differentiate between the wrist with DQT and the healthy wrist, as well as the potential for predicting the disease's severity using B-mode ultrasonography, SWE, and SMI. A total of 19 cases with unilateral clinical DQT were included in the prospective study. The wrists of these cases without DQT clinic constituted the control group. The SWE parameters of m/s and kPa cutoff values were ≤5.225 and ≤ 77.65, respectively, in the wrists with DQT compared to the wrists not diagnosed with DQT (p < 0.001). Regarding SMI findings no microvascularity was determined in the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendon sheaths of the wrists without DQT, and a significant increase was observed in the degree of microvascularity as the clinical severity of DQT increased. SWE results can differentiate between the presence and absence of DQT. SMI grading of the APL and EPB tendon sheaths may be helpful to the clinician in deciding the clinical severity of DQT.

How to Omit the Potential Pitfalls in Distal Radial Access: Lessons From Cadaveric and CTA Analysis.

To verify the anatomical basis, ideal puncture sites, and potential pitfalls of the distal radial artery (dRA) in the anatomical snuffbox region for distal radial access (dTRA). Overall, 26 formalin-fixed upper limbs and computed tomography angiography (CTA) of the upper limbs of 168 consecutive patients were studied. Cadaveric dissection and dRA 3D reconstruction were used to evaluate the dRA route for dTRA. The puncture sites, dRA diameter, and angle of the dRA and tendons of the extensor pollicis brevis were also measured in the patients and cadavers. The cadaver dissection provided more insights than did the dRA 3D reconstruction. However, preoperative evaluation had better diagnostic accuracy (p=0.024). Puncture sites 1 and 3 had a high success rate (63.2% possible success rate, 191/302). The DISFAVOR theory was put forward, in which 8 types of potential pitfalls that may interrupt puncture procedure or lead to a surgical failure were observed, including occlusion, stenosis, tortuosity, arteriovenous fistula, angioma, different radial artery (RA) ramifications, radial veins, and cephalic veins. The mean diameter of dRA based on cadaver dissection and CTA was 2.53 (SD=0.73) and 2.63 (SD=0.69) mm, respectively. Furthermore, the minimum distance from the outer layer of dRA to the skin was 5.71 (SD=2.0) mm based on CTA. The angle between the dRA and tendons of extensor pollicis brevis (TEPB) based on cadaver dissection and CTA was 58.0° (SD=21.5°) and 51.8° (SD=16.6°), respectively. Puncture sites 1 and 3 were more suitable for the dTRA, and we put forward the DISFAVOR theory to summarize the 8 types of potential pitfalls during the use of dTRA.

Insights with consensus on Abductor Pollicis Longus from the Central Indian population at Nagpur, Maharashtra.

The anatomical snuff box is bounded laterally by the Abductor pollicis longus (APL) and the Extensor pollicis brevis (EPB) tendons. The variation in insertion of extensor tendons at the forearm and wrist is an interesting phenomenon. Therefore, a sound knowledge of such variations in extensor tendons is essential to know the consequence of tendon injury during implementation of its repair. Hence, we studied 48 formaldehyde fixed forearms of Indian-origin cadavers with age groups ranging from 33 to 67 years from the Central Indian population at Nagpur, Maharashtra, India. Variation in the insertion of APL was checked by tracing the tendon till its insertion. APL muscle was found with single tendon in 20 forearms, double in 9, triple in 8 and quadruple in 5 and five (maximum) in 6 forearms. In 93% (n=45), the APL tendon was inserted into the first metacarpal bone and in 7% (n=03), it was inserted into the trapezium bone. No variation was noted in the EPB tendon. Data shows that there are accessory slips in the APL tendon, differing from the standard description. Thus, data provides awareness of such potential variation among operating surgeons for better management of the diseased during dissection.

Anatomical variations in the first dorsal compartment of the wrist: meta-analysis.

The first dorsal compartment of the wrist includes tendons of abductor pollicis longus (APL) and extensor pollicis brevis (EPB). However, many studies have showed multiple anatomical variations including anomalies in the number of both APL and EPB tendons and presence of intercompartmental fibro-osseous septum. Unfortunately, studies describing those variations are not consistent, hence, the aim of this study was to provide most accurate data about these anatomical variations in the population, using systematic review and meta-analysis. For this purpose, PubMed, Scopus, Web of Science, Embase and a number of minor online libraries were searched. Articles which included exact data about the number of APL or EPB tendons or a presence of intercompartmental septum were qualified for a more precise evaluation. Therefore, out of 1629 studies initially evaluated, 68 were finally included in this meta-analysis. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 5229 studied wrists have been included in this study. Double APL and single EPB are the most common variations of tendons in the first dorsal compartment, both in cadavers and patients with de Quervain's disease, with no statistically significant differences between those two groups. Presence of intercompartmental fibro-osseus septum is much more common in patients with de Quervain's disease than in cadavers. Our results should improve the awareness of anatomical variations in the first dorsal compartment, which in turn should have impact on treatment of de Quervain's disease in clinical practice.

Work-Related Risk Factors Contributing to De-Quervain's Tenosynovitis among Carpenters in Punjab

Purpose: De Quervain's Tenosynovitis is inflammation of extensor pollicis brevis and abductor pollicis longus tendons that run from the side of the wrist to the base of the thumb. To see the frequency of De Quervain’s Tenosynovitis and work related risk factors in carpenters of Punjab, Pakistan&#x0D; Methodology: It was a cross-sectional study. Sample size of the research was 492. Study was conducted at the province Punjab, Pakistan. Inclusion criteria of the study were carpenters of age between twenty to fifty years having experience of more than 2 years. Data was collected to the selected population, through convenient sampling technique. Duration of the study was 8 months. Outcome measures of the study were Finkelstein test, Visual analogue scale and a structured questionnaire. The collected data was analyzed by using SPSS version 25.&#x0D; Findings: Out of 492 participants, De-Quervain's Tenosynovitis was found to be present in 46% of carpenters Punjab. 25.6% of the participants had moderate, while 22.3% had extreme discomfort in lower back. 19.91% reported not to have an enough space for work. 55.69% didn’t take adequate breaks while working. 69.91% reported to have no back rest while working, 63% reported not use any wrist support or brace while working and 35.36% reported not to have any proper training for this work.&#x0D; Conclusion: De Quervain’s Tenosynovitis is prevalent in carpenters of Punjab, Pakistan. Work-related discomfort was found in various regions of body including eyes, neck, shoulders, arms, wrist and hand. Contributing work-related risk factors for De Quervain's Tenosynovitis among carpenters encompass insufficient training, absence of wrist support, and inadequate breaks during work.

Prevalence of De-Quervain’s Tenosynovitis in Female Tailors in District Wazirabad

Purpose: De Quervain's tenosynovitis affects the thumb abductors close to the radiostyloid process, causes a painful wrist complaint. When performing particular jobs incorrectly, the wrist and thumb might lead to De Quervain's Tenosynovitis. It is associated with work that necessitates repetitive wrist and thumb motion. Pain, numbness, tingling, burning, stiffness, and exhaustion are a few of the warning signs and symptoms. Complaints include a loss of normal sensation, a restriction in range of motion, and a decline in grip strength. The objective of the study was to determine the prevalence of De-Quervain's Tenosynovitis in female tailors in district Wazirabad.&#x0D; Methodology: Amongst female tailors, a cross-sectional survey was done. Based on the inclusion and exclusion criteria, 289 participants were chosen through convenient sampling technique. The process was described to the study participants. The degree of the pain was evaluated using the Numeric Pain Rating Scale (NPRS), and an assessment of the illness was made using the Finkelstein test. Both hands were put to use for the test. Pain over the abductor pollicis longus and extensor pollicis brevis tendons at the wrist is a sign of a positive diagnosis. The SPSS program was used to examine the data. Data was presented in for of tables and charts.&#x0D; Findings: De-Quervain's Tenosynovitis was present in 43% of the population overall. When the results of the right and left hands were compared, it was discovered that 33% females had right hand had De Quervain's tenosynovitis and 10% had it in both hands. Sixty of the respondents reported experiencing mild pain, 41 women reported moderate pain, and 23 reported severe pain. This study concluded that the prevalence of De-Quervain’s Tenosynovitis in female tailors is low.&#x0D; Recommendations: The study was grounded in the Cumulative Stress Theory, emphasizing repetitive motion's impact on occupational health. Tailors should receive training on ergonomics, use ergonomic tools, and undergo regular wrist health check-ups. Policy makers must set occupational health standards for tailors, ensuring ergonomic tool usage, and mandate periodic health audits in tailoring establishments

Surgical Treatment of Thumb-in-Palm Deformity: A Case Report.

A 13-year-old adolescent boy with spastic triplegia was referred to our institution with a thumb-in-palm deformity. An intramuscular slide of the flexor pollicis longus and augmentation of the weak abductor pollicis longus, extensor pollicis longus, and extensor pollicis brevis by tendon transfer were performed. Two years later, the result of the surgery was evaluated as excellent. There are several factors that will play a decisive role in the final outcome and effectiveness of hand surgery, such as the severity of the neuromuscular disorder, the extent of the deformity, the quality of voluntary muscle control, hand sensibility, and the age and intelligence of the patient.

Anatomo-Phylogenetic Arguments for the Production of Muscular Sports Injuries

"The striated muscles that appeared later on the phylogenetic scale have more white, fast fibers in their composition, more sensitive to metabolic aggression. Based on the composition, phylogeny and anatomical-functional characteristics, we selected the following muscles: semitendinosus, iliac, subscapular, extensor pollicis brevis and flexor pollicis longus. The data from the specialized literature show that the respective muscles are exposed to sports injuries. In principle, one can try to prevent injuries by changing the proportions in types of muscle fibers, possibly through physical exercises, but there is the potential danger of changing joint biomechanics. Keywords: striated muscles, phylogeny, fiber types, sports traumatology."

Prevalence of De-Quervain’s Tenosynovitis in Tailors of Multan (Punjab)

Purpose: De Quervain's Tenosynovitis is inflammation of extensor pollicis brevis and abductor pollicis longus tendons that run from the side of the wrist to the base of the thumb. To see the frequency of De Quervain’s Tenosynovitis and work related risk factors in tailors of Multan, Pakistan&#x0D; Methodology: It was a cross-sectional study. Sample size of the research was 246. Study was conducted at the city of Pakistan, Multan. Inclusion criteria of the study were tailors of age between twenty to fifty years having experience of more than 3 years. Data was collected to the selected population, through convenient sampling technique. Duration of the study was 8 months. Outcome measures of the study were Finkelstein test, Visual analogue scale and a structured questionnaire. The collected data was analyzed by using SPSS version 25.&#x0D; Findings: Out of 246 participants, 72.3% were males and 27.6% were females. Prevalence of De Quervain's Tenosynovitis was found to be 64% in tailors of Multan through Finkelstein test. 25.6% of the participants had moderate, while 22.3% had extreme discomfort in lower back. 35.3% reported to have mild discomfort in arms. 52.4% had mild to moderate discomfort in wrist or hand. 19.91% reported not to have an enough space for work. 44.30% did not have adjustable chairs. 69.91% reported to have no back rest while sewing, 63% reported unavailability of foot rest and 64.63% had no arm rest while sewing.&#x0D; Recommendations: De Quervain’s Tenosynovitis is prevalent in tailors of Multan, Pakistan. Work-related discomfort was found in various regions of body including eyes, neck, shoulders, arms, wrist and hand. Chairs with no adjustable height, unavailability of arm and foot rest and no back support were associated work related risk factors in tailors.

Functional Chimeric Double-barrel Fibula and Reinnervated Peroneus Brevis Osteomyocutaneous Flap for One-stage Forearm Reconstruction.

Reconstructing a mangled limb is complex and requires expertise in both bone and soft-tissue reconstruction, particularly when there is significant muscle loss. Typically, multistage surgery is necessary, starting with soft-tissue coverage, followed by bone grafting and tendon transfers. Sometimes, microsurgical techniques such as vascularized bone grafts and free functional muscle transfers are necessary, especially when there is a bone defect of over 6 cm; the soft-tissue environment is infected, scarred, or poorly vascularized; or there are extensive musculotendinous injuries. We treated a 34-year-old man who had a crushed left forearm resulting in an 18 × 8 cm open wound, 5-cm radius and 7-cm ulna bone defects, loss of the extensor pollicis longus and brevis muscles, and extensive injuries to the other musculotendinous structures of the forearm. To accomplish a one-stage reconstruction, we used a chimeric fibula osteomyocutaneous flap that included a 20 × 10 cm skin flap, peroneus brevis muscle with its motor nerve, and two segments of fibula. The proximal and distal fibula segments were used for ulnar and radial bone reconstruction, respectively, preserving forearm supination and pronation. The peroneus brevis tendon was sutured to the extensor pollicis longus tendon, and its motor nerve was coaptated with the posterior interosseous nerve to restore thumb extension. The skin flap provided complete coverage of all exposed bone and tendon structures. At the 12-month follow-up, the patient regained full extension of the thumb, and there were no difficulties with forearm supination and pronation or with foot eversion and plantar flexion at the donor leg.

Clinical Considerations of First Extensor Wrist Compartment (FEWC) Variants and De Quervain's Disease: A Review Study.

The first extensor wrist compartment (FEWC) displays significant variants. This review highlights all possible variants that may be associated with the occurrence and pathophysiology of de Quervain's tenosynovitis. A thorough search of PubMed and MEDLINE databases, following the PRISMA guidelines, was conductedfrom 2002 to 2022 to evaluate all FEWC variants, including the following: 1) the presence of an inter-tendinous septum, 2) the number of tendinous slips of the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) muscles, 3) their distal insertions and 4) the presence of a bony ridge within the FEWC.A total of 3878 wrists (1277 cadaveric and 1296 de Quervain patients) were included.Of the 1234 cadavers, a total of 701 (56.8%) were males and 533 (43.2%) were females. Regarding the 883 patients, 178 (20.2%) of them were males and 705 (79.8%) were females. An inter-tendinous septum was identified in 42.9% (47% of the patients' wrists compared to 39.3% of the cadaveric wrists, p<0.0001). Cadaveric wrists presented two or more slips for the APL in a significantly higher percentage (92.5%, p < 0.0001) compared to de Quervain patients' wrists (74.5%). Regarding the EPB muscle, de Quervain patients' wrists had a single slip in 93% (p=0.0007) and two or more slips in 3.6%, compared to cadaveric wrists (a single slip in 87%, and two or more slips in 11%, p< 0.0001). A bony ridge over the radial styloid process was recorded in 58.9% of the cadaveric wrists compared to 17.8% of the patients' wrists (p < 0.0001). Remarkable diversity concerning the structures within the FEWC was reported. The presence of an inter-tendinous septum dividing the FEWC and a single EPB muscle slip is more likely to be found in patients with de Quervain's disease.