Flexor Tendon Lengthening Research Articles

Use and Safety of the Precice Antegrade Femoral Nail in Pediatric Patients

Context: The Precice internal magnetic lengthening nail is used commonly for adult femur lengthening given its accuracy, precise control of lengthening, and patient comfort throughout the process. The nail is not currently approved by the Food and Drug Administration (FDA) for use in children, although many practices continue to use it off label. Aims: We aim to support the notion that the implant is efficient, reliable, and safe for femur lengthening in skeletally immature pediatric patients. Subjects and Methods: We performed a retrospective chart review of all skeletally immature patients who underwent treatment with a precice antegrade femoral nail to help establish the nail's safety and efficiency in this population. Results: We implanted 30 precice antegrade femoral nails (all trochanteric entry) in 25 patients (11 males, 14 females). The average lengthening goal for all surgeries was 47.62 mm (15 mm to 80 mm), and the average length achieved was 47.63 mm (15 mm to 80 mm). Twenty-four out of 25 patients (96%) achieved their lengthening goal within 5 mm. Average distraction rate was 0.97 mm/day (0.75 mm/day to 1 mm/day), and average bone healing index (time to consolidation/cm lengthened) was 19.69 days/cm (13.77 days/cm to 35.33 days/cm). Three patients experienced complications that required additional surgery, including a hip and knee flexor tendon lengthening, guided growth to correct a knee flexion contracture, and bilateral exchange nailing for implant fracture and delayed union. No patients experienced avascular necrosis of the hip, and all complications were ultimately resolved without permanent deficits. Conclusions: The precice antegrade femoral nail can safely and efficiently manage large lower extremity lengthening in skeletally immature children. Concurrent angular or rotational deformity correction was also possible, and postoperative complications were infrequent and manageable.

One-Stage Extension Shortening Osteotomy for Syndromic Camptodactyly.

Syndromic camptodactyly often affects multiple fingers, and severe deformities are common compared to idiopathic camptodactyly. This study aimed to evaluate the use of a one-stage extension shortening osteotomy of the proximal phalanx for patients with syndromic camptodactyly without tendon surgery. Forty-nine cases of syndromic camptodactyly were included. Forty fingers (81.6%) were associated with arthrogryposis multiplex congenita, and nine (18.4%) with other syndromes. Six fingers presented with a moderate form (30° to 60°) of camptodactyly, whereas 43 fingers manifested the severe form (>60°). The mean age at the time of surgery was 8.5 years, and the patients were followed for a mean of 3.9 years. The mean length of the shortening of the proximal phalanx was 4.9 mm, which averaged 17.8% of the proximal phalanx’s original preoperative length. The mean operative time was 25.8 min, and the PIP joint was fixed using Kirschner wires with an average flexion position of 7.6°. The mean flexion contracture improved from 76° preoperatively to 41° postoperatively. The mean preoperative active arc of motion was 23°, which improved to 49° postoperatively. A one-stage extension shortening osteotomy is a straightforward and effective technique for the improvement of finger function through the indirect lengthening of volar structures without the flexor tendon lengthening. The osteotomy could simultaneously correct bony abnormalities. This simple procedure is especially suitable for surgery on multiple fingers in patients with syndromic camptodactyly.

Usefulness of dexmedetomidine to prevent emergence agitation in a patient with Krabbe disease: a case report

BackgroundWe report the case of a child with Krabbe disease who underwent three repeated surgeries and anesthetic management, and we discuss the major concerns about Krabbe disease and the usefulness of a perioperative administration of dexmedetomidine to prevent emergence agitation and hypertension. The patient was scheduled to undergo bilateral orchiopexy, adenotonsillectomy, and knee flexor tendon lengthening under general anesthesia during a 2-year period.Case presentationAdenotonsillectomy was scheduled as the second operation when the patient was 4 years old. His height and body weight were 93 cm and 10.3 kg, respectively. Anesthesia was induced with 8% sevoflurane mixed with 6 L/min of O2 and maintained with N2O (3.5 L/min), O2 (1.5 L/min), and sevoflurane (1.5–2.0%). Upon completion of the right tonsillectomy, 1 h before the end of the surgery, a continuous infusion of dexmedetomidine (0.2 μg/kg/h) was started to prevent emergence agitation, irritability, resultant hypertension, and postoperative bleeding. Fentanyl (25 μg) was administered intravenously to reduce postoperative pain. The surgery was uneventful, and the patient’s emergence from general anesthesia was prompt. He exhibited no symptoms of emergence agitation or irritability. During his stay in the intensive care unit, 0.2–0.7 μg/kg/h of dexmedetomidine and 6.25 μg/h of fentanyl were continuously administered. The patient was discharged to the ward the following morning without complications.ConclusionsThe perioperative administration of dexmedetomidine was useful to prevent emergence agitation, hypertension, and resultant postoperative bleeding in a pediatric patient with Krabbe disease. Three repeated anesthetic management using inhalation anesthesia were completed uneventfully without muscle relaxants.

Fractional Flexor Tendon Lengthening for Advanced Metacarpophalangeal Flexion Contracture in Rheumatoid Hands

This technical report discusses a subgroup of rheumatoid patients who have minimal ulnar drift but a severe fixed metacarpophalangeal joint flexion contracture for whom conventional metacarpophalangeal joint arthroplasty alone was insufficient to correct the deformity. We describe a surgical technique to deal with this clinical problem that uses fractional flexor tendon lengthening in the forearm to correct the severe flexion deformity at the metacarpophalangeal joint.

Clinical outcome of early and late surgical treatment of moderate Volkmann contracture

目的 探讨中度前臂缺血性肌挛缩早、晚期手术治疗的疗效分析.方法 1997-2003年,对中度前臂缺血性肌挛缩25例早期患者采取神经、肌肉松解减压术,对其中6例行肌腱移位、延长、屈肌起点滑移术.25例晚期患者采取神经、肌肉松解减压和肌腱移位、延长、屈肌起点滑移等手术.结果术后随访1～5年,早期手术组手功能恢复:优11例,良8例,可6例,优良率为76％.晚期手术组:优6例,良6例,可11例,差2例,优良率为48％.早期手术组术后肌电神经传导速度显示正中、尺神经恢复明显优于晚期手术组.结论中度前臂缺血性肌挛缩早期手术治疗,对促进前臂神经、手内在肌功能和保护性感觉的恢复、防止关节挛缩等均有较好的疗效。

Flexor tendon lengthening in zone II injuries.

Primary repair of acute severed flexor tendons in zone II has replaced the "no-man's-land" concept, which advocates secondary procedures. Primary repair can be difficult when there are severe soft-tissue and bony injuries, and may lead to unfavorable results. The authors describe a technique that is simple, quick, and safe, and eliminates the need for tendon harvesting or other secondary procedures. It can also be used when a flexor profundus tendon gap occurs due to the injury.

The hyperflexed seemingly useless tetraplegic hand: a method of surgical amelioration.

In a series of 65 tetraplegic hands with severe disabling spasticity and/or flexion contracture, selective flexor tendon elongation procedures were employed to improve their static and kinetic postures. A kinetic approach was adopted, utilizing local anesthesia in a wide-awake patient. This was employed to allow for the patient's cooperation in determining at surgery the desired length of digital extension at the time of wrist tenodesis action. Elongation of the extensor digitorum communis (EDC), extensor indicis proprius (EIP), and extensor digiti quinti (ED V) were added to correct an 'extrinsic-plus' posture observed in 16 patients following flexor tendon lengthening. With the resultant improvement in the static posture of the digits, tendon transfers could then be employed to provide a more functional tenodesis action. These measures provided both improved palmar contact and prehension.

Flexor tendon lengthening by tenotomy at the musculotendinous junction.

The author presents his experience with an established technique of flexor tendon lengthening by tenotomy at the musculotendinous junction. This technique can be used for digital stiffness of forearm origin when active extension is possible on flexion of the wrist. There must not be adherence in the carpal tunnel or in the digital sheath, and active flexion must be preserved. It can also be used for digital stiffness in addition to other techniques. This kind of lengthening has some advantages: there are no sutures in the tendon itself, and it allows early reeducation in association with dynamic extension splinting. Active flexion is preserved immediately and there is good tendon healing. It is possible to lengthen selectively the superficial flexor or the deep flexor and in some cases both. Results are presented according to cause.