Motor Grade Research Articles

Исследование виброзащитной системы сиденья с квазинулевой жесткостью при стохастических воздействиях на элементы ходового оборудования автогрейдера

With the help of a complex simulation mathematical model of a motor grader developed in the Matlab environment, including subsystems of vibration-protective cab supports, a vibration-protective mechanism of the operator's seat, setting stochastic effects on the elements of running equipment when moving along a microrelief, a computational experiment is carried out, when processing the results of which, the influence of a number of system parameters on the root-mean-square seat acceleration deviation in the vertical direction. The variable parameters are the root mean square deviation of the vertical coordinates of the microprofile of the supporting surface, the speed of motion of the motor grader, the size of the zone of quasi-zero stiffness of the vibration protection mechanism of the operator's seat, the value of the increase in the spring stiffness coefficient of the vibration protection mechanism, which sets the slope of the average section of the static power characteristic of the vibration protection mechanism. An increase in the size of the zone of quasi-zero stiffness allows several times to reduce the average value of the root-mean-square deviation of the seat acceleration for a set of movements at various profile heights and speeds. Giving the middle part of the static characteristic a small slope also allows a slight decrease in the average value of the standard deviation of the seat.

Dermatomyositis Presenting with Isolated Dysphagia: A Case Report

We report a case of a 75-year-old woman who was diagnosed with dermatomyositis presenting with isolated dysphagia. There were no obvious cranial nerve deficits with normal motor grade in all the limbs in neurological examinations, but a suspicious rash was observed in the anterior chest. The serum creatine kinase was 306 IU/L, and active myopathic changes in bilateral limb muscles were observed in the electromyography test. Muscle biopsy from vastus lateralis showed perivascular infiltration of mononuclear inflammatory cells, which was compatible with dermatomyositis. She had responded to oral prednisolone and azathioprine.

Динамические свойства сиденья автогрейдера с квазинулевой статической характеристикой

During operation, transport and technological machines and equipment experience significant vibration effects from the working environment, which are transmitted to the human operator through the cab seat. The negative impact of dynamic influences and vibrations transmitted through the seat to the operator is noted in many works. The use of vibration protection systems for operator seats requires their simulation and study on mathematical models, which is an urgent task in the design of such systems. Vibration protection systems with the effect of quasi-zero stiffness are promising. To study vibration protection systems with quasi-zero stiffness, a complex simulation mathematical model of a motor grader was developed, the movements of which are of a spatial nature. The model includes subsystems of supporting elements of the base chassis, vibration-proof supports of the operator’s cabin, and, finally, the vibration-proof mechanism of the operator’s seat. The last subsystem makes it possible to study vibration protection mechanisms with a given size of the zone of quasi-zero stiffness in the static force characteristic. Using the developed complex simulation model, the system’s responses to step actions exerted on the elements of the running equipment of the base chassis of the motor grader were studied. The effects on one of the wheels of the front balance axle and one of the wheels of the rear balance bogie of the motor grader were investigated. Two static power characteristics of the vibration-protective seat system were considered, one of which had a section of quasi-zero stiffness, and the second did not. According to the results of the computational experiment, it was established that the vibration protection system with a quasi-zero stiffness section provides maximum seat accelerations that are ten times less than a vibration protection system without a quasi-zero stiffness section. This confirms the promise of using vibration protection systems with the effect of quasi-zero stiffness.

Bioengineered nerve conduits and wraps for peripheral nerve repair of the upper limb

Bioengineered nerve conduits and wraps for peripheral nerve repair of the upper limb

Comparisonal Analysis Of D35 Bulldozer And GD300A-1 Motor Grader As A Grade Tool Reviewing From Time

In the sub work of the Nglinggis access road, there is a work of embankment of soil fromselected local materials. This work includes taking material from the stock pile, transporting itto the site, leveling the soil and compacting the soil. Soil leveling in this project uses BulldozerD35 as a leveling tool. In doing land leveling work there is another method that can be used,namely the method of heavy equipment in the form of a Motor Grader. In the condition of theland for the Nglinggis access road, the type that is suitable for use is the Motor Grader GD 300A-1. The use of heavy equipment can affect the estimated time on a job. Therefore, the selectionof an efficient tool for the job is very important. From the specifications, the speed of the GD300 A-1 Motor Grader is superior to the D35 Bulldozer. The purpose of this study is to analyzethe comparison between Motor Grader and Bulldozer as a leveling tool, it can be seen whichtool is the most efficient if used as a leveling tool in earthworks at the Nglinggis Access RoadWorks at the Tugu Dam Spillway Construction Project, Kab. Trenggalek. The results showedthat based on the average waiting time, the Bulldozer D35 was 0.31 minutes faster than theMotor Grader GD 300 A-1 in each cycle. And based on time weighted average, the BulldozerD35 is 0.03 minutes faster than the Motor Grader GD 300 A-1 on each cycle.

Comparative Study of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Treating Cauda Equina Syndrome

Objective: The purpose of this study is to evaluate the clinical outcome of cauda equina syndrome (CES) using percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM).Methods: Fifteen patients with CES either underwent PELD or OLM from January 2017 to December 2019. The patients were divided into 2 groups according to the surgical methods: the PELD group (with 7 patients, 5 males and 2 females) and the OLM group (with 8 patients, 6 males and 2 females). The clinical outcomes were evaluated by the Visual Analogue Scale score (VAS), motor grade of lower extremities, perineal sensation, anal tone, and bladder dysfunction. Results: Both groups reported a significant postoperative reduction of VAS score for back and leg pain. When comparing the two groups, there was no significant difference in the improvement of leg pain. However, the improvement in back pain was significantly higher in the PELD group than in the OLM group (p=0.05). In the PELD and OLM groups, all 15 patients showed an improvement in preoperative CES symptoms including impaired lower limb motor power, perineal sensations, anal sphincter tone and bladder function at the one-year follow-up. The operation time (p=0.01) and length of hospital stay (p=0.01) were shorter in the PELD group compared with the OLM group. In the PELD group, the intraoperative bleeding was negligible whereas in the OLM group.Conclusion: The advantages of PELD, indicate it is a good alterative or option for the treatment of CES patients considering the appropriate indication.

Pure pursuit method use to control unmanned motor grader

The clarification to the article published in volume 19 No. 2 (84) 2022 pp. 156-169 is the following: the article has been amended at the end, the translator of the article is indicated: the translation was made by I. N. Churilova.

EVALUASI PRODUKTIVITAS DAN EFISIENSI ALAT BERAT PADA PEKERJAAN TANAH PROYEK PERPANJANGAN RUNWAY DI BANDARA INTERNASIONAL LOMBOK

Projects for the extension of the runway and other supporting facilities at the international airport of Lombok, Central Lombok, West Nusa Tenggara (NTB), where the implementation of the work is dominated by the use of heavy equipment to accelerate the completion of the work.The data obtained is by direct observation in the field. Analysis of the calculation of heavy equipment productivity, heavy equipment operating costs, revenue and profit were analyzed using the Bina Marga method. The heavy equipment studied in the field are excavators, dump trucks, motor graders, vibrator rollers, and water tankers.Productivity and the number of tools needed from the analysis results with those in the contract documents are appropriate, while the duration or time of work from the analysis results is more efficient. The hourly rental fee obtained from the calculation results for each heavy equipment, namely Excavator, is Rp. 694,260. Dump trucks of Rp. 753,762. Motor grader Rp. 642.188. Vibratorroller Rp. 551583.4. As for the Watertanker Rp. 384,646.04. The income and profit obtained from the use of heavy equipment on the ground work of the runway extension project at the Lombok international airport with a total of Rp. 38,279,148,142.96 and a profit of Rp. 3,469,922,558.05.

Comparison of Anterior vs. Dorsal Approach for Spinal Accessory to Suprascapular Nerve Transfer in Patients With a Brachial Plexus Injury and Its Outcome on Shoulder Function.

BackgroundBrachial plexus injuries are frequently encountered in the domain of plastic surgery, mostly secondary to road traffic accidents, gunshot injuries, or falls from a height. Many modalities have been described in the management, depending on the level and duration of the injury. C5, C6 and C5, C6, C7 are two common patterns in which nerve repair and transfers are described. At our center, we practice spinal accessory to suprascapular nerve transfer in all patients with upper trunk brachial plexus injury. There are two described approaches for the spinal accessory nerve to suprascapular nerve transfer, i.e. anterior or dorsal. The rationale for doing the posterior approach is that this approach avoids damaging the suprascapular nerve at its entrance in the suprascapular notch under the suprascapular ligament during exploration due to traction.Materials and methodsThis is a retrospective study with a consecutive sampling of 23 patients presenting at Liaquat National Hospital, Karachi, with upper trunk brachial plexus injuries during the time period from January 2016 to December 2017, i.e. two years. We divided these 23 patients into two groups, one with the anterior approach and the other with a dorsal approach for spinal accessory to suprascapular nerve transfer for shoulder abduction. The mean duration of post-surgical follow-up was from 18 to 24 months and recovery and functional outcomes were assessed.ResultsOut of the 23 patients that were included, 10 patients were operated on with an anterior approach and 13 with a posterior approach. Fifty percent (50%) of patients operated with the anterior approach and 84% of patients with the posterior showed the best motor grade recovery of M4, respectively, with better performance in patients with the posterior approach as compared to the anterior approach.ConclusionWe advocate taking a posterior approach for spinal accessory to suprascapular nerve transfer for shoulder abduction, as it has shown better results with reliable outcomes concerning shoulder abduction, angle of abduction, and range of motion.

PIT Design Area 206 Ha at PT Semen Padang Indarung

PT. Semen Padang is a mining company engaged in quarry (limestone) mining. The company is located in Bukit Karang Putih – Indarung, Padang City. Mining in this company uses the Type Side Hill Quarry system. For production in the 206 Ha mining area using a combination of mechanical devices in the form of Excavators and Dump Trucks. With supporting tools in the form of a D9R Bulldozer and a GC-02 Motor Grader. The target of this activity is to optimize mining production in the 206 Ha pit area. Efforts were made to optimize mining production in the Exit Area and PIT Limit from 2014 – 2016 by combining Excavator and Dump Truck mechanical devices to the crusher loading area with a volume of 24,872,835 tons, 28,304,505 tons and 26,029,609 tons. Whereas in 2017 – 2020 only the PIT Limit area will carry out mining production, this is because the reserves in the Existing area have run out. PIT Limit production from 2017 – 2020 is 21,864,874 tons, 20,981,407 tons, 20,831,837 tons, and 20,662,775 tons.

Is Conservative Treatment Better than Surgical Treatment for Basal Ganglia Hemorrhage in a Conventionally Non-Surgical Indication Group with Poor Motor Function?

Background: The treatment options for basal ganglia intracerebral hemorrhage (ICH), either surgical or conservative, remain controversial. A previous study developed “A new modified ICH (MICH) score” that suggests which treatment option will be better for basal ganglia ICH. According to this scoring system, a MICH score of 0 or 1 indicates that conservative treatment is better than surgical treatment. The purpose of this study was to determine whether conservative treatment is still a better option for a basal ganglia hemorrhage in patients with MICH scores of 0 and 1, with initial poor motor grades. Methods: This retrospective study was comprised of 41 patients with a spontaneous basal ganglia hemorrhage. These patient groups had no previous brain lesions, their initial MICH score was 0 or 1, and the manual muscle test (MMT) of their hand was grade 2+ or lower in the initial evaluation. All patients were transferred to the Department of Rehabilitation Medicine and received rehabilitation treatment. Ten patients had an operative intervention, which was burr-hole aspiration or craniotomy with hematoma removal. The control group included 31 patients who underwent conservative treatment. Outcome evaluations used the Berg Balance Scale (BBS), Modified Barthel Index (MBI), and Brunnstrom recovery stage (BRS) which were evaluated at initial and regular follow-ups after 1, 3, and 6 months. We defined an improvement state if the BRS of their hand became 4 or more in 6 months, which means an escape from the synergic pattern. Results: Demographic characteristics showed no significant differences in age, sex, hemiplegic side, initial GCS score, presence of IVH and hydrocephalus, or distribution of MICH scores 0 and 1. There was only a significant difference in the distribution of hematoma volume between groups of less than 20 mL and groups from 21 to 50 mL (p = 0.049). There were no significant differences in MBI values in 1 month or improvement of BRS of their hand in 6 months between the two groups. Conclusions: Even in the group classified as predominantly conservative in basal ganglia hemorrhage patients, if the initial muscle strength is low, it is necessary to reconsider whether conservative treatment is superior to surgical treatment in terms of functional improvement.

Pure pursuit method use to control unmanned motor grader

Introduction. A relevant objective of implementing the advanced systems of self-driving road construction vehicles can be accomplished by mathematical modelling. One of the important issues when creating a motion control system for a self-driving vehicle is to develop a trajectory following algorithm. The most well-known method of following the trajectory is a pure pursuit method, which is successfully used to control the movement of mobile robots.Materials and methods. Hence, the research objective has been defined and is to adapt the pure pursuit method to control an autonomous grader. To achieve the research objective, the task of a mathematical model of the motor grader movement with front steering wheels has been developed, and a mathematical model of the motor grader motion control system has been compiled. Besides, we propose an integral criterion to evaluate the efficiency of the motion control system of a unmanned grader. Some theoretical studies of the mathematical model have been carried out and the dependencies of the integral criterion on the design and operational parameters of the grader, as well as on the parameter of the control method (visibility range) have been obtained. Moreover, the optimal values of the visibility range for various values of the base length, base coefficient and machine speed have been defined according to the proposed efficiency criterion.Results. As a result of approximating the obtained optimal values, the pure pursuit method has been modified to control a self-driving motor grader, taking into account its design features and travel speed. The results obtained can be used to create the prototypes of unmanned control systems for road construction vehicles.

Indicators for Substantial Neurological Recovery Following Elective Anterior Cervical Discectomy and Fusion.

Retrospective cohort study. The purposes of this study were to determine the rate of improvement of significant preoperative weakness, identify risk factors for failure to improve, and characterize the motor recovery of individual motor groups. While neck and arm pain reliably improve following anterior cervical discectomy and fusion (ACDF), the frequency and magnitude of motor recovery following ACDF remain unclear. We performed a retrospective review of patients undergoing 1-4-level ACDF at a single institution between September 2015 and June 2016. Patients were subdivided into 2 groups based upon the presence or absence of significant preoperative weakness, which was defined as a motor grade <4 in any single upper extremity muscle group. Clinical notes were reviewed to determine affected muscle groups, rates of motor recovery, and risk factors for failure to improve. We identified 618 patients for inclusion. Significant preoperative upper extremity weakness was present in 27 patients (4.4%). Postoperatively, 19 of the affected patients (70.3%) experienced complete strength recovery, and 5 patients (18.5%) experienced an improvement in muscle strength to a motor grade ≥4. The rate of motor recovery postoperatively was 85.7% in the triceps, 83.3% in the finger flexors, 83.3% in the hand intrinsics, 50.0% in the biceps, and 25.0% in the deltoids. Risk factors for failure to experience significant motor improvement were the presence of myelomalacia (odds ratio: 28.9, P <0.01) and the performance of >2 levels of ACDF (odds ratio: 10.1, P <0.01). Patients with substantial preoperative upper extremity weakness can expect high rates of motor recovery following ACDF, though patients with deltoid weakness, myelomalacia, and >2 levels of ACDF are less likely to experience significant motor improvement.

Clinical Analyses of Traumatic Cervical Spinal Cord Injury Patients Treated in the Intensive Care Unit

Objective: Patients with spinal cord injury (SCI) are often unstable and require intensive care unit (ICU) treatment in the acute phase. This study assists in the prognosis and treatment direction of SCI patients by retrospectively examining and analyzing the clinical characteristics of SCI patients admitted to the ICU.Methods: In this study, a total of 102 SCI patients were admitted to the ICU of our hospital from February 2013 to March 2019. Based on the medical records, the patient's gender, age, mechanism of injuries, day of hospitalization, surgery timing, tracheostomy, ventilator use, steroid use, underlying disease, and hypotension were investigated. To assess the clinical outcome, the american spinal injury association (ASIA) impairment scale and limb motor grade three weeks and six months after injury was evaluated.Results: Of the 102 patients, 76 (74.51%) were male, and the average age was 57.57 years. Of these, 87 (85.29%) had spinal surgery, while 30 (34.48%) had surgery within 36 h after injury. High doses of steroids were administered in 15 patients (14.85%). As for the ASIA impairment scale, Grade A at the initial stage of injury reached 15% of all patients but decreased to 5.1% after three weeks and 1.9% after six months.Conclusion: Early surgery was advantageous in improving the lower extremity motor grade at three weeks of injury. Although steroid use has no significant effect compared to the risk of complications in several previous studies, in this study, it was observed that the ASIA scale improved six months after injury in patients receiving high-dose steroids.

Strategy for Motor Grader Blade Rotation considering Soil Distribution

Research on the automation of many types of construction equipment, including motor graders, is being actively conducted. In a motor grader cabin, the operator has difficulty observing the working environment because of a constructed field of view. Thus, workers rely on their experience and senses. Further, the working environment of the blade must be observed, and a control algorithm should be created to enable autonomous operation. In this study, a blade rotation control strategy considering the soil distribution was proposed. First, a co-simulation environment was constructed using RecurDyn for multibody dynamics analysis and EDEM for discrete element method simulation, and simulations were performed to determine the correlation between soil distribution and the blade rotation angle. Work quality and blade load were analyzed according to the simulation results. The optimal blade rotation angle according to soil distribution was obtained to develop the strategy for autonomous flattening and scattering work. The proposed control strategy was implemented in a 1/4 full-scale motor grader experimental setup. An experiment to evaluate work quality was conducted to validate the effectiveness of the proposed methods. The experimental results indicated that the proposed strategy effectively performed scattering work.

Femoral nerve inguinal approach versus proximal femoral triangle ap proach for continuous regional analgesia in active rehabilitation after total knee arthroplasty: A prospective, randomised study

BackgroundA catheter in femoral nerve block (F-Cath) is an effective regional analgesia technique in total knee arthroplasty (TKA) but results in significant quadriceps weakness. The femoral triangle catheter (FTB-Cath) seems to be an interesting alternative. In this study, we aim to demonstrate that the nerve block administration for analgesic purposes via an FTB-Cath results in less quadriceps weakness than via an F-Cath. MethodsThis study included patients scheduled for TKA performed under general anaesthesia. The patients were randomised to receive either an F-Cath or an FTB-Cath. A unique regimen of 0.2% ropivacaine was administrated for 72 h. The primary endpoint was quadriceps strength assessed clinically on postoperative day (POD) 2 by the Manual Muscle Test (MMT) using a motor grading scores (0–5). The secondary endpoints were quadriceps strength measured by a dynamometer, the Timed Up and Go (TUG) test, the 30-m walk test (30MWT) and pain scores. ResultsForty-four patients were analysed (22 in each group). On POD 2, 77.3% of the patients in the FTB-Cath group had MMT scores ≥ 4 and 13.6% in the F-Cath group (p < 0.001). During the first four POD assessments, quadriceps strength evaluated with a dynamometer was less diminished in the FTB-Cath group (p < 0,001). There was no difference between groups regarding pain scores, TUG test results and 30MWT assessment. ConclusionThe FTB-Cath provided a better preservation of quadriceps strength than the F-Cath in TKA, with a similar pain relief.

Replacement working body material as a way to increase reliability of road construction machines

Introduction. On the example of a motor grader knife, ways of increasing the reliability of road construction machines (RCM) operation are evaluated. For this purpose, the analysis of force effects nature on the working body of the RCM is carried out and its design features are highlighted (the presence of a welded joint). Based on the analysis, the range of characteristics necessary for making a decision on the possibility of replacement the material of the RCM working body is determined. Additionally, its thermocyclic treatment (TCT) is carried out. Experimental studies of the effect of this thermal impact type on the structure and properties of steels are described.Materials and methods. With the help of metallographic analysis, the author investigates the influence of the number of thermal effects cycles on the grain size and the complex of various materials physical and mechanical characteristics of road construction machines working body at various stages of the thermocyclic treatment.Results. It is determined that an increase in the level of the investigated steels physical and mechanical characteristics is possible through the use of TCT due to the obtaining of a fine-grained metal structure. The dependences of the main physical and mechanical characteristics of the investigated steels (ultimate strength and yield strength) on the number of thermal effects cycles are considered. Correlation relationships are selected to describe these dependencies. The relationship between the yield strength and ultimate strength of 09G2S and 30MnB5 steels and the grain size is considered. In addition, studies of the steels fatigue characteristics are carried out; data on determining the microhardness are presented for the welded joint. For various operating temperatures, fractographic studies are carried out on samples after cyclic loading.Discussion and conclusion. Based on a comparative analysis of the complex of physical and mechanical characteristics, the author made a conclusion about the possibility of replacing steel 09G2S with steel 30MnB5.

Concordance between the international standards for neurological classification of spinal cord injury motor examination and needle electromyography findings in muscles with a motor power grade of zero or trace

Context/Objective To evaluate the accuracy of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor examination in individuals with spinal cord injury (SCI) with motor grade 0 or 1 and analyze its degree of concordance with needle electromyography (EMG) findings for each key muscle. Design Retrospective study. Setting University hospital in Goyang, Korea. Participants Individuals with SCI admitted to the Department of Rehabilitation from January 2013 to June 2019. Interventions In the enrolled persons, needle EMG was performed on muscles with motor grade 0 or 1 on ISNCSCI examination, and muscle contraction was confirmed through the detection of motor unit action potential. Outcome measures The agreement between motor examination and needle EMG findings was analyzed. Results In 175 key muscles, needle EMG findings in 115 and 60 muscles evaluated as grades 0 and 1 on ISNCSCI examination showed 80% and 50% agreements, respectively. We found a fair agreement between motor examination and needle EMG findings (κ = 0.309, P < 0.0001). Moreover, statistically significant agreement was seen only in T1, L2, and S1 key muscles (κ = 1, P < 0.0001; κ = 0.359, P = 0.019; and κ = 0.521, P = 0.004, respectively). Conclusions It is important to accurately distinguish between grade 0 and 1 motor power to maximize the positive outcomes from rehabilitation treatment and predict the possibility of recovery in individuals with SCI. Therefore, to improve the accuracy of motor examination and the American Spinal Injury Association Impairment Scale, needle EMG confirmation could be considered for muscles with motor grade 0 or 1 in individuals with SCI.

ВОЗМОЖНОСТИ ЭФФЕКТИВНОГО ИСПОЛЬЗОВАНИЯ СЦЕПНОГО ВЕСА В АВТОГРЕЙДЕРАХ С БАЛАНСИРНЫМИ ТЕЛЕЖКАМИ НА ПРИМЕРЕ ПРОДУКЦИИ ЗАО «БРЯНСКИЙ АРСЕНАЛ»

The work of motor grader at traction mode by the action of simmetrical external longitudal load on the blade is consided. Using the desing scheme, evaluations of the irregularity of vertical reac-tions on the weels were obtained for the case of maximum traction and for the case of bracking on a roads with hard cover for motor graders with different design of bogies with balancers. The effect of using bogies with fully equilibrated balancers for some models of motor graders is evaluated.

Traumatic Peroneal Nerve Injuries: A Systematic Review

Category:TraumaIntroduction/Purpose:The common peroneal nerve (CPN) is the most commonly injured peripheral nerve of the lower extremity in trauma patients. Traumatic CPN injuries have historically been associated with relatively poor outcomes and patient satisfaction, though recent outcome data appear promising. Given the variety of underlying injury modalities, treatment options, and prognostic variables, this study sought to evaluate and summarize current literature on traumatic CPN injuries and provide recommendations for treatment and future research.Methods:A systematic review was performed using PubMed, Embase and Cochrane databases per PRISMA guidelines. Search terms consisted of variations of 'peroneal nerve' and 'fibular nerve' combined with 'injury,' or 'laceration,' or 'entrapment,' or 'repair,' or 'neurolysis.' Information regarding treatment modality, outcomes and patient demographics were recorded and analyzed.Results:2,301 articles were identified in the initial search, 42 met eligibility criteria (Figure 1). Factors associated with better clinical outcomes included shorter pre-operative interval, shorter graft length when an interposed graft was used, nerve continuity and younger patient age. Sex or gender did not affect outcomes in any studies in this review. Motor grades of M3 or greater on the MRC scale are typically considered successful outcomes. In studies we analyzed, this was achieved in 81.2% of patients who underwent neurolysis, 78.8% of patients who underwent end to end suture, 49.8% of patients who underwent nerve grafting, 62.9% of patients who underwent nerve transfer, 86.0% of patients who underwent posterior tibial tendon transfer (PTTT) and 73.9% of patients who underwent surgery with concurrent PTTT.Conclusion:Included studies were heterogenous, complicating our ability to further analyze the data. It is not possible to uniformly advocate for the best treatment option given diverse injury modalities, presentations and prognostic factors. Many studies do not report outcomes with respect to specific injury modality. Future studies should clearly report outcomes based on injury modality and surgical treatment option. This would allow for greater analysis on the most appropriate treatment option for a given mechanism of injury. Newer surgical techniques, such as addition of growth factors to nerve repairs and concurrent tendon transfer are promising and should be further explored.