Extensor tendon injuries.

A thorough knowledge of anatomy, injury patterns, repair techniques, and evolving rehabilitation methods is necessary to best treat extensor tendon injuries. These injuries are conceptualized as occurring in one of eight zones, which are numbered distally to proximally in the hand and forearm. Even though surgical technique and rehabilitation are specific in each zone, injuries over and proximal to the proximal interphalangeal joint tend to yield less satisfactory results. Dynamic postoperative extension splinting is one factor that is improving long-term results.     

Untreated hip dislocation in cerebral palsy

The purpose of this study was to evaluate the problems associated with hip dislocation in adults with cerebral palsy. Twenty-nine subjects with dislocated hips and no prior hip surgery were identified. There were a total of 38 dislocated hips. Age range was 21 to 52 years (average 34). Seven dislocated hips (18%) were definitely painful and four hips (11%) produced only mild or intermittent pain. Twenty-seven hips (71%) were not painful. The seven painful hips underwent proximal femoral resection, resulting in excellent range of motion and no pain. In conclusion, for established nonpainful hip dislocation in the severely involved spastic quadriplegic patient, aggressive surgical treatment should be undertaken only after careful consideration of the natural history. If a dislocated hip becomes painful in adulthood or develops an adduction contracture interfering with perineal care, a proximal femoral resection can be performed with reliably good success.     

Transfer of tibialis posterior tendon in cerebral palsy.

Posterior tendon transfer to the dorsum of the foot through the interosseous membrans is an effective procedure for spastic equinovarus deformity. The complications of excessive calcaneal or excessive valgus deformity can be avoided if the transfer is not inserted too tightly with the foot in dorsiflexion and if it is not transferred to a cuboid insertion. Electromyographic activity was demonstrated in some of the transferred muscles during the swing phase of gait. Tendo achillis lengthening in association with posterior tibial transfer must be done judiciously to avoid deformity of the calcaneus.     

Hip dislocation and subluxation in cerebral palsy

Four hundred sixty-four patients with cerebral palsy were reviewed. They were placed in four function groups: independent ambulators (n = 76), dependent ambulators (n = 43), independent sitters (n = 41), and dependent sitters (n = 304). The percentage of subluxated or dislocated hips increased from 7% for independent ambulators to 60% for dependent sitters. In the dependent sitters, a level pelvis or different degrees of pelvic obliquity did not correlate with whether the hip was located, subluxated, or dislocated. The subluxated or dislocated hip did not correlate with the high side or the amount of pelvic obliquity. Muscle imbalance around the hip and not the pelvic obliquity is the cause of the hip subluxation or dislocation.     

Surgery for hip dislocation in cerebral palsy

In 10 children seriously disabled by cerebral palsy, 12 dislocated hips were surgically reduced. The main indications for surgery were impaired perineal care, decreasing sitting balance, and pain. Furthermore, the operations were considered in order to anticipate major problems in the future, such as the wind-swept hip phenomenon and pain in the hip. At follow-up, it appeared that all the children had profited from the surgical procedures.     

Surgery for hip dislocation in cerebral palsy

In 10 children seriously disabled by cerebral palsy, 12 dislocated hips were surgically reduced. The main indications for surgery were impaired perineal care, decreasing sitting balance, and pain. Furthermore, the operations were considered in order to anticipate major problems in the future, such as the wind-swept hip phenomenon and pain in the hip. At follow-up, it appeared that all the children had profited from the surgical procedures.     

Radial head dislocation in children with cerebral palsy

Dislocation of the radial head in children with cerebral palsy (CP) is rarely reported, and the incidence of the condition is unknown. The authors present the treatment and outcome of 10 painful radial head dislocations in eight children with spastic quadriplegic-pattern CP treated over a 21-year period. Four patients were managed by open reduction of the radial head and reconstruction of the annular ligament, and four were managed by radial head excision followed by early motion. All of the patients who underwent reconstructive surgery suffered redislocation within 16 weeks of the procedure, with a return of pain and contracture of the elbow at subsequent follow-up. All four patients who underwent excision of the radial head remained pain-free, with improved elbow motion, at a follow-up of 4 years 4 months. The authors believe that once symptomatic radial head dislocation is established in CP patients, excision of the radial head gives a better final outcome than reconstructive procedures.     

Extensor tendon lacerations in a preterm neonate.

A fetus of 30-weeks' gestation sustained 2 extensor tendon lacerations as an intraoperative complication of an emergency Cesarean section. This report describes treatment of the tendon lacerations in the preterm neonate using 2 different repair techniques which both yielded an excellent clinical outcome.     

Extensor tendon injuries in children

INTRODUCTION: This study retrospectively analyzes primary extensor tendon repairs in children younger than 15 years. METHODS: Exclusion criteria were skin loss, devascularization, fractures, or flexor tendon injuries. Fifty patients who had sustained extensor tendon laceration with 53 digits injured were available for review. Treatment consisted of primary repair of the extensor tendon injury within the first 24 hours. The results were assessed by means of total active motion system and by Miller's rating system. The mean follow-up was 2 years. RESULTS: Although 98% of the digits were rated as good or excellent according to the total active motion system and 95% according to Miller's classification, 22% of the fingers showed extension lag or loss of flexion at the last follow-up. DISCUSSION: Pejorative influencing factors were injuries in zones I, II, and III; children younger than 5 years (P < 0.05), and complete tendon laceration. Articular involvement had no significant influence on final outcome.     

Extensor carpi ulnaris subluxation or dislocation? Ultrasound measurement of tendon excursion and normal values.

Dislocation or subluxation of the extensor carpi ulnaris (ECU) tendon is one of the differential diagnoses of ulnar-sided wrist pain. No data exists on the degree of subluxation occurring in normal wrists. Retrospective review of surgical cases revealed two patients with dorsal and four with volar instability. Magnetic resonance imaging and ultrasound were not always predictive of the direction of instability. A standardised ultrasound technique was used to evaluate ECU subluxation in 20 asymptomatic wrists. In normal subjects, as a percentage of the width of the osseous groove, the volar edge of extensor carpi ulnaris may displace by up to 40% beyond the volar lip of the osseous groove with wrist flexion and the dorsal edge by 33% beyond the dorsal lip with wrist extension. The effect of gender on normal range and the diagnostic use of the standardised ultrasound technique need further evaluation.     

Hip dislocation in spastic cerebral palsy: long-term consequences

We evaluated 38 noninstitutionalized patients with spastic quadriplegic cerebral palsy with 51 dislocated hips. Nine hips had been reduced. The mean follow-up was 18 years, with an average age of 26 years. At follow-up, four were ambulatory with aids. Patients who could walk had normal intelligence and a level pelvis. In patients with 18 unreduced unilateral hip dislocations, pelvic obliquity and scoliosis were present in 12. In seven patients with reduced unilateral hip dislocations, similar findings were present in only two patients. Half of the dislocated hips were painful. Based on these findings, we recommend reduction of unilateral dislocations. Bilateral dislocations may benefit from reduction if treatment is undertaken before significant adaptive deformity of the femoral head occurs.     

Extensor tendon injuries in the hand

Extensor tendon injuries of the hand are often inadequately managed. Poor outcomes include extensor lag, reduced range of flexion and weakened grip strength. Poor outcomes are particularly associated with injuries in zones 2–4, with severe crush and tissue damage, and in the presence of associated injuries. Dynamic splintage and controlled active mobilisation have some benefits over static splinting for zone 5–8 injuries but require closer supervision.