Are hand biomechanics affected following radial forearm flap harvest? A systematic review and meta-analysis

Donor site morbidity following radial forearm flap (RFF) harvest remains a controversial issue. The aim of this meta-analysis was to answer the question “Are the range of wrist movements (range of motion, ROM) and hand strength affected after RFF harvesting?” The PubMed, Embase, Scopus, and Cochrane Library electronic databases were systematically searched (to December 2019). Self-controlled studies evaluating hand biomechanics after RFF harvest were included. Weighted mean differences with 95% confidence intervals were calculated using the random-effects model. The outcome variables were ROM, forearm movements, grip, and pinch strengths. Thirteen studies involving a total of 335 patients were included. With the exception of grip strength and supination, which showed statistically significant reductions of about 2.40 kg and 2.86° (P < 0.05), all other ROM, forearm movements, and pinch strengths showed an insignificant difference when the operated hand was compared to the non-operated hand (P > 0.05). Regression analysis showed that the method of donor site closure and size of the donor site defect had an insignificant impact on hand biomechanics. This study confirms the lack of discernible biomechanical morbidity after RFF transfer. The minimal reduction in hand biomechanics after RFF is considered to be clinically negligible.     

Wrist arthroscopy

Major advancement in arthroscopic equipment and techniques has extended the ability of large joint arthroscopy to be performed in smaller joints. Although wrist arthroscopy is performed in small numbers, the same advantages are afforded as in large joint procedures. It provides important diagnostic information and therapeutic intervention, while avoiding the significant morbidity of open techniques. Patients with mechanical wrist pain are the best candidates for arthroscopy to evaluate ligamentous injuries or triangular fibrocartilage complex injuries. Arthroscopy is also an effective tool in the evaluation and treatment of intra-articular distal radius fractures and is particularly useful in radial styloid fractures. Wrist arthroscopy is a technically demanding procedure. However, it remains a safe and effective method for diagnosis and treatment if performed using a precise technique and if the surgeon has a precise understanding of the anatomy of the wrist.     

手舟骨的形态、血供及临床意义

在100侧手舟骨,30侧手标本和4个新鲜手血管透明标本上,观察了手舟骨的形态,表面投影和血供规律。手舟骨有84%是中部细小型,故多发生中部骨折。舟骨滋养孔83.9%集中手舟骨背外侧面,采用背侧手术入路时,尽可能减少对腕背侧韧带的剥离或横断,以保护部份血供来源。舟骨内固定进针时,可采用手背伸30°,内收10～15°,按舟骨结节至桡骨背侧结节下缘这个表面摄影穿入,方向以与水平线呈20～25°,与前臂冠状平面呈30～45°为宜。     

桡侧腕屈与腕长伸肌腱部分转位修复手部关节脱位应用解剖

目的 :为桡侧腕屈与腕长伸肌腱部分转位修复桡尺远侧及第 1腕掌关节脱位提供解剖学基础。方法 :3 0侧成人上肢标本 ,分别对桡侧腕屈肌腱、桡侧腕长伸肌腱进行形态学测量。结果 :桡侧腕长伸肌腱性部长 ( 17.8± 2 .6)cm ,肌腱的上、中、下段宽分别为 ( 13 .7± 3 .1)、( 5 .6± 1.1)和 ( 4 .6± 0 .5 7)mm肌腱的上、中、下段厚分别为 ( 1.5± 0 .5 )、( 2 .0± 0 .3 )和 ( 2 .4± 0 .3 )mm。桡侧腕屈肌腱性部长 ( 14 .3± 1.1)cm ,肌腱的上、中、下段宽分别为 ( 9.11.4)、( 5 .5± 0 .9)和 ( 4 .0± 0 .4) ,肌腱的上、中、下段厚分别为 ( 2 .4± 0 .6)、( 2 .2± 0 .4)和 ( 2 .6± 0 .5 )mm。结论 :采用桡侧腕屈肌腱和桡侧腕长伸肌腱部分转位 ,有足够的长度和强度 ,适用于桡尺远侧关节或第 1腕掌关节脱位的修复 ,临床应用获得良好效果