Trends in digital joint motion following surgical reconstruction of a tendon rupture after distal radius fracture.

BACKGROUND: Tendon rupture has been recognized as a complication of distal radius fracture (DRF); however, the clinical outcome of reconstructive surgery for this injury remains unclear. We examined prognostic factors for the outcomes of reconstructive surgery in patients with a tendon rupture after DRF. METHODS: This study was a retrospective review of a case series. Seventy-five consecutive patients were treated at our institution for tendon rupture after DRF. The cohort included 14 males and 61 females with a mean age of 67.7 years at the time of tendon reconstruction. Sixty-four and eighteen tendon ruptures occurred after non-operative management for DRF and palmar locking plate fixation, respectively. Seven ruptured tendons received a free tendon graft from the palmaris longus tendon, and the others underwent tendon transfers. All patients were managed postoperatively by our hand therapy unit according to a controlled active mobilization regime. RESULTS: The mean follow-up period was 28 weeks (range: 12-80 weeks). Patients with extensor tendon ruptures were significantly younger than those with flexor tendon ruptures regardless of the initial DRF treatment. The mean percentage active range of motion of the injured digits relative to normal active motion (%AROM) at the final follow-up was 70% (range: 30-101%) in all patients. The %AROM after flexor tendon reconstruction for patients after non-operative management was significantly inferior to that of other patients. Multiple regression analysis revealed that aging and non-operative management of DRF are independent risk factors for poor %AROM. CONCLUSIONS: This study confirmed that advanced age and non-operative management of DRF were prognostic factors for digital joint motion following surgical reconstruction for tendon rupture. Our results suggest that it may be difficult to achieve good clinical outcomes in elderly patients with tendon ruptures (particularly flexor tendon ruptures) following non-operative management of DRF.

Biomechanical Analysis of a New Eight-Strand Suture for Flexor Tendon Repair.

Background The placement of multistrand sutures during flexor tendon repair requires complicated surgical skills; such suturing is difficult. We developed a new, simpler eight-strand suture, which we term the Yoshizu cross-lock. This reduces the numbers of suture passages through the tendons, as well as the numbers of knots. Methods Fourteen porcine flexor tendons were transected and repaired using the Yoshizu cross-lock system; no peripheral sutures were placed. Our system is a modification of the published, exposed cross-lock repair method that employs a 4-0 monofilament nylon two-strand line and two needles. The repaired tendons were subjected to linear, noncyclic load-to-failure tensile testing. The initial gap, the 2-mm gap force, and the ultimate strength were measured. Results The initial gap force was 12.6 ± 5.6 Newtons (N), the 2-mm gap force was 33.9 ± 10.9 N, and the ultimate strength was 70.1 ± 17.0 N. All tendons subjected to Yoshizu cross-lock repair failed due to suture rupture rather than pullout. Conclusions Our biomechanical study revealed that Yoshizu cross-lock repair had sufficient tensile strength but was associated with wide variation in the 2-mm gap load (standard deviation = 10.9 N). This study is clinically relevant, showing that the Yoshizu cross-lock repair combined with peripheral suturing may allow a repaired flexor tendon to withstand the stresses encountered during early active mobilization. This simple eight-strand technique will be particularly useful to surgeons who commonly employ the cross-lock stitch for primary flexor tendon repair following early mobilization.

Long-term results of closed-wedge osteotomy of the lateral humeral condyle for osteochondritis dissecans of the capitellum.

BACKGROUND: Various surgical methods are used for osteochondritis dissecans of the capitellum; however, we have consistently performed a closed-wedge osteotomy of the lateral humeral condyle since 1983. The purpose of this study is to clarify the long-term results of closed-wedge osteotomy for osteochondritis dissecans of the capitellum. METHODS: Seventy-seven elbows with all lesion types of osteochondritis dissecans of the capitellum were treated with closed-wedge osteotomy. Unstable osteochondral fragments were fixed with a bone graft and bone pegs in combination with osteotomy. The mean age of the patients was 14.0 years. The patients were clinically and radiographically evaluated at a median value of 9.0 years after surgery. RESULTS: The range of elbow motion and standard deviation were increased significantly from 119° ± 22° preoperatively to 131° ± 18° postoperatively (P < .001). The Timmerman and Andrews score were improved significantly from 141 ± 26 points preoperatively to 184 ± 21 points postoperatively (P < .001). The Timmerman and Andrews score and the range of elbow motion at final examination in patients with preoperative osteoarthritic changes were significantly inferior to those in patients without preoperative osteoarthritic changes. Good remodeling of the capitellar lesions was radiographically observed in 53 elbows (69%). In the long-term follow-up evaluation, although 41 elbows (53%) had advanced osteoarthritic changes that were classified as grade II or III, disease progression was controlled in most of these cases. CONCLUSIONS: Good or excellent long-term clinical results were maintained in most of our patients. Closed-wedge osteotomy of the lateral humeral condyle is a useful method that can provide acceptable long-term clinical results.

A Novel Reconstruction Technique for Chronic Distal Biceps Tendon Rupture: A Case Report.

CASE: A 71-year-old otherwise healthy man presented with an 8-week history of elbow pain and weakness in both elbow flexion and forearm supination. Magnetic resonance imaging revealed complete rupture of the distal biceps tendon insertion associated with 65 mm of proximal retraction. At 10 weeks after initial injury, the patient underwent a novel reconstruction technique using a periosteal flap from the iliac crest; subsequently, all symptoms resolved. CONCLUSION: Chronic distal biceps tendon injuries can be reconstructed safely and effectively using a periosteal flap from the iliac crest that allows not only rigid but also biological graft attachment.

Influence of the direction of suture strands on the tensile strength after flexor tendon repairs.

We assessed the influence of different directions of suture strands using the double Tsuge repair on the resistance to gap formation and mode of failure. In total, 25 porcine flexor digitorum profundus tendons were split into two groups. One group was repaired using a conventional double Tsuge suture created by two bands of looped suture placed longitudinally parallel (parallel method), and the other group was repaired using a new technique comprising two bands of looped suture placed in a crossed fashion in the anterior and posterior half of the tendon (cruciate method). The repaired tendons were subjected to linear, non-cyclic load-to-failure tensile testing. The cruciate method had a significantly higher mean load at a 2-mm gap tensile load (29.7 N [SD, 8.3]) than the parallel method (21.6 N [SD, 4.9]) and failed significantly more often due to suture pull-out. The direction of a core suture and its location within the tendon affect both gap resistance and the mode of failure of repair when using the double Tsuge suture technique, with a cruciate configuration achieving a greater gap resistance than a parallel one.

The Duration of Bone Healing and Nonunion Ratio After Ulnar Shortening Osteotomy Using a 5-Hole Forearm Compression Plate With Transverse Osteotomy.

BACKGROUND: Ulnar shortening osteotomy using various osteotomy sites, osteotomy methods, and surgical techniques with a variety of implants has been reported, but nonunion rates and the duration of bone healing are not uniform by the authors. The purpose of this study was to investigate the duration of bone healing and nonunion ratio in patients who underwent ulnar shortening osteotomy by a 5-hole nonlocking plate with a simple transverse osteotomy for ulnar impaction syndrome and to determine the correlation between the gap length of the osteotomy site and the duration of bone healing. METHODS: We assessed patients who underwent ulnar shortening osteotomy for ulnar impaction syndrome using a 5-hole nonlocking plate fixation followed by a simple transverse osteotomy between July 2012 and October 2021. This study was a case series study, and the level of evidence was IV. RESULTS: A total of 80 patients were included. The mean age of the patients was 46.7 years, and 46 patients were men. The average bone union period was 41.8 ± 18.7 weeks. The correlation between the gap length of the osteotomy site and the duration of bone union of the osteotomy site was not significant. The nonunion ratio of our method was 2.5%. CONCLUSION: The nonunion rate of our ulnar shortening osteotomy with a simple transverse osteotomy and a 5-hole nonlocking plate was comparable to that in previous reports, but our method required slightly longer periods for bone union. There was no correlation between the gap length of the osteotomy and the duration of bone union. LEVEL OF EVIDENCE: Level IV (Case series).