Combined congenital radial and ulnar longitudinal deficiencies: report of 2 cases.

Variation in longitudinal deficiencies is likely related to the timing and duration of an insult during early limb development. In experimental models, teratogenic insults induce ulnar deficiencies earlier in gestation than radial deficiencies. In this report, we describe the rare combination of right radial and left ulnar deficiencies in 2 cases. Interestingly, 1 case had a history of 2 separate and apparently distinct episodes of bleeding during early gestation, whereas the other demonstrated associated hematoma formation early in development. These cases also demonstrate the susceptibility for ulnar defects on the left and radial defects on the right. The authors discuss the relationship of prenatal insults on limb development and the mechanisms underlying longitudinal deficiencies.

Functional deficit after transfer of the pronator teres for acquired radial nerve palsy.

PURPOSE: A suitable muscle motor in reconstruction after acquired never injury should have adequate strength to perform the desired task, be aligned in the direction of pull, have synergistic action, and not result in unacceptable functional loss. In radial nerve palsy, the pronator teres is the most common motor donor used to restore wrist extension. Although the pronator teres remains aligned to provide pronation, the force deficit of the transfer is not known. METHODS: We used 6 cadavers and 6 patients to determine the loss of pronation strength both experimentally and clinically. RESULTS: Cadaveric testing showed a loss of pronation produced with similar load after transfer of the pronator. Clinical testing showed statistically significant loss of pronation ranging from 24% to 44%, depending on the method of testing. This deficit may be an important consideration in some clinical situations when transfers are used while waiting for radial nerve function to return. CONCLUSIONS: In the cadaveric biomechanic testing, we simulated the pronator teres-to-extensor carpi radialis brevis tendon transfer and showed a decreased range of motion and force developed after transfer. The clinical arm of the study confirmed our biomechanic findings by showing the loss of pronation function. This loss may be an important factor when planning reconstruction for radial nerve injuries. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Surgical treatment of congenital syndactyly of the hand.

Syndactyly is a congenital anomaly of the hand that is more common in males, is present bilaterally in 50% of affected patients, and often is associated with other musculoskeletal malformations or systemic syndromes. The goal of syndactyly release is to create a functional hand with the fewest surgical procedures while minimizing complications. For simple syndactyly, surgical reconstruction can begin at approximately 6 months, although many surgeons prefer to wait until the infant is 18 months old. Special situations, such as complex syndactyly and involvement of border digits, may warrant surgical intervention earlier than 6 months. Reconstruction of the web commissure is the most technically challenging part of the operation, followed by separation of the remaining digits. Full-thickness skin grafting is almost always required for soft-tissue coverage. Complex syndactyly and syndactyly associated with other hand anomalies warrant special consideration. After reconstruction, patients should be examined periodically until they have achieved skeletal maturity because late complications such as web creep can occur.

Thumb radial angulation correction without phalangeal osteotomy in Apert's syndrome.

A surgical technique to correct thumb metacarpophalangeal (MCP) joint radial angulation in patients with Apert's syndrome that obviates osteotomy of the proximal phalanx is described. The anomalous insertion of the abductor pollicis brevis tendon to the distal phalanx radially is released and reattached to the radial base of the proximal phalanx. A radial MCP joint capsulotomy is performed; excision of a cartilaginous prominence on the ulnar aspect of the metacarpal head is required to assist in joint alignment, which is temporarily maintained with a K-wire. Two children underwent bilateral thumb reconstructions using this technique. At 1.5 and 5.6 years after surgery the thumbs were straight and radiographs revealed no residual lateral angulation at the MCP joint. The parents were satisfied with the results. This technique of correction of Apert's thumb radial angulation is simple and reliable and produces satisfactory clinical results.