Pronating radius osteotomy for supination deformity in children with obstetric brachial plexus palsy.

PURPOSE: In obstetric brachial plexus lesions, muscle imbalance caused by active supinator muscles and paralyzed pronator muscles can result in a supination position of the wrist, which, apart from cosmesis, may interfere with function. METHODS: In this retrospective study, we describe the results of a pronating radius osteotomy for supination deformity of the hand in children with an obstetric brachial plexus lesion. RESULTS: After a mean follow-up of 23 months, all 8 patients (mean age, 9.4 years; range, 4-13 years), operated between 1998 and 2006, had improved functionally and aesthetically. CONCLUSIONS: All patients had improved functionally and aesthetically.

Results of latissimus dorsi transfer in obstetrical brachial plexus injury.

This study reports on 9 patients with obstetrical brachial plexus injury who underwent a latissimus dorsi (LD) transfer to reconstruct external rotation of the upper extremity. Transfer of the LD to the rotator cuff is widely used for restoring shoulder abduction and external rotation in patients with obstetrical brachial plexus injury. Patients were classified according to type of paralysis, age of surgery, and shoulder function. This retrospective article evaluated the results of the LD transfer in a group of 9 patients. The study shows that in the near future, profit can be made in active and passive external rotation.

Plastic solutions for orthopaedic problems.

INTRODUCTION: Infection and exposure of the implant may occur in 1-12% of patients operated on for arthroplasty or osteosynthesis. Variables such as tissue viability, presence of infection, exposure of osteosynthesis material and patient-related factors contribute to the lack of general consensus regarding the management of these defects. MATERIALS AND METHODS: Between January 1999 and January 2001, six patients were treated for complex soft-tissue defects following various orthopaedic procedures at the Department of Plastic Surgery in the Slotervaartziekenhuis in Amsterdam, a rheuma-orthopaedic orientated hospital. All patients were initially treated by radical debridement and vacuum-assisted closure (VAC) system of the wound. After 1 week, this was followed by transplantation of a pedicled or free flap to cover the defect. We studied the medical history, initial orthopaedic procedure, wound treatment, transplanted flap and outcome of plastic surgery in this group. RESULTS: Plastic surgical intervention led to wound closure in all cases. In only one case was the osteosynthesis material removed because of osteomyelitis. CONCLUSIONS: We conclude that the earlier coverage with vital tissue is obtained, the lower the incidence of infection. Early consultation by a plastic surgeon will increase a positive outcome of treatment of complex tissue defects.

Internal anatomy of the communicating branch between the ulnar and median nerves in the hand and its relevance to volar digital sensibility.

We studied the microanatomy of the communicating branch between the ulnar and median nerves in 26 adult cadaver hands to explain diminished sensibility in the fourth and fifth fingers we had observed in 2 patients after complete transection of the median nerve. Two new variations of the communicating branch were observed. In the first variation the communicating branch originated proximally from the third common digital nerve to distally join the ring finger ulnar digital nerve and the small finger radial digital nerve. In the second variation the ramus communicans traversed perpendicularly between the third and fourth common digital nerves with a crossover of nerve fibers.