Repair of the femoral nerve by two motor branches of the obturator nerve: A case report.

Complete femoral nerve palsies are uncommon but devastating injuries when they are caused by large nerve defects. Direct repair is usually not possible and nerve grafting renders uncertain outcomes. Recent studies proposed different peripheral nerve transfers as treatment strategies for large femoral nerve defects. We report a clinical application of a nerve transfer to reinnervate the quadriceps muscle with two motor branches of the obturator nerve in a 48 years-old man that was diagnosed with a femoral nerve palsy after resection of a retroperitoneal schwannoma. The branches supplying the gracilis and adductor longus muscles were transferred to the motor branch of the femoral nerve to the quadriceps muscle at 6 months postinjury. At 34 months of follow-up, knee extension was quoted M4. The presented nerve transfer may be feasible, technically simple, and renders good functional outcomes.

Chronic Boutonniere Deformities, Supple, or Stiff: A New Surgical Technique With Early Mobilization in 11 Cases.

Injuries to the central slip of the extensor mechanism can lead to a Boutonniere deformity with important functional consequences. We report a series of 11 patients treated by lengthening-dorsalizing the lateral bands and tightening the central slip with early mobilization. The average age of the patients was 42 years (14;52). The extension defect of the proximal interphalangeal (PIP) joint was 64 degrees (80;55) and the hyperextension of the distal interphalangeal joint was 10 degrees (15;5). The surgery was performed with peripheral nerve block (sensitive), allowing dynamic adjustment of the tendinous sutures. With a dorsal incision, a tenolysis of the extensor was performed. The central slip was tightened and the lateral bands dorsalized by cross-stitches over the PIP joint. The active flexion/extension was tested, and then lengthening of the lateral bands by "mesh graft" tenotomy was performed over the second phalange. There was no immobilization. The deformity was improved in 10 patients with a total flexion of the finger. The mean lack of extension in the PIP was 8 degrees (0;20) and the active flexion of the distal interphalangeal joint was 80 degrees (70;85). There was 1 failure. The majority of techniques necessitate an immobilization of 3 to 6 weeks. Our procedure uses the elastic properties of the elongation and allows immediate mobilization. The result can be compromised in case of insufficient tendinous surface or if postoperative instructions are not followed.