Comparison of time-efficiency of individually wrapped screws and sterile screw racks in distal radius fracture treatment.

INTRODUCTION: Time-efficiency of individually wrapped screws versus screws in a screw rack is not well established. MATERIALS AND METHODS: We performed a prospective single-center clinical study timing the interval between the surgeon asking and receiving a screw during plate and screw osteosynthesis of distal radius fractures. Patients were randomized for individually wrapped screws or screws in a screw rack. The study was conducted in a Level 1 Trauma Center and surgeries were performed between March and June 2023. RESULTS: Average handling time for screws from a screw rack was 9 s (SD 5.5; range 3-28) and 22 s for individually wrapped screws (SD 6.1; range 6-38). This average difference of 13 s is significant (p < 0.0001). CONCLUSION: There is a significant increase in handling time using individually wrapped screws over using a screw rack. LEVEL OF EVIDENCE: Level I (therapeutic, randomized controlled trial).

Evaluation of MRI Signal Changes of the Distal Biceps Tendon in Asymptomatic Patients.

PURPOSE: Magnetic resonance imaging (MRI) is used widely for complete ruptures of the distal biceps tendon. The validity of this investigation for bicipital bursitis and tendinosis is unknown. The purpose of present study was to assess the prevalence of incidental (asymptomatic) signal changes in the distal biceps tendon in patients who underwent MRI including the elbow. Our null hypothesis was that signal changes of the distal biceps tendon do not occur in asymptomatic patients. This would empower MRI as a diagnostic tool for bicipital bursitis and tendinosis as well as complete and partial distal biceps tendon ruptures. METHODS: We evaluated 1,191 elbow MRI scans including the distal biceps tendon insertion. The prevalence of incidental findings was calculated and sensitivity, specificity, positive predictive value, negative predictive value, false positive probability, and false negative probability were calculated. RESULTS: Signal changes of the distal biceps tendon or bursitis were identified in 8 of 1,191 asymptomatic patients (prevalence 0.6%). The sensitivity of MRI for distal biceps pathology was 97% (95% confidence interval [CI], 93%-99%), specificity 99% (95% CI, 98%-99%), positive predictive value 94% (95% CI, 89%-97%), negative predictive value 99% (95% CI, 99%-99%), false positive probability 6% (95% CI, 3%-10%), and false negative probability 0.3% (95% CI, 0.1%-0.9%). There was no correlation between explanatory variables, including age, sex, race, occupation, and inflammatory disease and incidental distal biceps tendon signal changes. CONCLUSIONS: The prevalence of distal biceps tendon signal changes on MRI in asymptomatic patients is very low. CLINICAL RELEVANCE: The negative predictive value of 99% shows that patients without signal changes on MRI may be assumed to have no distal biceps tendon pathology. MRI investigation of distal biceps tendon is a valuable tool in the diagnosis of tendinosis and bicipital bursitis.

Evaluation of clinical tests for partial distal biceps tendon ruptures and tendinitis.

BACKGROUND: The clinical diagnosis of partial distal biceps tendon ruptures or tendinosis can be challenging. Three clinical tests have been described to aid in an accurate and timely diagnosis: biceps provocation test, tilt sign, and resisted hook test. However, not much is known about the sensitivity, specificity, and inter-rater reliability as the available evaluations are based on small groups or are case based. Furthermore, these tests have not been compared together in the same patient group. METHODS: Two dedicated elbow surgeons each included 20 consecutive patients in whom distal biceps tendon pathology was suspected. Patients with a complete distal biceps tendon tear were excluded. As a control, the same number of consecutive patients with various elbow pathologies other than distal biceps tendon problems was included. All 3 tests were performed both in control patients and in patients with suspected biceps tendon pathology. Magnetic resonance imaging (MRI) in the flexion-abduction-supination view and/or surgical exploration was performed in both groups. The findings of the clinical tests were determined before the results of MRI and other technical investigations were analyzed. The values of sensitivity, specificity, and accuracy were calculated. RESULTS: The combined sensitivity, specificity, and accuracy values for the biceps provocation test were 95%, 97%, and 96%, respectively. For the resisted hook test, the combined values were 78%, 76%, and 77%, respectively. The combined values for the tilt sign were 58%, 55%, and 56%, respectively. When the biceps provocation test and the resisted hook test were combined in a parallel testing setup, the sensitivity increased to 98% whereas the specificity was 73%. The sensitivity and specificity of the biceps provocation test and the tilt sign in a parallel testing setup were 97% and 53%, respectively. Finally, the sensitivity and specificity of the tilt sign and the resisted hook test in a parallel testing setup were 90% and 41%, respectively. CONCLUSIONS: The biceps provocation test yielded higher accuracy than the resisted hook test and the tilt sign. When the biceps provocation test and the resisted hook test were combined, the sensitivity increased to 98%. We advise integration of these tests in daily practice to minimize delays in the diagnosis of partial distal biceps tendon ruptures, distal biceps tendon bursitis, or tendinosis. MRI in the flexion-abduction-supination view is still advised to distinguish between a partial biceps tendon rupture and tendinosis or bursitis at the distal biceps tendon insertion as this may influence further treatment.

Reconstruction of flexor pollicis longus tendon with palmaris longus interposition graft: results in 14 patients.

The flexor pollicis longus tendon is prone to attritive rupture and retraction. Direct repair is often not possible. Interposition grafting is a treatment option to restore tendon continuity, although the surgical technique and postoperative results have not been well defined. We report our experience with this procedure. 14 patients were prospectively followed for a minimum of 10 months after surgery. There was one postoperative failure of the tendon reconstruction. Postoperative strength was comparable to the contralateral side, but thumb range of motion was significantly reduced. In general, patients reported excellent postoperative hand function. This procedure seems a viable treatment option with lower donor site morbidity than tendon transfer surgery.

Radial tuberosity anatomy in intramedullar repair of distal biceps tendon ruptures. A radiological study.

The aim of this study was to measure cortex thickness and medullar canal width of the bicipital tuberosity, to evaluate the accessibility of a intramedullar fixation device and the resistance to pullout strengths of the anterior cortex. The final objective was to determine the length of tendon ingrowth size that will be expected when using this surgical technique. A total of 144 computer tomography images of the proximal radius were used. Bone thickness of the anterior and posterior cortex and medullar canal size were measured. The possible ingrowth of the tendon was measured both for an anatomical and non- anatomical reinsertion. Statistical and concordance analyses of results were performed. The average width of the medullar canal was 8,7mm proximal, 7,9mm distal and 7,7mm at the tuberosity. The average posterior and anterior cortex measured respectively 2,5mm and 2,9mm proximal, 3,2mm and 3,2mm distal and 2,8mm and 1,9mm at the radial tuberosity. The possible non-anatomical ingrowth was 7,6 mm on average and the possible anatomical ingrowth was 7,6mm on average. The radial tuberosity anatomy can accommodate the new distal biceps fixation device. The anterior cortex on which the new device relies for support has a similar thickness as the posterior cortex used in bicortical fixation devices which may suggest similar resistance to pull-out strengths. The availability for intra-osseous fixation of the tendon stump may avoids tendon gapping. The intra-osseous length for the tendon stump surpassed reported tendon slippage during mobilization and active contraction of the distal biceps tendon.

Distal Biceps Provocation Test.

PURPOSE: To describe and study a test for distal biceps tendon pathology other than complete tears. METHODS: In this prospective study, the biceps provocation test (BPT) was performed in a cohort of 30 patients with suspected distal biceps tendon pathology and 30 patients with another elbow pathology. Patients with a complete tear were excluded. Diagnosis was confirmed on magnetic resonance imaging or from surgical findings. The BPT is a 2-part test. The elbow is flexed to 70° with the forearm supinated. The examiner's hands are placed on the patient's forearm and the patient is asked to flex the elbow against resistance (BPTs). The forearm is then pronated and the test is repeated (BPTp). Pain is documented for both supination and pronation using a visual analog scale from 0 to 10. The test is positive when the patient indicates an increase in pain with BPTp compared with BPTs. RESULTS: The BPT was positive in all patients with distal biceps tendon pathology. The average visual analog scale score in this group was 1 (range, 0-7) for the supinated part of the test (BPTs) and 7 (range, 4-10) with the forearm in pronation (BPTp), with an average increase of 5 points (range, 2-8). This difference was significant. No significant difference was found in the control group. Among the controls, BPTp and BPTs were rated as equally painful by 27 patients, and BPTp was less painful than BPTs in 3. Sensitivity and specificity were both 100% in this small group of 60 patients, with a high prevalence of distal biceps tendon pathology. CONCLUSIONS: The BPT appears to be highly sensitive and specific for distal biceps partial injury or tendinitis. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.

In vivo evaluation of a new intramedullary distal biceps tendon fixation device.

BACKGROUND: Intramedullary fixation in distal biceps tendon repair may be a solution to address specific shortcomings of current fixation techniques. Most investigations are limited to biomechanical evaluation. The purpose of this study was to report the short-term outcomes of an intramedullary fixation device. METHODS: We evaluated functional and radiographic outcomes at up to 6 months of follow-up. Patients with an acute distal biceps tendon rupture eligible for surgical repair were invited to take part in the study. Ten patients were included in the final analysis. All patients were evaluated both clinically and radiographically at 2 weeks, 6 weeks, 3 months, and 6 months. Outcomes were recorded using a visual analog scale score for pain, the Mayo Elbow Performance Score, and the Disabilities of the Arm, Shoulder and Hand score. Radiographic evaluation comprised radiographic and computed tomography evaluation. RESULTS: There were no failures of fixation in the patient group examined. Elbow mobility was symmetrical for all patients from 3 months onward. Supination strength was 86% of the uninjured side at final follow-up. The mean Disabilities of the Arm, Shoulder and Hand score and Mayo Elbow Performance Score at final follow-up were 0 and 100, respectively. Computed tomography images showed no signs of button migration, cortical thinning due to button pressure, or button breakout. The tendon could be followed to the button in all cases. CONCLUSIONS: The intramedullary fixation button technique to repair the distal biceps tendon has excellent functional outcomes at 6 months. No adverse reactions of the button on the bone were seen. As this technique minimizes the risk of posterior interosseous nerve injury and has a sufficient bone tunnel to avoid gap formation, this may be a promising new technique for distal biceps tendon rupture refixation.

Scaphoidectomy and 4-corner arthrodesis with headless compression screws: results, complications and their treatment.

Scaphoidectomy and 4-corner arthrodesis is a common salvage surgery for degenerative wrist pathology. The purpose of this study was to evaluate the results of this procedure performed with headless compression screws, with a special focus on postoperative complications and their treatment. We assessed 36 wrists in 31 patients that were treated between 2009 and 2017. Mean follow-up was 5.2 years (range 2.9- 9.4). Pain was expressed on a Visual Analog Scale. The Quick Disabilities of the Arm, Shoulder and hand (qDASH) questionnaire and Michigan Hand Outcome Questionnaire (MHOQ) were used to assess patient functionality and satisfaction. Range of motion and grip strength of both wrists were measured. Radiographs of the operated wrist were evaluated. Mean pain score was 1.5 ± 2.3 with 19% of patients being completely free of pain also during activity. Mean qDASH was 44 ± 20 and mean MHOQ was 10 ± 5. Mean flexion-extension arc of the operated wrist was 69° and 61% of the contralateral wrist. Mean grip strength was 35kg and 89% of the opposite wrist. Non-union was observed in two patients. Two patients required hardware removal and in three patients a pisiformectomy was performed. Conversion to total wrist arthrodesis was needed in one patient. We observed postoperative complications in 28% of our patients. Most complications can successfully be treated with additional surgery. The presence of pisotriquetral arthritis should be assessed before surgery and treated with pisiform excision.

Is the flexion-abduction-supination magnetic resonance imaging view more accurate than standard magnetic resonance imaging in detecting distal biceps pathology?

BACKGROUND AND HYPOTHESIS: Partial biceps tendon pathology is difficult to diagnose. The flexion-abduction-supination (FABS) magnetic resonance imaging (MRI) view has been advocated to improve the accuracy of MRI investigation. The purpose of this study was to evaluate the accuracy of the FABS view MRI in the diagnosis of distal biceps tendon pathology. METHODS: The study included 50 patients with surgically confirmed distal biceps tendon pathology and 50 patients with other elbow disorders. In both groups, standard elbow MRI (retrospective review of previously obtained MRI data) was performed in half of the patients whereas FABS views MRI were obtained in the other half. These were evaluated by 2 independent musculoskeletal radiologists. The sensitivity and specificity of both MRI views were determined. Tendinosis and grade of rupture were reported from MRI and then compared with surgical findings. RESULTS: There were no significant differences in sensitivity and specificity in detecting partial distal biceps injuries when the FABS view MRI (sensitivity, 84%; specificity, 86%) and standard MRI (sensitivity, 76%; specificity, 98%) were compared. The interobserver reliability was 92% for the FABS view MRI with biceps pathology and 68% for standard MRI. In the control group, the interobserver reliability was 88% for the FABS view MRI and 96% for standard MRI. FABS MRI was significantly better regarding grade of injury. CONCLUSIONS: No significant differences in sensitivity and specificity were found between the FABS view and standard elbow MRI in the diagnosis of partial distal biceps tendon injuries, with high sensitivity and specificity for both views. Inter-rater reliability was better for FABS views, and FABS views were significantly more accurate than surgical findings in grading the extent of pathology.

A new intramedullary fixation method for distal biceps tendon ruptures: a biomechanical study.

BACKGROUND: Various techniques have been described for distal biceps tendon reinsertion. Although high success rates have been reported, all current techniques have specific shortcomings, with complications such as heterotopic ossification, nerve damage, and gap formation. The purpose of the present study was to biomechanically evaluate a new intramedullary fixation device that might reduce the risk of posterior interosseous nerve lesions. We therefore compared the fixation strength of this new intramedullary button with an extramedullary placed classic extracortical button. METHODS: A standard bicortical button was compared to the new intramedullary fixation device using fresh-frozen cadaveric specimens. The fixation strengths were tested both cyclically and statically. Load to failure and method of failure were also recorded. RESULTS: There were no failures during the cyclic load testing. The mean tendon-bone displacement was 0.87 ± 0.13 mm for the bicortical group and 0.83 ± 0.13 mm for the new button. During static loading, the mean load to failure for the bicortical group was 296 ± 97 N, whereas the new button group showed a higher mean load to failure of 356 ± 37 N. Breakout through the anterior cortex was recorded in 2 of 6 bicortically placed buttons and 1 of 6 in the new device. CONCLUSIONS: The new intramedullary fixation device yields comparable loads to failure compared with currently used techniques in a biomechanical setup. These findings together with the theoretical advantages suggest that this technique may be a valuable solution for the repair of distal biceps tendon rupture.

Accuracy and safety of the endoscopic repair of the distal biceps : a cadaveric study.

Clinical results of endoscopic distal biceps tendon repair have been shown to be comparable to open techniques in small series. This study evaluates safety and accuracy of the endoscopic technique. Sixteen fresh-frozen paired cadaveric upper extremities were used. The distal biceps tendons were cut and then repaired with the classic single incision bone button technique. Eight were done through an open technique, and eight were repaired endoscopically. Safety and accuracy were assessed by comparing the distance of the repair to neurovascular structures as well as the distance of the bone tunnel to the native biceps insertion. Paired t-tests were used to compare measurements. Significance level was set at p=0.05. There were no significant differences between the open and endoscopic groups, for any of the anatomic measurements. The ulnar artery was the closest neurovascular structure to the tunnel, with an average of 1 mm. The radial and recurrent radial arteries were located at 3 and 19 mm respectively. The median nerve was an average 10 mm from the tunnel, and both the SBRN and PIN at 12 mm. The distance between the PIN and the endobutton at the posterior side of the radius was an average 6 mm. There were no significant differences in variance between both groups related to the placement of the tunnel relative to the native biceps insertion. The single incision endoscopic-assisted technique of distal biceps repair can be performed consistently and with no added risk to neurovascular structures when compared to the classic open technique.

Can a ratio between medial and lateral meniscal volumes be calculated to determine critical meniscal volume in view of post-meniscectomy symptoms?

Partial meniscectomy is a frequently performed treatment strategy for non-suturable meniscal tears. However, the meniscal volume which can be resected without compromising the load-bearing, shock-absorbing function of the meniscus remains a topic of ongoing research. The aim of this study was to calculate the medio-lateral meniscal volume ratio to estimate this volume. In 90 patients (98 pairs of menisci) without meniscal injury, medial and lateral menisci were segmented on MRI imaging and 3D surface models were created to calculate volume. The mean medial meniscal volume was 1928,9mm3 and the mean lateral meniscal volume was 1681,7mm3. A fixed ratio of the medial over the lateral meniscal volume was calculated to be 1,16. The standard deviation of the prediction errors based on this ratio equals 217mm3. This ratio seems a useful parameter in follow-up research to determine whether there is a critical volume which can be resected without post-operative pain and osteoarthritis.

Radiological and Clinical Evaluation of the Transosseous Cortical Button Technique in Distal Biceps Tendon Repair.

PURPOSE: One of the options to repair a ruptured distal biceps tendon to the radial tuberosity is by means of a transosseous cortical button. Although excellent functional outcomes have been reported, no studies have been performed to quantify the effect of the transosseous fixation technique on the radius. Our study evaluated the clinical outcome and radiological outcome of this technique. The main goal of this study was to evaluate the radiographic evolution of the bone tunnel in the radius. METHODS: Patients with an acute distal biceps tendon rupture treated with a transosseous cortical button were invited to take part in the study. Fourteen patients were included in the final analysis. All patients were evaluated both clinically and by computed tomography scanning of the proximal radius after a minimum follow-up of 2 years. Outcomes were recorded using the visual analog scale score for pain, the Mayo Elbow Performance Score, and Disabilities of the Arm, Shoulder, and Hand scores. Bone tunnel volume was measured with semiautomated computed tomography segmentation using image-processing software. RESULTS: There were no failures of fixation in the patient group examined. Elbow mobility, arm, and forearm circumference were symmetric for all patients. Average visual analog scale for pain was less than 2. Mean Disabilities of the Arm, Shoulder, and Hand score and Mayo Elbow Performance Score were 2.3 and 97.6, respectively. Computed tomography images showed an average closure of the radial bony tunnel of 64% of the initial volume. CONCLUSIONS: Biceps tendon repair with cortical button fixation only shows partial tunnel closure. This could reduce the risk of potential complications due to osteolysis, such as radius fracture or hardware failure. Functional results were excellent and comparable to other fixation methods. The role of interference screws in transosseous cortical button techniques to strengthen the repair and to avoid osteolysis may therefore be questioned. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Distal biceps tendon repair: comparison of clinical and radiological outcome between bioabsorbable and nonabsorbable screws.

BACKGROUND: Distal biceps tendon repair to the radial tuberosity can be conducted by means of an interference screw in combination with a transosseous button. Bioabsorbable interference screws have been associated with complications such as severe osteolytic reactions. We questioned whether patients with a distal biceps tendon repair with bioabsorbable poly-L-lactide (PLLA) screws had different functional, clinical, and radiologic outcome than patients with nonabsorbable poly-ether ether ketone (PEEK) screws. METHODS: Between 2010 and 2014, 23 patients with an acute distal biceps tendon rupture were treated with reinsertion of the distal biceps tendon in a bone tunnel at the radial tuberosity through a single anterior incision using a transosseous button combined with an interference screw. A PLLA screw was used in 12 patients and a PEEK screw in 11 patients. All patients were retrospectively evaluated with a minimal follow-up of 1 year clinically and by means of the visual analog scale for pain, Mayo Elbow Performance Score, and Disabilities of Arm, Shoulder and Hand Outcome Measure score. Bone tunnel volume was measured with computed tomography segmentation. RESULTS: Elbow mobility and arm and forearm circumference were symmetric for all patients. The visual analog scale for pain was 0.2 in the PLLA group and 0.7 in the PEEK group. The Disabilities of Arm, Shoulder and Hand score and Mayo Elbow Performance Score were 5.4 and 98.7 in the PLLA group vs. 3.1 and 95.9 in the PEEK group. Bone tunnel enlargement of 43% in the PLLA and 38% in the PEEK group was noted. CONCLUSIONS: Clinical and functional outcome at more than 1 year after distal biceps tendon repair was excellent in both groups. Bone tunnel widening occurred in all patients.

Biohacking and Chip Implantation in the Human Hand: An Introduction.

Biohacking is a term used to describe people making changes to their bodies to improve their well-being. This includes the implantation of radiofrequency identification implants. This technology for wireless communication is already incorporated into our daily lives as in the use of contactless payment and badges to open doors. Since the first radiofrequency identification implantation in a human in 1998, the possibilities of this technology have dramatically increased, and the number of persons that have been chipped is growing. The hand seems to be the most popular body part to implant these chips because it can easily be positioned close to a reader. Currently, implantation is typically not performed in a medical environment. However, implantation of these devices in humans can result in complications, such as infection and tendon attrition, and the relevant safety implications have not been extensively studied. The scope of this review was to inform the hand surgeon community about the existence of these implants, why they are used, and to open the debate about the possible future role of the hand surgeon in safely implanting these devices and dealing with possible complications.

Does trapezium remodeling correlate with cup shape?

We investigated whether trapezium bone reaction was different following implantation of a trapeziometacarpal total joint replacement with a hemispheric or a conical cup. Fifty-three Keri Medical Touch implants with hemispheric cup and 53 with conical cup were prospectively followed up radiographically. We compared radiographs taken immediately and one year after surgery for cup subsidence, tilt, heterotopic ossification and loosening. Cup subsidence of at least 1 mm was detected in 4% of cases for both cup types. Additive bone reaction around the cup of more than 1 mm was present in 62% of conical cups and 47% of hemispheric cups. These were minor and there were no large ossifications with risk of impingement. Minor radiolucency was seen superficially at the implant-bone interface of 13% of the hemispheric cups and 9% of the conical cups. None of these bone reactions differed significantly according to cup design.

Polyethylene liner fracture in dual mobility trapeziometacarpal total joint replacement: how to make a timely diagnosis?

We present a case of fracture of the polyethylene liner of a dual-mobility trapeziometacarpal total joint arthroplasty. Standard radiographic imaging was normal. This case highlights the importance of dynamic radiographic imaging to make a timely diagnosis.

Sublaminar devices for the correction of scoliosis: metal wire versus polyester tape.

The authors conducted a retrospective study comparing the corrective effect of two sublaminar techniques on scoliosis: the classical one, based on metal wire, and a more recent one, based on polyester tape (thoracic Universal Clamp), known to be safer (less risk of neurological damage, less laminar breakthrough) and compatible with MRI. Lumbar screws were used in both groups. The authors composed two groups of 25 scoliosis patients, matched for gender, age, aetiology, anterior release, number of levels fused, number of infections, major curve and flexibility: there was no significant difference. Only the follow-up period was different: 55 months in the metal wire group, versus 17 months in the polyester tape group (p < 0.001), but this was immaterial because the curves were compared one year after surgery. After one year there was no significant difference between both groups, as to correction in the coronal or in the sagittal plane. This means that the polyester tape technique offers an interesting alternative, given that it yields supplementary advantages, as mentioned above.

Anatomical intramedullary distal biceps tendon fixation. Our first experience.

Background: Intramedullary fixatiovn in distal biceps tendon repair has been proposed to address specific shortcomings of current fixation techniques. Previous studies described a nonanatomical repair. Hypothesis: The purpose of the present study is to report the short-term outcomes of an anatomic intramedullary fixation. Study Design: We evaluated functional and radiographic outcomes up to 6 months of follow-up. Methods: Patients with an acute distal biceps tendon rupture eligible for surgical repair were invited to take part in the study. Eleven patients were included in the final analysis. All patients were evaluated both clinically and radiographically at 2 weeks, 6 weeks, 3 months, and 6 months. Outcomes were recorded using the visual analog scale score for pain, the Mayo Elbow Performance Score, and Disabilities of the Arm, Shoulder, and Hand scores. The radiographic evaluation comprised X-ray and CT evaluation. Results: There were no failures of fixation in the patient group examined. Elbow mobility was symmetric for all patients from 6 months onward. Supination strength was similar uninjured side at final follow-up. Mean Disabilities of the Arm, Shoulder, and Hand score and Mayo Elbow Performance Score at final follow-up were 0 and 100, respectively. Computed tomography images showed no signs of button migration, cortical thinning due to button pressure or button breakout. The tendon could be followed to the button in all cases. One case of heterotopic ossification was seen. Conclusions: Anatomical intramedullary fixation of the DBT has excellent functional outcomes at 6 months. The anatomical repair resulted in a restoration of supination strength. This technique allows the anatomical reinsertion of the distal biceps tendon while minimizing the risk of PIN injury. The intraosseous position of the tendon avoids gap formation. No adverse reactions of the button on the bone were seen.

Motor-Sparing Nerve Blocks Can Improve the Results of Digit Tendon Surgery: A Case Report.

A 56-year-old woman presented with flexion dysfunction of the fifth digit 6 weeks after surgical repair of a flexor digitorum profundus laceration. She was scheduled for surgical adhesiolysis and restoration of the functionality of the finger. Intraoperative monitoring of the range of motion by active flexion was deemed important to prevent incomplete release of the tendon and residual dysfunction. Distal median and ulnar nerve blocks were used for anesthesia with the patient's ability to flex the finger. This case suggests that motor-sparing peripheral nerve blocks can improve functional outcome in certain hand surgeries.