MICROSURGICAL REIMPLANTATION OUTCOMES FOR COMPLETE AND INCOMPLETE AMPUTATIONS OF DISTAL PHALANGES OF FINGERS.

Introduction: The intricate endeavor of replanting the distal phalanx of the finger remains a persistent challenge. In the pursuit of addressing this concern, microsurgical replantation procedures have been systematically examined for distal phalanx injuries encircling the distal interphalangeal (DIP) joint, conducted at the Orthopaedic Hospital situated in Ho Chi Minh City. Materials and Methods: This investigation encompassed a cohort of 31 patients, comprising individuals with 17 instances of complete and 21 instances of incomplete amputations of the distal phalanges. The subjects' ages spanned a range from 3 to 56 years. Results: The study divulged that eight fingers, involving four complete amputations and four incomplete amputations, did not achieve successful outcomes. In contrast, the remaining 30 fingers exhibited survival. A meticulous long-term follow-up of 17 fingers, extending over a period exceeding six months, unveiled commendable achievements encompassing satisfactory sensory recovery, cosmetic enhancement, and the resumption of pre-injury occupational activities by the patients. Discussion: Vein anastomosis was revealed as a notably challenging aspect of the surgical procedures. In scenarios where conventional vein suturing was rendered unfeasible, the innovative recourse of one-way drainage emerged as a viable alternative. Conclusion: The endeavor to replant the distal phalanx of the finger engenders a substantial level of complexity, particularly in the realm of venous anastomosis. This research underscores the need for focused efforts to address and surmount the intricacies associated with this aspect of surgical intervention.

TREATMENT OF IRRECOVERABLE RADIAL NERVE PALSY USING THE MODIFIED MERLE D'AUBIGNÉ TENDON TRANSFER METHOD.

Background: Irrecoverable radial nerve palsy (RNP) leads to the inability to extend the wrist and fingers and significant reduction in grip strength. The aim was to assess the outcomes of treating non-recovering motor RNP using the modified Merle d'Aubigné tendon transfer method. Materials and Methods: A descriptive prospective study involved 33 patients between January 2017 and March 2019. Results: Males constituted the majority (32/33 cases, 97%). The ratio of radial nerve and posterior interosseous nerve injuries was nearly equivalent (16/17). The mean extension range of the wrist was 48.6° ± 14.9° during finger extension and 30.9° ± 14.4° during finger flexion. The mean flexion range of the wrist was 34.8° ± 15.8° during finger extension and 42.6° ± 14.8° during finger flexion. 93.9% of patients achieved full finger extension when the wrist joint was extended beyond 10°. The mean angulation range of the index finger was 55.3° ± 7.4°. The Kapanji score achieved was 8.4 ± 1.2. The achieved grip strength was 65.4% compared to the unaffected side. The surgery did not induce radial deviation deformities of the wrist joint. 32/33 patients were satisfied with the surgical outcomes. 31/33 patients returned to their previous professions. 93.9% of patients achieved very good and good results, while 6.1% achieved fair results. Conclusion: Treating irrecoverable radial nerve palsy using the modified Merle d'Aubigné tendon transfer method yields very good results. The utilization of the pronator teres for wrist extensor transfer and the flexor carpi radialis for finger extensor transfer is appropriate and contributes to limiting wrist joint radial deviation deformities. This modified technique has been researched and recommended by various authors worldwide.

Outcomes of early treatment of radial dysplasia.

Purpose: Radial dysplasia, also termed radial club hand is an abnormality along the longitudinal axis of the hand characterized by hypoplasia or aplasia of radial structures. Surgery that centralize the wrist on the distal end of the ulna gives quite good results in terms of anatomical recovery but affecting range of motion of the wrist and fingers, limbs length. We conducted this study to evaluate the outcome of serial casting followed by centralization at our institution. Materials and methods: We conducted a prospective study involving 20 pediatric patients with 25 limbs affected by Bayne Types III and IV radial dysplasia, with an average follow-up period of 4.2 years. Each limb underwent progressive soft tissue stretching via serial casting, followed by centralization. Clinical and radio-graphic data were collected at surgery and during follow-up assessments. Results: The study achieved an average correction of 60° in radial deviation, with a decrease in wrist range of motion from 79° to 28° over the follow-up period. Finger mobility showed increased stiffness. Ulnar length recovery reached 57% of the normal contra-lateral side. Final results, based on the Bayne and Klug criteria, revealed that 24 out of 25 hands (96%) exhibited good or satisfactory outcomes. Conclusion: Early intervention employing gradual corrective casting followed by centralization is an effective treatment for radial dysplasia in children, consistently resulting in good or satisfactory outcomes. However, this approach entails a trade-off with reduced wrist and finger range of motion and potential implications for limb growth.