Mallet thumb.
A case of mallet thumb, with a closed rupture of the extensor pollicis longus at its distal insertion, is presented. Conservative treatment resulted in a near normal function.
Adult↗
Biomedical subjects
H Van Ransbeeck
Publications and source records attributed to H Van Ransbeeck.
Stabilization of the pre-arthritic trapeziometacarpal joint using ligament reconstruction.
INTRODUCTION: Trapeziometacarpal pre-arthrosis is a common condition with only limited therapeutic possibilities. Eaton and Littler designed a tendon stabilization. MATERIALS AND METHODS: A series of 21 thumbs with painful carpometacarpal joints, treated with a ligament reconstruction according to Eaton and Littler, is described. Three failed and further surgery was required. The outcome of 18 is evaluated. There were 11 women, 7 men with a mean age of 33.7 years, all having stages I or II of osteoarthritis. Six (30%) had a traumatic event in their history. RESULTS: In the early stages of degenerative osteoarthritis, the overall outcome was good with a mean DASH score of 23.2. The carpometacarpal joint was stable but a 43% progression of radiographic osteoarthritic deterioration of the joint occurred. CONCLUSION: Stabilization of a painful pre-arthritic trapeziometacarpal joint is useful and reliable. A traumatic instability had worse results and probably is a contraindication to this technique.
Adolescent↗
Outcome study of arthroscopic suturing of ulnar avulsions of the triangular fibrocartilage complex of the wrist.
INTRODUCTION: Ulnar wrist pain due to a TFCC lesion is frequent. Based on studies of the vascularity, ulnar avulsion can be sutured. Arthroscopic techniques have been designed but results are sparsely published. MATERIALS AND METHODS: This is a retrospective study of 35 patients with an ulnar avulsion of the TFCC. All the patients were treated with an originally designed arthroscopical technique. The evaluation was focused on the subjective and functional ouome. A pain score and a DASH score were used. RESULTS: The general impression was positive with a mean DASH score of 15 points. Two-thirds of the patients had a DASH score totaling less than 20. Twenty-nine patients had a good outcome, six were fair or poor. CONCLUSION: Arthroscopical repair of the TFCC is a reliable and useful technique.
Adolescent↗
Ligament reconstruction/tendon interposition arthroplasty for thumb basal joint osteoarthritis preliminary results of a prospective outcome study.
Ligament reconstruction/tendon interposition arthroplasty (LRTIA) is a common procedure for basal joint osteoarthritis of the thumb. We evaluated 31 operations in 30 patients, 28 females, 2 males with a mean age of 57 years. The mean follow-up was 24 months (range 8 to 46 months). Pain reduction was 75% on average, with good preservation of motion and of first web space. Twenty-six patients were satisfied or very satisfied; five were not. The grip strength and key-pinch strength increased post-operatively, albeit not significantly.
Aged↗
Lunotriquetral arthrodesis, a procedure with a high failure rate.
The authors retrospectively reviewed 29 patients with chronic lunotriquetral ligament tears who were treated with lunotriquentral arthrodesis. Arthrography confirmed the diagnosis in 17 cases, arthroscopy in 18. Associated lesions included 13 TFCC tears and 8 scapholunate ligament tears. The fusion was carried out with staples in 5 cases, a Herbert screw in 17, a Kirschner wire in 6. Bone grafts were used in 24 cases. In 15 cases additional procedures were performed. As for the subjective outcome, 5 patients were fully satisfied, 10 had reservations and 14 were not satisfied; 17 patients would repeat the procedure. The average Pellenberg wrist score for pain and function was 59/80 (0 no symptoms, 80 maximal pain). Mean grip force was 69% of the contralateral side and lateral pinch force was 79%. Flexion loss averaged 24 degrees, and extension loss 21 degrees. Fusion was achieved in 16 cases; nonunion persisted in 13. Twelve important complications were noted. In 17 cases the wrist remained painful; in 19 patients an average of two additional surgical procedures were required. Fusion was obtained in two of seven revision cases; five remained painful. Three patients went on to complete wrist arthrodesis. In the light of these results the effectiveness of this procedure has to be reconsidered compared to other alternatives, such as ligamentoplasty and extended arthrodesis (4 corner).
Adolescent↗
Intraosseous ganglion of the triquetrum. A transpisiformal approach.
A cystic subchondral bone defect without joint pathology is called an intraosseous ganglion. Most occur in the lower limb. In the wrist the scaphoid and lunate are most often involved. We report a case of an intraosseous ganglion within the triquetrum, treated by curettage and grafting with the pisiform that had been removed.
Adult↗
The Sauvé-Kapandji procedure for posttraumatic wrist disorders: further experience.
A prospective survey was conducted to evaluate the outcome of the Sauvé-Kapandji procedure for posttraumatic wrist disorders. Eighty four patients were treated, all with posttraumatic disorders of the distal radioulnar joint, 73 as an isolated procedure, 11 in combination with another wrist procedure. There was significant pain decrease and high patient satisfaction (74%). The range of motion increased in the flexion/extension arc from 109 degrees to 124 degrees (p = 0.006) and, in those with limited forearm rotation, from 71 degrees to 134 degrees (p = 0.006). According to the Mayo Clinic wrist score, we obtained 20 excellent, 34 good, 18 fair and 12 poor results. Complications were rare.
Adolescent↗
Bowler's thumb treated by translocation of the digital nerve.
A case of neuroma of the ulnar digital nerve of the thumb in a bowler was treated successfully by translocation of the nerve beneath the adductor pollicis.
Adolescent↗
Blatt dorsal capsulodesis for scapholunate instability.
This retrospective series reviews 17 patients with scapholunate instability treated with the Blatt procedure between 1994 and 1997. Indications were 11 cases of preradiographic instability, three dynamic and three static instabilities. Subjective and objective assessment was carried out. Average pain and level of activity score was 60.8/80 (good). Only three patients failed to continue their jobs. Ten patients were fully satisfied, and seven had minor to major reservations. Flexion loss averaged 11 degrees and extension loss was 11.3 degrees. Grip force improved significantly by 11.2 kg. Associated scapholunate interosseous ligament repair in 6 patients resulted in no further improvement. Major complications were deep infection (one case) and reflex sympathetic dystrophy (two cases). Given the lack of a superior procedure, we considered the Blatt capsulodesis a valuable therapeutic option for cases of preradiographic and dynamic instability, or as an adjunct to scapholunate interosseous ligament repair in more acute lesions.
Adolescent↗
Radial tunnel release and tennis elbow: disappointing results?
In a retrospective study, 19 patients with 20 decompressions of the posterior interosseous nerve for radial tunnel syndrome were reviewed. The results were evaluated using Roles and Maudsley's criteria; they were found to be consistent with those previously reported: i.e. 75% favorable outcomes. Despite this finding only 8 patients (40%) stated they were satisfied. The main reason was residual pain. Shorter delay between the onset of symptoms and surgical treatment as well as simultaneous release of the lateral epicondylar muscles was found to influence positively patient satisfaction. These findings suggest that the scoring system used in the present study and also in previous studies is inappropriate. They also cast some doubt on the role of compression of the posterior interosseous nerve in the pathogenesis of chronic lateral elbow pain.
Adult↗
Grip strength in tennis elbow : long-term results of operative treatment.
In a prospective study the grip strength was measured preoperatively in 17 patients with chronic tennis elbow and postoperatively after a minimum follow-up of 1 year. The grip strength measured with a flexed and extended elbow was significantly less on the involved side (28.4 and 17.2 kg) than on the normal side (36.4 and 36.5 kg) ; postoperatively it increased significantly (33.9 and 34.2 kg) and almost reached the level of the normal contralateral side. An increase of grip strength measured with an extended elbow was correlated significantly with a satisfactory clinical outcome.
Adult↗
Syndactyly release: results of the Flatt technique.
The results of 50 web reconstructions in 35 hands in 24 patients were reviewed. The technique described by Flatt was used in all cases. Web creep occurred in 13 webs (26%) of which 11 were operated before the age of 2 years. Active abduction was seen in 86% of the involved fingers. A normal or near normal web was seen in 74%. Cosmesis was satisfactory in 64%.
Adolescent↗
The so-called congenital trigger digit: further experience.
The authors reviewed 53 patients with 70 congenital trigger digits. Three of these were seen at an early age. Most "congenital" trigger digits present later than the neonatal period. A clear difference exists between trigger thumbs and trigger fingers. In our series, thumbs were more frequently affected, 30% were bilateral and none resolved spontaneously. The long fingers were less frequently affected, and two of them (28%) recovered without operation. All other children had an operative release of the A1 pulley of the flexor tendon sheath, with excellent results.
Child, Preschool↗
Surgical treatment of trigger fingers.
The surgical treatment of 55 trigger fingers resulted in 87% patient satisfaction, without major complications. The mean incapacity was 1.4 weeks. Three recurrences were noted; four patients had a slight extension lag and three still experienced some local pain.
Adult↗