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Fifty hands with rheumatoid ulnar drift treated by resection of the metacarpal heads and replacement with silicone prostheses were studied. The procedure is outlined which consists of an arthroplasty using a silicone prosthesis with tendon transfer. The complications are also studied and the results evaluated. Of the cases studied 20% were excellent, 40% were good, and 40% fair.
Hallux varus deformity, which may be either congenital or acquired, can be very painful and disabling, in addition to having a poor cosmetic appearance. In this paper, the author discusses the acquired type. He believes the abductor hallucis tendon transfer to be the procedure of choice for correction of hallux varus deformity, and he discusses its use and results in three cases.
Reconstructive procedures to optimise the function of patients with upper brachial plexus injuries are well described. From 1999 to 2005, nine patients underwent a single stage Brooks Seddon pectoralis major to biceps tendon transfer with a glenohumeral arthrodesis for restoration of elbow flexion and shoulder stability. All of these patients had sustained traumatic upper trunk brachial plexus injuries which had not responded to nerve repair, grafting or neurotisation or had a delayed presentation. Results were assessed using a goniometer and the Medical Research Council strength grading. At follow-up of 28.5 months, the average arc of elbow flexion was 103 degrees and eight had good elbow flexion power. There was one failure. We had two complications, both related to humerus fractures below the arthrodesis plate. Both united with conservative treatment. Our experience has given encouraging results with a high level of patient satisfaction. Our indications, operative technique and results are presented.
Eighty patients with persistent clinical and functional instability of the knee due to anterior cruciate ligament insufficiency underwent the operation reported, in which one-third of the patellar ligament substitutes for the cruciate ligament and extraarticular tendon transfers, medial and lateral, augment the substitution. The patients were followed for a minimum of two years, and fifty returned for personal evaluation. The average follow-up was thirty-three months, with a range of two to five years. There were thirty-five male and fifteen female patients. The average age was twenty-three years. The average interval from initial injury to the index operation was two years. Meniscal tears and articular changes were noted in most of the patients. Forty-three (86 per cent) of the fifty patients had at least one torn meniscus, twenty-seven patients (54 per cent) had significant degenerative articular changes, and fourteen (28 per cent) had patellar articular changes. In the procedure described, eccentric placement of the tibial and femoral tunnels for more accurate placement of the patellar ligament substitute is essential. The over-all results were graded as excellent in thirty knees, good in seventeen, fair in one, and a failure in two. One knee that was classified as a failure showed excellent stability, but the patient had significant pain from chondromalacia of the patella, while significant pain and hyperesthesia from a neuroma was the reason for failure in the second patient.
Patients with cervical spinal cord injury have partial paralysis of their upper limbs, depending on the precise level of the injury. Twenty years ago, attempts at surgical rehabilitation of upper limb function in such patients started with tendon transfers, along with tenodeses, and some arthrodeses. These procedures are performed at least one year post-trauma. Depending upon the level of the injury, they usually significantly improve the functional autonomy of these otherwise severely handicapped patients. It is estimated that 60-70% of all tetraplegic patients can benefit from this type of surgery.
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Electromyography was done in patients at the C6 level of quadriplegia after transfer of the brachioradialis to the flexor pollicis longus to restore lateral pinch and transfer of the posterior deltoid to the triceps to restore elbow extension. The relationship of the integrated electromyogram to pinch force during a graduated isometric contraction enabled characterization of the motor recruitment pattern. After tendon transfer, the pattern of the electromyographic response for the brachioradialis was the same as in the flexor pollicis longus in normal subjects, and the posterior deltoid after transfer to the triceps fired synergistically with the brachioradialis. These findings indicate reeducation of transferred muscles occurred after surgery and that they functioned as active primary motors.
In sixty-five knees followed for an average of 4.5 years after treatment of subluxation or dislocation of the patella by the slot-block method of medial patellar-tendon transfer, the results were satisfactory in fifty-four (83%) and unsatisfactory in eleven (17%). Recurrent subluxation or dislocation occurred in three (5%) of the knees and was attributed to insufficient displacement. Chondromalacia of the patella became worse after transfer in three of the sixty-two knees in which the distal realignment was technically correct. Two knees (3%) required patellectomy because of patellofemoral symptoms and there were nineteen complications in seventeen knees, including loss of motion in six, wound infection in six, displacement of the bone block in three, recurrent dislocation in three, and rupture of the patellar ligament in one. The method is believed to give superior results but it is technically demanding.
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