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Delayed union or non-union of the scaphoid was treated by a bone graft on a pronator quadratus pedicle in eight cases. This produced earlier union than the Russe procedure. The procedure is simple and is recommended for old un-united scaphoid fractures.
A function preserving method for radical removal of tumors located anterolaterally in the lower leg is described. The loss caused by the inclusion of all extensors and pronators of the foot in the surgical specimen is compensated for, to a large extent, by transfer of the tendon of the tibialis posterior muscle to the conjoint tendons of the extensor digitorum longus and peroneus tertius. The function after such an operation has been studied in two patients using various methods including strength measurements and, in one of them, electromyography.
Normal flexion of the fingers involves an involuntary contraction of the pronator and lumbrical muscle. In individuals whose profession involves constant flexing of the fingers those muscles become hypertrophied, impinging on the carpal tunnel. The narrowing of the carpal tunnel yields well to ultrasonography. The objective of this investigation was to find an ultrasonographic index of occupational carpal tunnel syndrome. Thus "Index M" denotes the variation obtained in the "M Space" before and after flexion-extension of the fingers. The study included 45 subjects performing tasks which involved the risk of cumulative trauma disorders. The subjects were tested using the electromyography and ultrasonography. The method was based on relation between the decrease in conduction of the median nerve measured by electromyography and the ultrasonographically measured variation of "M Space" in terms of sensitivity and specificity. The sensitivity of ultrasonography was 85%, as it confirmed the pathologic findings determined by electromyography ("M Index" positive) in twenty-two out of 26 hands, but the specificity was not statistically significant. Ultrasonography seems to have found very important application as a screening technique in occupational medicine. It is non-invasive, sensitive, easily repeated, and costs little.
By an ultrasonic technique (B. scan), the authors have analysed dynamically, the wrist during pronation. They could show that when the elbow is bended at 90 degrees, the distal tip of the radius effects a circular movement of great radius but low grade value, while the ulna draws in the opposite direction a nearly complete small circle.
Surgical and nonsurgical treatment of distal radioulnar joint instability has characteristically been unsatisfactory. This present paper presents a surgical method involving the removal and transfer of the origin of the pronator quadratus to a more dorsal position, which effectively gives a dynamic stabilization to the joint. Temporary internal immobilization is performed with a transverse Kirschner wire that is removed at four weeks, and graded physical therapy is started at that time.
This study reports the results of a computerized baropodometric analysis of the function of primary valgus pronated flat foot submitted to talocalcanear arthrodesis according to the Grice-Green method (Grice, 1952; 1955) as modified by Vigliani et al., (1978). Our purpose was to document any anomalies in the behaviour of such feet, which up until now have been based on conventional evaluation (plantar imprints, podoscopy, etc.), which are much less sensitive than those of modern electronic systems.
The Grice-Green operation was designed to correct pronated valgus flat foot. Initially, poliomyelitis provided the majority of candidates for this operation. Now, with the disappearance of poliomyelitis, its idiopathic variety in childhood has become the most common indication for this operation, whose effectiveness is universally acknowledged. The present paper is concerned with a quantitative assessment of its corrective potential, but the opportunity has also been taken to investigate more fully the evolution of the bone graft that is interposed as an arthrodesing agent between the talus and calcaneus.
The STA operation is a modified subtalar arthroereisis that uses an endoprosthesis manufactured from ultrahigh-molecular-weight polyethylene. It is fashioned into the shape of a small peg and implanted into the dorsal surface of the calcaneus. Its purpose is to eliminate abnormal pronation, correct heel valgus, and produce an increase of the medial longitudinal arch.
A modified subtalar arthrorisis is obtained by implantation of an endoprosthesis manufactured from ultrahigh molecular weight polyethylene. It is fashioned into the shape of a peg and implanted into the dorsal surface of the calcaneus just anterior to the posterior facet of the subtalar joint and fixed with polymethylmethacrylate. The purpose of the implant is to eliminate abnormal pronation, correct heel valgus, and produce an increase of the medial longitudinal arch in the growing child.
After examining the traumatic mechanism responsible for the lesion and considering the possible pathogenetic interpretations, the Authors pass to a description of the clinical picture and the simple but effective reduction manoeuvre. The attached cases tend to emphasize the by no means negligible frequency of painful pronation among childhood traumatisms, a condition often misunderstood and a source of wrong diagnostic interpretations.
UNLABELLED: Ten fresh human upper-extremity cadaver specimens were tested for the effect of residual angulation from simulated fractures of both bones of the forearm on the potential for range of rotation of the forearm and for limitations of pronation and supination specifically. Ten and 20-degree angulations for the radius and ulna, such as might be encountered in all reasonable clinical situations, were tested. Little significant loss of forearm rotation resulted from angulations of 10 degrees in any direction. With 20 degrees of angulation, there was statistically significant and functionally important loss of forearm rotation. CLINICAL RELEVANCE: A residual angulation of 10 degrees in mid-shaft fractures of the radius, ulna, or both bones of the forearm will not limit forearm rotation anatomically. Loss in the range of rotation can be expected with residual angeles of 20 degrees or more.
A case of median nerve entrapment at the elbow between the supracondyloid process and the anomalous origin of the pronator teres on it is presented. The anatomical variant and the histological background of this syndrome are outlined. The pathophysiology of the neuralgia is discussed. A relatively simple surgical procedure afforded complete relief of symptoms.
A clinically simple and logical classification of pronation deformity in cerebral palsy into four groups is presented. The appropriate procedure for each group is defined. The validity of this classification is documented with our results in 32 patients.
The distal third of the forearm is a tendinous area, in which nerves could be irritated by surrounding skin scars or synovitis. In this area, a distally or proximally based pronator quadratus muscle flap could be used to wrap around the median or superficial branch of the radial nerve. Such flaps have been used successfully in eight cases, four cases of chronic neuritis, 2 cases of wrapping a median nerve graft and 2 cases of nerve coverage following trauma. All patients obtained pain relief with no alteration of finger movements.
In order to obtain the anatomical basis of transferring the anterior interosseous nerve to repair the injury of thenar or ulnar nerve at the wrist level, ten fresh cadaveric forearms were dissected. The pronator quadratus branch of the median nerve was (1.5 +/- 0.4) mm in diameter with (866 +/- 144) nerve fibers. The recurrent branch of median nerve was (1.7 +/- 0.3) mm in diameter with (1,120 +/- 97) nerve fibers. The deep branch of ulnar nerve was (2.1 +/- 0.4) mm in diameter with (1,318 +/- 120) nerve fibers. To repair the thenar recurrent branch, nerve graft should be used to bridge between the distal end of the anterior interosseous nerve and the origination of the recurrent branch. The deep branch of the ulnar nerve could be repaired by direct suture after being dissected proximally. In patients, the technique was applied to repair 17 cases of injury of thenar branch and 3 cases of injury of deep branch of ulnar nerve. Among them, seventeen cases were followed up from 2 to 7 years. On electromyogram it was normal in 10. The myodynamia was restored in different degree: M2 in 2, M3 in 5, M4 in 7, M5 in 3. The procedure of the operation and the matters needed attention during the operation were discussed.
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