Ankit Thora

Early reimplantation for open total talar extrusion

Purpose. To review outcome of early reimplantation for open total talar extrusion in 7 patients. Methods. Medical records of 5 men and 2 women aged 19 to 53 years who underwent reimplantation for open total talar extrusion within 6 hours after road traffic accident (n= 6) or industrial injury (n=1) were reviewed. The talus was first irrigated with 9 to 10 litres of saline solution, followed by 10% povidone iodine. It was then reduced after thorough debridement and fixed with tension band wiring or external fixation. Ankle mobilisation exercises were started at week 6 and full weight bearing at week 14. Outcome was assessed using the American Foot And Ankle Society score. Results. After a mean follow-up of 31.9 (range, 24–46) months, the mean American Foot and Ankle Society score was 81, and the mean dorsiflexion-plantar flexion arc was 36.9° (range, 25°–45°). All patients were able to walk with a balanced, unaided gait with mild-to-moderate pain (n=3) or pain-free (n=4). No patient developed deep infection or instability. Three patients developed avascular necrosis of the talus; restriction of motion was moderate at the ankle joint and severe at the subtalar joint. None of these 3 patients opted for revision surgery, as the pain was tolerable and did not limit their daily activities, but their condition was expected to deteriorate with time. Conclusion. Early reimplantation is recommended for open total talar extrusion, as it restores (to some extent) hind foot mechanics, heel height, and bone stock for activities of daily living and future reconstructive options.

Finger trapped in door latch removed using an electric saw. A new technique and review of other techniques

Trapping of fingers in metallic bands is a commonly encountered situation. The children, elderly people, and psychiatric patients are the usual victims. The constricting object in the digit causes obstruction to lymphatic and venous drainage leading to oedema distal to the constriction, which leads to further neurovascular compromise and presents as a surgical emergency. A 7-year-old boy presented to us with his right middle finger being stuck in a steel door latch. Multiple attempts were made to remove the trapped finger with conventional methods, and subsequently, it was removed by electric-driven metal cutting saw, which was not previously described in medical literature to the best of our knowledge.

Single tendon transfer of the flexor carpi ulnaris for high radial nerve injury

Purpose. To evaluate the outcome after single tendon transfer of the flexor carpi ulnaris (FCU) to the digital extensors for high radial nerve palsy. Methods. Records of 10 patients aged 16 to 43 (median, 27) years who underwent single tendon transfer of the FCU to the digital extensors for high radial nerve palsy secondary to closed (n=4) or open (n=4) diaphyseal humeral fractures or deltoid injection (n=2) were reviewed. Two of the patients with open fractures also underwent treatment for non-union in a staged manner. Grip strength (power grip and precision grip) was measured monthly using an automated dynamometer. The range of motion of the wrist, and metacarpophalangeal joints of the thumb and fingers was measured monthly using a goniometer. Results. All patients were followed up for at least one year. Preoperatively, the overall power grip strength of the injured hands was about 1/5 of the normal hands. At 12 months, the mean improvement was 202.5% for overall power grip strength and 43% to 57% for precision grip strength parameters. Compared with the normal hands, the mean deficit of the operated hands was 39% for overall power grip strength and 32% to 37% for precision grip strength parameters. At 12 months, mean wrist extension was 50.4°, with about 10° lag in finger and thumb extension. The mean total active motion was 86.7° in the operated wrists and 128.1° in normal wrists. The decrease in wrist flexion and ulnar deviation was 7.8° and 6.8°, respectively. Conclusion. Single tendon transfer of the FCU is a viable option to restore hand function and strength following high radial nerve injuries.