Batia Yaffe

Ankle instability of the donor site following removal of vascularized fibula bone graft.

We have assessed the donor site of fibula bone graft to detect signs and symptoms of ankle instability in 8 patients. In 1 patient with generalized joint hyperlaxity pain, clinical instability and pathological motion of the proximal end of the distal remaining fibula were encountered. Seven other patients were asymptomatic and had no instability both clinically and on stress radiographs.

Self-inflicted hand injuries: diagnostic challenge and treatment.

Self-inflicted injuries are probably more common than is generally appreciated. Three patients with self-inflicted hand injuries are described. A delay in making the correct diagnosis resulted in severe hand disability in 2 of the patients. Early diagnosis of this entity, combined with prompt psychotherapy, prevented disability in the third. The pertinent literature is reviewed and the importance of early diagnosis and psychotherapy is stressed.

The effect of allopurinol on experimental island skin flap survival under prolonged periods of arterial ischaemia

The aim of this study was to assess the effect of allopurinol on rat groin flaps rendered ischaemic by selectively occluding the feeding femoral artery and reperfused by means of microsurgical anastomosis. For the establishment of the critical arterial ischaemia time, the femoral artery of 29 rat groin flaps isolated on the inferior epigastric pedicle was occluded for 10, 12 and 14 h. Following 12 h or more of ischaemia, 5.25% of the flaps survived, compared to 40% survival after 10 h (p = 0.04). In the second stage of the study, 34 rat groin flaps were subjected to arterial ischaemia for 12 h. Of these, 12 rats received allopurinol solution I.V. 30 min prior to reperfusion, 10 received the vehicle solution (control) and 12 underwent no treatment (control). After 7 days, survival of the groin flaps was observed in 41.7%, 0 and 8.3% of the groups, respectively (p = 0.0164). This study suggests that systemic administration of allopurinol has a beneficial effect on rat arterial ischaemic groin flaps and may prolong their critical ischaemia time.

Combined Iliazarov and free flap for severe recurrent flexion-contracture release.

This article discusses the treatment of recurrent flexion-contracture of the knee after circumferential burns involving the entire limb. A two-team approach to surgery is used: the orthopedic team widely excises the scar tissue and releases tendons, muscles, and adjacent soft tissue that limit joint movement. The microsurgery team covers the exposed popliteal neurovascular elements with a latissimus dorsi free flap. However, full range of the knee is still limited by the short neurovascular bundle. Therefore, the orthopedic team applies a circular hinged Iliazarov external-fixator-frame to achieve gradual correction, until full range of the knee is achieved. Intensive physiotherapy and continuing use of extension splints for additional 6 months until the scars are deemed stable compliment the treatment regimen and prevent the recurrence of contractures. Between the years 2002 and 2003, we treated four patients (totaling five knee joints) with recurrent severe flexion-contractures after circumferential burns of the entire lower extremity. A significant limitation was caused by the abnormal scarring, which left the patients confined to a wheelchair. In all our patients, previous attempts to release the flexion-contracture failed. With the aforementioned technique, within 3 months after the procedure, all patients were able to walk. We encountered one major complication (ie, drop foot). At follow-up, all patients enjoyed a full range of motion and were able to walk. The strength of our approach comes from combining a free muscle flap with an Iliazarov external fixation and a detailed postoperative rehabilitation plan.

The role of three dimension computerized imaging in hand surgery

Three-dimensional computerized imaging is a new modality of radiological imaging. This new technique transforms the two-dimensional slices of bi-plane CT into a three-dimensional picture by a computers monitor adjusted to the system. This system enables the physician to rotate the angle of viewing of the desired region to any desired angle. Moreover, this system can delete certain features of different densities from the picture, such as silicone implants, thus improving visualization. Our preliminary results using this technique are presented. The advantages, pitfalls, and suggested future applications of this new technique in hand surgery are discussed.

Postburn peroneal nerve palsy — a report of two consecutive cases

We report two patients suffering from mixed deep partial and full skin thickness flame burns covering 45 and 95 per cent of the total body surface area respectively. These patients, following sepsis and multisystem failure, developed unilateral peroneal nerve palsy. The possible aetiology of isolated injury to the peroneal nerve in burned and critically ill trauma patients is discussed.

Rupture of extensor digitorum communis after distal ulnar styloidectomy

Attrition ruptures of tendons in the hand, other than those caused by rheumatoid arthritis, are rare. We report a case in which high styloidectomy of the distal ulna caused the rupture of the extensor digitorum communis tendon to the long finger. This complication can be avoided by resection of the smallest segment of the distal ulna that is compatible with relief of the problem. Soft tissue closure over the resected end of the ulna should also be carried out.

Camera-tracking gaming control device for evaluation of active wrist flexion and extension

Study Design: Cross sectional. Introduction: Measuring wrist range of motion (ROM) is an essential procedure in hand therapy clinics. Purpose of the Study: To test the reliability and validity of a dynamic ROM assessment, the Camera Wrist Tracker (CWT). Methods: Wrist flexion and extension ROM of 15 patients with distal radius fractures and 15 matched controls were assessed with the CWT and with a universal goniometer. Results: One‐way model intraclass correlation coefficient analysis indicated high test‐retest reliability for extension (ICC = 0.92) and moderate reliability for flexion (ICC = 0.49). Standard error for extension was 2.45° and for flexion was 4.07°. Repeated‐measures analysis revealed a significant main effect for group; ROM was greater in the control group (F[1, 28] = 47.35; P < .001). The concurrent validity of the CWT was partially supported. Conclusion: The results indicate that the CWT may provide highly reliable scores for dynamic wrist extension ROM, and moderately reliable scores for flexion, in people recovering from a distal radius fracture. Level of Evidence: N/A.

Free myocutaneous flap transfer to treat congenital Volkmann’s contracture of the forearm

The purpose of this study is to report our experience with free functional muscle transfer procedures for the late sequelae of the rare condition of congenital Volkmann’s ischaemic contracture of the forearm. Four children, with an average age of 9.5 years (range 1.5–17), were treated and were followed for a mean of 6 years (range 1–14). Two patients had dorsal forearm contractures, and two had both flexor and extensor forearm contractures. We carried out free functional muscle transfers to replace the flexor or extensor muscles. The functional result was assessed according to the classification system of Hovius and Ultee. All patients had wrist contractures and skeletal involvement with limb length discrepancy that influenced the outcome. All five transferred muscles survived and improved the function of the hand in three of the four patients. Level of evidence: 4

The effect of a simple preservation method on immediate and late patency rates of autogenous microvenous grafts.

The subject of this study was assessing in vivo a simple short-term preservation method of autogenous microvenous grafts. Forty-five autogenous vein grafts in rats were divided into groups of five and preserved in lactated Ringers solution at 4 degrees C for 0, 1, 2, 3, 5, 8, 10, 12, and 14 days. After a designated preservation period, the veins were implanted as autografts into defects created in the animals femoral arteries, while a small portion of each vein was processed for histologic examination. The patency was assessed immediately, at 1 week, and at 5 to 6 weeks following grafting, at which time the patent grafts were biopsied. Preserving the grafts for up to 2 days had no effect on their patency rate, which remained 100 percent, and no histologic changes were noted in the veins preserved for this period. However, longer preservation resulted in gradual necrotic changes in the veins, which were reflected in lower patencies of the grafts. The histology of the preserved veins and of the patent vein grafts 5 to 6 weeks following grafting is discussed. The model developed in this study can be used as a benchmark for further preservation studies using more sophisticated methods.