Академический Документы
Профессиональный Документы
Культура Документы
www.diuchirurgiemain.org
SHOULD WE REPAIR AN ISOLATED
LESION OF THE EIP ?
• ➽ Should be repair
Noorda RJP et al. Index Finger Extension and Strength After Extensor Indicis Proprius Transfer. JHS 1984;19A:844-849.
Kerr CD, Gittins ME. Analysis of donor deficit after extensor indicis proprius tendon transfer. J Am Osteopath Assoc 1991;91:245-6,249.
Moore JR, et al. Independent index extension after extensor indicis proprius transfer. J Hand Surg 1987;12A:232-6.
Magnussen PA, et al. Extensor indicis proprius transfer for rupture of the extensor pollicis longus tendon. J Bone Joint Surg 1990;72B: 881-3.
DO WE NEED TO REPAIR THE EXTENSOR DIGITI MINIMI ?
• ➽ Should be repair
Zilber S, Oberlin C. Anatomical Variations of the Extensor Tendons to the Fingers over the Dorsum of the Hand: A Study of 50
Hands and a Review of the Literature. Plast. Reconstr. Surg. 2014;113: 214-221
Gonzalez MH et al. The Extensor Tendons to the Little Finger: An Anatomic Study.J Hand Surg 1995;20A:844-847.
SHOULD WE REPAIR THE CAPSULE ?
• No idea and no clear sentence in
literature
Patzakis MJ, Dorr LD, Ivler D, Moore TM, Harvey JP Jr. The early management of open joint injuries. A prospective study of one hundred and forty patients. J Bone
Joint Surg Am. 1975;57(8):1065-70.
Melone CP Jr, Polatsch DB, Beldner S. Disabling Hand Injuries in Boxing: Boxer’s Knuckle and Traumatic Carpal Boss. Clin Sports Med 28 (2009) 609–621
Gladden JR (1957). Boxer’s knuckle. A preliminary report. American Journal of Surgery, 93: 388–397.
Posner MA, Ambrose L. Boxer’s knuckle-dorsal capsular rupture of the metacarpophalangeal joint of a finger. J Hand Sur 1989;14A:229-236.
Arai A et al. Treatment of soft tissue injuries to the dorm of the metacarpophalangeal joint (Boxer’s knuckle) . J Hand Surg 2002;27B(1)90-95.
CAPSULAR REPAIR ?
• However reparable
longitudinal capsular tear in
bower’s knuckle may be
different from transverse
tears ?
OPEN JOINT INJURIES
• Mostly sharp wounds over MP
joints ➜ capsular suture if
possible
Zancolli EA. Structural and dynamic bases of hand surgery. 2nd Ed. Philadelphia: JB Lippincott, 1979:3–36.
Marshall TG et al. Mechanics of Metacarpophalangeal Joint Extension. J Hand Surg 2018; 43(7):681.e1-e5
WHAT IS THE ROLE OF SAGITTAL BANDS ?
Young CM, Rayan GM. The Sagittal Band: Anatomic and Biomechanical Study. J Hand Surg 2000;25A:1107–1113.
CLINICAL CONSEQUENCES
• Should repair
radial sagittal
bands
• Should protect
repair with limited
MP flexion
WHAT ARE JUNCTURAE TENDINUM USEFUL FOR ?
RadioGraphics
• There is no finger
independence during extension
Figure 8. Axial anatomic slice (a) and corresponding T1-weighted MR image (b) obtained a
hand show the extensor digitorum tendons (arrowheads) and extensor digiti minimi tendons (a
Kang N, Smith P. Congenital Absence of the Juncturae Tendini Contributing to Dislocation of the Extensor Tendons. J Hand Surg 2001;26A:501–505.
Farrar NG, Kundra A. Role of the juncturae tendinum in preventing radial subluxation of the extensor communis tendons after ulnar sagittal band
rupture: a cadaveric study. Orthopedics, doi:10.5402/2012/597681
Young CM, Rayan GM. The Sagittal Band: Anatomic and Biomechanical Study. J Hand Surg 2000;25A:1107–1113.
ROLE IN ADJACENT FINGER EXTENSION
• Proximal traction on the index finger extensors provides 32% of maximal extension
of the long finger MCP joint ☞ reduced by 10% to 22% by cutting the junctura
• Traction on EDC4 provides 67% of long finger extension = 38° ☞ After cutting
the junctura, the long finger MCP joint is only able to extend to 20°.
Von Schroeder HP, Botte MJ. The functional significance of the long extensors and juncturae tendinum in finger extension. J Hand
Surg 1993;18A:641-7.)
JUNCTURAE SHOULD (PROBABLY) NOT BE
REPAIRED
• Division of juncturae is
mandatory in reverse
intermetacarpal flaps w/o
consequences
• EDM: Repair
• EIP: Repair