PURPOSE OF THE STUDY: The aim of this study to evaluate the subjective and objective results of Extensor indicis proprius (EIP) to extensor pollicis longus (EPL) transfer with an emphasis on donor site morbidity. MATERIAL AND METHODS: 17 patients (59% men, 41% women) who underwent EIP-EPL transfer were retrospectively analyzed. The mean age was 43 (9-64) years, and the mean follow-up was 72 (19-124) months. The extensor strengths were measured according to the Medical Research Council (MRC) scoring system. Nail tip-table surface distance (NTD) was measured to evaluate extension loss, and pulp-palm distance (PPD) to evaluate thumb flexion-adduction limitation. Grip and key pinch strengths were measured and corrected regarding the dominance and compared with those of the non-operated side. Quick Disability of Arm, Shoulder, and Hand (QDASH) and satisfaction scores of the patients were evaluated. RESULTS: Donor site morbidity was detected in 6 patients (35%). The extension strength of the index finger was found to be significantly lower than the non-operative side (p<0.05). Thumb mean NTD and PPD values were 6.8 (0-50) and 2.9 (0-20) mm, respectively. The index finger mean NTD was 0.6 (0-10) mm. The grip strength was 86% (43%-100%) and the pinch strength was 82% (31-100%) of the expected strengths. Compared to the preoperative period, there was a significant decrease in the QDASH score (p <0.05). Postoperative QDASH scores of patients with donor site morbidity were significantly higher than those without (p <0.05). CONCLUSIONS: Although patients are generally satisfied with the EIP-EPL transfer results, the permanent morbidity rate in the index finger is high. Therefore, alternatives other than EIP should be considered for transfer to EPL in individuals whose occupation requires complete and strong index finger extension. KEY WORDS: extensor pollicis longus, neglected tendon laceration, extensor indicis proprius, tendon transfer, donor site morbidity.

• MeSH
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• palec ruky chirurgie   fyziologie   MeSH
• přenos šlachy * metody   MeSH
• retrospektivní studie MeSH
• rozsah kloubních pohybů MeSH
• síla ruky fyziologie   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Gas gangrene is a rare and potentially fatal surgical complication, most often associated with contaminated traumatic wounds or more rarely following cases of abdominal surgery. The following article describes a case of gas gangrene in the right lower limb of a 34-year-old patient following an elective posterior tibial tendon transfer. The surgery was performed in bloodless fashion, utilizing a surgical tourniquet. Fifteen months prior to the procedure, the patient was attacked by a wild boar, resulting in a tear of the upper calf with complete transection of the right common fibular nerve. The patient underwent a total of three acute surgical procedures, of which the third resulted in below knee amputation. The patient then underwent a final corrective procedure and was fitted with a suitable leg prosthesis. In the discussion, three possible pathophysiological mechanisms of gas gangrene development are described - iatrogenic inoculation of bacteria during injection of local anesthetics for conduction anesthesia, iatrogenic inoculation of bacteria during the posterior tibial tendon transfer and activation of latent clostridial spores within the original wound caused by the wild boar. We consider the third mechanism most likely, as boar tusks contaminated with soil and debris are a more likely source of clostridial spores, than sterile surgical instruments. Furthermore, it is likely the surgical tourniquet played a key role in activating latent spores within the patient wound, as changes in tissue oxygen levels are a common cause of spore activation. Thus, we suggest caution in utilizing bloodless operating fields in elective cases with a history of open contaminated wounds, as the iatrogenic hypoxia can potentially activate sporulent bacteria within the patients wound.

• Klíčová slova
• amputation, gas gangrene, nerve trauma, tendon transfer, tourniquet,
• MeSH
• amputace MeSH
• dospělí MeSH
• elektivní chirurgické výkony MeSH
• gangréna plynatá * etiologie   MeSH
• lidé MeSH
• nervus peroneus MeSH
• prasata MeSH
• přenos šlachy MeSH
• zvířata MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE OF THE STUDY The prevalence of nerve structure injuries accompanying pelvic and acetabular fractures is stated to be 5-25 %, with most frequent injuries to motor nerve structures associated with fractures of the posterior wall of the acetabulum. Prognostically worse outcomes of regeneration are documented mainly in iatrogenic, intraoperative injuries to nerve structures. This study aims to document the functional effect of muscle transfers restoring the movement of lower extremities with irreversible nerve lesion caused by the pelvic and acetabular fracture. MATERIAL AND METHODS A total of 18 patients with irreversible palsy of lower extremities in L4-S1 segments underwent a reconstruction surgery in the period 2006-2016, of whom 13 patients with the mean age of 42 (21-79) years arrived for a follow-up. The group included 10 patients with the loss of function of peroneal portion of the sciatic nerve, one patient sustained femoral nerve lesion and two patients suffered complete sciatic nerve lesion (both the peroneal and tibial portion). The patients were evaluated at the average follow-up of 77 (24-129) months after the reconstruction surgery. The average time interval from pelvic fracture to reconstruction by muscle transfer was 47 (18-151) months. Due to a wide spectrum of functional damage, the patients were evaluated in terms of the overall effect of the reconstruction surgery on the activities of daily living using the LEFS (The Lower Extremity Functional Scale). The surgical techniques used transposition of tensor fascie latae for femoral nerve lesion, transposition of tibialis posteriormuscle for palsy of the peroneal division of the sciatic nerve and tenodesis of tibialis anterior tendon and peroneus longustendon for the palsy of the peroneal and tibial portion of sciatic nerve. RESULTS The effect of movement restoration on daily living evaluated using the LEFS achieved 65 points (53-79) which is 85% of the average value of LEFS in healthy population. The transposition of active muscles tibialis posterior and tensor fasciae latae resulted in all the patients in active movement restoration. A loss of correction of foot position following the performed tenodesis of the paralysed tibialis anterior muscle was observed in one patient, with no significant impact on function. No infection complication was reported in the group. In 78% of patients the intervention was performed as day surgery. DISCUSSION There is a better prognosis for restoration in incomplete nerve lesion than in complete lesions and also in the loss of sensation than in the loss of motor function. The mini-invasive stabilisation of pelvic ring according to literature does not increase the risk of nerve lesions, while on the other hand a higher incidence of femoral nerve damage by INFIX fixator is documented. The type of muscle transfer is selected based on the availability of active muscles suitable for transposition and also with respect to functional requirements of the patient. CONCLUSIONS Irreversible palsy of lower extremity after the pelvic fracture is easily manageable as to the restoration of function. Surgical interventions using the preserved active muscles to restore the lost movement should be a component part of comprehensive surgical care for patients who sustained a pelvic fracture and should be performed centrally at a centre availing of comprehensive expertise. Key words: nerve lesion, tendon transfer, acetabulum, pelvis, fracture.

• MeSH
• acetabulum zranění   MeSH
• činnosti denního života MeSH
• dospělí MeSH
• fraktury kostí komplikace   MeSH
• kosterní svaly inervace   transplantace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mononeuropatie etiologie   chirurgie   MeSH
• pánevní kosti zranění   MeSH
• paraplegie etiologie   chirurgie   MeSH
• plexus lumbosacralis zranění   MeSH
• poranění dolní končetiny chirurgie   MeSH
• poranění periferního nervu etiologie   chirurgie   MeSH
• přenos šlachy metody   MeSH
• prognóza MeSH
• senioři MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

Vascularized bone grafting was for the first time described in the 1970s. It has become a crucial component in the reconstruction of long bone defects and non-unions in a poorly vascularised environment. Although the vascularized bone is well described for the lower extremity and mandibular reconstructions, it started to be used for the upper extremity bone defects only recently. This publication presents a case of a young man with an open fracture of both the forearm bones. The treatment of the injury has been complicated with anaerobic gas gangrene of the forearm. This resulted in a non-union, radius shortening and necrosis of both the thumb extensors and flexors muscles. Once the acute infection was managed, the patient received a two-step treatment provided jointly by orthopaedic and plastic surgeons at the University Hospital in Bratislava. At the first stage auto transplantation of the vascularized fibula into the defect of radius was performed, with radial artery and radial veins being the recipient vessels. One year later, a tendon transfer was made in order to reconstruct the extension and flexion of the thumb. Donor tendons were the following: extensor indicis proprius and flexor digitorum superficialis for ring finger. The result of the reconstruction is the full incorporation of the fibular transplant (6 months after the primary operation) and the excellent range of motion of the hand and wrist. Thanks to the tendon transfer the function of the thumb, including the opposition, was achieved two months after the secondary surgery. Key words: defect of radius, tendon transfer, anaerobic infection, gas necrosis, microsurgery.

• MeSH
• autologní transplantace MeSH
• fibula krevní zásobení   transplantace   MeSH
• fraktury ulny chirurgie   MeSH
• fraktury vřetenní kosti chirurgie   MeSH
• gangréna plynatá chirurgie   terapie   MeSH
• lidé MeSH
• otevřené fraktury chirurgie   terapie   MeSH
• poranění předloktí chirurgie   terapie   MeSH
• předloktí krevní zásobení   chirurgie   MeSH
• přenos šlachy metody   MeSH
• transplantace kostí MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE OF THE STUDY Transposition of tibialis posterior muscle ranks among the methods of dorsiflexion restoration in patients with peroneal nerve palsy. Even though this method is commonly used, anatomical variations are still encountered which make us modify the established procedures. The purpose of this study is to evaluate the functional outcomes of operated patients and based on the clinical experience to define by cadaver preparation the anatomical causes preventing the use of the standard transposition technique. MATERIAL AND METHODS The clinical group includes 21 patients (15 men, 6 women) with the mean age of 34.2 years and with common peroneal nerve palsy confirmed by EMG. In 20 patients, transposition of the tendon of the tibialis posterior muscle (MTP) through the interosseous membrane of the leg was performed. In one patient the tendon was transposed ventrally to the distal end of the tibia and fixed in the lateral cuneiform bone due to an extremely narrow space of the interosseous membrane of the leg distally between the lower limb bones. In 18 patients the tendon was fixed by osteosuture to the base of 3rd metatarsal bone, in three patients to the lateral cuneiform bone. The outcomes were evaluated at 6 months after the surgery, when active ankle dorsiflexion (DF) range of motion greater than 5° was considered an excellent outcome, active position at 90° up to DF less than 5° a satisfactory outcome, and any plantigrade position as a poor outcome. The anatomical study included 20 extremities fixed by formalin (10 cadavers, 5 men and 5 women with the mean age of 71.3 years). The length of the individual parts of tibialis posterior muscle was measured and the variations of the muscle attachment were evaluated. The measurement was concluded by a simulation of surgical procedure. RESULTS When evaluating the clinical group, an excellent outcome was reported in 12 patients (57%), a satisfactory outcome in 8 patients (38%) and a poor outcome in one patient (5%). When evaluating the anatomical group, a division of the attaching part of the tendon into three main strips was observed. The thickest middle strip attached to the tuberosity of navicular bone and medial cuneiform bone was reported in all the specimens. The thinner lateral strip (originating from the tendon in 90% of specimens) was attached to the intermediate and lateral cuneiform bone, the cuboid bone, metatarsal bones II-V, and moreover it grows into the origin of the flexor hallucis brevis muscle. The third strip of the tendon attached to the sustentaculum tali, plantar calcaneonavicular ligament and fibrocartilago navicularis was missing in one specimen (5%). When the passing the tendon through the interosseous space between the lower limb bones was simulated in order for the tendon to go in the direction of the planned traction, in two specimens (10%) the pulling through was impossible due to the tendon being thicker than the interosseous space. In two specimens (10%) it was not the tendon, but already the muscular belly which passed through the given space. DISCUSSION In our group, 95% of the functional outcomes were excellent or satisfactory. A poor result was reported in one patient, in whom the EMG examination was not performed as a standard procedure and in whom the muscular strength was insufficient to achieve full dorsiflexion of the ankle. The anatomical study indicates that the narrow space between the lower limb bones can prevent the pulling through of the tendon, which can be addressed intraoperatively by the transposition of the tendon ventrally to tibia. The study reveals that the tendon necessary for transposition can be elongated by the strips of the tendon attached to the sole of the foot. CONCLUSIONS The knowledge of the anatomical conditions may help us better manage potential complications intraoperatively. Key words: tibialis posterior muscle, peroneal nerve palsy, transposition of tibialis posterior muscle, anatomy of tibialis posterior muscle, common fibular nerve palsy.

• MeSH
• dospělí MeSH
• kosterní svaly transplantace   MeSH
• lidé MeSH
• mrtvola MeSH
• neuropatie nervus peroneus chirurgie   MeSH
• obnova funkce MeSH
• přenos šlachy metody   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

For a foot drop resulting from peroneal nerve palsy transferring the tibialis posterior tendon is a standard surgical treatment. The situation of foot drop with no functioning tibialis posterior presents a challenge. We describe a case of successful flexor hallucis longus transfer in such a case. Key words: foot drop, flexor hallucis longus, peroneal nerve palsy; tendon transfer.

• MeSH
• lidé MeSH
• neuropatie nervus peroneus komplikace   chirurgie   MeSH
• přenos šlachy metody   MeSH
• získané deformity nohy (od hlezna dolů) etiologie   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE OF THE STUDY: The aim of the study was to compare results of the Burton-Pellegrini trapeziectomy with ligamentoplasty using the flexor carpi radialis tendon with those of trapeziometacarpal joint replacement in the treatment of advanced rhizarthrosis. MATERIAL AND METHODS: A group of 17 patients, 15 men and two women, underwent trapeziectomy with ligamentoplaty; in 12 of them, the dominant hand was involved. The trapeziometacarpal joint prosthesis Beznoska was implanted in 11 patients (10 men and one woman) with seven dominant and four non-dominant hands. All patients pre-operatively experienced pain during thumb movement and hand grip. They were examined before surgery and at 3, 6 and 12 months after it; the values obtained before and at 1 year after surgery were compared. The methods of evaluation included pain intensity assessed using the visual analogue scale (VAS), the Kapandji thumb opposition test and the disabilities of the arm, shoulder and hand (DASH) score (total DASH score and its thumb-targeted module). RESULTS: In the group treated by the Burton-Pellegrini procedure, the average pre- and post-operative Kapandji scores were 6.4 and 8.9, respectively. The average VAS scores were 5/10 pre-operatively and 1/10 post-operatively. The average values for the total pre- and post-operative DASH scores were 58 and 19 points, respectively. The DASH score in a thumb-targeted module assessing basal joint-loading in the thumb was 63 points before and 21 points after surgery. In the patients with total joint replacement, the average pre- and post-operative values were as follows: Kapandji score, 7.4 and 9.8; VAS score, 5/10 and 1/10; total DASH score, 56 and 7 points; thumb module DASH score, 60 and 11 points. Two serious complications were recorded, an infection in resection interposition arthroplasty and a trauma associated with total joint replacement loosening. Four patients showed transient paresthesia. DISCUSSION: Several methods for surgical treatment of rhizarthrosis are available today. Arthrodesis is still a widely used procedure although it inhibits thumb movements. Resection arthroplasty provides sufficient pain-free thumb motion, but radial shortening and a loss of grip strength are its disadvantages. Resection interposition arthroplasty results in sufficient painless motion. Tendon interposition provides enough stability for the thumb and for sufficient grip and pinch strength. The disadvantages of this method include a potential for failure of the suspensory tendon during over exercising or a weakened attachment of the autologous tendon to the bone and thus a risk of rupture. Total joint replacement respects the thumb anatomy, preserves the articular capsule and fibrous structures during conservative resection of joint surfaces and keeps the biomechanics of the basal joint of the thumb. It combines advantages of the other surgery procedures, by allowing for a painless range of motion in the joint and vital pinching and gripping abilities, while avoiding their disadvantages such as movement restriction and loss of grip strength. However, the technique may still bear any of the risks associated with foreign material implantation (dislocation, replacement failure, infection, etc.). CONCLUSIONS: The two techniques present valuable contributions to the treatment of advanced rhizarthrosis. In our patients, better outcomes are shown in trapeziometacarpal joint replacement though, in comparison with resection interposition arthroplasty, the indication criteria for this surgery are limited by factors such as the height of the trapezium bone and bone quality necessary for good osseointegration.

• MeSH
• artrodéza metody   MeSH
• artroplastiky kloubů metody   MeSH
• karpometakarpální klouby chirurgie   MeSH
• lidé MeSH
• měření bolesti metody   MeSH
• obnova funkce fyziologie   MeSH
• osteoartróza chirurgie   MeSH
• palec ruky chirurgie   MeSH
• přenos šlachy metody   MeSH
• protézy kloubů MeSH
• rozsah kloubních pohybů MeSH
• šlachy transplantace   MeSH
• trapézová kost chirurgie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

PURPOSE OF THE STUDY: Especially in such complex salvage procedures as latissimus dorsi transfer for irreparable rotator cuff tears there is a need for valid prognostic prediction parameters. Parameters such as osteoarthritis, acromiohumeral distance, subscapularis, or teres minor insufficiency are controversial. The aim of this study is to present our data and to evaluate the literature regarding such parameters. METHODS: Fifty-seven patients with a follow-up of 3 years (range, 18-72 months, n = 57) were selected for this study. Average age of patients at the time of surgery was 64.9 years. Patients were evaluated using the age and gender adjusted scoring system according to Constant and Murley score (CS). Standard radiography was attempted containing a true-ap, outlet, and axillary view. The acromio-humeral distance was measured in the true ap view. The grade of glenohumeral osteoarthritis and cuff tear arthropathy was detected using the classification of Hamada et al. Differences in CS were compared for each of the PPP. RESULTS: Mean Constant score increased significantly (p < 0.0001) 3 years postoperatively from initially 22.7 points to 66.0 points (adjusted CS 80.3%). We found a major difference in the Constant score in patients with or without previous surgery (80.4% vs, 65.2%). CONCLUSION: Latissimus dorsi transfer is an excellent option in the treatment of irreparable postero-superior tears of the rotator cuff in well-selected patients. The literature remains ambiguous with regard to valid prognostic predictive parameters for complex salvage procedures, owing to the consistent use of small study samples. Thus, there is an overwhelming need for a multicenter study.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• poranění rotátorové manžety * MeSH
• přenos šlachy metody   MeSH
• prognóza MeSH
• rotátorová manžeta chirurgie   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY: Two tendons, i.e., the extensor indicis proprius (EIP) and the extensor carpi radialis longus (ECRL), are commonly used to reconstruct the function of a ruptured extensor pollicis longus (EPL) tendon. We reviewed a group of patients with EPL ruptures treated by ECRL tendon transfer to the EPL tendon, which was the method of choice. The aim was to evaluate the results and to assess the effect of ECRL detachment on hand function. MATERIAL AND METHODS: Twenty patients were treated surgically for a subcutaneous rupture of the EPL tendon between 2003 and 2007. Each patient was examined at 2 years after surgery. The range of motion (ROM) of both the injured and the contralateral hand was recorded and evaluated with a modified Geldmacher scoring system; a response to the DASH questionnaire was obtained. The mean follow-up was 24 months (19-31 months). RESULTS: For the ROM of the operated hand, the mean Total Active Motion (TAM) of 98.75 degrees (60-140, SD 22.74) was calculated. The mean extension lag at the interphalangeal (IP) joint was 5.42 degrees (0-25, SD 8.77) and the mean IP flexion was 65.8 degrees (40-80, SD 13.2). In order to evaluate body side differences, the ROM of the contralateral thumb was recorded. The values were as follows: mean TAM, 141.3 degrees (115-190, SD 20.43); mean IP extension lag, 0 degrees (0-0, SD 0); mean IP flexion, 68.8 degrees (50-80, SD 9.6). DISCUSSION: The extension lag at the IP joint was detected in both the operated and the contralateral hands. The patients examined at a longer interval after surgery showed an increase in extension lag. This may have been caused by undesired adaptation of the donor muscle, the presence of adhesions or suture loosening. CONCLUSIONS: The results showed increased adaptation of thumb motion to the extension lag at the IP joint, which had a mild effect on the patient's hand function. The difference in wrist extension between the operated and the contralateral hand corresponded to the pre-operative condition.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• palec ruky zranění   MeSH
• poranění šlachy chirurgie   MeSH
• přenos šlachy * metody   MeSH
• prsty ruky MeSH
• ruptura MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• senioři MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

INTRODUCTION: Common peroneal nerve palsy is the commonest lower extremity peripheral paresis. The foot drop and inability or difficulty to move the ankle and toes dorsally and inability to perform foot pronation is a debilitating condition for the patient. Tendon transfer is a treatment option often used to restore the foot function after the peroneal palsy in cases when reinervation is not clinically satisfactory. MATERIAL AND METHODS: The study group included 14 patients treated in the Trauma department of FNO either for common or deep peroneal nerve paresis, or for isolated lesion of the anterior tibial muscle. Active muscles, i.e.the posterior tibial muscle (13 patients) or long peroneal muscle (1 patient) were used for the movement restoration procedure. The tendons were anchored to the cuneiform bone. RESULTS: In all the patients, active foot extension was restored, with the average range of motion of 12.3 degrees (4-20) and with sufficient muscle strength. Based on the Stanmore score assessment, the subjects showed good results, reaching 87-100 points. CONCLUSION: The posterior tibial muscle tendon transfer, or peroneus longus muscle tendon transfer lead to restoration of active extension of the foot. The reconstruction procedure results in a minor restriction of the ankle range of motion. Considering the foot functionality, it is better to perform the transfer with a slight preload of the tendon, in order to achieve adequate postoperative ankle extension.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• neuropatie nervus peroneus patofyziologie   chirurgie   MeSH
• noha (od hlezna dolů) inervace   patofyziologie   MeSH
• přenos šlachy * MeSH
• rozsah kloubních pohybů MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH