Background: Use of fascio-cutaneous or fascial flaps are well known methods of reconstruction of dorsal hand defects to preserve the gliding movement of the extensor tendons. Whilst reconstruction of large hand defects extending to the wrist or the distal forearm entails use of larger flaps with large donor sites, so muscle flaps may have an advantage over the fascial or fascio-cutaneous flaps in coverage of these large defects. The aim of this study is to compare the gliding of the extensor tendons underneath fascio-cutaneous and muscle flaps on the dorsum of the hand. Patients and Methods: The study included 20 patients with dorsal hand trauma with exposed extensor tendons, ten defects were reconstructed by free muscles flap and split thickness skin graft and the other ten were reconstructed with fascio-cutaneous flaps. Early rehabilitation in all cases was done by a single dedicated physiotherapist. Tendon gliding was assessed by measurement of active flexion and extension at the metacarpo-phalangeal joint using goniometer after complete flap healing four months following flap inset. Results: There was no statistically significant difference in gliding for extensor tendons in patients with hand defects reconstructed by free muscle flaps and skin graft versus fasciocutaneous flaps. Conclusion: Both fascio-cutaneous and free muscle flaps had comparable results concerning the extensor tendons gliding underneath.
Background: Hand injuries are among the most frequent injuries worldwide, constituting between 6.65% to 28.6% of all injuries and 28% of injuries to the musculoskeletal system. Early post-operative rehabilitation and splinting after flexor tendon repair is very important to improve tendon healing. Presence of dedicated physical therapists play a golden role in early rehabilitation and diagnosis of tendon complications.Patients and Methods: Data collected from all admitted cases with hand injuries during the period (from January 2016 to December 2017). In late 2016, a dedicated physical rehabilitation hand subunit was created in Physical Medicine and Rehabilitation Department. Hand ultrasound was done to exclude tendon rupture or tendon adhesions.Results: 475 cases of flexor tendon injury, zone II injuries for fingers were the most common meanwhile, for thumb injuries; zone III in 2016 and zone II in 2017 were the most common, the rate of flexor tendon rupture in 2016 was 4.32% (3.3% was early rupture within three weeks) while in 2017 was 2.87% (2.6% were early rupture after three weeks), Tendon adhesions occurred in 7.32% of total cased in 2016 while in 2017 was 4.76%. Conclusion:Epidemiological data enhances our knowledge of injury patterns and may play a role in the treatment of tendon injuries. With early physical rehabilitation, better prognosis was achieved and hence better functional outcome.
Base of the thumb OA represents one of challenges to clinicians due to limited efficacy of treatment options. Resulting in OA pain, in addition it can cause deformity, stiffness with decreased range of motion and strength. The conservative therapeutic approach is the main line in management. Local injection treatment could be a good choice because of low systemic side effects and rapid improvement. Objectives to compare the effectiveness of PRP versus hyaluronic acid injection in osteoarthritis of thumb carpometacarpal joint based on clinical and functional outcome measures. Patients and Methods Prospective interventional study conducted on thirty patients with thumb CMC OA. Patient was assessed by joint Palpation for tenderness with grading from I-IV, Provocative tests (Grind test and Lever test), VAS for pain, AUSCAN score, grip and pinch strength. The patients were randomly divided into two equal groups, Group 1: received single Platelet-Rich Plasma (PRP) intra-articular injection. Group 2 received single hyaluronic acid injection. Re-evaluation at 4 and 12 weeks was done for tenderness, VAS, AUSCAN index, Grip and pinch strength. Results This study was conducted on thirty patients with ages ranged from 40 to 70 years (mean: 52.77 ± 8.59). Our results revealed that both groups showed a highly significant improvement after 4 weeks regarding pain relief assessed by VAS, tenderness grading, AUSCAN hand function score, grip and pinch strength after injection in comparison to before injection (P = 0.000). However, these improvement couldn’t be sustained for the PRP group after 12 weeks, there was a highly statistically significant increase (deterioration) in hand functional score from 4 to 12 weeks follow up (P = 0.000) and total score (P = 0.004) , highly statistically increase in VAS(P = 0.000) and decrease in grip & pinch strength (P = 0.000) , while HA group showed a highly statistically significant improvement regarding pain, hand function score , grip and pinch strength after 12 weeks of injection. Conclusion We observed clinical improvement in both groups of CMC OA treated either with single dose of HA or PRP at 4 and 12 weeks follow up. However, HA provide a superior improvement with respect to PRP at 12 weeks follow up regarding VAS for pain, joint tenderness, AUSCAN hand function score, grip and pinch strength. So we support the use of a single hyaluronic acid injection as therapy for thumb CMC OA in preference to PRP injection.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.