Leprosy, Hansen's disease caused by mycobacterium leprae, is widely known. Though there has been a substantial achievement in recent years given eliminating the disease, the deformity caused by the disease needs to be managed by reconstructive surgery. The ulnar nerve being superficial, is the most common nerve affected. When affected, the muscles innervated by the nerve begin to weaken, leading to a disparity between the strong extrinsic muscles and the weakened intrinsic muscles and is characterized clinically by metacarpophalangeal joint hyperextension and flexion of the proximal and distal interphalangeal joint. Doing reconstructive surgery on these patients will help them carry out day-to-day activities and reduce social awkwardness. Corrective surgeries like modified Stiles-Bunnell transfer, extensor carpi radialis graft, Zancolli lasso procedure, and palmaris longus tail graft are known to us. Out of all, the Zancolli lasso procedure was chosen for operating on all our cases because all other surgeries need high precision with proper training and proper post-operative physiotherapy. The study aims to evaluate the functional outcome of patients with leprotic ulnar claw hand operated with the Zancolli lasso procedure. Objectives assessed were deformity correction, grip strength, and range of motion. During the last two years, ten patients with ulnar claw hands came to Sree Balaji Medical College and Hospital, Chennai. They were operated on with the Zancolli Lasso procedure with adequate results. The zancolli procedure is easy to do and can be done in small centers, which restores finger flexion and doesn’t harm other superficialis tendons, thus preventing swan neck deformity of the fingers.
Sustentaculum tali is a horizontal shelf-like projection on the medial part of the calcaneum. The medial facet articulates to the talus and supports the medial column of the foot. The spring ligament originates at the plantar aspect of sustentaculum tali, and flexor hallucis longus passes below it and indirectly supports the longitudinal arch of the foot. Sustentaculum tali is a strong cortical bone, so its isolated fracture is unusual. Therefore, the fracture of the sustentaculum tali is easily misdiagnosed. The patients complain of pain below the medial malleolus and also on passive movement of the flexor hallucis longus tendon. The patient has a history of falls from height with the foot supinated or associated talus fracture. Sustentaculum tali fractures are sometimes considered to be extra-articular fractures. CT scan helps diagnose the intraarticular medial facet involvement in this fracture and is now regarded as intra-articular. Need of the study is to make the clinicians aware that these fractures, even if rare, do happen, if mismanaged, may lead to complications like impingement of flexor hallucis longus, post-traumatic arthritis etc. The study aimed to identify the clinical features and diagnosis of sustentaculum tali fracture and its management to prevent complications. Surgical reconstruction of the sustentaculum tali with a direct medial approach and fixation with cannulated cancellous screws. Ten patients were operated on in the last five years, and seven patients showed up for follow-up and had excellent results per the AOFAS scoring system. All of the fractures had signs of radiological union by the end of the third month. In Conclusion, Sustentaculum tali fracture, when suspected, should not be ignored, and the fracture must be fixed surgically. The current aspect of surgical fixation is befitting and should not be disregarded.
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