Aims.
Aims. To describe and analyze the mid-term functional outcomes of a large series of patients who underwent the Hoffer procedure for
We reviewed 101 patients with injuries of the
terminal branches of the infraclavicular
Objectives. Traumatic
We present the long-term results of open surgery
for internal shoulder rotational deformity in
We evaluated results at one year after surgical
correction of internal rotation deformities in the shoulders of
270 patients with obstetric
A total of 11 patients with combined traumatic injuries of the
Aims. Multiple secondary surgical procedures of the shoulder, such as soft-tissue releases, tendon transfers, and osteotomies, are described in
We describe the long-term results in ten patients with obstetric
We present our experience of managing patients
with iatropathic
1. In the first 1600 of the series of peripheral nerve injuries treated during the years 1940-45 at the Peripheral Nerve Injuries Unit, Oxford, 52 per cent. were due to penetrating wounds, and 6 per cent. of these involved the
We studied a consecutive series of 58 patients with penetrating missile injuries of the
Intraspinal re-implantation after traumatic avulsion of the
Residual muscle weakness in obstetric
Most
This is a prospective study of 107 repairs of obstetric
We investigated the incidence of evidence of irritation of the
Restoration of hand function is rarely achieved after a complete closed traction lesion of the supraclavicular
Clavicular fractures are occasionally responsible for lesions of the
1. Twenty-nine patients with traction lesions of the
Between March 1994 and June 2003, 80 patients with
We used evoked spinal cord potentials (ESCP) for intraoperative diagnosis in 17 cases of traumatic
We reviewed 28 patients with
We describe the results of surgical treatment in a prospective study of 183 consecutive cases of subluxation (101) and dislocation (82) of the shoulder secondary to obstetric
Hand function was evaluated in 105 patients who had been operated on in early infancy for
Most obstetric
We have compared the functional outcome after glenohumeral fusion for the sequelae of trauma to the
We investigated the effect of delay before nerve repair on neuropathic pain after injury to the
Shoulder arthrodesis is often used to treat flail shoulder after a
We reviewed 42 consecutive children with a supination deformity of the forearm complicating severe birth lesions of the
We retrospectively reviewed 26 patients who underwent reconstruction of the shoulder for a medial rotation contracture after birth injury of the
Over a period of twenty years a small number of patients, thirty-one, have been seen who suffered injuries of the infraclavicular
Between March 1969 and May 1978, 36 babies sustained birth injuries of the
We have assessed the efficacy of free nerve grafts in 90 cases of
We describe the early results of glenoplasty as part of the technique of operative reduction of posterior dislocation of the shoulder in 29 children with obstetric
An internal rotation contracture is a common complication of obstetric
1. Sixty-three traction injuries of the
1. Sixty myelographs have been obtained in severe traction injuries of the
The clinical results in a series of 131 patients with 134
1 . Thirty-six patients with complete irrecoverable
Between October 1972 and December 1980, 139 post-traumatic
We used magnetic resonance (MR) myelography in ten patients with injuries to the
We have reviewed seven patients who had triceps transfer after an old
Severe traction injuries may damage the
After
Four cases of posterior dislocation of the shoulder at birth in association with obstetric
1. The deep posterior muscles of the neck are innervated by the posterior branches of spinal nerves, which branch off immediately after the root emerges from the intervertebral foramen. Electromyographic examination of these muscles permits a differential diagnosis to be made between intraforaminal and extraforaminal
Of 64 patients with stab wounds involving the
We reviewed 19 children who had undergone a new modification of the L'Episcopo procedure for obstetric
We have reviewed 50 patients at a mean period of 2.7 years after operations to restore elbow flexion lost as a result of traction injuries of the
Ultrasound (US) was used to determine the congruity of the shoulder in 22 children with a deformity of the shoulder secondary to chronic obstetric
Twenty patients with complete
We reviewed a consecutive series of 33 infants who underwent surgery for obstetric
Of 22 infants aged between 11 and 29 months who underwent a combined reconstruction of the upper
We undertook a prospective MRI study to measure the retroversion of the humeral head in 33 consecutive infants with a mean age of 1 year 10 months (3 months to 7 years 4 months) who had an obstetric
The precise point of intradural rupture in preganglionic traction injuries to the
Non-operative management has frequently been adopted for closed injuries of the infraclavicular
We performed intercostal nerve transfer in 19 patients to relieve pain from preganglionic injury to the
The purpose of this study is to investigate the diagnostic value of evoked spinal cord potentials (ESCPs) and choline acetyltransferase (CAT) activity during exploration of injuries to the
Of a consecutive series of 70 babies with obstetric traction injury to the
We performed a prospective study using MRI in 16 consecutive infants with a mean age of 5.2 months (2.7 to 8.7) who had shown inadequate recovery from an obstetric lesion of the
One pattern of injury to the
In 15 patients who underwent open exploration of the
We studied the motor evoked potentials (MEP) in the biceps of 25 patients with traumatic
The medial rotation contracture caused by weak external rotation secondary to obstetric brachial plexus injury leads to deformation of the bones of the shoulder. Scapular hypoplasia, elevation and rotation deformity are accompanied by progressive dislocation of the humeral head. Between February and August 2005, 44 children underwent a new surgical procedure called the ‘triangle tilt’ operation to correct this bony shoulder deformity. Surgical levelling of the distal acromioclavicular triangle combined with tightening of the posterior glenohumeral capsule (capsulorrhaphy) improved shoulder function and corrected the glenohumeral axis in these patients. The posture of the arm at rest was improved and active external rotation increased by a mean of 53° (0° to 115°) in the 40 children who were followed up for more than one year. There was a mean improvement of 4.9 points (1.7 to 8.3) of the Mallet shoulder function score after surgical correction of the bony deformity.
Between 2002 and 2011, 81 patients with a traumatic total brachial
plexus injury underwent reconstruction by double free muscle transfer
(DFMT, 47 cases), single muscle transfer (SMT, 16 cases) or nerve
transfers (NT, 18 cases). They were evaluated for functional outcome and quality of life
(QoL) using the Disability of Arm, Shoulder and Hand questionnaire,
both pre- and post-operatively. The three groups were compared and
followed-up for at least 24 months.Aims
Methods
The use of a rotation osteotomy of the humerus in 10 patients with disabling loss of lateral rotation at the shoulder due to brachial plexus birth injuries is described. The operative technique and complications are discussed. Before operation only one patient was independent, but after operation nine of them were. Restoration of lateral rotation at the shoulder can improve the function, the appearance and the independence of these handicapped patients.
We investigated the predictive value of intra-operative
neurophysiological investigations in obstetric brachial plexus injuries.
Between January 2005 and June 2011 a total of 32 infants of 206
referred to our unit underwent exploration of the plexus, including
neurolysis. The findings from intra-operative electromyography,
sensory evoked potentials across the lesion and gross muscular response
to stimulation were evaluated. A total of 22 infants underwent neurolysis
alone and ten had microsurgical reconstruction. Of the former, one
was lost to follow-up, one had glenoplasty and three had subsequent
nerve reconstructions. Of the remaining 17 infants with neurolysis,
13 (76%) achieved a modified Mallet score >
13 at a mean age of
3.5 years (0.75 to 6.25). Subluxation or dislocation of the shoulder
is a major confounding factor. The positive predictive value and
sensitivity of the intra-operative EMG for C5 were 100% and 85.7%,
respectively, in infants without concurrent shoulder pathology.
The positive and negative predictive values, sensitivity and specificity
of the three investigations combined were 77%, 100%, 100% and 57%, respectively. In all, 20 infants underwent neurolysis alone for C6 and three
had reconstruction. All of the former and one of the latter achieved
biceps function of Raimondi grade 5. The positive and negative predictive
values, sensitivity and specificity of electromyography for C6 were
65%, 71%, 87% and 42%, respectively. Our method is effective in evaluating the prognosis of C5 lesion.
Neurolysis is preferred for C6 lesions. Cite this article:
Injuries to the limb are the most frequent cause
of permanent disability following combat wounds. We reviewed the medical
records of 450 soldiers to determine the type of upper limb nerve
injuries sustained, the rate of remaining motor and sensory deficits
at final follow-up, and the type of Army disability ratings granted.
Of 189 soldiers with an injury of the upper limb, 70 had nerve-related
trauma. There were 62 men and eight women with a mean age of 25
years (18 to 49). Disabilities due to nerve injuries were associated
with loss of function, neuropathic pain or both. The mean nerve-related
disability was 26% (0% to 70%), accounting for over one-half of
this cohort’s cumulative disability. Patients injured in an explosion
had higher disability ratings than those injured by gunshot. The
ulnar nerve was most commonly injured, but most disability was associated
with radial nerve trauma. In terms of the final outcome, at military
discharge 59 subjects (84%) experienced persistent weakness, 48
(69%) had a persistent sensory deficit and 17 (24%) experienced
chronic pain from scar-related or neuropathic pain. Nerve injury
was the cause of frequent and substantial disability in our cohort
of wounded soldiers. Cite this article:
The October 2023 Shoulder & Elbow Roundup. 360. looks at: Arthroscopic capsular shift surgery in patients with atraumatic shoulder joint instability: a randomized, placebo-controlled trial; Superior capsular reconstruction partially restores native glenohumeral loads in a dynamic model; Gene expression in glenoid articular cartilage varies in acute instability, chronic instability, and osteoarthritis; Intra-articular injection versus interscalene
In adults with
We performed a double-blind, randomised controlled trial to assess the effectiveness of a continuous-infusion
Aims . To analyse the influence of upper extremity trauma on the long-term
outcome of polytraumatised patients. . Patients and Methods. A total of 629 multiply injured patients were included in a follow-up
study at least ten years after injury (mean age 26.5 years, standard
deviation 12.4). The extent of the patients’ injury was classified
using the Injury Severity Score. Outcome was measured using the
Hannover Score for Polytrauma Outcome (HASPOC), Short Form (SF)-12, rehabilitation
duration, and employment status. Outcomes for patients with and
without a fracture of the upper extremity were compared and analysed
with regard to specific fracture regions and any additional brachial
plexus lesion. Results. In all, 307 multiply-injured patients with and 322 without upper
extremity injuries were included in the study. The groups with and
without upper limb injuries were similar with respect to demographic
data and injury pattern, except for midface trauma. There were no
significant differences in the long-term outcome. In patients with
brachial plexus lesions there were significantly more who were unemployed,
required greater retraining and a worse HASPOC. Conclusion. Injuries to the upper extremities seem to have limited effect
on long-term outcome in patients with polytrauma, as long as no
injury was caused to the
We describe three patients with pre-ganglionic (avulsion) injuries of the
Symptoms of obstetric brachial plexus injury (OBPI) vary widely
over the course of time and from individual to individual and can
include various degrees of denervation, muscle weakness, contractures,
bone deformities and functional limitations. To date, no universally
accepted overall framework is available to assess the outcome of patients
with OBPI. The objective of this paper is to outline the proposed
process for the development of International Classification of Functioning,
Disability and Health (ICF) Core Sets for patients with an OBPI. The first step is to conduct four preparatory studies to identify
ICF categories important for OBPI: a) a systematic literature review
to identify outcome measures, b) a qualitative study using focus
groups, c) an expert survey and d) a cross-sectional, multicentre
study. A first version of ICF Core Sets will be defined at a consensus
conference, which will integrate the evidence from the preparatory
studies. In a second step, field-testing among patients will validate this
first version of Core Sets for OBPI.Background
Methods
1. Evidence is presented that certain types of cervical spine injury are due mainly to lateral flexion forces. 2. These injuries are often complicated by a
An experimental model was established to investigate the possibility of repairing cervical nerve roots avulsed from the spinal cord, as occurs in traction injuries of the
Aims. Improvements in the evaluation of outcomes following peripheral nerve injury are needed. Recent studies have identified muscle fatigue as an inevitable consequence of muscle reinnervation. This study aimed to quantify and characterize muscle fatigue within a standardized surgical model of muscle reinnervation. Patients and Methods. This retrospective cohort study included 12 patients who underwent Oberlin nerve transfer in an attempt to restore flexion of the elbow following
We examined the outcomes and levels of patient
satisfaction in 202 consecutive cases of ultrasound-guided supraclavicular
brachial plexus block (SBPB) in upper limb surgery performed between
September 2007 and March 2010. All blocks were performed by orthopaedic surgeons using ultrasound
visualisation with a high-frequency linear probe. The probe was
placed in the coronal–oblique plane in the supraclavicular fossa,
and the puncture was ‘in-plane’ from lateral to medial. Most of
the blocks were performed with 0.75% ropivacaine/1% lidocaine (1:1),
with or without adrenaline in 1:200 000 dilution. In 201 patients
(99.5%) the
1 . Twenty-one cases of poliomyelitis and twenty cases of
After establishing anatomical feasibility, functional reconstruction to replace the anterolateral part of the deltoid was performed in 20 consecutive patients with irreversible deltoid paralysis using the sternoclavicular portion of the pectoralis major muscle. The indication for reconstruction was deltoid deficiency combined with massive rotator cuff tear in 11 patients,
We describe a patient who sustained a widely displaced, high-energy, mid-shaft clavicular fracture in association with
We retrospectively studied the possibility that direct trauma to the biceps muscle might be the cause of poor elbow flexion and supination in 18 consecutive children with birth lesions of the
The February 2013 Children’s orthopaedics Roundup. 360 . looks at: ABC treated with suction and curettage; peri-acetabular osteotomy; cast index; Perthes’ disease associated with accidental injury;
Aims. Improvements in the evaluation of outcome after nerve transfers
are required. The assessment of force using the Medical Research
Council (MRC) grades (0 to 5) is not suitable for this purpose.
A ceiling effect is encountered within MRC grade 4/5 rendering this
tool insensitive. Our aim was to show how the strength of flexion
of the elbow could be assessed in patients who have undergone a
re-innervation procedure using a continuous measurement scale. Methods. A total of 26 patients, 23 men and three women, with a mean age
of 37.3 years (16 to 66), at the time of presentation, attended
for review from a cohort of 52 patients who had undergone surgery
to restore flexion of the elbow after a