AO Trauma Hand NA Faculty Contribute to Evidence
15 October 2020
Upper Extremity Tendon Transfers
Tendon transfer in the upper extremity represents a powerful tool in the armamentarium of a reconstructive surgeon in the setting of irreparable nerve injury or the anatomic loss of key portions of the muscle-tendon unit. The concept uses the redundancy/expendability of tendons by utilizing a nonessential tendon to restore the function of a lost or nonfunctional muscle-tendon unit of the upper extremity.
The conceptual foundation of using a dispensable muscle to replace the function of a paralyzed or lost muscle lies in the polio epidemics in Europe in the 19th century which left many children paralyzed at the inception of early modern surgery. The father of this technique is generally considered to be Carl Nicoladoni who first described its use in Innsbruck, Austria, using the peroneus longus tendon to treat paralysis from polio in 1882.
Tendon transfers have evolved from polio to tetraplegia to war and represent an extremely powerful technique to correct neurologic and musculotendinous deficits in a variety of patients affected by trauma, peripheral nerve palsies, cerebral palsy, stroke, and inflammatory arthritis. In the contemporary setting, these very same principles have also been very successfully applied to vascularized composite allotransplantation in the upper limb.
Find the full article here: Upper Extremity Tendon Transfers: A Brief Review of History, Common Applications, and Technical Tips.
Tension Band Wiring in Upper Extremity Surgery
Tension band wiring is a simple, inexpensive, and effective technique to treat many upper extremity fractures. When tension forces result in a mechanical failure of bone, tension band wiring provides stability and promotes early mobilization by converting tensile forces across a fracture into compressive forces.
The tension band principle has distinct advantages of reducing periosteal stripping, technical ease, and cost effectiveness when compared with other operative strategies. This technique can be implemented in a variety of fractures and avulsions about the upper extremity as well as small bone arthrodeses.
Find the full article here: Tension Band Wiring in Upper Extremity Surgery.