We designed a new method using hemi-longitudinal second metacarpal bone to reconstruct grade -3 hypoplastic thumbs. Seven patients were treated in two stages. In the first stage, the second metacarpal was split longitudinally and transferred to reconstruct the first metacarpal. In the second stage, opponensplasty was performed by transferring the FDS tendon. Bone union was achieved in all cases. All patients could oppose to their middle finger at least. They managed to do daily activities such as writing, eating, using smartphones and so on. This is a useful procedure to preserve a 5 -digit hand with good function in treating grade -3 hypoplastic thumbs, with no harm to the foot and no need for vascular anastomosis. Level of evidence: IV. (c) 2023 Published by Elsevier Masson SAS on behalf of SFCM.

OBJECTIVESThe aim of this study is to make a diagnosis and a classification for congenital central slip hypoplasia. The surgical treatment was determined according to the classification.METHODSA retrospective study of 25 treated digits in 13 patients with congenital central slip hypoplasia was carried out. The central slip was classified into two types. Type I: The distance between the insertion of central slip and the proximal interphalangeal joint was shorter than or equal to 5 mm. Type II: The distance between the insertion of central slip and the proximal interphalangeal joint was longer than 5 mm. Tendon advancement or tendon graft was used for type I or II, respectively.RESULTSThe preoperative mean extension lag was 91° (range, 80°-100°), and the mean follow-up duration was 18 months (range, 9-24 months). The postoperative mean extension lag was 19° (range, 0°-50°). No matter whether in type I or II, the postoperative ranges of proximal interphalangeal joint extension had significant improvement compared with the preoperative ones. There was no statistical difference of proximal interphalangeal joint extension lag changes before and after surgery between the two types.CONCLUSIONCongenital central slip hypoplasia could be classified into two types. Either tendon advancement or tendon graft might be effective, which depended on the classification.

Objective To analyze the intraoperative exploration and postoperative follow-up of revision cases of ulnar nerve anterior transposition,to summarize the main reasons for poor initial surgical efficacy of ulnar nerve anterior transposition,as well as the key points and treatment effects of revision surgery.Methods A retrospective analysis was conducted on 37 patients who underwent revision surgery for ulnar nerve anterior transposition in our hospital from January 2008 to August 2019.The general case information,physical examination before and after revision surgery,auxiliary examinations(including neuroelectrophysiological examination and neuroultrasound),and patient self-evaluation scale results were collected,and intraoperative exploration status was recorded.Results All patients were follow-up for 4 to 18 months,with an average of(10.3±3.7)months.The main reasons for the poor initial surgical efficacy of ulnar nerve anterior transposition included the compression of scar tissue around the ulnar nerve,the incomplete removal of local compression factors,and the improper preparation of fascia flap.At the last follow-up after the revision surgery,ulnar numbness in the hand was alleviated in 25 cases(67.6％),ulnar pain in the hand and elbow joint was alleviated in 9 cases(81.8％),and atrophy of the hand muscles was alleviated in 18 cases(81.8％).According to Gu Yudong's criteria for cubital tunnel syndrome,the functional results were evaluated as excellent in 2 cases,good in 23 cases,fair in 10 cases,and poor in 2 cases,with an excellent and good rate of 67.6％.The possible related factors that affect the effectiveness of revision surgery include the time from the initial surgery to the revision surgery,and whether there is severe pain before the revision surgery.Conclusion The initial surgery for ulnar nerve anterior transposition should carefully and cautiously explore and remove all possible factors that may cause the ulnar nerve to become compressed again,and prepare appropriate fascia flaps for anterior transposition.For patients with poor postoperative outcomes,revision surgery can bring relatively good clinical efficacy.

目的:对儿童前臂缺血性肌挛缩不同时期的手术疗效进行对比及疗效分析。方法:自2008年至2020年我科共收治小儿前臂缺血性肌挛缩19例，予手术治疗，随访统计手术疗效，并对不同时间的疗效作对比分析。结果:前臂缺血性肌挛缩术后较术前均有明显改善，手术越早，疗效越好，需要的手术次数越少，手术方式越简单；患儿年龄越小恢复越好。结论:儿童缺血性肌挛缩的手术越早介入，对神经、肌肉和关节功能的恢复越好，所需手术次数越少，并且可以阻止病情进一步发展。

Objective:To investigate the clinical efficacy of nonvascularized toe phalangeal transfer for treatment of congenital symbrachydactyly in infants and children and summarize the experience of surgical treatment.Methods:From May 2016 to December 2019, 8 cases (13 fingers) with congenital symbrachydactyly were treated by nonvascularized toe phalangeal transfer into the soft tissue of affected fingers. The iliac bone was transplanted into the donor area of phalangeal bone. Both donor and recipient areas were fixed with Kirschner wire. The survival, epiphyseal development and finger growth length of free transplanted phalanges were followed up.Results:The follow-up time was 12 months to 4 years, with an average of 24 months. All the 8 cases (13 fingers) survived after operation. There was no premature closure of epiphysis. Bone resorption occurred in one case of iliac bone graft in the donor area of toe. The average extension of the affected finger was 6 mm (range, 4 to 15 mm). The appearance of all the affected fingers was significantly improved and the function was partially restored.Conclusion:The nonvascularized toe phalangeal transfer is an optional method for the treatment of symbrachydactyly in infants and children.

目的:分析臂丛神经下干受压型胸廓出口综合征的超声声像图特征,探讨超声在诊断此类疾病中的价值.方法:回顾分析2012年5月至2020年5月之间于我院进行超声诊断并经手术证实为臂丛神经下干受压型胸廓出口综合征的23例患者.检查仪器为PHILIPS EPIQ5及iU22彩色多普勒超声诊断仪.以术中所见为金标准,归纳臂丛神经下干受压型胸廓出口综合征的超声声像图特征,分析超声诊断此类疾病的直接征象与间接征象.结果:臂丛神经下干受压型胸廓出口综合征超声声像图的直接征象为:颈8与胸1神经根或/与下干受压,19例,阳性率为82.6％.间接征象为:①锁骨下动脉上抬,18例,阳性率为78.3％;②异常突起的骨性结构,9例,阳性率为39.1％;③颈8或胸1神经根或/与下干增粗,且均未见直接受压征象,3例,阳性率为13.0％.结论:超声观察到颈8与胸1神经根或/与下干受压的直接征象对诊断臂丛神经下干受压型胸廓出口综合征具有较强的提示作用.间接征象如锁骨下动脉上抬、异常突起的骨性结构、颈8或胸1神经根或/与下干增粗有助于此类疾病的超声诊断.

目的 观察第2掌骨纵向半侧骨干移位和二期拇对掌功能重建治疗改良Blauth 3B和3C型拇指发育不良的疗效.方法 2013年12月至2018年6月,复旦大学附属华山医院手外科收治的改良Blauth3B和3C型患儿资料12例.将第2掌骨纵向半侧移位延长第1掌骨,稳定第一腕掌关节.确认骨折愈合后,二期行肌腱移位拇对掌功能重建术.术后评估掌骨愈合情况,有无并发症.使用Percival拇指功能评估法,从握力、捏力、对掌、感觉、活动范围、外观等几个方面,评估拇指功能.结果 平均随访3.4年,12例患者中,9例达到一期掌骨愈合;2例发生第1掌骨骨不连;1例发生第2掌骨骨折;后二者均在二期手术时一并修复并最终愈合.通过Percival评分,6例优秀,3例良好,3例一般.结论 第2掌骨纵向半侧移位结合拇对掌功能重建的手术,可有效重建改良Blauth 3B及3C型发育不良拇指,既保留拇指又能重建较好的功能,远期疗效需要更多随访.

Objective:To compare the advantages and disadvantages of Patterson and modified Hennigan Classification in amniotic band syndrome and review the features of 21 cases.Methods:From January 2019 to April 2020, 21 cases of amniotic band syndrome were enrolled. Basic information of the patients were recorded, medical history was reviewed to record the conditions on the affected limbs. The Patterson and modified Hennigan Classification were used on these patients separately to compare the features of these two classification systems. Then data were collected and calculated to have a brief view of the status of affected limbs.Results:Twenty-one cases were enrolled, including 7 boys and 14 girls. In 9 cases, only upper limbs were affected. In 5 cases, only lower limbs were affected. In 7 cases, both upper and lower limbs were affected. In 16 cases with upper limbs affected (18 limbs), one different Patterson classification was counted as 1. In these cases, 13 of Patterson type 2, 5 of type 3 and 5 of type 4 were included. There were 16 fingers of type 3, including 6 index-middle finger acrosyndactyly, 6 middle-ring finger acrosyndactyly and 4 ring-little finger acrosyndactyly. 13 fingers of type 4 were seen, including 6 index fingers, 4 middle fingers, 1 thumb, 1 ring finger and 1 little finger. In the same way, in 12 cases with lower limbs affected (15 limbs), 13 of Patterson type 2, 2 of type 3 and 5 of type 4 were included. 2 of type 3 were seen, including 2nd to 5th toe acrosyndactyly and 3rd to 5th toe acrosyndactyly. Besides on one amputation at the ankle level, there were 13 toes of type 4 affected, including 3 of 1st, 2nd, 3rd toes separately and 2 of 4th, 5th toes separately. While using modified Hennigan Classification, one different classification was also counted as 1. 10 finger of zone 1 (finger), 1 of zone 2 (palm), 7 of zone 3 (forearms) and 2 of zone 4 (arms) were affected in all upper limbs. 1 of zone 1 (thigh), 11 of zone 2 (shanks) and 4 of zone (toe) were affected in all lower limbs.Conclusion:The Patterson and modified Hennigan Classification system in amniotic band syndrome can be combined to clearly reflect the location and severity of the disease, facilitate the guidance of treatment and data statistics, and provide reliable data resources for future research.

Nerve transfer is the most common treatment for total brachial plexus avulsion injury. After nerve transfer, the movement of the injured limb may be activated by certain movements of the healthy limb at the early stage of recovery, i.e., trans-hemispheric reorganization. Previous studies have focused on functional magnetic resonance imaging and changes in brain-derived neurotrophic factor and growth associated protein 43, but there have been no proteomics studies. In this study, we designed a rat model of total brachial plexus avulsion injury involving contralateral C-7 nerve transfer. Isobaric tags for relative and absolute quantitation and western blot assay were then used to screen differentially expressed proteins in bilateral motor cortices. We found that most differentially expressed proteins in both cortices of upper limb were associated with nervous system development and function ( including neuron differentiation and development, axonogenesis, and guidance), microtubule and cytoskeleton organization, synapse plasticity, and transmission of nerve impulses. Two key differentially expressed proteins, neurofilament light (NFL) and Thy-1, were identified. In contralateral cortex, the NFL level was upregulated 2 weeks after transfer and downregulated at 1 and 5 months. The Thy-1 level was upregulated from 1 to 5 months. In the affected cortex, the NFL level increased gradually from 1 to 5 months. Western blot results of key differentially expressed proteins were consistent with the proteomic findings. These results indicate that NFL and Thy-1 play an important role in trans-hemispheric organization following total brachial plexus root avulsion and contralateral C-7 nerve transfer.

Introduction: The aim of this study was to determine the value of Doppler sonography for evaluation of ulnar neuropathy at the elbow (UNE). Methods: A total of 102 patients with a clinical suspicion of UNE and 50 healthy controls were examined by Doppler and gray‐scale sonography. Results: Intraneural vascularization was found in 31 (46.3%) of 67 patients with confirmed UNE and in 3 (6.0%) of 50 healthy controls. Combining gray‐scale sonography measurement of nerve size and the presence of intraneural vascularization increased sensitivity by 3%, but decreased the specificity. Patients with intraneural vascularization had more severe disease than those without intraneural vascularization (P < 0.05). The variables obtained by Doppler sonography were associated with the severity of UNE (P < 0.05). Conclusions: Doppler sonography is not helpful for diagnosing UNE but can be used to assess the severity of UNE. Muscle Nerve 54: 258–263, 2016

Objective To establish the protein spectrums of contralateral motor cortex differential proteins after total brachial plexus injury (TBPI) and investigate the performance of motor cortical remodeling at molecular level.Methods TBPI models were established in SD rats,and then the differential proteins of contralateral motor cortex after TBPI for one day using isobaric tags for relative and absolute quantitation (iTRAQ).Results Totally 1293 proteins were identified,including 259 differentially expressed proteins,214up-regulated and 45 down-regulated.18 differential proteins were related to brain development or axonogenesis.The differential proteins were mainly localized in plasma membrane,playing biological process of protein localization,protein transport and intracellular transport.The molecular functions of the differential proteins involved ion binding and nucleotide binding.Conclusion There are lots of differentially expressed proteins of contralateral motor cortex after TBPI,which may be the performance of motor cortical remodeling at molecular level after acute injuries.

OBJECTIVE:To identify palmar cutaneous branches of median nerve and ulnar nerve (PCBMN and PCBUN) and try to find a safe path at wrist and forearm in the decompression procedure of carpal tunnel syndrome.MATERIALS AND METHODS:Ten formalin-fixed and five fresh-frozen cadaveric forearms were included in the study. The cross point of longitude of middle finger and distal wrist crease was defined as 0 point. Distal wrist crease (DWC) and 0 point were chosen as references for measurements. Several points on the pathway of PCBMN and PCBUN were measured.RESULTS:The average distance between the origin of the PCBMN and PCBUN to the DWC was 4.95 ± 0.88 cm, 10.12 ± 1.50 cm, separately. The average distance between DWC and the point where PCBMN and PCBUN separated from their trunk was found to be 2.09 ± 0.31 cm, 2.90 ± 0.50 cm, separately. The distances between PCBMN, PCBUN and 0 point at DWC level was found to be 0.61 ± 0.12 cm, 0.47 ± 0.31 cm, separately. The diameters of two cutaneous branches were 0.10 ± 0.02 cm, 0.11 ± 0.04 cm, separately.CONCLUSION:The general longitudinal palmar incision could avoid injuries to recurrent branch of median nerve and distal branches of palmar cutaneous nerve can be avoided macroscopically. The area about 5 mm ulnar and 6 mm radial to 0 point at wrist level was a relatively safe area.

Obective To observe the early electrophysiological changes after using PDLLA film in the subcutaneous anterior transposition in ulnar nerve. Method We collected 34 patient with cubital tunnel syndrome. 10 of them had syndromes which reflected the compression of ulnar nerve after trauma of their elbows , 24 patients had syndromes with no obvious cause. All of the patients underwent the decompression of ulnar nerve at elbow and subcutaneous anterior transposition of the nerve. In the operation, nerves of 19 cases were wrapped by a PDLLA film. The follow-up time ranged from 2 months to 15 months. The follow-up content was to collect elcetromyogram of the patients. We compared the nerve conduction velocities from 5cm above elbow to 5cm below elbow and the wave amplitudes of CMAP which were educed in abductor digiti minimi after stimulating the ulnar nerve at elbow before and after the operation. Results The nerve conduction velocities from 5cm above elbow to 5cm below elbow had improvement in both groups. There was 1 in the control group and 3 in the observed group that CMAP can’t be educed in the abductor digiti minimi, and the nerve conduction velocities were 0 before operation. These patients had certain improvements after operations. The rest patients showed that: in the control group, MNCV improved about 43% averagely; in the observed group, MNCV improved about 58.7%. However, there was no statistically differences between them totally. The amplitudes of CMAP which were educed in abductor digiti minimi improved about 54.6% averagely in the control group, while it improved about 108.3% in the observed group. Totally, there was statistical differences between two groups in this aspect. Conclusion PDLLA film had some electrophysiological effect in the early period of subcutaneous anterior transposition in ulnar nerve.

Objective To investigate the outcomes of advanced Kienbock' s diseases treated by vascularized pedicled distal radius bone flap transfer.Method Two patients with advanced Kienbock's diseases ( type Ⅴ) underwent distal radius bone flap transfer pedicled by dorsal branches of the radial artery.The observations included pain evaluation,radiography,function assessment of the wrist ( range of motion and Krimmer scale),and quality of life ( DASH questionnaire).Results Pain disappeared after surgery in both patients at rest,and reduced in intensity to a mild level during wrist motion.In one patient,X-ray showed the high density image of the lunate had disappered and now bone had formed.In the other patient,there was no aggravation in X-ray or MRI.According to the assessment of hand function,the Krimmer score and DASH score were higher comparing with that assessed before the operation.Conclusion Distal radius bone flap transfer pedicled by dorsal branches of the radial artery is a feasible procedure to treat advanced Kienbock's diseases,with favorable preliminary results.