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.

(文接上期) 3讨论 手作为人类生产、生活的主要工具,是最常受伤的部位之一.随着工业化进程,目前临床各种严重手外伤较为常见,且常合并神经、血管、肌肉肌腱、皮肤软组织及骨缺损.其中骨缺损的重建是手外科与显微外科治疗、研究的热点及难点.骨缺损即骨骼结构完整性被破坏,分为容积性骨缺损和结构性骨缺损.

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.

并指畸形是指相邻指间软组织和(或)骨骼不同程度的融合,是最常见的手部先天性畸形之一,手术分离是其最重要的治疗手段.通过引入精准康复理念,对并指畸形术后康复方案进行全面优化,可以进一步提高患者康复疗效.本共识以循证医学证据为依据,经过全国专家组反复讨论,同时借鉴和参考国内外近年来的研究成果,供全国手外科医师、康复医师、康复治疗师、康复工程师、护理人员等在临床工作中参考使用.本共识主要内容包括先天性并指畸形术后康复的目标、关注的问题、治疗的主要内容、团队的组成与职责、治疗手段与措施以及推荐康复方案等.

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.

Background: Amniotic band syndrome (ABS) is a congenital malformation that results in abnormalities in many parts of the body. Most surgical treatments for ABS used multi-stage Z-plasties. The purpose of this study was to assess the clinical results of one-stage circular incision techniques for limb ring constriction due to amniotic band syndrome. Methods: We reviewed 27 patients with limb ring constriction in ABS from 2010 to 2020. The mean ages of the patients were 11.7 months (range, 0-72 months). The complete circular incision release the ABS. All patients' operations were used one-stage circular incision surgical techniques, including patients with multiple bands. All the patients were followed up with a period ranges from 2 years to 10 years. Patient-reported visual analog scale (VAS) scar ranking on a scale of 0 (minimum satisfaction) to 10 (maximum satisfaction) were used to evaluate esthetic outcomes. Results: After our surgery, all the limbs, toes, and fingers were rescued, and the lymphedema reduced remarkably. The VAS scores (mean +/- SD) for patient satisfaction were 7.55 +/- 1.89. The surgical treatment of amniotic band syndrome in a one-stage circular incision is safe and effective. Conclusion: The one-stage circular incision surgical techniques have many advantages, including reduced surgical invasiveness, scar formation, and the cost of treatment.

Conducting polymers (CPs) can regulate cell behavior and promote the regeneration of damaged tissues, which are widely applied in tissue engineering. In this study, poly(3-hexylthiophene) (PHTP) was first obtained by the catalyst + transfer poly-condensation method, and then, it was mixed with poly(lactide-co-glycolide) (PLGA) to obtain a composite material with superconductivity (PHTP/PLGA). Besides, ferric chloride (FeCl 3 ) was selected as the dopant, and the doping time was changed, so as to obtain 5 PHTP/PLGA materials with different conductivity (10 -7 S/cm, 10 -6 S/cm, 10 -5 S/cm, 10 -4 S/cm, and 10 -3 S/cm). While PHTP/PLGA was physically characterized, the cell proliferation ability and blood compatibility of this series of materials were further analyzed, and the materials were made into medical sutures for the treatment of congenital thumb deformities. In the experiment, the surface morphology, hydrophilicity, and hydrophobicity of materials with different conductivity would not affect the difference in cell behavior. Using mouse embryonic osteoblasts (MC3T3-E1) as the research objects, increasing PHTP/PLGA conductivity could promote MC3T3-E1 alkaline phosphatase activity cell mineralization, and collagen type I expression. PHTP/PLGA series materials had a low hemolysis rate and were not easily affected by platelet adhesion and activation, meaning that they would not cause coagulation. The material was applied in the direct suture method of hammer deformity, and the results showed that the patient’s deformed thumb had a knot reaction and local skin edge necrosis. After dressing change, it gradually improved. Moreover, the excellent and good rate of deformed thumb based on this material was higher than that of wire extraction method and Kirschner wire fixation method ( P < 0.05).

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.

Objective To evaluate the clinical outcomes of the minimally invasive technique of percutaneous Kirschner wire fixation combined with mini external fixation in the treatment of the fifth metacarpal base fractures.Methods Eleven patients underwent this minimally invasive technique were enrolled and followed up.All of the patients were diagnosed as the fifth metacarpal base fractures according to the typical X-ray manifestation.In this modified procedure,the fracture was reduced by mini external fixation traction and manual manipulation,and the fifth metacarpal was then fixed to the fourth and third metacarpal by 2 percutaneous Kirschner wires.All the fixation devices were removed 6 weeks postoperatively.The mean follow-up period was 15.7 weeks.X-ray,VAS score,range of motion (ROM) as well as the grip strength of the affected hand were checked for all the patients and the TAM scoring system was used for the function evaluation.Results All the 11 patients achieved satisfied union for the fifth metacarpal base fractures without wire tract infection or screw rod loosening and break.The average postoperative VAS score was 1.13.The patients achieved an averaged 89.3％ grip strength compared to the healthy side.According to the TAM scoring system,the results were excellent in 6 cases,good in 4 cases and fair in 1 case.Conclusion The minimally invasive technique of percutaneous Kirschner wire fixation combined with mini external fixation appears to be an effective and safe procedure for treatment of the fifth metacarpal base fractures.

目的 对比分析微型钢板与克氏针内固定治疗掌骨骨折的临床疗效.方法 62例掌骨骨折患者按照治疗方法 不同分为A组与B组,各31例.A组采用微型钢板内固定,B组采用克氏针内固定,比较两组患者功能优良率、手术时间、住院时间、并发症发生率、骨折愈合时间及外观满意度.结果 A组功能优良率为90.32%,明显高于B组的64.52%,差异具有统计学意义(P<0.05).A组手术时间与B组比较更长,骨折愈合时间与B组比较更短,差异均具有统计学意义(P<0.05);A组住院时间与B组比较稍长,但差异无统计学意义(P>0.05).两组并发症主要表现为术后感染、肌腱黏连、延迟愈合等,A组术后并发症发生率为6.46%(2/31),B组并发症发生率为22.58%(7/31),A组术后并发症发生率与B组比较更低,差异具有统计学意义(P<0.05).A组外观满意度为93.55%,明显高于B组的70.97%,差异具有统计学意义(P<0.05).结论 微型钢板治疗掌骨骨折患者有显著疗效,患者术后可快速恢复,安全性高,患者外观满意度更高,可作为治疗掌骨骨折的一种有效方法 在临床推广应用.

Objective To evaluate the clinical outcomes of a modified procedure of ulnar nerve anterior transposition in the treatment of severe cubital tunnel syndrome.Methods From September 2015 to May 2016,25 patients with cubital tunnel syndrome underwent vascularized ulnar nerve anterior transposition were followed up after operation.All the patients had severe muscular atrophy and deformity of elbow joint before operation.According to Gu Yudong's classification of cubital tunnel syndrome,they were graded as severe.In this modified procedure,the sufficient neurolysis of ulnar nerve as well as the anterior transposition of ulnar nerve accompanied with superior ulnar collateral artery were conducted.Results All the 25 patients were follow-up from 12 to 21 months with an average of 15.3 months.All the patients achieved sensory recovery in different degrees without temporary worsening of clinical symptoms.Completely sensory recovery was observed in 20 patients (80％).4 patients (16％) remained occasional sensory symptoms while only 1 patient (4％) remained persistently moderate sensory symptoms.The mean two-point discrimination of little finger pulp was improved from preoperative 6.08 mm to postoperative 2.93 mm.Obvious improvement of intrinsic muscular atrophy was observed in 17 patients (68％).According to the Gu Yudong's function evaluation standard of cubital tunnel syndrome,the results were excellent in 16 patients,good in 6 patients and fair in 3 patients with the excellent and good rate being 88％.Conclusion The modified technique of vascularized anterior transposition of unlar nerve appears to be an effective and safe procedure for the treatment of severe cubital tunnel syndrome.It might reduce the incidence of postoperative nerve symptoms caused by devascularization of ulnar nerve.

Objective To compare the clinical effect of humeral shaft fracture with radial nerve injury patients treated with different methods of conservative treatment,early radial nerve exploration. Methods 65 cases of humeral shaft fracture with radial nerve injury patients were selected from Jan 2013 to Mar 2016 in our hospital ,all the patients were divided into two groups according to different methods of treatment,group A (n=33) administered early radial nerve exploration,group B (n=32) was given conservative treatment. Two groups of patients were followed up for a period of 5~18 months ,the neurological function recovery excellent rate,fracture healing time,neurological damage begin to recover time and fully recover time of two groups were compared. Results The neurological function recovery excellent rate,neurologic damage begin to recover time,and full recov-ery time of group A compared with group B,there were no significant differences between two groups(P>0.05).The fracture heal-ing time of group A was shorter than group B,the difference was statistically significant(P<0.05). Conclusion Early conser-vative treatment of radial nerve exploration of two different methods for treating humeral shaft fracture with radial nerve injury can receive good clinical results,good recovery of neurological function,but early exploration of the radial nerve fracture healing time is shorter.

肘管综合征是上肢最常见的周围神经卡压综合征之一，其发病率仅次于腕管综合征［1-2］。Feindel 等［3］于1958年首次提出肘管综合征是指尺神经在尺神经沟处受压而产生的神经压迫、损伤性病变，其主要表现为手肌肉萎缩、无力及手尺侧麻木。尺神经在行走过程中有多个潜在的卡压部位，但是最重要的部位是在肘关节。患者常见的症状是尺神经分布区的麻木、手内肌的萎缩和无力。症状较轻的患者可以采取保守治疗，中、重度的需要手术治疗。近几年出现大量关于尺神经原位松解和前置手术效果的比较研究。

Objective To study the method and effect of using self-made facile fixative bracket combined with Kirschner wire in the treatment of comminuted middle and proximal phalanx fractures. Methods From June 2009 to August 2013, we had treated 26 patients with comminuted middle and proximal phalanx fractures (32 fingers) using self-made facile fixative bracket combined with Kirschner wire and absorbable suture, and all these cases were followed-up and observed regularly. Results All these cases achieved bone healing without osteomyelitis, malunion and fracture displacement after operation, external bone callus formation were found in 9 cases during bone healing process. We evaluated all the cases according to the Tatol Active Motion (TAM) rating system and Tatol Active Flexion (TAF) rating system, excellent cases were 5 (5 lesions), good were 16 (17 lesions), fair in 3 (6 lesions), poor in 2 (4 lesions), overall excellent and good rate were 80.8% (excellent rate of fracture part was 68. 8%). Conclusion Using self-made facile fixative bracket combined with limited internal fixation can provide an effective immobilization, less invasion and early exercises to restore the function of the fingers for comminuted fracture of proximal and middle phalanx.

The upper brachial plexus injury leads to paralysis of muscles innervated by C5 and C6 nerve roots. In this report, we present our experience on the use of the combined nerve transfers for reconstruction of the upper brachial plexus injury. Nine male patients with the upper brachial plexus injury were treated with combined nerve transfers. The time interval between injury and surgery ranged from 3 to 11 months (average, 7 months). The combined nerve transfers include fascicles of the ulnar nerve and/or the median nerve transfer to the biceps and/or the brachialis motor branch, and the spinal accessory nerve (SAN) to the suprascapular nerve (SSN) and triceps branches to the axillary nerve through a posterior approach. At an average of 33 months of follow-up, all patients recovered the full range of the elbow flexion. Six out of nine patients were able to perform the normal range of shoulder abduction with the strength degraded to M3 or M4. These results showed that the technique of the combined nerve transfers, specifically the SAN to the SSN and triceps branches to the axillary nerve through a posterior approach, may be a valuable alternative in the repair of the upper brachial plexus injury. Further evaluations of this technique are necessary. (C) 2011 Wiley Periodicals, Inc. Microsurgery, 2012.

Objective To study the effects of human amniotc epithelial cells (HAECs) on regeneration of rat sciatic nerve. Methods Sixty SD rats were randomly divided into two groups, the HAECs group and control group. Each group was further divided into two week group and four week group, with 15 rats each. The sciatic nerve was cut and the regeneration chamber was created. The HAECs were implanted into the regeneration chamber in the HAECs group and normal saline was injected into the regeneration chamber in the control group.Electro-physiological and the histological study was done at two weeks and four weeks after the surgery. The results of nerve conduction study and HE staining of regenerating nerve fibers were analyzed statistically.Results There were no statistically significant differences between the two groups at two weeks post-operatively.At four weeks, the experimental group showed significantly higher nerve conduction velocity and amplitude of evoked potentials comparing to those of the control group. Nerve fibers and inflammatory granulation tissue was seen near the lesion site by HE staining in the control group, whereas the HAECs group showed more integrated nerve fihers and mature myelination distal to the lesion site. Conclusion The application of human amniotic epithelial cells may enhance nerve regeneration in rats.

The purpose of this study is to describe the harvesting technique, anatomic variations, and clinical applications of a compound flap from the great toe and vascularized joint from the second toe used for thumb reconstruction. Five fresh cadaver dissections were studied, focusing attention on the dorsal or plantar vascular dominance, position of the communicating branch between the dorsal and plantar system, the Gilbert classification, and the size of the first dorsal metatarsal artery (FDMA) and first plantar metatarsal artery (FPMA) to the great toe and second toe. Five compound flaps were performed on five patients with traumatic thumb amputation at the level of proximal metacarpal bone. The patients' ages ranged from 14 to 47. Follow‐up period was 11–24 months. The anatomic study showed that FPMA had larger caliber in 40% of dissections, FDMA in 40%, and had the same caliber in 20%. The Gilbert classification of FDMA was 40% class I and 60% class III. In the clinical applications, four patients achieved good functional opposition and motion of transferred joints with good pinch and grip strength. There was one flap failure, and donor‐site morbidity was minimal. The compound flap offers advantages over traditional toe transfer by providing two functional joints. It can be used for amputation of the thumb at carpometacarpal joint level. Finally, the compound flap maintains growth potential in children through transfer of vascularized epiphyses. The disadvantages of this compound flap include a technically challenging harvest and a longer operative time. © 2008 Wiley‐Liss, Inc. Microsurgery, 2009.