The impact of replantation surgery upon reconstruction of the hand has been immense since the first revascularization of a digit performed by Dr. Harold E. Kleinert in 1962, and published in the Kentucky Journal of Medicine in 1963.Malt reported by the media on full replantation of the upper extremity in 1962.Kumatsu and Tamai in 1964 replanted a thumb which was published in 1967, following which surgeons became comfortable with the idea of putting small vessels together, and that spun on the ability to transfer the recently discovered, at that time, the axial pattern flap into free flaps.The history is then wide, and this has influenced every aspect of our lives.Before replantation, patients had mutilations that left them with both a stigmata of an injury and the inability to use the extremities.Not only in regard to the loss of the digits, but often because the lack of blood supply resulting in ischemic parts that fibrosed and lacked motion.Replantation was then born around the world, in Japan, Kumatsu and Tamai, in China with Chen Zong Wei, in Australia, Ian Taylor and Bernie O'brien, in United States, Kleinert and Buncke.Initially the surgeons were happy to just making things pink, survival being the rule of the game.Today function is the end result sought.From up into the arm to the tip of the fingers, refinement of replantation has taken place.Cooperative teams working together to reduce surgery time were formed.The work of the Japanese, Chinese, as well as those in Germany had large numbers of patients with replantation with very acceptable results.However, amputation occurs at times in both upper extremities, and at times all the extremities.The injury in some cases is of a crushing type rendering the amputated part not replantable to its corresponding stump.In cases of bilateral amputation, ectopic replantation may save function in one extremity.The first documented case of transposition of a hand, or switching of the upper extremities was carried out by Dr.Joseph E. Kutz in Louisville, Kentucky, on a gentleman who sustained bilateral upper extremity amputations.This individual's one side proximal stump would not accept the replantation of the distal part that was in good condition, while the contralateral stump was good condition and the distal part was totally crushed.The transfer of the right hand to the left hand position resulted in the thumb facing down, being placed in the ulnar position,
GUPTA, AMIT M.D., F.R.C.S.‡; SHATFORD, RUSSELL A. M.D.‡; WOLFF, THOMAS W. M.D.‡; TSAI, TSU-MIN M.D.‡; SCHEKER, LUIS R. M.D.‡, LOUISVILLE, KENTUCKY; LEVIN, L. SCOTT M.D.§, DURHAM, NORTH CAROLINA Author Information
Distal radioulnar joint (DRUJ) problems can occur as a result of joint instability, abutment, or incongruity. The DRUJ is a weight-bearing joint; the ulnar head is frequently excised either totally or partially, and in some cases it is fused, because of degenerative, rheumatoid, or posttraumatic arthritis. Articles about these procedures report the ability to pronate and supinate, but they rarely discuss grip strength, and even less do they address lifting capacity. We report the long term results of the first 35 patients who underwent total DRUJ arthroplasty with the Aptis DRUJ prosthesis after 5 years follow-up. Surgical indications were all causes of dysfunctional DRUJ (degenerative, posttraumatic, autoimmune, congenital). We recorded data for patient demographics, range of motion (ROM), strength, and lifting capacity of the operated and of the nonoperated extremity. Pain and functional assessments were also recorded. The Aptis DRUJ prosthesis, a bipolar self-stabilizing DRUJ endoprosthesis that restores forearm function, consists of a semiconstained and modular implant designed to replace the function of the ulnar head, the sigmoid notch of the radius, and the triangular fibrocartilage ligaments. The surgical technique is presented in detail. The majority of the patients regained adequate ROM and improved their strength and lifting capacity to the operated side. Pain and activities of daily living were improved. Twelve patients experienced complications, most commonly being extensor carpi ulnaris (ECU) tendinitis, ectopic bone formation, bone resorption with stem loosening, low-grade infection, and need for ball replacement. The Aptis total DRUJ replacement prosthesis is an alternative to salvage procedures that enables a full range of motion as well as the ability to grip and lift weights encountered in daily living activities.
Instability of the distal radioulnar joint results from fracture and/or malunions of the forearm bones, disruption, or laxity of the ligaments of the triangular fibrocartilage. Such instability often-times is not diagnosed acutely and presents as a chronic problem. When these ligaments fail to heal adequately after injury, distal radioulnar joint instability develops into mechanical problems resulting in pain, limited range of motion, and decreased grip strength. In this case, reconstruction of the disrupted distal radioulnar joint ligaments is essential to restore proper function. In this presentation, a technique of ligament reconstruction using palmaris longus, plantaris, or toe extensor tendon graft is outlined with mid-term functional results.
