The PDF of the article you requested follows this cover page. This is an enhanced PDF from The Journal of Bone and Joint Surgery 1939;21:377-383. J Bone Joint Surg Am.LEO MAYER EXTREMITYOPERATIVE RECONSTRUCTION OF THE PARALYZED UPPERThis information is current as of March 7, 2010 Reprints and PermissionsPermissions] link. Duhovno-energetska medicina sve terapije u ovoj oblasti podrazumeva kao bezaparaturne pristupe. And click on the [Reprints andjbjs.orgarticle, or locate the article citation on to use material from thisorder reprints or request permissionClick here to Publisher Information www.jbjs.org20 Pickering Street, Needham, MA The Journal of Bone and Joint SurgeryVOL. 2, APRIL 1939 377OPERATIVE RECONSTRUCTION OF THE PARALYZEDUPPER EXTREMITY *BY LEO MAYER, M.D., NEW YORK, N. Y.Three operations are of particular value in the re(onstru(tioll surgeryof the paralyzed uper extremity. These are: (1) the Biinnehl operation forparalysis of the small muscles of the thumb; (2) the Steindler tendon shiftat the elbow; (3) arthrodesis of the shoulder. Tile purpose of the presentpaper is to present a few oi)servations of practical iniportance connectedwith these operations and to report the authlors experiences with a fourthoperation,-the transplantation of the trapezius, which may at times beusedi insteadi of the shoulder arthrodesis.THE BUNNELL OPERATIONTilis ol)eration has been so clearly presented by Dr. Bunnell in theApril 1938 issue of The Journal of Bone and Joint Surgeiy that it needs nofurther clarification. The writer be- ___________________________________gan doing the operation more then tenyears ago and!, although in many casesthe results were excellent, he found tohis great disappointment that in mostof the poliomyehtic patients the re-stilts were disappointing. The pa-tients were able to adduct the tinunb(Fig. 1), the transplanted tendoncould be felt acting with considerableforce, but a satisfactory oppositionmotion (lid! Despite allatteml)ts to improve tile technique andthe after-treatment, the poor resultscontinued to Inulti)ly and until twoyears ago the author could find noexplanation. Cadaver studies showedtilat, following the execution of theBunnehl operation, tlaction on tiletransplanted tell(lon vould produce analmost perfect opposing motion of the FIG. Why did thus not occur in Tile result of all unsuccessful Bun-nell operation. There is powerful ad-patients. Some of the writer s asso- duction, hut 110 opposition.ciates suggested some type of bone-blocking procedure which would prevent adduction bitt would permitopposition. When tried on the cadaver, this did not result successfully.* Read at the Annual Meeting of the American Academy of Orthopaedic Surgeons,Memphis, Tennessee, January 17, 1939.I378 LEO MAYERTHE JOURNAL OF BONE AND JOINT SURGERYOthers suggested a coml)ination of the Bunnehl operation with a. Tenodesisof the extensor tendlons, so as to 1101(1 the first metacarpal in an extendedposition. Thus was equally unsuccessful. Finally, it occurred to theauthor that possibly, i)ecause of the long continuance of the deformity inparalyzedi cilil(lren, a contracture mighthave developed. Vith this in nuind heperformed a sinul)le experiment. On thecadaver to reproduce a contracture similarto that found in a flat handi. Tilis was(lone by intro(hlcilig a silk suture into theposterior capsule of the carpometacarpaljoint of the thunul). After this suture hadbeen introduced, the Biinnell operation onthe cadaver failed. Thue thlunb (Olild notInove iiut() the position of opposition, be-cause the normal rotation motion of theInetacarl)al bone was hindered. Thus fact.seems so elementary tuiicl obvious that. Thewriter hesitates to publish it; yet its prac-tical application has resulted in suchmarked iml)rovement in our operativeI results (Fig. 2) that others may possibly. Ayat2 cinta mp3. I benefitfromourexperience. 2 with paralysis of the opposing muscles ofThe result of a successful Bull- the thumb is now subjected to a rigid cx-nell operation for complete paral-.ysis of the opposing muscles of the amination for a possible contracture eitherthumb. The operation in this at the carpometacarpal joint or the inter-case was preceded by the (Ilvision.of the dorsal capsule of the carpo- carpal jomt. The examiner must he care-metacarpal joint. Ful not to be deceived by a pseudo motion.These weakened paralyzed hands are sorelaxed that, unless great care is taken, the surgeon willnot note the exist-ence of the contracture. Convertxtodvd 4 free download no watermark. However, in our experience it is almost invari-ably present in patients who have been paralyzed for two or more years.Once the contracture has been recognized, it is evident that it must. Becorrected, just as every contracture must be corrected before a tendontransplantation is done.
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