RU2405483C1 - Method of restoration of active extension of joints of three-phalanx fingers after replantation (revascularisation) of large segments of upper extremity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics. Mobilisation of tendons of own extensors of 2 and 5 fingers with their further excision is carried out. Tendon transplants are sewn in split manner to proximal ends of excised tendons, which are passed under intermetacarpal ligaments and exteriorised into 2 and 4 interdigital spaces, split at the level of intermetacarpal ligaments and sewn with tightening to lateral cords of extensor apparatuses of 2 and 4 fingers from elbow side and 3 and 5 fingers from flexion inradial side in position of complete extension in interphalangeal joints and flexion of metacarpophalangeal joint.

EFFECT: method ensures reconstruction of active extension of three-phalanx fingers in interphalangeal joints with simultaneous correction of hyperextension in metacarpophalangeal joints after replantation of large segments of upper extremity.

5 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to restore active extension of the three-phalangeal fingers in the interphalangeal joints, the loss of which is one of the symptoms of neurogenic deformity of the hand in patients after replantation (revascularization) of large segments of the upper limb.

After replantation or revascularization of the hand (or a larger segment of the upper limb), combined damage to the nerves and tendons of the extensors of the fingers of the hand always occurs. The second component of the negative effect on the short muscles of the hand is the ischemic component due to a violation of the blood supply to the severed segment. In the postoperative period, persistent over-extension of the metacarpophalangeal joints and clawed deformation of the three-phalangeal fingers, due to atrophy of the short muscles of the hand, are gradually forming. To correct this neurogenic deformity, the Fowler operation (Campbell operative orthopedics. Vol. Four. Edited by S. Terry Canale., 2003, p. 3638-3643) is used. The extensors of 2 and 5 fingers are used as muscle motors. From the incisions on the rear of the hand, the extensor 2 and 5 fingers are isolated and cut off. The extensors split in two, conduct them under the intercarpal ligaments and fix 2-5 fingers from the radial side to the tendon extensor apparatus. The aim was to restore the active extension of the phalanges of the three-phalangeal fingers. This operation is a prototype of the proposed method.

This surgical intervention has a number of technical difficulties - the moved tendons are short and limit the dynamic effect, and can not always be used in patients after replantation (revascularization) of large segments of the upper limb due to anatomical damage to the necessary tendons.

The technical result of the invention is the restoration of active extension of the three-phalangeal fingers in the interphalangeal joints with simultaneous correction of hyperextension in the metacarpophalangeal joints after replantation (revascularization) of large segments of the upper limb.

The result of the invention is achieved through the use of tendons of own extensors of the 2nd and 5th fingers from the level of damage with suturing of tendon grafts to them, which are carried out under the metacarpal ligaments in the 2nd and 4th interdigital spaces and after splitting at the level of the metacarpal ligament, are sutured to the lateral bundles from the elbow side 2 and 4 fingers and the radial side of 3 and 5 fingers.

The drawings show:

Figure 1: Fowler claw deformity correction method.

Figure 2: sectional diagram.

Figure 3: scheme of the allocation of the tendons of their own extensor 2 and 5 fingers.

Figure 4: scheme of hemming and conducting tendon grafts.

Figure 5: scheme of fixation of tendon grafts to the lateral bundles of the extensor apparatus.

The proposed method is as follows: the operation is performed under conduction anesthesia, in the patient’s position on the back. Under the tourniquet on the back of the forearm or ligament that holds the extensor tendons (depending on the level of replantation or revascularization), the extensor extensors of the 2nd and 5th fingers are secreted and mobilized, followed by cutting off at the level of the hand or forearm (depending on the condition of the tendons). Tendon grafts are hemmed to the proximal ends of the excised tendons. Perform additional Y-shaped incisions in the 2 and 4 interdigital spaces on the rear of the hand with the transition to adjacent lateral surfaces of the main phalanges of the fingers. Transplants are carried out under the metacarpal ligaments between the 2nd and 3rd metacarpal bones and the 4th and 5th metacarpal bones, removed into the interdigital spaces and split in two at the level of the metacarpal ligament. On the rear of the main phalanges along the radial edge of the 3 and 5 fingers and the elbow edge of the 2 and 4 fingers, the lateral bundles of the extensor apparatus of the fingers are isolated and mobilized, and active traction is checked. Tendon grafts are twice wrapped around the lateral bundle of the extensor apparatus and in the position of full extension in the interphalangeal joints and flexion of the metacarpophalangeal joint are sutured with the lateral bundles. Wounds on the hand and fingers are sutured. In the postoperative period for 4 weeks, two plaster casts are immobilized: the palmar and the back, with the fingers fixed in the position of full extension in the interphalangeal joints and flexion in the metacarpophalangeal joints.

According to the authors, this method of restoring active extension of the interphalangeal joints of the three-phalangeal fingers is the best way to restore active extension and simultaneously eliminate hyperextension of the metacarpophalangeal joints after replantation (revascularization) of segments of the upper limb, accompanied by impaired functioning of the interosseous muscles.

Clinical observation

Patient R., 45 years old, case history No. 3789, DZ: Condition after replantation of the left forearm at the level of the lower third. Neurogenic deformity of the left hand. Operation 02.28.2008: restoration of active extension of the interphalangeal joints of 2-5 fingers of the right hand. Surgery was performed under conduction anesthesia of the brachial plexus. The operation time was 1 hour 30 minutes. The postoperative period was uneventful, the wounds healed by first intention, the sutures were removed on day 12. The plaster cast was immobilized for 4 weeks. After removal of the immobilization, a course of rehabilitation treatment (exercise therapy, FTL) was carried out. A good aesthetic and functional result was achieved (after rehabilitation treatment).

Claims (1)

A method of restoring active extension of the interphalangeal joints of the three-phalangeal fingers after replantation (revascularization) of large segments of the upper extremity, including mobilization of the tendons of the extensors 2 and 5 of the fingers, followed by their cutting, characterized in that the tendon grafts are sutured to the proximal ends of the excised tendons that are held between the metacarpal ligaments and output into 2 and 4 interdigital spaces, split at the level of the metacarpal ligaments and hem with tension to the side vym beams extensor units 2 and 4 with a finger ulnar sides 3 and 5 and with the radial finger side to full extension in interphalangeal joints, flexion of the metacarpophalangeal joint.

Images