RU2456961C1 - Method for early rehabilitation following injury of middle portion of finger extensor - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely traumatology and orthopaedics, and can find application in treating finger extensor injures. Substance of the method consists in splinting, physiotherapy and therapeutic exercises. It involves recovering a middle portion of the extensor and fixing a proximal finger bundle with a maximally extended finger with a pin. It is followed by short plaster splinting of the finger and hand to a level of distal finger bundle. Physiotherapy is prescribed starting from the 2nd postoperative day. Therapeutic exercises are made once the oedema and pains are relieved. From the 4th day to the moment of skin suture release, the patient makes self-supporting active-passive movements of the nail phalanx placed in the short splint. On the 14th day, the plaster cast is discarded, and the skin sutures are released. The patient carries out the self-supporting work out of either the distal finger bundle, or the metacarpophalangeal joint. When working out the distal finger bundle, the patients moves the nail phalanx to bend and extend it with using the healthy fingers to hold the surgically operated proximal finger bungle. The metacarpophalangeal joint is worked out with the finger unsupported. The pin-fixed proximal finger stands still. The work-out exercises are continued until the pin is removed from the proximal finger bundle.

EFFECT: use of the given invention enables early work out of the joint, prevention of cicatrical adhesions, promotes avoiding joint contractures.

Description

The invention relates to medicine, namely to traumatology and orthopedics, and may be applicable for the treatment of damage to the extensor apparatus of the finger.

Existing methods of treating a damaged extensor apparatus of the finger include fixing the interphalangeal joints to fusion of the extensor finger. At the same time, from the immobility of the finger, the tendons of the flexors and extensors are soldered by a cicatricial process to the wall of the tendon vagina or the skin of the finger - there are contractures in the interphalangeal joints that contribute to the early development of tendo-and arthrogenic extensor contractures of the damaged finger. Particularly affected are the lateral portions of the extensor apparatus at the level of the proximal interphalangeal joint.

The well-known "Method of functional treatment of contractures of the joints of the extremities", which after physiotherapy and exercise therapy provides for the application of a daily modeled longet. However, this method is indicated for chronic contractures of the joints of the limbs and cannot be used in the early stages after surgery to prevent the development of early contractures in the joints of the limbs and to provide active movements of the tendons of the deep flexors and lateral portions of the extensor finger.

The essence of the invention lies in the combination of distinctive features sufficient to achieve the desired technical result, consisting in early movements of the nail phalanx, contributing to the active functioning of the deep flexor, and intact lateral portions of the extensor finger, early movements in the metacarpophalangeal joint for the prevention of immobilization contractures of the joint.

The essence of the invention lies in the fact that the method of early rehabilitation in case of damage to the middle portion of the extensor extensor involves the imposition of a longet, physiotherapy and physiotherapy. After restoring the middle portion of the extensor, with the proximal interphalangeal joint held in place by the needle in the position of maximum extension of the finger, a short plaster cast to the level of the distal interphalangeal joint is imposed on this finger, on the palm side, with the grasp of the hand. Physiotherapy is carried out from the 2nd day after surgery. Therapeutic gymnastics is carried out after the edema subsides and the pain subsides, from the 4th day until the removal of skin sutures. The patient independently conducts active-passive movements of the nail phalanx of the finger in a shortened splint. On day 14, gypsum and skin sutures are removed, the patient independently develops alternately either the distal interphalangeal or the metacarpophalangeal joints of the finger. When developing the distal interphalangeal joint with the movements of the nail phalanx in the flexor and extensor directions, the patient holds the proximal interphalangeal joint of the operated finger with the fingers of a healthy hand. The metacarpophalangeal joint is developed without manual fixation of the finger, while the proximal interphalangeal joint fixed with a spoke does not work. Development continues until the needles are removed from the proximal interphalangeal joint. On healing of the spoke wound - thermal procedures, exercise therapy and massage until restoration of the function of the finger.

The advantages of the proposed method are as follows.

A short palmar gypsum splint on the palmar side, with a grip of the hand, without fixing the distal interphalangeal joint, provides early movements of the nail phalanx in the flexor-extensor direction, which contributes to the active functioning of the deep finger flexor and undamaged lateral portions of the extensor finger, prevents scar adhesions.

Conducting physiotherapy from the 2nd day after surgery helps to relieve swelling and pain, which allows for the early development of the joint.

Removal of the palmar gypsum splint on the 14th day after surgery provides simultaneous, early development of the distal interphalangeal and metacarpophalangeal joints of the finger.

Holding the proximal interphalangeal joint with the fingers of a healthy hand as an additional support provides optimal conditions for the movement of the nail phalanx in the distal interphalangeal joint during development.

The development of movements in the metacarpophalangeal joint until the knitting needle is removed from the proximal interphalangeal joint of the finger helps to prevent immobilization contractures in this joint.

The method is as follows.

After the restoration of the middle portion of the extensor, with the proximal interphalangeal joint fixed with the needle in the position of maximum extension of the finger, on the operated finger, on the palmar side, with a grasp of the hand, apply a plaster cast to the level of the distal interphalangeal joint of the finger. From 2 days after the operation conduct diadynamic currents, UHF. From 4 days after the edema subsides and the pain subsides, the patient is prescribed independent active-passive movements of the nail phalanx in a shortened plaster cast. The patient regularly continues such movements until removal of skin sutures. On the 14th day after the operation, gypsum and skin sutures are removed. The area of the spokes is sealed with adhesive tape to prevent spoke infection. Further, the patient independently develops alternately either the distal interphalangeal or metacarpophalangeal joints of the finger, holding the proximal interphalangeal joint of the operated finger with the fingers of a healthy hand. The development of the distal interphalangeal joint occurs due to the movements of the nail phalanx in the flexor and extensor directions. The metacarpophalangeal joint is developed without manual fixation of the finger, while the proximal interphalangeal joint fixed with a spoke does not work. Development continues until the needles are removed from the proximal interphalangeal joint. 3 weeks after surgery, the needle is removed. After healing of the spinal wound on the finger, thermal procedures are connected, exercise therapy and massage are performed until the function of the finger is restored.

Thus, the proposed method of early rehabilitation in case of damage to the middle portion of the extensor finger allows you to start active-passive movements of the nail phalanx for the prevention of scar adhesions of the deep flexor tendon and lateral portions of the extensor finger, to prevent healing of the postoperative wound and fusion of the tendon and further, to remove the knitting needle, to prevent immobilization contractures in the metacarpophalangeal joint.

Information sources

Copyright Certificate No. 1117046, A61B 17/00, Bull. No. 37, 1984, p. 15.

Claims (1)

A method of early rehabilitation in case of damage to the middle portion of the extensor extensor, including the application of a splint, physiotherapy and therapeutic exercises, characterized in that after the restoration of the middle portion of the extensor with fixation of the proximal interphalangeal joint in the position of maximum extension of the finger, a short finger is placed on this finger from the palm side with a hand grip plaster cast to the level of the distal interphalangeal joint, physiotherapy is carried out from the 2nd day after surgery, therapeutic exercises are carried out after from swelling and subsiding of pain, from the 4th day until the skin sutures are removed, the patient independently conducts active-passive movements of the nail phalanx of the finger in a shortened splint, on the 14th day they remove gypsum and skin sutures, the patient independently develops alternately the distal interphalangeal, then the metacarpophalangeal joints of the finger, when developing the distal interphalangeal joint with the movements of the nail phalanx in the flexor and extensor directions, the patient holds the proximal interphalangeal joint of the fingers with the fingers of a healthy hand finger, metacarpophalangeal joint is developed without manual fixation of the finger, while the proximal interphalangeal joint fixed by a spoke does not work, development continues until the needle is removed from the proximal interphalangeal joint, thermal procedures, exercise therapy and massage are restored to restore the function of the finger .