RU2464947C1 - Method of treating extending finger contracture in proximal interphalangeal joint - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics, and can be used in treatment of extending finger contraction in proximal interphalangeal joint. From joint capsule at the level of proximal interphalangeal joint П-shaped flap on distal pedicle, attached to the base of middle phalanx, is cut out. Middle phalanx is bent in proximal interphalangeal joint and transarticulation fixation is performed by means of wire. After that, interrupted suture is applied on edges of remaining joint bursa interrupted suture is applied. Interrupted suture is covered with П-shaped flap with its sewing to remaining part of tendon sheath.

EFFECT: method ensures elimination of extending finger contracture, prevention of pathology recurrences.

7 dwg

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of the effects of damage to the flexor tendons and the ligamentous-ligamentous apparatus of the proximal interphalangeal joint.

In case of damage to the flexor tendons at the level of the proximal interphalangeal joint, with violation of the integrity of the joint capsule along the volar surface, the extensor tendon (its main portion, which is attached to the base of the middle phalanx) extends the middle phalanx of the finger, resulting in a swan-neck deformation. This is due to an imbalance between the flexor and extensor tendons. On the volar surface, the legs of the superficial flexor are attached to the middle phalanx of the finger, which are damaged in case of injury, and on the rear, to the base of the middle phalanx, the main portion of the extensor is attached with the function preserved. This deformation persists even after restoration of the deep flexor, since the restored deep flexor loses its ability to bend the middle phalanx.

The prototype of the invention is the Zancolli operation, which includes capsuloplasty - shortening the palmar capsule of the joint by cutting out the flap and fixing it with shortening and folding of the finger phalanx. However, this intervention, both according to the author himself and others, leads to a relapse of the deformity in 50% of cases.

The invention consists in a combination of essential features sufficient to achieve a technical result, consisting in the elimination of extensor contracture of the finger in the proximal interphalangeal joint, preventing the relapse of this pathology.

The essence of the method of treating extensor contracture of the finger in the proximal interphalangeal joint includes capsuloplasty with shortening of the palmar capsule by cutting out the flap and fixing it. From the capsule of the joint, at the level of the proximal interphalangeal joint, a U-shaped flap is cut out on the distal leg, attached to the base of the middle phalanx. The middle phalanx is bent in the proximal interphalangeal joint and transarticular fixation is made with a knitting needle, after which a knotted suture is applied to the edges of the remaining articular bag, the knotted suture is closed with a U-shaped flap and sewn to the remains of the tendon sheath.

Cutting a U-shaped flap on the distal leg from the joint capsule at the level of the proximal interphalangeal joint attached to the base of the middle phalanx, fixing when bending the finger in the proximal interphalangeal joint with a transarticular needle, applying a knotted suture to the edges of the remaining articular bag, overlapping the knotted suture the flap, and sewing it to the remains of the tendon vagina are performed to ensure reliable fixation of the remains of the joint capsule, ensuring its full regeneration.

The method is illustrated by illustrations.

Figure 1 is a photograph of a brush before surgery;

figure 2 shows the diagram of the operation, where figure 2-1 - cut from the capsule of the joint U-shaped flap on the distal leg; figure 2-2 - fixation during flexion of the finger in the proximal interphalangeal joint transarticularly with a knitting needle, the imposition of a knobby suture on the edges of the remaining joint bag; Fig.2-3 - overlap of a knotted seam with a U-shaped flap; in Fig.2-4-suturing of the flap to the remains of the tendon sheath;

figure 3 - access to the proximal interphalangeal joint;

figure 4 - cutting a U-shaped flap on the distal leg attached to the base of the middle phalanx taken on the holder;

figure 5 - fixation during flexion of the finger in the proximal interphalangeal joint transarticular needle;

in Fig.6 - the imposition of a knotted suture on the edges of the remaining articular bag with overlapping knotted suture with a U-shaped flap;

Fig.7 is a snapshot of the brush one year after the operation.

The method is as follows.

After treatment of the skin of the hand under regional local anesthesia with 2% novocaine solution, a semi-oval incision along the volar surface of the finger at the level of the proximal interphalangeal joint, with the transition to the main and middle phalanges, the skin-subcutaneous flap is uncovered with exposure of the proximal interphalangeal joint (Fig. 3). From the capsule of the joint, a U-shaped flap on the distal pedicle, attached to the base of the middle phalanx, is cut out and taken onto the holders (Fig. 4). The middle phalanx is bent in the proximal interphalangeal joint and transarticular fixation with a knitting needle (Fig. 5), after which a nodal suture is applied to the edges of the remaining articular bag and a U-shaped flap is sutured to the remnants of the tendon sheath, overlapping the previously applied nodal suture (Fig. 6). The wound on the finger is sutured, the back of the plaster cast is laid before removal of the skin sutures. The needle is removed after 4-5 weeks from the day of surgery.

Information sources

A.M. Volkova “Hand Surgery”, Volume I, Ekaterinburg, 1991, p. 204.

Claims (1)

A method for treating extensor contracture of the finger in the proximal interphalangeal joint, including capsuloplasty with shortening of the palmar capsule by cutting the flap, and fixing it, characterized in that a U-shaped flap is attached to the base of the distal leg attached to the base of the joint at the level of the proximal interphalangeal joint, attached to the base middle phalanx, bend the middle phalanx in the proximal interphalangeal joint and produce transarticular fixation with a knitting needle, and then on the edges of the remaining articular bag they fix the knotted suture, overlap the knotted suture with a U-shaped flap, and sew it to the remains of the tendon sheath.

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