RU2621277C1 - Method of ii-v fingers extension recovery in interosseous muscle shrinkage - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: lateral portions of II-V fingers extensor tendons, attached to interosseous muscles, are resected for 1-1.5 cm. Capsulotomy of proximal interphalangeal joints is carried out along a palmar surface. Limb is immobilized by plaster palmar splint in the position of finger extension and radiocarpal joint flexion.

EFFECT: method improves the results of patients treatment by achieving extension of the affected fingers.

4 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used to restore extension of the II-V fingers in cicatricial wrinkling of the interosseous muscles.

A known method of restoring extension by lengthening the tendons used to treat tenomyogenic contractures. The tendon is dissected in a Z-shape, and the longitudinal part of the incision along the length should be sufficient so that the segments of the tendinum come into contact with the lateral surfaces for at least 1 cm (I. A. Movshovich. Operative orthopedics. A guide for doctors. - M .: Medical Information LLC Agency ”, 1994. - S. 19). The method cannot be used to restore extension of the II-V fingers of the hand, since the scarred interosseous muscles and lateral portions of the tendon extensor apparatus of the fingers are tightly connected to the bones.

There is a method of restoring extension of the hammer-shaped toes, when the length of the finger is shortened by resection of the main phalanx of the finger (V. M. Shapovalov. Textbook of military traumatology and orthopedics. - SPb .: VMedA, 2004. - P. 621).

The disadvantage of this method is the following. The method cannot be applied to restore extension of the II-V fingers of the hand, since reducing the length of the finger will lead to impaired function and weakening of the force.

The aim of the invention is to improve the results of treatment of patients by achieving extension of the affected fingers.

The technical result of the task is achieved in that they resect for 1-1.5 cm the lateral portions of the tendons of the extensors of the II-V fingers, attached to the interosseous muscles, conduct a capsulotomy of the proximal interphalangeal joints on the palmar surface, and also immobilize the limb with a gypsum palmar span in the extension position fingers and dorsiflexion of the wrist joint.

The structure of the musculoskeletal system contains a kinematic chain consisting of bones, tendons and muscles. For example, the kinematic chain of the biceps of the shoulder muscle is “bone-tendon-muscle-tendon-bone”, the kinematic chain of the interosseous muscle of the fingers - “bone-tendon-muscle-bone”, the kinematic chain of the muscle of the square pronator of the forearm - “bone-muscle- bone "(Fig. 1, 2).

Biomechanical substantiation of surgical intervention. The extensor apparatus of the II-V fingers of the hand has a complex structure and consists of three portions - the central and two lateral. The central portion is driven by the extensors of the hand at the level of the forearm, and the lateral - by the interosseous muscles at the level of the hand. With denervation of the interosseous muscles, their cicatricial degeneration occurs, leading to a shortening of the kinematic chain: “bone-tendon-muscle”. As a result of this, the main phalanx moves to the back side, and the middle - to the palmar. The nail phalanx takes the position of extension. When the side portions of the extensor II-V fingers are cut off and resected, these pathological displacements are eliminated. The extension of the finger occurs in full due to the action of the central portion of the extensor tendon of the corresponding finger.

The operation was performed as follows. The lateral portions of the extensor tendons of the II-V fingers of the hand were attached over 1-1.5 cm and attached to the interosseous muscles, capsulotomy of the proximal interphalangeal joints was performed on the palmar surface, the fingers were placed in the extension position, the palmar gypsum splint was placed in the extension of the fingers and dorsiflexion of the wrist joint.

The drawings depict the following.

FIG. 1. The kinematic chain of the biceps of the shoulder ("bone-tendon-muscle-tendon-bone"). Kinematic chain of the brachioradialis muscle (“bone-tendon-muscle-bone”). Arrows indicate: 1 - biceps muscle of the shoulder; 2 - brachioradialis muscle.

FIG. 2. The kinematic chain muscle of the square pronator of the forearm (“bone-muscle-bone”). The arrow indicates: 3 - muscle square pronator.

FIG. 3. The position of the finger before surgery. Operation scheme. Arrows indicate: 4 - level of resection; 5 - cicatricial interosseous muscle; 6 - shortened kinematic chain.

FIG. 4. The position after resection of the extensor tendon of the finger of the hand. Operation scheme. Arrows indicate: 7 - the length of the resection; 8 - the restored length of the kinematic chain.

Clinical observation

Patient C., 35 years old, September 15, 2013 injured his right hand with a knife. I did not go to the doctor, I was not treated. After 7 months a “clawed hand” was formed - the fourth and fifth fingers were twisted and set in a flexion position in the proximal interphalangeal joints. The deformation could not be eliminated during physiotherapy exercises and redress. The fourth and fifth fingers of the right hand were in the position of flexion in the proximal interphalangeal joints.

On October 14, 2015, the clinic of military traumatology and orthopedics underwent surgery according to the developed technique. Under conduction anesthesia, a longitudinal section of 4 cm along the midline of the radial surface of the fourth and fifth fingers of the right hand exposed the lateral portions of the extensor tendons attached to the interosseous muscles. Lateral portions of tendons were resected over 1.5 cm. The same intervention was performed on the ulnar surface of the fourth and fifth fingers. With finger regression, full extension was not achieved. To achieve full extension, a capsulotomy of the proximal interphalangeal joints of the fourth and fifth fingers on the palmar surface was performed. A complete extension of the IV and V fingers was achieved. The wounds are gone. The limb was immobilized with a plaster cast in the position of full extension and back flexion of the wrist joint at an angle of 30 °. There were no complications. Immobilization continued for 15 days. After removing the plaster cast, the full extension of the fourth and fifth fingers of the right hand was preserved.

According to the developed technique, 23 patients were operated on. A complete extension of the fingers of the hand is achieved. There were no complications.

In the published works, it was not possible to find descriptions of the developed treatment methodology.

Claims (1)

A method of restoring extension of the II-V fingers of the hand during cicatricial wrinkling of the interosseous muscles, characterized in that the lateral portions of the tendons of the extensors of the II-V fingers of the hand attached to the interosseous muscles are resected for 1-1.5 cm, capsulotomy of the proximal interphalangeal joints on the palmar surface is performed , and also immobilize the limb with a plaster palm pad in the position of extension of the fingers and dorsiflexion of the wrist joint.

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