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Re: WRIST FLEXION CONTRACTURE
послал Sudhir Warrier 19 Ноябрь 2006, 14:12
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Dear Cherian,
Please dont go about excising bone to get a correction in this case! He is only 11 years old!
Distraction is ideally suited for such instances. The UMEX fixator is perfect. Light and yet strong. Erected on smooth pins and with differential distraction and gradual angular (manual) correction, the wrist and the finger deformities will most certainly correct to a great extent. ((A computer modified model picture of the frame is attached)
The synostotic bridge must be excised (along with preventive measures to try and prevent a recurrence) at the time of the application of the frame.
Reassess the situation at the time of the frame removal. Maintain the correction in a plaster (not a removable splint, which most certainly will be removed! resulting in inevitable "recurrence") and finally long term splinting and mobilization will be needed.
I usually release the volar skin and subcut tissues until I reach tendon/nerve/vascular sheaths, which are not tampered with. Split skin grafts can cover the raw areas created from this release. This reduced the strain on the fixator, reduces distraction period and allows distraction to act on tissues trying to bridge a gap (much in the same way as the Ilizarov lengthenings where as nature tries to bridge two yearning bone ends, the surgeons teasingly pulls them further apart making nature work harder to achieve the objective!)
The corrections achieved are always more supple than excision and fusion and flaps etc.
Functional enhancement may require further procedures (including "touch ups" as Dr BB Joshi would call the further corrections of incompletely corrected deformities or the procedures for the stubborn ankylosed joints that dont yield to distraction).
Well, finally the statutory warning: If you are not familiar with distraction deformity correction, please call in someone experienced. These are the most difficult ones needing complex frames and frequent minor modifications as correction proceeds.
Not the same age and not the same etiology, I understand, but all the same,
A case in point:
Etiology: Post burns contractures of the hands and the wrists Time elapsed since episode: 9 months In frame time: 7 weeks follow up after 4 years (his son had a compound supracondylar femoral fracture and he brought him to us for treatment from approximately 1600 kms away!)
Sudhir Warrier
Hand and Reconstructive Orthopedic Surgeon
Laud Clinic . Lilavati . Jaslok . LH Hiranandani . Shushrusha . Sir HN Hospitals
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