RU2397722C1 - Method of recovery of active extension of three-phalanx fingers interphalangeal joints at neurogenic deformation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to traumatology and orthopedics, and can be applicable to restoration of active extension of three-phalanx fingers interphalangeal joints at neurogenic deformation. It is carried out at the level of the ligament retaining extensor tendons, flake of common extensor tendons of 2-3-4-5 fingers in a distal direction. Obtained transplants are led under intermatacarpus ligaments and sutured to the lateral fascicles of extensor apparatus of the fingers.

EFFECT: method enables to improve the functional result.

1 ex, 5 dwg

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 with damage to peripheral nerves.

With combined damage to the ulnar or combined damage to the median and ulnar nerves proximal to the carpal ligament, the possibility of active extension of the fingers in the interphalangeal joints is lost, persistent over-extension of the metacarpophalangeal joints and clawed deformation of the three-phalanx fingers due to atrophy of the short muscles of the hand gradually form. To correct this neurogenic deformity, the Fowler operation (Campbell operative orthopedics. Vol. Four. Edited by S. Terry Canalc., 2003, p. 3638-3643) is used. As muscles-motors own extensors of 2 and 5 fingers are used. From the incisions on the rear of the hand, the extensor 2 and 5 fingers are isolated and cut off. Perform additional incisions on the rear of the hand in 2-3-4-5 interdigital spaces. The extensors are split in two in the proximal direction, held under the intercarpal ligaments and fixed to the tendon extensor apparatus of 2 and 3 fingers on the radial side and 4 and 5 fingers on the ulnar side. 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 for restoring the active extension of the phalanges of the three-phalangeal fingers and eliminating hyperextension of the metacarpophalangeal joints, as well as the tendons proposed by the author for the use of tendons to restore other lost functions.

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.

The result of the invention is achieved by flaking in the distal direction of the tendons of the common extensor 2-3-4-5 fingers from the level of the ligament that holds the extensor tendons, and suturing to the lateral bundles from the ulnar side of the 2 and 4 fingers and the radial side of the 3 and 5 fingers after under metacarpal ligaments.

The figures depict:

Figure 1: Fowler claw deformity correction method.

Figure 2: sectional diagram.

Figure 3: scheme flake transplant tendons of common extensor 2-3-4-5 fingers.

Figure 4: diagram of the flakes of the tendons of the common extensor under the metacarpal ligaments.

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 position of the patient on the back. Under the tourniquet, an incision is made on the rear of the brush. At the level of the ligament holding the extensor tendons, the tendons of the common extensors of 2-5 fingers are isolated. In turn, each of them intersects 1/2 of the width and splits in the distal direction and displays in additional Y-shaped sections in the 2 and 4 interdigital spaces on the back 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 and are displayed on the rear of the main phalanx 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 distinguished 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 author, this method of restoring the active extension of the interphalangeal joints of the three-phalangeal fingers is the best way to restore active extension and eliminate hyperextension of the metacarpophalangeal joints with neurogenic deformities of the hand, accompanied by damage and impaired functioning of the interosseous muscles.

Clinical observation

Patient S., 34 years old, case history No. 14595, DZ: Neurogenic deformity of the right hand. Operation 06.12.07: 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 2 hours. 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 with neurogenic deformation, characterized in that at the level of the ligament that holds the extensor tendons, a flap is removed in the distal direction of the tendons of the common extensor 2-3-4-5 fingers, the resulting grafts are carried out under the metacarpal ligaments and sutured to the lateral bundles of the extensor apparatus of the fingers.

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