RU2492826C1 - Method of correcting claw toe deformity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to traumatology and orthopaedics. Release of metatarsophalengeal joint capsule is carried out. Z-shaped elongation of tendon of long toe extensor is carried out. Correction of deformity and holding toe in normal position is carried out by passing vicryl thread on sole surface of nail phalanx of toe subcutaneously and under head of respective metatarsal bone. After that, plantar flexion of toe is carried out, thread is tied up and toe is held in achieved position before formation of soft-tissue scar.

EFFECT: method prevents deformity recurrence.

1 ex, 4 dwg

Description

The invention relates to medicine, in particular to traumatology and orthopedics, namely, it is intended for the treatment of acquired deformities of the forefoot, and more specifically, to methods used to correct hyperextension in the metatarsophalangeal joint after eliminating the claw-like deformation of the toe.

A known method of fixing the finger in the normal position after correction of claw-like deformation by intramedullary axial transarticular introduction of the Kirchner needle. In this case, the spoke is inserted into the diaphysis of the metatarsal bone (Reconstructive plastic surgery of transverse flatfoot, A.M. Savintsev, St. Petersburg, 2006, p. 32, 34).

However, the disadvantages of this method of fixation are: the possibility of migration of the spokes, fracture of the implant, there is a high risk of infectious complications, since the presence of the spokes on the tip of the finger can be the entrance gate of infection.

A known method of fixing a finger in a normal position after correction of claw-like deformation by using a redidi-fixing bandage Digidress. When performing the known method, rings of elastic material are worn on the operated fingers, which are fixed to the cuff, dressed on the rear of the foot (fixation on the basis of the Vilkro fastener) (http://www.a2j-intl.com/de/produkte-orthopaedie/fuss/ meta-digidress.html)

However, the use of this dressing is difficult due to the presence of fresh postoperative scars on the back of the fingers, and also increases the risk of infectious complications.

There is a method of treating hammer-like deformation of II-V toes by redistributing stress vectors between the flexors and extensors of the hammer-shaped toes, in which the intersection of short extensors is carried out in the projection of the metatarsophalangeal joints, and the intersection of the long flexor of the affected hammer-like finger is carried out at the level of the middle phalanx (application RU No. 2004113427. Published on October 27, 2005).

However, this method is applicable for the correction of the hammer-shaped middle fingers, and not the claw-like deformation of the middle toes.

A known method of distraction tendolysis of tendons with contractures of the fingers and toes, in which an external fixation device is applied to the affected joints of the finger. In this case, with the help of dosed distraction, the finger is given a position opposite to deformation. Then, by alternating gradual distraction for the phalanges at the level of each joint, tendons are released from the surrounding adhesions. The finger is stabilized in the apparatus in an extended position for 12-14 days. Then the apparatus is removed, intensive development of movements in the joints and splinting of the finger is carried out in the position opposite to deformation (US Pat. RF No. 2417761. Publ. 10.05.2011).

However, the use of the known invention carries the risk of infection by the knitting needle, there is a possibility of teething bone with a knitting needle in conditions of osteoporosis, in addition, it provides for additional fixation after dismantling the device, which lengthens the rehabilitation time.

The objective of the present invention is to perform surgical intervention without the use of external fixation devices or transarticular implants, reduce the possibility of infection, create a more gentle mode of preservation of the achieved correction, the ability to use orthopedic shoes (Barouk shoes or rocker shoes) and reduce pain.

The problem is solved in that in the method of correction of the claw-like deformation of the toe, including the release of the capsule of the metatarsophalangeal joint, the Z-shaped lengthening of the tendon of the long extensor of the finger, the correction of deformation and the holding of the finger in the normal position, carry out the acrylic filament on the plantar surface of the nail phalanx of the finger subcutaneously and under with the head of the corresponding metatarsal bone, then plantar flexion of the finger is carried out, the thread is tied and the finger is held in the reached position until it is formed oia soft tissue scar.

The present invention is illustrated by a detailed description, examples of the method and illustrative materials on which:

Figure 1 is a copy of the photo during the conduct of the vikrilovoy threads on the plantar surface of the nail phalanx of the finger subcutaneously;

Figure 2 is a copy of a photo characterizing the holding of a vikrilovy thread under the head of the metatarsal bone;

Figure 3 is a copy of a photo illustrating plantar flexion of the finger when tying the thread;

Figure 4 is a copy of a photo illustrating the end of the operation.

The method of correction of the claw-like deformation of the toe is as follows.

The treatment of this pathology is operational and depends on the degree of fixation of the deformity. The degree of fixation is determined using the Puch up test - when pressing on the heads of the metatarsal bones on the plantar surface with non-fixed deformation, the fingers straighten, with fixed deformation (contracture) - the deformation is preserved. In case of non-fixed deformation, surgery is performed according to this method, in case of fixed deformation, surgery is performed on the bones.

In the operating room, after performing regional anesthesia, with the patient lying on his back and three (3) times treating the surgical field, they have front access to the metatarsophalangeal joint and release the capsule of the metatarsophalangeal joint. In addition, carry out Z-e extension of the tendon of the long extensor of the toe. If after the Z-shaped lengthening of the tendon of the long extensor of the finger, the tendency of hyperexcision of the finger persists, the finger is fixed with a vikril thread to the plantar surface of the foot in the projection of the head of the corresponding metatarsal bone. To do this, conduct on the plantar surface of the nail phalanx of the finger and under the head of the corresponding metatarsal bone a subcutaneous vicryl thread. Then plantar flexion of the finger is carried out, a thread is tied and the finger is held in the created position for a maximum of two (2) weeks until the soft tissue scar is formed.

An example of the method of correction of the claw-like deformation of the toe

Patient K., medical record No. 623 of a hospital patient, 63 years old, was admitted to the hospital with a diagnosis of Hallux valgus deformation of the first toes of both feet, claw-like deformation of the second toes of both feet, third to fourth fingers of the left foot, varus deformity of the fifth toes of both feet.

Conducted x-ray examination of the foot in direct projection with load.

In the operating room, after performing regional anesthesia, in the position of the patient lying on his back and three (3) times processing the surgical field, they had front access to the metatarsophalangeal joint and released the capsule of the metatarsophalangeal joint. Then performed Z-oe lengthening the tendon of the long extensor of the finger. If, after performing the intervention on a soft tissue apparatus, there is a clinical tendency to relapse, we fix the finger with a vikril drink to the plantar surface of the foot in the projection of the head of the corresponding metatarsal bone.

At the same time, a subcutaneous vicryl thread was drawn along the plantar surface of the nail phalanx of the finger and under the head of the corresponding metatarsal bone. Then plantar flexion of the finger was carried out, the thread was tied and the finger held in the created position for two (2) weeks until the soft tissue scar was formed.

The method of correction of claw-like deformation of the finger was applied in clinical conditions in 2010-2011. Twelve (12) patients underwent surgery on twelve (12) toes. Duration of observation from 4 months to one year. There were no complications and relapses of claw-like deformity.

Claims (1)

A method for correcting claw-like deformation of the toe of the toe, including the release of the capsule of the metatarsophalangeal joint, Z-shaped tendon extension of the long extensor of the finger, correction of deformation and retention of the finger in the normal position, characterized in that the acrylic filament is carried out along the plantar surface of the nail phalanx of the finger subcutaneously and under the head of the corresponding metatarsal bones, then plantar flexion of the finger is carried out, the thread is tied and the finger is held in the reached position until the formation of a soft-woven ru btsa.

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