RU2782649C2 - Method for treatment of congenital hypoplasia of first finger of hand in children - Google Patents

Abstract

FIELD: medicine; traumatology; orthopedics.

SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics; it can be used for the treatment of congenital hypoplasia of the first finger of the hand in children. The rudiment of the first metacarpal bone and the trapezoid bone are isolated and released from soft tissues. Then, the proximal phalanx of the second toe is isolated and borrowed, middle, nail phalanges and the second metatarsal are fixed with a pin, the wound is sutured layer-by-layer. The borrowed proximal phalanx of the toe is combined with the rudiment of the first metacarpal bone, the trapezoid bone to form the first carpometacarpal joint, and it is fixed with a pin. After moving flaps, sutures are applied to the skin.

EFFECT: method allows for restoration of a function of two-way grip of the hand due to the formation of the first carpometacarpal joint.

1 cl, 8 dwg, 1 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics.

A known method for the treatment of hypoplasia of the first finger of the hand, which consists in the longitudinal splitting of the second metacarpal bone into the ulnar and radial halves with their separation at the base, replacing the resulting defect with a bone autograft, separating the carpometacarpal joint of the second finger and the small polygonal bone into the ulnar and radial halves with the possibility formation of the first ray of the hand (patent RU No. 2 297 190 C1 dated April 20, 2007).

Significant disadvantages of this method are: the risk of partial resorption of the first metacarpal bone formed from the longitudinal flake of the second metacarpal bone, as well as the possible limitation of passive and, accordingly, active mobility of the formed first ray due to splitting of the carpometacarpal joint.

The objective of the invention is to restore the bilateral grasp of the hand by forming the first finger of the hand with its congenital hypoplasia in children.

The technical result of the task is achieved by the fact that in the method of treating congenital hypoplasia of the first toe in children, which consists in the formation of the first metacarpal bone, it is proposed: to transpose the borrowed proximal phalanx of the second toe into the position of the first metacarpal bone of the hand; in the area of the first interdigital space, cut out the figure of opposing triangular flaps; on the back of the hand, continue the incision in the proximal direction with the formation of a rear rotational flap; from the specified access to select and free from soft tissues and remnants of the capsule the rudiment of the first metacarpal bone and the trapezoid bone; make an oval incision along the dorsal surface of the second toe, longitudinally dissect the extensor tendon, isolate and remove the proximal phalanx of the toe from the soft tissues; fix the middle, nail phalanx and the second metatarsal bone with a knitting needle, sutured the wound in layers; compare the borrowed proximal phalanx of the second toe with the rudiment of the first metacarpal bone, the trapezoid bone on the hand, thus form the first carpometacarpal joint and fix the finger with the previously drawn needle; after moving the flaps, suture the skin; close the wound defect at the site of borrowing the rotational flap with a thick split skin graft taken from the outer surface of the left thigh; suture the donor wound. After the described steps, it is shown to perform X-ray control of the hand and foot, apply aseptic dressings, back plaster splints on the hand and foot.

Photos 1-5 show photographs of the stages of the proposed method for the treatment of congenital hypoplasia of the first finger in children.

Radiographs 6, 7 show images of the hand and foot after surgery.

In photo 1: position 1 - hypoplastic first finger, position 2 - scheme of incisions in the form of a figure of oncoming triangular flaps of the dorsal rotational flap.

Photo 2 shows the stage of the operation: harvesting the proximal phalanx of the second toe, where position 3 is the borrowed proximal phalanx of the second toe, position 4 is the pin fixing the middle, nail phalanx of the donor finger and the second metatarsal bone.

In photo 3, the stage of the operation: transposition of the proximal phalanx of the second toe to the position of the first metacarpal bone, where position 1 is the hypoplastic first toe, position 3 is the borrowed proximal phalanx of the second toe, position 5 is the rudiment of the first metacarpal bone, position 7 is the pin, fixing the borrowed phalanx of the toe, the rudiment of the first metacarpal bone and the hypoplastic first toe.

In photo 4, the stage of the operation: fixation with a pin of the borrowed proximal phalanx of the second toe, where position 1 is the hypoplastic first toe, position 3 is the borrowed proximal phalanx of the second toe, position 5 is the rudiment of the first metacarpal bone, position 6 is the cartilaginous bone-trapezium, position 7 - a pin fixing the hypoplastic first toe, the rudiment of the first metacarpal bone, the borrowed phalanx of the toe, the trapezoid bone, position 8 - the formed first carpometacarpal joint.

Photo 5 shows the appearance of the hand after surgical treatment of congenital hypoplasia of the first finger.

X-ray 6 shows a picture of the hand before surgery, where position 1 is the hypoplastic first finger of the hand, position 5 is the rudiment of the first metacarpal bone, position 6 is the cartilaginous bone-trapezium.

Radiograph 7 shows a control radiograph of the foot, where position 4 is a pin that fixes the middle, nail phalanges of the donor finger and the second metatarsal bone.

X-ray 8 shows a control image of the hand, where position 1 is the hypoplastic first toe, position 3 is the borrowed proximal phalanx of the second toe, position 5 is the rudiment of the first metacarpal bone, position 6 is the cartilaginous bone-trapezium, position 7 is the pin fixing the hypoplastic the first finger of the hand, the rudiment of the first metacarpal bone, the borrowed phalanx of the toe, the trapezoid bone, position 8 - the formed first carpometacarpal joint.

A method for the treatment of congenital hypoplasia of the first finger in children is carried out as follows.

Clinical example. Patient 3., 9 years old, was admitted to the clinic named after G.A. Albrecht with a diagnosis of congenital hypoplasia of the first finger of the right hand IV degree. Complaints at the time of admission: a violation of the function of the bilateral grip of the right hand, a pronounced cosmetic defect of the hand.

In the position of the patient lying on her back in the area of the first interdigital space, a figure of oncoming triangular flaps was cut out with a main incision of 2.0 cm and angles of the lateral incisions of 45-90 degrees (Photo 1). On the back of the hand, the incision is continued in the proximal direction with the formation of a dorsal rotational flap. From the indicated access, the rudiment of the first metacarpal bone and the trapezoid bone were isolated and freed from soft tissues and remnants of the capsule. An oval incision was made along the dorsal surface of the second toe, the extensor tendon was dissected longitudinally, and the proximal phalanx of the toe was isolated and borrowed from the soft tissues (Photo 2). The middle, nail phalanges and the second metatarsal bone are fixed with a pin, the wound is sutured in layers. The borrowed phalanx of the toe was juxtaposed distally with the rudiment of the first metacarpal bone and proximally with the trapezius bone with the formation of the first carpometacarpal joint and fixed with an earlier wire (Photo 3, 4). After moving the flaps, the sutures are on the skin (Photo 5). The wound defect at the site of borrowing the rotational flap was closed with a thick split graft taken from the outer surface of the left thigh. X-ray control of the hand and foot (X-rays 6, 7), aseptic dressings, back plaster splints on the hand and foot. The donor wound is sutured.

The positive effect of the proposed technical solution lies in the fact that the risk of partial resorption of the formed first metacarpal bone is minimized, passive mobility of the formed first finger is achieved due to the formation of the first carpometacarpal joint, and, as a result, the function of the bilateral grip of the hand is improved.

Claims (1)

A method for treating congenital hypoplasia of the first toe in children, including the transposition of the proximal phalanx of the second toe borrowed from the foot into the position of the first metacarpal bone of the hand, while in the area of the first interdigital space a figure of oncoming triangular flaps is cut out, on the back of the hand the incision is continued in the proximal direction with the formation of the dorsal rotational flap, then a rudiment of the first metacarpal bone and a trapezium bone are isolated from the indicated access, then an oval incision is made along the dorsal surface of the second toe, the extensor tendon is longitudinally dissected, the proximal phalanx of the toe is isolated and taken from the soft tissues, then the middle, nail phalanx and the second metatarsal bone are fixed with a knitting needle and the wound is sutured in layers, the borrowed proximal phalanx of the second toe is compared with the rudiment of the first metacarpal bone, the trapezoid bone on the hand and fixed with a knitting needle, after moving the flaps, sutures are applied to the skin, wound defect at the site of borrowing the rotational flap, it is closed with a split skin graft taken from the outer surface of the left thigh, the donor wound is sutured, then X-ray control of the hand and foot is performed, aseptic dressings and back plaster splints are applied to the hand and foot.

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