1/15. Optimizing the correction of severe postburn hand deformities by using aggressive contracture releases and fasciocutaneous free-tissue transfers.Severe postburn hand deformities were classified into three major patterns: hyperextension deformity of the metacarpophalangeal joint of the fingers with dorsal contracture of the hand, adduction contracture of the thumb with hyperextension deformity of the interphalangeal joint, and flexion contracture of the palm. Over the past 6 years, 18 cases of severe postburn hand deformities were corrected with extensor tenotomy, joint capsulotomy, and release of volar plate and collateral ligament. The soft-tissue defects were reconstructed with various fasciocutaneous free flaps, including the arterialized venous flap (n = 4), dorsalis pedis flap (n = 3), posterior interosseous flap (n = 3), first web space free flap (n = 3), and radial forearm flap (n = 1). Early active physical therapy was applied. All flaps survived. Functional return of pinch and grip strength was possible in 16 cases. In 11 cases of reconstruction of the dorsum of the hand, the total active range of motion in all joints of the fingers averaged 140 degrees. The mean grip strength was 16.5 kg and key pinch was 3.5 kg. In palm reconstruction, the wider contact area facilitated the grasping of larger objects. In thumb reconstruction, key-pinch increased to 5.5 kg and the angle of the first web space increased to 45 degrees. Jebsen's hand function test was not possible before surgery; postoperatively, it showed more functional recovery in gross motion and in the dominant hand. Aggressive contracture release of the bone,joints, tendons, and soft tissue is required for optimal results in the correction of severe postburn hand deformities. Various fasciocutaneous free flaps used to reconstruct the defect provide early motion, appropriate thinness, and excellent cosmesis of the hand.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/15. Postoperative management of functionally restrictive muscular adherence, a corollary to surgical tenolysis: a case report.After a surgical release of adhered nongliding tendons, early active mobilization is encouraged to prevent the reformation of unfavorable adhesions that would limit functional tendon excursion. These restricting adhesions can also occur in non-synovial regions, such as within the flexor mass in the forearm. A "myolysis," or release of muscle fibers from tethering adhesions, can be performed surgically to restore the muscle's gliding and lengthening properties. Postoperative management consists of treatment techniques that include low-load prolonged stress, differential tendon gliding, and active-resistive exercises, all of which are effective in restoring and maximizing a patient's active and passive range of motion to allow optimal mobility and performance. This case study demonstrates the successful management of a patient following a surgical myolysis, utilizing treatment techniques conceptually derived from postoperative tenolysis rehabilitation.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
3/15. Proximal interphalangeal joint surface replacement arthroplasty.A consecutive series of 20 joints in 13 patients underwent arthroplasty with the RMS PIP joint surface replacement implant. Twelve joints were treated for painful osteoarthritis (all females). Two joints were implanted for rheumatoid arthritis, two for post-traumatic pain and stiffness, two for post-traumatic stiffness and one each for post-traumatic pain and pain-free post-traumatic instability. Excellent, often total long-term pain relief was obtained in 18 joints. The other two patients with (compensible work-related) post-traumatic pain and stiffness reported "50-70% pain reduction". No patients lost movement and 14 out of 20 joints were pain-free with a 73.1 degrees average arc of motion. Six joints from the first half of the series had poor motion (average arc of 19.6 degrees ), even after open extensor tenolysis or manipulation under anaesthesia. As experience was gained, reliably better results were achieved with a more intensive regimen of hand therapy, particularly within the first post-operative week.- - - - - - - - - - ranking = 0.66666666666667keywords = motion (Clic here for more details about this article) |
4/15. Anesthetic management of a difficult airway in a patient with epidermolysis bullosa: a case report.epidermolysis bullosa is an inherited skin disease that leads to an array of medical problems. patients are susceptible to blistering and scar formation following even minor trauma. These patients may present with scarring, limiting the range of motion of their temporal mandibular joint. This case report describes a 15-year-old patient with epidermolysis bullosa presenting for contracture release, with a difficult airway.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
5/15. Soft tissue contractures from melorheostosis involving the upper extremity.melorheostosis is a rare disorder characterized by a linear hyperostosis of cortical bone, joint pain, stiffness, deformity, and limited motion. In the hand, the disease is often disabling because of progressive contractures of the joints and soft tissues involved. Two cases of melorheostosis involving the radial side of the hand and upper extremity are reported. Splinting or surgical release did not result in permanent correction of the soft tissue contractures. Retraining patients to use their unaffected hand should be considered early in the course of the disease.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
6/15. Dorsal Dupuytren's disease causing a swan-neck deformity.A previously undescribed lesion of Dupuytren's disease is presented. An oblique cord coursed parallel to the oblique retinacular ligament of Landsmeer, but inserted proximal to the proximal interphalangeal joint, tethering the central slip and radial lateral band across the intervening transverse retinacular ligament. Contraction of this cord caused a rigid swan-neck deformity. Excision of the cord resulted in complete resolution of the deformity and a full range of motion in the affected digit.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
7/15. Microvascular reconstruction of congenital anomalies and post-traumatic lesions in children.A series of toe-to-hand transfers in children with congenital or post-traumatic deficits is reported to emphasize the role of microvascular reconstruction as an important alternative. morbidity to the donor site is almost negligible, and the functional improvement to the hand is reasonably good considering the young age of the patients. Functional results are limited by the lack of full motion, soft-tissue contractures, sensory recovery, and the delay in cortical reeducation. We were surprised to find a relatively high number of vascular anomalies in the foot (both traumatic as well as congenital). Abnormalities in the transferred toe can limit the function of the hand, and the best (not worse) tissues available should be transferred. The importance of digit positioning to provide prehensile pinch and grasp as the ultimate goal needs to be emphasized so that opposing fingers rather than cosmetic fingers result in effective hand use. We recommend this operative procedure in selected patients along with other reconstructive alternatives, taking care in the selection process to consider factors related to both asthetic improvement of the hand as well as long-term functional return.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
8/15. Total palmar resurfacing with scapular free flap in a 26-year contracted hand.The scapular free flap offers a large-sized and well-vascularized coverage for variable defects. It is not regarded, however, as a favorite tool for palmar resurfacing because of its bulky and rigid nature. A 28-year-old man had sustained a contact dermal injury at the age of 2 years that resulted in a severely deformed hand. The total palmar defect was resurfaced by surgical intervention with a scapular free flap. After secondary procedures, the final result was promising. The present report focuses on the secondary procedures, which make a more functional and aesthetically pleasing hand after coverage with the scapular flap. Also, our result suggests that even finger joints contracted for 26 years can recover motion if they have not been directly damaged.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
9/15. Soft tissue metacarpophalangeal reconstruction for treatment of rheumatoid hand deformity.The long-term results of soft tissue metacarpophalangeal reconstruction without articular resection were reviewed in 16 hands of 12 patients with painful ulnar deviation-subluxation deformity. No splinting was used beyond 3 weeks. patients had either lupus or rheumatoid arthritis. The mean age at operation was 66 years, with mean disease duration of 15.9 years before operation. At follow-up (mean, 81 months), complete pain relief occurred in 88% of patients and 56 degrees and 64 degrees mean active metacarpophalangeal and proximal interphalangeal range of motion was present, respectively. Ulnar drift was corrected to 6 degrees on the average. The first semiobjective grading scale for metacarpophalangeal reconstruction was introduced. There were 82% good or excellent results.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
10/15. Tendon transfers in muscle and tendon loss.Tendon transfers in muscle and tendon loss offer some of the most gratifying results to both patient and surgeon. Poor results do occur at times in tendon transfer. When patients whose results were found to be less than expected were studied, the following problems were identified: 1. Acceptance of less than full passive range of motion before transfer. In some instances, this will be unavoidable. The use of pretransfer hand therapy techniques may improve the situation; or, if possible, pretransfer capsulotomies may better prepare the patient for the tendon transfer. 2. Adhesions along the course of the transfer. At times the transfer route can be better prepared by the use of skin grafts adding subcutaneous tissue to the transfer bed. The use of a staged technique in which a silicone rubber tendon implant is installed along the transfer route, to prepare for a later transfer, is occasionally indicated. 3. Technical failures: a. juncture breakdown, b. transfer put in under too little tension. 4. Patient noncompliance. A recent experience in which a patient removed his postoperative cast and came in 2 weeks later with his transfer disrupted is an extreme example. Many other patients are not prepared to undertake what may be a rigorous and time-consuming postoperative transfer program. Adequate preoperative evaluation, including patient selection as well as careful attention to the details of the procedure during surgery, along with attentive postoperative care, should eliminate most of these problems.- - - - - - - - - - ranking = 0.33333333333333keywords = motion (Clic here for more details about this article) |
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