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Results for “Hand Deformities”

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PubMed1998

[Callus distraction for lengthening of mid-hand and finger stumps in congenital hand abnormalities--personal results and review of the literature].

Distraction-lengthening technique is quite useful in a variety of congenital hand deformities with hypoplastic, or primary normal but secondary shortened (constriction ring syndrome) finger rays. It appears that around the age of two years is the earliest practical time to start distraction; certainly distraction and secondary surgical procedures to improve function should be completed before school entry age whenever possible. Between June 1990 and March 1993, nine distraction lengthening procedures (5 thumbs, 1 index, 3 little fingers) in five patients presenting with congenital hand deformities, were carried out. Although restoring length to the finger, lengthening does not provide normal circumference or, of course, interphalangeal joint motion. Amelioration in function seems to be more important than the esthetic gain. Distraction lengthening tolerates only few errors of indication, operative technique, and/or postoperative management. A high compliance of the patient and her/his parents as well as a close follow-up by an experienced surgeon, are mandatory for a good result. A variety of possible complications have been described. Generally, complication risk increases in cases of simultaneous and multiple level lengthening. Provided adequate operative technique and postoperative care, superficial pin infection and fracture in the region of distraction are the major complications. Contrary to adults, sufficient bone formation by distraction is the rule in children. Therefore, the distraction-lengthening technique is preferred to the distraction-interposition technique in the treatment of congenital hand deformities. The latter should only be used as a salvage procedure in the rare cases of insufficient callus formation. Because of the missing growth potential and reduced joint mobility, distraction lengthening is the therapy of second choice when compared to microvascular second toe transplantation.

Acrocephalosyndactylia↗
PubMed1983

Relationship between finger and wrist deformities in rheumatoid arthritis.

The present study was undertaken to test the hypothesis that there is a significant correlation between the position of the wrist and metacarpophalangeal angulation in the common rheumatoid hand deformities. Measurements were carried out on radiographs of the hand from 2 comparative groups: 67 patients (134 hands) with classical or definite rheumatoid arthritis (RA), and a control series of 50 adults (100 hands) attending the routine fracture clinic. Rheumatoid patients were unselected and included those with a variety of hand deformities. The results showed a statistically significant relationship between finger and wrist deformities in patients with RA but not in the normal controls.

Adult↗
PubMed1989

Severe thermal hand burns--factors affecting prognosis.

This paper presents the results of the analysis of clinical data from a series of 132 thermally injured patients with 214 burned hands. The objective was to identify the factors affecting the pathogenesis of postburn hand deformities. The study indicates that deep burns have the worst prognosis and that circumferential burns are always followed by secondary sequelae. The incidence of secondary hand deformity rises sharply when the burn affects more than 25 per cent of the total body surface area (TBSA). Given the same physical therapy programme, early tangential excision and immediate grafting yield better results than conservative treatment. The results underline the role of patient motivation in maximal hand rehabilitation.

Adolescent↗
PubMed1989

Multifaceted pediatric congenital hand reconstruction.

The management of a variety of complex congenital hand deformities is presented. The importance of early parental education by the surgeon and the rehabilitation team is stressed so that staged reconstruction can be planned and executed. New surgical techniques are demonstrated that provide the patient with the ability to perform normal bimanual activities at an early age.

Blood Vessels↗
PubMed2003

Surgical reconstruction of irreversible ulnar nerve paralysis in leprosy.

Twenty-five patients with irreversible leprotic ulnar nerve palsy having undergone lumbrical replacement with two different tendon transfer techniques were assessed 6-120 months after surgery. Nineteen patients were reconstructed with the flexor digitorum four-tail procedure (FDS-4T), and six with Zancolli's lasso procedure (ZLP). Mean paralysis times were 103 months for FDS-4T, and 68 months for ZLP. Mean age of the patients was 36 years (21-57). Grip strength measurements, improvement in active range of motion at the PIP joints, patients' ability to open and close their hands fully, as well as sequence of phalangeal flexion, were noted. Mean grip strength measurements during follow-up were 76% of the contralateral extremity in the FDS-4T group and 82% in the ZLP group. Comparison of the follow-up grip strength with the preoperative value revealed 1% improvement in the FDS-4T group and 20% in the ZLP group. Claw hand deformity was completely corrected in 12 patients in FDS-4T group, and in five patients in the ZLP group. Residual flexion contracture remained in five patients after surgery. Swan-neck deformity subsequently developed in seven fingers. Age, sex, mean follow-up and surgical technique did not relate statistically to the functional outcome. However, preoperative extensor lag of the PIP joint and mean paralysis time significantly affected the functional outcome. ZLP was found to be a more effective procedure in restoring grip strength, whereas FDS-4T was more effective in correcting claw hand deformity.

Adult↗
PubMed1990

Congenital malformations of the hand. A study of the vascular pattern.

Sixty-five children with 76 hand anomalies had brachial angiography performed to help plan appropriate surgical management. Three different methods of angiography were used. The study showed that the direct exposure method is safe and simple, has few complications and gives the best visualisation of the arterial supply of the hand. It also showed that each type of congenital hand deformity is frequently associated with specific vascular alterations. Angiography is an important and safe investigation in the pre-operative assessment of cases of complex congenital hand deformities.

Angiography↗
PubMedDate not supplied

The optimal management of pediatric steam burn from electric rice-cooker: STSG or FTSG?

The steam burn caused by an electric rice-cooker is a unique mode of burn injury in Asian countries, especially Korea and Japan. This type of burn injury is characterized by 1) occurring most frequently on the volar aspect of the hand in toddlers younger than 2 years of age (92.8%); 2) the depth of burns are normally deep second-degree to third-degree (98%) and usually need surgery at the time of injury; 3) flexion contractures of multiple finger joints and web space contracture are common sequelae. We hypothesized that primary full-thickness skin graft (FTSG) would give more reliable results and eliminate the late reconstructive procedures. Between January 1997 and September 1999, 36 patients underwent primary FTSG, and the results of this primary FTSG group were compared with 124 patients who were treated with split-thickness skin graft (STSG; 79/124; 63.7%) or by conservative management (45/124; 36.3%), and readmitted for the correction of hand deformities between September 1995 and September 1999. In the primary FTSG group, 11.1% (4/36) of mild web contractures and 5.5% (2/36) of finger joint contractures were documented, and these did not require the reconstructive procedure during a follow-up period of 8.8 +/- 4.8 months. In 124 patients of the primary STSG or conservative group, the mean time interval to reoperation was 8.9 +/- 4.0 months and all patients received FTSG for correction of late hand deformities. In a retrospective study of the primary STSG group, 42 of 53 patients (79.2%) received reconstructive procedure during a 5-year follow-up period. In this report, we introduce the nature of steam burn caused by electric rice-cooker and propose that primary FTSG may be a reliable method for the treatment of this more severe type of acute burn in pediatric patients.

Burns↗
PubMed1984

The pronated index finger deformity in the rheumatoid hand.

Rotatory deformities of the digits have received little attention in either the anatomical or surgical literature. In developing the flexible hinge silicone arthroplasty method for the metacarpophalangeal joint, we found rotation deformity was a problem that interfered with obtaining an ideal functional result. The study reported here was the result of our interest in improving this arthroplasty method for the rheumatoid patient.

Arthritis, Rheumatoid↗
PubMed1984

Transfer of the abductor digiti minimi (quinti) in radial deformities of the hand in children.

The abductor digit minimi (quinti) transfer is an opposition plasty which is rarely used because of the large armamentarium of other possible transfers. However, it is a very good technic to use in radial side dysplasia in children, especially in the case of four-fingered hands in which it can improve the results of pollicisation. A series of 14 cases with 13 "good" or "very good" results is presented. An anatomical study has defined the distal insertion, distinct from that of the flexor digiti quinti brevis, the vascularisation (Mathes's type II) and the innervation of the muscle. The division of the muscle from the pisiform bone is not recommended because of the risk of pedicular injury.

Child↗