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At least 55 records · Page 3Linked to original sources
PubMedDate not supplied

Radial club hand deformity--the continuing challenges and controversies.

The records of 27 patients with Radial club hand deformity attending the Hospital and Rehabilitation Centre for Disabled Children (HRDC) were reviewed. This longitudinal intercalary deficiency of forearm growth has a varied clinical presentation and the goals of management are both improved function and cosmesis. We present the results of our treatment and review the current world literature on this challenging orthopaedic deformity.

Activities of Daily Living↗
PubMed1997

Introducing a solid model for reconstructing the severely deformed hand.

We report a case of a 39-year-old man with a severely deformed hand resulting from an injury sustained in a traffic accident at 2 years of age. A Marjolin ulcer appeared on the cicatricial area 3 years ago. After radical surgery for squamous cell carcinoma, we planned to realign the axis of the ulnarly flexed hand. Prior to surgery, we produced a solid model of the bony framework using laser lithography based on 3-D CT digital image data. The solid model furnished us and the patient with precise information on the deformity and allowed us to perform preoperative simulation surgery. By a two-stage wedge-shaped ostectomy at the end of the radius, the ulnarly deviated axis of the hand was realigned from 100 to 30 degrees (approximate) in clinical measurement and the patient was quite satisfied with the resulting function and appearance. However, there are some disadvantages of the laser lithography solid model: the cost is high, the resin material is very hard and difficult to operate on, and the model does not include soft-tissue structures. The development of a model in the future that includes vessels, nerves, and tendons will enable surgeons to transfer more precisely the results of the simulation surgery to the patient in the operating room.

Adult↗
PubMed1989

Surgery for hand deformities due to electrical injury.

The study discusses the treatment of 56 patients with severe hand deformities due to electrical injury. This group of patients underwent clinical and laboratory examinations; the defect was excised and a plastic operation was performed using a pedicle flap, sporadically, Filatov's tubular flap. The defect was determined by angiography. As regards reconstruction and rehabilitation, good results were achieved only in patients with considerable trophic improvement of the hand at 8-10 months after surgery.

Adult↗
PubMedDate not supplied

[Surgical treatment of hand deformities in hereditary dystrophic bullous epidermolysis].

In the period 1996-2001 in the Clinic for Plastic Surgery and Burns of the Military Medical Academy, 18 patients. 12 male and 6 female, with hereditary dystrophic epidermolysis bullosa (HDEB) and hand deformities were surgically treated, to achieve the complete separation of fingers, correction of the thumb adduction contracture and flexion or extension contracture of finger joints. The period of wound healing on flat surfaces after surgery, and the period between two operations was estimated. The most common deformity was the flexion contractures of metacarpophalangeal (MP) joints (45%) and one or both interphalangeal (IP) joints (types A1, A2). In 20% of the hands MP joint was stretched with the flexion contracture in distal interphalangeal (DIP) or both IP joints (types B1, B2). In 35% of hands MP joint was in hyperextension with folded proximal interphalangeal (PIP) or both IP joints (C1 i C2). The adduction deformity of the thumb type 1, without the possibility of abduction, was present in 15%, type 2, when the thumb was placed above the palm in 60% and type 3, when the thumb was fused in the palm in 25%. Pseudosyndactyly of the first degree (till PIP joint) was found in 30% of hands, the second degree (till DIP joint) in 25%, and the third degree (the whole finger length) in 45% of hands. Fingers were completely separated and stretched surgically. The period of spontaneous healing was 15 days on the average. EBDC represents great medical and social problem that requires multidisciplinary approach of physicians of various specialties (surgeons, dermatologists, pediatrists, geneticists, nutritionists, physiatrists, ophthalmologists, dentists, ENT, as well as specially trained persons and families). The efficient specific systemic therapy aiming to increase the skin resistance to mechanical trauma does not exist yet, and should be developed in the field of gene therapy. The surgical correction of hand deformities, acrylate glove use in the longer post operative period combined with physiotherapy, the active use of hands, the protection of injuries and skin care are the measures which prolong the period between the recurrence of contractures.

Child↗
PubMed1986

Single stage lengthening by intercalary bone graft in patients with congenital hand deformities.

The experience with single-stage lengthening by intercalary bone graft in four patients with congenital hand deformities is presented. In all seven lengthenings the gap was bridged by a toe phalanx bone graft. The elongation of the ray ranged from 5-14 mm. Examination of patients followed from one to five years after the treatment showed a good appearance of the lengthened ray. One bone graft assimilation resulted in a pseudoarthrosis and another had osteopenia that resolved spontaneously. All others healed uneventfully. The quality of the skin sensitivity, vascular status and tendon balance is preserved after the lengthening.

Bone Lengthening↗
PubMed2002

[Deforming hand arthropathy in systemic lupus erythematosus].

A case of systemic lupus erythematosus with deforming hand arthropathy (DHA) is reported in a woman observed for 15 years. DHA was presented with stable ulnar deviation, deformation of the fingers. This resulted in functional insufficiency of the hand of the third degree.

Adult↗
PubMed1978

Epidermolysis bullosa: current concepts and management of the advanced hand deformity.

A current classification of the types of epidermolysis bullosa is reviewed, in conjunction with some etiological concepts. The pathomechanics of the advanced hand deformity are discussed, and applied to a sequential plan of reconstructive surgery. The objective is the restoration of elementary hand function. Two illustrative cases are presented.

Adolescent↗
PubMed1989

First web-space reconstruction by Caroli's technique in congenital hand deformities with severe thumb ray adduction.

A personal technique is described for reconstruction of the first web-space in congenital hand deformities with severe adduction of the thumb. The technique is based on the use of two local rotation flaps, one designed on the thenar area and the other on the radial half of the back of the hand. Seven patients were treated with such a technique and followed up for an average of 32 months. Excellent results were obtained in five cases.

Child↗
PubMed1988

The pathogenesis and treatment of rheumatoid wrist and hand deformities.

As rheumatoid arthritis progresses, pannus formation causes subchondral bone damage and later cartilage and bone destruction. Stretching of ligaments due to capsular distension causes joint instability, and infiltration. These processes are frequently responsible for deterioration in hand function. However, present surgical treatments of wrist and hand deformities allow a degree of independence.

Arthritis, Rheumatoid↗
PubMed2000

[Value of a new first web space reconstruction in congenital hand deformities. A study of 54 patients].

INTRODUCTION: Only a few studies are available in the literature on the specific problem of the congenital contracture or absence of the first web in hand deformities, and first web reconstruction. MATERIAL AND METHODS: Sixty-seven first web plasties in 54 patients were retrospectively analyzed: they included 44 cases of classical plasties, i.e., Z-plasty (21 cases); dorsal flap plasty of the index (19 cases), thumb (1 case), or the hand (10 cases), and 16 cases of' pseudo-kite flap. RESULTS: The results were difficult to assess, as the syndromes were dissimilar and the deformities were not comparable (e.g., Apert syndrome versus Poland syndrome). However, it was found that the 'pseudo-kite' technique which was applicable to certain cases resulted in a web extension of 3.2 cm without any deepening. DISCUSSION: No method of classical assessment can be used to comprehensively evaluate the results of first web reconstruction due to the wide variability in clinical characteristics, the lack of patient cooperation in this young age group, the possible MPJ articular thumb instability, and growth factors. Although 4-flap Z-plasty is an adequate technique for non-severe first web deformities, the 'pseudo-kite' flap approach is useful in more severe cases. In 13 cases, a peroperative measurement before and following plasty was made, and a significant increase (205%) in planimetric and stereotactic gain compared to pre-plasty findings was noted. CONCLUSION: It does not seem logical to have a particular preference for a certain approach when considering first web reconstruction in congenital malformations. Each technique has its advantages and disadvantages, depending on patient age, the type of malformation, the state of the thumb, the extent of the first web deformity and the possible presence of scar tissue.

Acrocephalosyndactylia↗
PubMed2002

[Dystrophic epidermolysis bullosa: surgical treatment of advanced hand deformities].

Dystrophic epidermolysis bullosa (Hallopeau-Siemens, recessive dystrophic epidermolysis bullosa) is a rare inherited disorder of the skin and mucosa, characterized by blistering in response to the slightest mechanical trauma. Healing is associated with scarring and the formation of contractures and milia. Following repetitive trauma (friction), this process leads to severe hand deformities with digits contracted in flexion, the thumb contracted in adduction and pseudo-syndactyly. In advanced cases (as described here), the hands show a mitten-like deformity and digits are encased in an epidermal "cocoon". This results in complete loss of function with major consequences for both the patient's (children's) daily life and their psychosocial development. We demonstrate the advantages of the (simplified) surgical procedure including "de-cocooning"/degloving, syndactyly-release, release of the thumb and the digital joint contractures and Kirschner-wire stabilization. Spontaneous epithelialisation of skin defects proved to be unproblematic and advantageous compared to skin transplantations, flaps, keratinocyte transplantations and other more ambitious procedures. Reviewing the published long-term results of other methods, we favour the procedure described because it simplifies and accelerates the overall treatment. From 1998 to 2001, we treated three children with recessive dystrophic epidermolysis bullosa and five hands were operated. A total number of 23 interventions was necessary (21 x using face masks, 2 x oral intubation). Pseudo-syndactyly (digits II - V, partially or totally) occurred in four hands after six to ten months. Flexion contractures of the digits occurred in two hands after eight to ten months. Limitating adduction contracture of the thumb occurred in two hands after eight to twelve months. Digital function (pinch and grasp) was actually preserved in two hands for 15 to 30 months. An active surgical approach is justified by the gain in functional improvement of the hand - even if only temporary - and, consecutively, by the positive effect on the child's development.

Bone Wires↗
PubMed1978

Rheumatoid hand deformities: pathophysiology and treatment.

Rheumatoid disease, as it affects the hand, is a disease of the synovium lining the joints and sheaths of the tendon. The proliferating synovium destroys the articular surfaces of the joint, interferes with the gliding mechanism of the tendons and weakens the supporting ligaments of the joints. The degree and variety of deformities is multifold. Treatment of the rheumatoid hand is aimed at conservation and restoration of hand function, as well as prevention of future deformities. Rheumatologists, physical therapists and hand surgeons carry out important functions in the well-planned, integrated regimen. Surgical treatment of the rheumatoid hand deformity may alleviate pain, lessen deformity and improve function in selected cases. It should be integrated in the general medical management of a patient. Treatment of tendon ruptures includes tenorrhaphy, tendon grafting and arthrodesis in the case of mallet finger deformity. The wrist joint is improved by synovectomy and carpal tunnel release is accomplished by median nerve decompression. Metacarpal phalangeal joint deformities may be treated by synovectomy or silastic joint replacement when there is destruction of the articular joint surface, severe subluxation, or persistent painful motion.

Arthritis, Rheumatoid↗