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PubMedDate not supplied

Complications following surgical treatment for Dupuytren's contracture.

Dupuytren's disease is a proliferative fibroplasia that can lead to a significant contracture of the metacarpophalangeal (MCP) and interphalangeal (IP) joints, causing a functional disability. Surgical excision of the Dupuytren's tissue and release of the contracted joints may be necessary to restore function. Most patients require hand therapy postoperatively. Postoperative complications have been reported at 17%. These include excessive inflammation, hematoma, ischemic skin necrosis, infection, granuloma formation, transient paresthesia, scar contracture, persistent proximal interphalangeal (PIP) flexion contracture, distal interphalangeal (DIP) hyperextension deformity, joint stiffness, poor flexion and grip strength, pain, and reflex sympathetic dystrophy (RSD). The hand therapist plays a vital role in the early detection and treatment of many of these complications.

Dupuytren Contracture↗
PubMed2000

A randomized comparative study of two methods for controlling Tendo Achilles contracture in Duchenne muscular dystrophy.

A 30-month prospective randomized study of 27 Scandinavian boys with confirmed diagnosis of Duchenne muscular dystrophy was done to compare the effect of passive stretching combined with the use of night splints (group A) or passive stretching (group B) on the evolution of Tendo Achilles contractures. Assessments were based on the methodology of Scott et al. (Muscle Nerve 1982;5:291-301)Analysis of the pattern and mechanism of dropout was done to eliminate bias between the two groups. Logistic regression showed that Tendo Achilles contracture was the most important variable (P=0.0020) for dropout. Methods of statistical analysis for longitudinal data avoiding induced serial correlations were used in the analysis. The expected annual change in Tendo Achilles contracture was found to be 23% less in group A than in group B after equalization for total muscle strength (%MRC).

Achilles Tendon↗
PubMedDate not supplied

Application of external fixators in major foot contractures.

Extremity contractures are one of the most common deformities faced by the reconstructive surgeon. Major deformities with ankylosis of the related joint have to be managed by both soft tissue and bone operations. Contractures existing for a long period of time cannot be brought into anatomic position easily because of shortened tendons, nerves, and vessels or ankylosed joints. Although tendons can be lengthened in one operation, this is not the case for neural and vascular structures. The authors use external fixators associated with soft tissue procedures to gradually correct major foot dorsiflexion contractures.

Adult↗
PubMed2001

Treatment of knee contracture in cerebral palsy by hamstring lengthening, posterior capsulotomy, and quadriceps mechanism shortening.

Results of surgery to correct fixed flexion contracture of the knee and improve voluntary knee extension in 39 knees in 20 children (11 females, 9 males; mean age 12 years 8 months, age range 5 to 20 years) with cerebral palsy were analyzed. All patients had neuromotor disease and 18 children had spastic diplegia or quadriplegia. All patients could initiate voluntary knee extension but lacked full passive extension. Five patients (10 knees) were free walkers with a mean motor severity index of 19 and mean fixed knee contracture of 20 degrees. Fifteen patients (29 knees) were not free walkers and 13 were wheelchair ambulators. They had a mean motor severity index of 8 and mean fixed knee contractures of 30 degrees. Surgical procedures included various combinations of hamstring lengthening and/or posterior capsulotomy to allow free passive knee extension, with or without quadriceps mechanism shortening, to enhance voluntary extension. The best results were in patients who had hamstring lengthening, posterior capsulotomy, and quadriceps mechanism shortening.

Adolescent↗
PubMed1999

Management of fixed flexion contracture of the elbow in haemophilia.

The authors stress that prevention of flexion contractures and artropathy by early factor replacement and physical therapy for every haemophiliac is the standard of care. Physical therapy, serial casting, and Quengel cast correction have not proven successful in correction of fixed flexion contractures at the elbow. In the patient who has a flexion contracture that interfered with function, an attempt at physical therpay combined with the use of either the Dynasplint or Flowtron will be tried. If there is no response, a surgical synovectomy combined with a possible radial head resection and anterior capsular release would be the authors' procedure of choice. In the face of advanced arthropathy, the authors would consider a distraction arthroplasty.

Contracture↗
PubMed2001

Deltoid contracture: MR imaging features.

AIM: To describe the magnetic resonance imaging (MRI) features of deltoid contracture and compare these findings with the operative and histological findings and to determine the utility of MRI for diagnosis and treatment planning. PATIENTS AND METHODS: Retrospective review of clinical and imaging in six patients with deltoid contracture, as well as the operative and histological findings of four operated patients. RESULTS: Magnetic resonance imaging clearly demonstrated the intramuscular fibrous bands of the deltoid as a homogeneously hypointense area with distinctive margins on T1-, T2- and T2*-weighted images. Operative findings were exactly consistent with the findings observed by MRI. CONCLUSION: Deltoid contracture is best evaluated with MRI which facilitates visualization of the intramuscular fibrous bands being pathognomonic of this entity and may provide information useful in treatment planning.

Adult↗
PubMed2002

Dynamic splinting of forearm rotational contracture after distal radius fracture.

The results of dynamic forearm rotational splinting for the treatment of forearm rotational contractures in patients with acceptably aligned, healed distal radius fractures are documented. Fifteen patients with distal radius fractures that healed with < or =+5 mm ulnar variance and < or =20 degrees dorsal tilt had dynamic forearm rotational splinting for contractures that had failed conventional hand therapy. Average pronosupination arc before splinting was 83 degrees. Dynamic forearm rotational splinting increased forearm rotation by 52% to an average of 126 degrees. Only one patient with development of ectopic bone in the interosseous space during splinting failed to obtain at least 30 degrees pronation and supination after splinting. Dynamic forearm rotational splinting effectively treats rotational contractures in patients who have healed distal radius fractures that are in acceptable alignment.

Adult↗
PubMed1998

Versatility of modified planimetric Z-plasties in the treatment of scar with contracture.

The planimetric Z-plasty proposed by Roggendorf provides elongation by excision of a pair of triangular pieces of tissue. The application of planimetric Z-plasties has been modified by making the vertical angle flexible, and making them continuous in the same or in opposite directions. Continuous planimetric Z-plasties in the same direction elongate an oblique contracture in the longitudinal direction. Continuous planimetric Z-plasties in an alternative direction elongate a disproportioned scar contracture in the longitudinal direction. Both techniques partially reduce unsightly scarring. Furthermore, they can be used in combination with V-Y-plasties. These modifications permit rational planing of the treatment of complicated scars with contracture.

Adult↗
PubMed2002

Dupuytren's contracture and sarcoma.

In order to study possible connections between Dupuytren's contracture and sarcoma we analysed the records of 18 patients who developed sarcoma 5 years or more after surgery for Dupuytren's contracture. We found an increased frequency of fibrosarcoma and malignant fibrous histiocytoma, but these patients did not differ from the other patients in the study group. Our analysis suggests that neither smoking, diabetes nor cancer syndromes can explain why patients with Dupuytren's contracture have a higher incidence of sarcoma.

Aged↗
PubMed2001

Restrictive dermopathy: case report, subject review with Kaplan-Meier analysis, and differential diagnosis of the lethal congenital contractural syndromes.

We report on a 34-week-old infant with restrictive dermopathy (RD), a rare lethal genodermatosis, characterized by an abnormal skin growth and differentiation with thin, tightly adherent skin that causes a dysmorphic face, generalized flexion joint contractures, and respiratory insufficiency. Kaplan-Meier analysis of 32 previously well-described infants affected with RD showed a median survival of 132 hours. Lethal congenital contractural syndromes, including Pena-Shokeir phenotype, cerebro-oculo facio-skeletal syndrome, and lethal multiple pterygium syndrome, should be considered first in the differential diagnosis. Other lethal contractural syndromes are discussed.

Contracture↗
PubMed2005

Secondary breast reconstruction with deepithelialized free flaps from the lower abdomen for intractable capsular contracture and maintenance of breast volume.

Although surgical techniques and the quality of mammary prostheses have been improved significantly in recent years, capsular contracture attendant on prosthetic mammary reconstruction remains a major flaw. Although rarely, some patients are confronted with recurrent and intractable capsular contractures with resultant breast deformity, even after multiple attempts at capsulectomies and implant exchange. Patients with recurrent capsular contracture often do not want replacement with a new prosthesis, but desire the maintenance of their breast volume with a safe alternative. In an attempt to maintain breast volume and to improve the aesthetic appearance, secondary breast reconstruction using bilateral deepithelialized free flaps from the lower abdomen was performed in a series of seven patients. Three bilateral muscle-sparing TRAM flaps, two bilateral DIEP flaps, one bilateral SIEA flap, one unilateral SIEA flap, and one unilateral DIEP flap (a total number of 14 flaps) were used following implant removal, total capsulectomy, and prophylactic subcutaneous mastectomy. The early postoperative course was uneventful, and all flaps survived completely with no complications. There were no donor-site problems, except in one patient (case 5), who had partial skin necrosis of the abdominal flap. The long-term results (mean follow-up: 4.8 years) demonstrated an aesthetically satisfactory appearance of the breasts, with no major donor-site problems. Several advantages, as well as drawbacks, are highlighted with this technique.

Abdomen↗
PubMed2005

[Dupuytren's contracture -- surgery of recurrencies].

BACKGROUND: The present study is a retrospective investigation of patients who underwent surgery for recurrence of Dupuytren's contracture. We discuss the indications for this intervention, operative methods, and postoperative therapy. Surgical treatment for recurrence of this condition is incomparably more difficult and risky than the primary operation. METHODS: At the Innsbruck University Clinic for Plastic and Reconstructive Surgery, 50 patients underwent 70 operations for treatment of recurrence of Dupuytren's contracture between March 1999 and September 2004. Thorough pre- and postoperative clinical investigations and assessment of hand status as well as analysis of the indication for the first operation and the surgical method used were carried out. All patients underwent intensive postoperative hand therapy from day 1 for restoration of function and flexibility. RESULTS: After completion of therapy, in 32 patients there was an improved ROM of between 40 and 270 degrees per finger, in five patients an unchanged ROM, and in three patients, reduction in ROM by 5 to 58 degrees; six patients failed to show up for their follow-up despite being asked to do so several times. No data are as yet available on four patients who had undergone primary operation elsewhere and were operated within the past six months for recurrence in our clinic. In nine patients, there was a decrease in sensation immediately after surgery; but improvement was achieved within six months in three of these patients after intensive hand therapy. CONCLUSION: Careful assessment of hand function, establishing the indications for surgery at the right time, choice of the appropriate surgical approach and initiation of intensive hand therapy immediately after surgery are decisive for effective treatment of recurrent Dupuytren's contracture. However, amputations and ray resections cannot be avoided in all cases, especially if nerve injuries incurred during previous operations, resulting in joint stiffness.

Adult↗
PubMedDate not supplied

[Congenital contractural arachnodactyly (CCA syndrome)--an autosomal dominant hereditary connective tissue disease].

Congenital contractural arachnodactyly (CCA syndrome) is an autosomal dominant connective tissue disease which must be distinguished in particular from Marfans' syndrome and the heterogeneous arthrogryposis multiplex congenita. The principal symptoms are multiple congenital contractures with a quite pronounced tendency to regression, scoliosis, dolichostenomelia and arachnodactyly, and malformation of the auricles. The authors report on a young woman (the proposita) and her son, who are typically affected. Observation of the course in these two patients confirms the rule that the condition has a relatively favorable prognosis. The mother of the proposita suffered from dolichostenomelia and arachnodactyly, while congenital contractures and dysmorphous auricles were absent; this could represent a--still hypothetical--mild form of the syndrome. The symptomatology, differential diagnosis, treatment and genetics of the CCA syndrome are discussed in detail with reference to a further 33 cases in the literature.

Adult↗
PubMed2002

Multiple congenital contractures: birth prevalence, etiology, and outcome.

OBJECTIVES: We wanted to estimate the birth prevalence of multiple congenital contractures (MCC), determine the cause of the MCC according to the primary level of involvement of the developing motor system, and compare the different groups in terms of inheritance, mortality, and morbidity. STUDY DESIGN: A retrospective epidemiologic study through the screening of registers, reviews of medical records, and clinical re-examinations was performed in western Sweden to identify all the children with MCC born between 1979 and 1994. RESULTS: The birth prevalence of MCC on the basis of 68 cases was 1 in 5100 live births. The majority of cases with cerebral involvement (n = 23), spinal involvement (n = 16), or mechanical restriction (n = 3) were sporadic, whereas most cases with neuromuscular (n = 12) or connective tissue involvement (n = 9) were inherited. The cerebral group was more severely affected compared with the other groups in terms of mortality, joint contractures at birth, feeding difficulties during infancy, and independent walking at follow-up. In 8 cases with myopathy, the joint contractures were normalized on follow-up. CONCLUSION: A search for a specific etiology in each case is important for genetic counseling, prognosis, and therapy because inheritance, mortality, and morbidity differ between the groups.

Contracture↗
PubMed1959

Calcium influx in skeletal muscle at rest, during activity, and during potassium contracture.

Calcium influx in the sartorius muscle of the frog (Rana pipiens) has been estimated from the rate of entry of Ca(45). In the unstimulated preparation it is about equal to what has been reported for squid giant axons, but that per impulse is at least 30 times greater than in nerve fibers. The enhanced twitch when NO(-) (2) replaces Cl(-) in Ringer's is associated with at least a 60 per cent increase in influx during activity, whereas this anion substitution does not affect the passive influx significantly. Calcium entry during potassium contracture is even more markedly augmented than during electrical stimulation, but only at the beginning of the contracture; thus, when a brief Ca(45) exposure precedes excess K(+) application, C(45) uptake is increased three- to fivefold over the controls not subjected to K(+), whereas when C(45) and K(+) are added together, no measurable increase in Ca(45) uptake occurs. These findings are in keeping with the brevity of potassium contracture in "fast (twitch)" fibers such as in sartorius muscle.

Calcium↗
PubMed1960

Increase of labeled calcium uptake in heart muscle during potassium lack contracture.

Analyses of ashed muscle tissue show that the uptake of Ca(45) by isolated frog heart ventricles from normal Ringer's solution containing 1 mM Ca reaches a maximum value in about 30 minutes of perfusion which is not exceeded after 3 hours of perfusion. The average amount of this labeled Ca taken up from normal Ringer's is 0.7 mM/kg. wet weight of muscle. In contrast to this, the amount of labeled Ca taken up by ventricles perfused with K-free Ringer's increases at a linear rate over a 60 minute period to twice the normal value coinciding with the gradual development of contracture and coinciding with a cellular K loss and Na gain of about 30 mM/kg. How much of the extra labeled Ca taken up from K-free Ringer's represents a net gain in cellular Ca content is not known. However, evidence has been obtained that some of this labeled Ca enters an intracellular compartment. EDTA in K-free Ringer's solution causes relaxation of ventricles in contracture and also renders the muscle fibers indiscriminately permeable. This indicates that a combination of Ca with sensitive intracellular sites is probably the cause of the K lack contracture.

Calcium↗
PubMed1999

Bethlem myopathy: a slowly progressive congenital muscular dystrophy with contractures.

Bethlem myopathy is an early-onset benign autosomal dominant myopathy with contractures caused by mutations in collagen type VI genes. It has been reported that onset occurs in early childhood. We investigated the natural course of Bethlem myopathy in five previously published kindreds and two novel pedigrees, with particular attention to the mode of onset in 23 children and the progression of weakness in 36 adult patients. Our analysis shows that nearly all children exhibit weakness or contractures during the first 2 years of life. Early features include diminished foetal movements, neonatal hypotonia and congenital contractures which are of a dynamic nature during childhood. The course of Bethlem myopathy in adult patients is less benign than previously thought. Due to slow but ongoing progression, more than two-thirds of patients over 50 years of age use a wheelchair.

Activities of Daily Living↗
PubMed1992

Vibration white finger and Dupuytren's contracture: are they related?

Between 1988 and 1990, 500 claimants were assessed and considered to have vibration white finger (VWF). Of these, 137 were under 45 years of age and none had Dupuytren's contracture of the remaining 363, 311 were aged 50-85 years, and of these 62 (19.9 per cent) had Dupuytren's contracture. Statistically, this prevalence was significantly higher than that in a control group of 150 men of similar age distribution (10.7 per cent). As far as can be ascertained, this is the first study to indicate that there may be a causal relationship between VWF and Dupuytren's contracture, and the possible theoretical reasons for this are discussed. It is suggested that further studies are required to confirm or refute the findings.

Adult↗