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At least 1,045 records · Page 58Linked to original sources
PubMed1997

The dorsal transposition flap for congenital contractures of the first web space: a 20-year experience.

Fifty-four dorsal transposition flaps were performed in 38 patients (46 hands) for severe congenital thumb web-space contractures. At an average follow-up interval of 6 years, complications or unsatisfactory results had occurred in 100% of symbrachydactyly patients and in 27% of all other patients. Postoperative first web-space angle was augmented an average of 59 degrees with a distal flap two-point discrimination of 8 mm. Mean postoperative pinch and grip strengths were 58% and 72%, respectively, of the normal contralateral hand. Parental satisfaction with the functional results was high, and the aesthetic results were generally acceptable. With the exception of symbrachydactyly patients, the dorsal transposition flap remains an excellent reconstructive option for severe congenital contractures of the thumb web space.

Adolescent↗
PubMed1982

Lateral digital rotation flaps in the treatment of forms of Dupuytren's contracture. 141 cases.

Severe contractures of the little finger can be corrected with a rotation flap. It has been used 141 times in a homogeneous series of 522 Dupuytren diseases. This flap brought to the metacarpophalangeal crease to the proximal phalanx can provide a skin lengthening of about 15 mm. The incision can be extended to the palm in order to remove the other fascial lesions. It was used mainly on the little finger (9 times out of 10). A single flap was usually made, but one may use two flaps from contiguous fingers, and even raise two flaps from the same finger. A comparative study with "Z" plasties was carried out. Out of 131 "Z" plasties with an average lack of extension of 126 degrees, the rate of improvement was 57%. The rotation flap was used in 141 cases with an average lack of extension of 140 degrees, and the rate of improvement was 79%. This flap seems to be an interesting procedure in the surgical treatment of severe Dupuytren contractures and seems more efficient than "Z" plasties.

Bandages↗
PubMed1998

Severe capsulorhexis contracture after cataract surgery in myotonic dystrophy.

A 42-year-old woman with myotonic dystrophy developed bilateral severe capsulorhexis contracture after uneventful phacoemulsification cataract surgery with implantation of 1-piece poly(methyl methacrylate) intraocular lenses (IOLs). The anterior capsular opening in her right eye constricted to a diameter of 0.7 mm, reducing visual acuity to counting fingers. Complete closure of the capsulorhexis with IOL encapsulation developed in her left eye, reducing visual acuity to hand movements. Surgical anterior capsulectomies restored visual acuity to 6/9 in both eyes. Myotonic dystrophy may predispose to the development of severe capsulorhexis contracture after cataract surgery.

Adult↗
PubMedDate not supplied

Optimal daily total end range time for contracture: resolution in hand splinting.

Reduced passive range of motion (PROM) of the joints of the hand is a common sequela of traumatic upper limb injury. Although mobilizing splinting is a common modality used by hand therapists to improve PROM, limited empirical evidence is available to guide therapist prescription. This study investigated the importance of the timing of splint application per 24-hour period, daily total end range time (TERT), via a prospective sequential clinical trial. A total of 43 subjects with joint contractures of the hand after traumatic upper limb injury were randomly allocated to one of two splint programs. Subjects in group A used their splint for less than 6 hours per day, and subjects in group B used their splint for 6 to 12 hours per day. Daily TERT was recorded by subjects in a splint diary. Passive torque range of motion (TROM) was used to measure the extent of contracture resolution over four weeks of splinting. High intrarater, interrater, and test-retest reliability of the TROM technique was established for this sample (intraclass correlation coefficients 0.993 to 0.998). Sequential analysis showed a statistically significant preference for group B, daily TERT of 6 to 12 hours per day (p < 0.05). Pretreatment joint stiffness (p = 0.162) and joint type (p = 0.463) did not influence final TROM significantly. These findings help to provide some controlled data from which therapists may base future prescription (dose) of daily TERT.

Adult↗
PubMedDate not supplied

Deltoid contracture: a radiographic survey of bone and joint abnormalities.

We performed a radiographic survey on 12 shoulders in 11 patients with a contracture of the deltoid present since childhood (juvenile) but left untreated until adulthood and on 14 shoulders in 10 patients with the same disorder first developed in adulthood (adult type). The greater tuberosity was located either under or near the acromion in all but 1 shoulder. Flattening of the humeral head, a high-positioned greater tuberosity, posterior rotation and vertical disposition of the acromion, inferior angulation of the lateral clavicle, and anterosuperior subluxation of the humeral head were noted in 58%, 33%, 75%, 67%, and 8% of the juvenile cases, respectively. Scoliosis and narrowing of the thoracic cage were each detected in 36% of the patients with juvenile deltoid contracture. Six of the juvenile cases were treated surgically and followed-up for a lengthy period. In these cases, however, the abnormalities persisted, except for subluxation of the humeral head and abnormal proximity of the acromion and greater tuberosity. In the adult-type cases no abnormalities were observed except for scoliosis in 4 patients and anterosuperior subluxation of the humeral head in 1 shoulder. We conclude that treatment by surgical intervention should be performed at an age when spontaneous correction of the bone deformity can prevent future development of secondary arthrosis.

Adolescent↗
PubMedDate not supplied

A modified lateral approach for release of posttraumatic elbow flexion contracture.

A modified lateral approach for release of posttraumatic flexion contracture of the elbow is described. The approach is a modification of the procedure described by Nirschl for resection and repair of lateral elbow tendinosis (tennis elbow). The modified approach allows visualization of the entire anterior elbow joint without disturbing the common extensor origin or the collateral ligaments. If necessary, a second, posterior triceps-splitting incision is used to access the olecranon fossa. Twelve consecutive patients were treated from 1988 to 1992. Mean flexion/deformity, which measured 41 degrees before operation, measured 8 degrees immediately after operation. The mean flexion/extension arc measured 70 degrees before operation and improved to 117 degrees after operation. With an average follow-up of 36.5 months, mean flexion contracture was 11 degrees and the mean flexion/extension arc of motion was 114 degrees. In no case was a medial approach or transhumeral perforation required. All patients were treated after operation with the elbow splinted in extension for 3 days, after which they were started on an aggressive physical therapy regimen. There were no wound complications, no neurovascular injuries, and no formations of heterotopic bone.

Adolescent↗
PubMed1999

Non-operative treatment of flexion contracture of the knee in haemophilia.

For the non-operative treatment of flexion contracture of the haemophilic knee we have used serial casting and wedging in 58 patients, and extension/de-subluxation orthoses in 13 patients. On average it was possible to achieve -5 degrees of extension by 4 weeks, with only a little improvement in the following 4 weeks. The short--to medium-term results using either the extension/de-subluxation hinges or serial casting were similar. Both methods have been shown to result in significant improvement in joint contracture.

Adolescent↗
PubMed1996

Detrusor myopathy: an accurate predictor of bladder hypocompliance and contracture in interstitial cystitis.

OBJECTIVE: To determine whether any histological characteristics within the detrusor in cases of early interstitial cystitis (IC) predict the subsequent development of severe symptoms due to bladder contracture. PATIENTS AND METHODS: The detrusor muscle component of bladder biopsies from 21 patients with IC was examined in sections stained with haematoxylin and eosin. Videocystometrography was performed at least 2 months after the biopsy and the patients were then followed up clinically for at least 3 years. RESULTS: The detrusor appeared normal in 13 patients; in eight there was evidence of detrusor myopathy. Patients with biopsies confirming detrusor myopathy were significantly more likely to have hypocompliant bladders than those with normal detrusor muscle histology (P < 0.02). Over the following 3 years, six of the eight patients with detrusor myopathy developed progressively severe symptoms and required subtotal cystectomy and enterocystoplasty. None of the 13 patients without detrusor myopathy required bladder substitution. CONCLUSION: In IC, detrusor myopathy is associated with bladder hypocompliance. Patients with detrusor myopathy appear to have more severe disease and are more likely to progress to bladder contracture requiring substitution enterocystoplasty.

Contracture↗
PubMed1999

Results of proximal interphalangeal joint release for flexion contractures: midlateral versus palmar incision.

Forty-two patients (45 fingers) were retrospectively reviewed after operative release of flexion contractures of the proximal interphalangeal (PIP) joint. The release was accomplished through a palmar incision in 19 fingers, usually followed by skin coverage using a lateral transposition flap. A midlateral incision was used in 26 fingers. The 2 groups were comparably matched with respect to degree of contracture and demographic characteristics. Active range of motion (ROM) was measured before and after surgery. In the palmar incision group, preoperative median PIP joint ROM was 60 degrees to 90 degrees (extension/flexion) and 30 degrees to 90 degrees at the 3-year follow-up examination. In the midlateral incision group, preoperative median PIP joint ROM was 50 degrees to 90 degrees (extension/flexion) and 0 degrees to 90 degrees at the 1.5-year follow-up examination. The improvement in ROM was significantly better in the midlateral incision group than in the palmar incision group.

Adult↗
PubMed2001

Emergency microsurgical revascularization for critical ischemia during surgery for Dupuytren's contracture: a case report.

Injuries to the common digital or proper digital arteries during surgery for Dupuytren's contracture are relatively rare but may be underreported. Delay in recognition and inadequate management may result in prolonged ischemia or gangrene and eventually necessitate finger amputation. A patient who sustained inadvertent injury to several digital arteries during reoperation for recurrent Dupuytren's contracture of the ring and small fingers developed persistent critical ischemia of both fingers. He was transported emergently to a replantation center where the arterial injuries were immediately repaired by microsurgical techniques, resulting in successful salvage of both fingers.

Dupuytren Contracture↗
PubMed2001

Pre-expanded arterialised venous free flaps for burn contracture of the cervicofacial region.

Despite the fact that arterialised venous flaps provide thin good-quality tissue to repair defects of the face and neck, their clinical applications have been limited by an unstable postoperative course and variable flap necrosis. In an effort to resolve these problems, a tissue-expansion technique has been applied to the arterialised venous flap before flap transfer. Three pre-expanded arterialised venous free flaps have been used to treat post-burn scar contracture of the cervicofacial region. The donor site was confined to the forearm in each case. A rectangular expander was usually placed over the fascia of the flexor muscles in the proximal two-thirds of the forearm. The mean expansion period, volume and flap size were 44 days, 420 cm(3)and 147 cm(2), respectively. There were no complications caused by insertion and expansion. The cervicofacial region was successfully reconstructed, after excision of the post-burn contractures, with pre-expanded arterialised venous flaps, with no marginal necrosis or postoperative instability. Large thin arterialised venous flaps are well matched with the recipient defect in the cervicofacial area and the colour and texture match obtained with forearm tissue produced an aesthetically favourable result. Pre-expanded arterialised venous flaps are another new option for free flap reconstruction of the face and neck.

Adult↗
PubMed2000

Severe Dupuytren's contracture of the proximal interphalangeal joint: treatment by two-stage technique.

Thirty-four patients with a Dupuytren's contracture in excess of 70 degrees of the proximal interphalangeal (PIP) joint were treated by preliminary palmar fasciotomy, release of the accessory collateral ligaments and PIP joint distraction using the S-Quattro for 6 weeks. A formal fasciectomy with full thickness skin graft was then performed 2 weeks after removal of the fixator. There was a mean residual flexion deformity of the PIP joint of 22 degrees (mean correction of 67 degrees) at an average follow-up of 30 months. There were no infections or amputations. We recommend this technique for the management of severe Dupuytren's contracture of the PIP joint.

Aged↗
PubMed2005

[Congenital contractural arachnodactyly (Beals-Hecht syndrome) associated with Brown's syndrome].

BACKGROUND: We report what is probably the first report of an association between congenital contractural arachnodactyly (CCA) and Brown's syndrome. CASE REPORT: A 7 (1/2)-year-old boy exhibited characteristic signs of CCA: multiple flexion contractures, marfanoid habitus and "crumpled" ears. In addition, the boy had Brown's syndrome. He had an up-gaze deficit and a slight down-shoot of the left eye in adduction. He held his head tilted to the left shoulder. As the cause, computed tomography revealed a thickening of the superior oblique muscle tendon near the trochlea. A molecular genetic examination revealed a mutation of Fibrillin-2 (FBN2 - 5 q 23 - q 31). CONCLUSIONS: The association of the CCA and Brown's syndrome seems to be very rare. A specific link between the two mesenchymal disorders was not found. Probably the combination was coincidental.

Abnormalities, Multiple↗
PubMed1988

[Surgical therapy of severe knee flexion and hip flexion contractures in caudal regression syndrome].

In severe cases of caudal-regression syndrome one usually can find hip-flexion and knee-flexion-contractures, which can hardly be treated. We report about a new possibility of operative treatment. In this case we correct the contractures with a shortening of the proximal part of the femur and with a resection-arthrodesis of the knee-joint. The clinical result, which we obtained by this way, allows the orthotic management with an orthoprosthesis. The maintaining mobility of the hip joint and the sitting-comfort is very sufficient.

Braces↗
PubMedDate not supplied

Arthroscopic treatment of post-traumatic elbow contracture.

The purpose of this study was to evaluate range of motion and patient-reported outcome after complete arthroscopic release of post-traumatic elbow contracture. Fourteen consecutive patients who underwent elbow arthroscopy and capsular release were reviewed retrospectively at a minimum follow-up of 1 year. Pain and range of motion were measured. Patient outcome was assessed with the American Shoulder and Elbow Surgeons Elbow Assessment Form. Mean self-reported satisfaction on a visual analog scale was 8.4 out of 10. Only 6 patients continued to have pain, with a mean maximum pain score of 4.6 out of 10. Flexion increased from a mean of 117.5 degrees to 133 degrees, and extension improved from a mean of 35.4 degrees to 9.3 degrees. In those patients with a preoperative arc of motion less than 100 degrees (10 patients), the mean arc of motion improved from 69 degrees to 119 degrees. All patients had improved function after the procedure, with a mean self-reported functional ability score of 28.3 out of 30. There were no neurovascular complications. The improvement in range of motion and functional outcome compares favorably with open-release procedures. Combined with the potential benefits of improved joint visualization and low surgical morbidity, arthroscopic release of post-traumatic elbow contracture appears to be a reasonable alternative to open techniques.

Adolescent↗
PubMed2002

High collagen type I and low collagen type III levels in knee joint contracture: an immunohistochemical study with histological correlate.

We studied the levels of collagen type I and type III in the knee joints of rats immobilized for periods of 2, 4, 16 and 32 weeks and sham-operated controls. The intensities of immunostaining of the anterior and posterior synovial intima, anterior and posterior subintima, and patellar tendon were graded on a scale from 0 to 3. We found higher type I collagen levels in immobilized legs than in sham-operated legs in the anterior subintima after 4 and 16 weeks (mean score 2.1 vs 1.3, 2.2 vs 1.3, respectively) and posterior subintima after 2, 4 and 16 weeks of immobility (2.4 vs 1.7, 2.3 vs 1.5, 2.2 vs 1.3, respectively). Lower type III collagen levels were found in immobilized legs than in sham-operated legs in the anterior synovial intima after 32 weeks (1.3 vs 2.3), and posterior synovial intima and posterior subintima after 16 weeks of immobility (1.4 vs 2.8, 1.2 vs 1.7, respectively). The higher type I collagen levels in the subintima combined with lower type III suggests that the contracture process is marked by fibrosis, not new tissue proliferation. In this respect, contractures differ from granuloma, scar tissue and the pannus of inflammatory arthritis.

Animals↗