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Various splints are available for the correction of proximal interphalangeal (PIP) joint flexion contracture in patients with hand injuries. This article discusses the mechanics of several splints. The belly gutter splint, an alternative design that can be used for this contracture, is introduced.
Dupuytren's contracture is a fibroproliferative disorder of autosomal dominant inheritance that most commonly affects men over age 60 who are of Scandinavian, Irish, or eastern European descent. Local microvessel ischemia in the hand and specific platelet-derived and fibroblast growth factors act at the cellular level to promote the dense myofibroblast population and altered collagen profiles seen in affected tissue. Surgical treatment depends to some degree on patient preference and a clear understanding of the possible complications and considerable postoperative therapy commitment. Operative management is appropriate when metacarpophalangeal or proximal interphalangeal joint contracture exceeds 30 degrees. A volar zigzag Brunner incision in the digit and palm provides reliable exposure and leads to predictable healing in most cases. The mainstay of postoperative hand therapy is early active-flexion range-of-motion exercises to restore grip strength. A nighttime extension splint is often used for several months postoperatively to maintain the correction achieved in the operating room. Early recurrence of disease is most common in individuals with Dupuytren's diathesis; use of full-thickness skin grafts may be helped for these patients.
Posterior capsular contracture is a common cause of shoulder pain in which the patient presents with restricted internal rotation and reproduction of pain. Increased anterosuperior translation of the humeral head occurs with forward flexion and can mimic the pain reported with impingement syndrome; however, the patient with impingement syndrome presents with normal range of motion. Initial management of posterior capsular contracture should be nonsurgical, emphasizing range-of-motion stretching with the goal of restoring normal motion. For patients who fail nonsurgical management, arthroscopic posterior capsule release can result in improved motion and pain relief. In the throwing athlete, repetitive forces on the posteroinferior capsule may cause posteroinferior capsular hypertrophy and limited internal rotation. This may be the initial pathologic event in the so-called dead arm syndrome, leading to a superior labrum anteroposterior lesion and, possibly, rotator cuff tear. Management involves regaining internal rotation such that the loss of internal rotation is not greater than the increase in external rotation. In the athlete who fails nonsurgical management, a selective posteroinferior capsulotomy can improve motion, reduce pain, and prevent further shoulder injury.
A case of burn injury to lips and cheek mucosa is reported who developed severe contracture of cheek mucosa leading to inability to open mouth. Patient was misdiagnosed as a case of temporomandibular ankylosis and was managed on those lines to no relief. When the contracture was released and soft tissue defect repaired with nasolabial flap, patient gained near normal mouth opening.
Early results after conservative or operative treatment of 15 patients (6 females, 9 males) for contracture of the elbow are presented. The correction achieved has been evaluated by Mayo Elbow Performance Index and by range of flexion and extension movement. Immobilization of the injured elbow should be as short as possible, fixed deformity is an indication for surgery. Resulting contracture of the elbow depends not only on injury severity but on the type of treatment also. One case has been discussed.
BACKGROUND: Aim of this technical note is to describe the fabrication procedure of a new thermoplastic static-progressive hand-based splint for PIP joint flexion contractures, and report its effects in the treatment of a small group of sportsmen. METHODS: The serial-static splint consists of a short metacarpal gauntlet base, with a hole for the thumb and a dorsal finger gutter that extends to the distal extremity. A low-temperature thermoplastic material, two loop fastener straps, three small pieces of self-adhesive hook fastener and cooling spray are required. The orthosis has been tested on four professional volleyball players (3 females and 1 male), aged 18-24 years, suffering from PIP joint flexion contractures after traumatic hand injuries occurred 2 to 3 months before. Patients wore the splint for 1 hour followed by 1 hour of rest (6 times per day), for 2 to 3 weeks. During the resting periods patients performed a few sets of active ROM exercises at their PIP joint. RESULTS: This new splint design demonstrated to be effective in early recovery of complete PIP joint extension and subjects resumed soon their sports activity. CONCLUSIONS: Our device is easy to fabricate and to use and comfortable for patients.
OBJECTIVE: To measure intraarticular pannus proliferation after early and prolonged joint immobility using an animal model. METHODS: Forty rats underwent unilateral immobilization of a knee joint with an internal fixator for periods of 2, 4, 8, 16, and 32 weeks. Twenty rats received sham surgery. The knee joints were harvested and processed for histological examination. The synovial intima length and the subintimal area were measured on standardized sagittal sections with image analysis software. The measurements were recorded with regard to their location (anterior or posterior; superior or inferior). RESULTS: Intra and interrater reliabilities for all measurements were > 87.9%. The synovial intima length was smaller in immobilized knees than in controls at all time points. At 4 and 32 weeks, the difference was statistically significant (p < 0.05). The differences were marked in the posterior synovium, where the intima length of immobilized knees was significantly smaller than in controls after 4, 8, 16, and 32 weeks of immobilization (p < 0.05). The subintimal area was comparable in immobilized and control knees at all time points. CONCLUSION: We standardized the quantification of intraarticular pannus in a joint contracture model after immobility of up to 32 weeks' duration. This study revealed a significant decrease in synovial intima length but no change in the subintimal area of immobilized knees compared with controls. The decrease in synovial intima length with immobility suggests that adhesions of synovium villi rather than pannus proliferation are the major pathophysiological changes leading to contracture after immobility.
Congenital contractural arachnodactyly (CCA) is an autosomal dominant connective tissue disorder, comprising marfanoid habitus, flexion contractures, severe kyphoscoliosis, abnormal pinnae, and muscular hypoplasia. It is now known that mutations in the gene encoding fibrillin-2 cause CCA. Interestingly, mutations described to date cluster in the fibrillin-2 region homologous to the so-called neonatal Marfan syndrome region of fibrillin-1. Thus, it has been hypothesized that the relative infrequency of CCA compared with the Marfan syndrome is due to the limited region of the gene targeted for mutations. In support of the above hypothesis, we report here the finding of two additional FBN2 mutations in CCA, C1141F (exon 26) and C1252W (exon 29). In addition, a new 3' UTR polymorphism is also described.
Results are analyzed of treatment of four patients presenting with extension contractures of the knee joint after total knee replacement with the aid of the arthroscopic arthrolysis technique. All patients demonstrated increase in the joint movement size. The conclusion reached was that in the incipient manifestations of the knee joint extension contractures, the arthroscopic arthrolysis technique is superior to the conventional one.
OBJECTIVE: To present the clinical application of the window parascapular free flap. METHOD: The window parascapular free flap was used in 6 cases of serious facial burn scar contracture. The age of the patients ranged from 5 to 17 years. Based on circumflex scapular vessels, small windows were made on the flap for the palpebral fissure, the oral fissure, the nostrils or the external auditory meatus. The flap size ranged from 15 cm x 8 cm to 17 cm x 17 cm. All the free flaps were successful. RESULTS: With the survival of the free flap, the nose, the lids, the lips, etc. were reconstructed at the same time and obtained good appearance. CONCLUSION: For repair of serious facial burn scar contracture, the window parascapular free flap was successfully used to reconstruct the eye, the mouth, the nose and the ear. The method is safe and reliable because the blood supply of the scapular free flap was not affected by the opening.
The first case of Dupuytren's contracture in a black patient with no obvious caucasian admixture was reported in 1979. This condition is rare in the purely black population and since 1979 only 23 cases have been reported. We present the case of a black man with no history of caucasian admixture with bilateral Dupuytren's contracture. We suggest that this condition may not be as rare as the literature suggests and, that canvassing other hand societies for their experience, particularly in the continent of Africa, may help to establish the true incidence of this condition.
OBJECTIVE: To provide ideal materials for cervical burn contracture repair through a morphological study of free flaps of the scapular region. METHODS: Variform free flaps of the scapular region were designed according to the cervical defect after scar had been resected. The angiosomes of each cutaneous branch of the circumflex scapular artery (CSA) were observed and investigated through uninterrupted extension of the flap size. RESULTS: A total of 73 cases of cervical burn contracture have been treated with free flaps of different shapes of the scapular region since 1992. 41 were fusiform flaps pedicled on ascending and descending branches of the CSA. 26 were three-lobe flaps pedicled on ascending, transverse and descending branches of the CSA. 6 cases were two-lobe flaps pedicled on transverse and ascending or branches of the CSA. Two fusiform flaps necrosed owing to atherosclerosis and hyperemesis. The survival rate of the flaps was 97.26%. CONCLUSIONS: The free flaps of scapular region could be designed in different based on the three cutaneous branches of the CSA. More diverse designs can be expected since the report of the inflamammary branches of the CSA recently.
Nine cases of abduction contracture of the hip in children from contracture of the gluteus maximus muscle are reported. Division of the aponeurosis glutens maximus over the greater trochanter always permitted full adduction.
OBJECTIVE: To evaluate the efficacy of musculocutaneous flap containing the upper part of bilateral trapezius muscles in the treatment of cicatricial contracture deformity of neck. METHODS: From January 1990 to January 1997, twelve cases were treated by musculocutaneous flap containing upper part of bilateral trapezius muscles from 14 cm x 16 cm to 28 cm x 11 cm in size, and 9 of the 12 cases were followed up for 2-3 years. RESULTS: Primary healing of the wounds was observed in all of the cases. The function and the external appearance were satisfactory, and no graft contracture was found in the 9 cases followed up. CONCLUSION: The musculocutaneous flap grafting was an ideal method in the repair of soft tissue defect of neck, with the advantage of invariable blood supply and simple operative procedure.
OBJECTIVE: To explore a better surgical mode to treat gluteal muscle contracture. METHODS: In 98 cases, superior cross incision of large tuberosity was performed in 20 cases, posterosuperior curve incision of large tuberosity was performed in 20 cases, and exteroinferior cross incision of iliac spine in the other 58 cases. The patients were observed after operation and followed up. RESULTS: The patients who received exteroinferior cross incision of iliac spine recovered soon without bleeding and infection after operation, which indicated the lowest incidental rate of postoperative complication. CONCLUSION: Exteroinferior cross incision of iliac spine is a safe and effective surgical operation to loosen the gluteal muscle contracture.
OBJECTIVE: To explore the treatment of breast sclerosis caused by capsular contracture after augmentation mammaplasty, and preventive measures after the treatment to avoid the recurrence. METHODS: With the incision through periareola, a part of the fibrous capsule and fibrillate tissue which is between the base of the capsula and the wall of the capsula were resected in the shape of wedge. At the same time, the wall of the capsular cavity was incised in radiant shape to relax it. After operation, the early and effective massage should be fully used. RESULTS: 17 case of 26 case were given follow-up over half a year, the results were satisfactory. CONCLUSIONS: After capsular contracture was relaxed and a part of the fibrous capsula between the base and the wall of the capsular cavity was resected in the shape of wedge, the prosthesis can be moved smoothly in the suitable cavity without any obstruction. In addition to the early and effective massage after operation, the methods might reach the ideal results.
OBJECTIVE: To provide an ideal method for repairing the circular cicatricial contracture of thigh. METHODS: Deep inferior epigastric perforator (DIEP) island flaps was elevated based only on the deep inferior epigastric artery and vein and transferred to cover the thigh wound after scar had been resected. RESULTS: Four DIEP island flaps was applied clinically and all flaps survived. The size of the flaps ranged from (8 cm x 28 cm) to (11 cm x 32 cm). Venous return and edema had been obviously improved postoperatively. There was no abdominal weakness and hernia in the donor sites. CONCLUSION: DIEP flap not only retains the advantages of TRAM flap such as good blood supply and rich tissue volume, but also preserves the integrity of the rectus abdominis muscle. DIEP island flap is a good material for repair of the circular cicatricial contracture of the thigh.
In those cases in which a contracted capsule at the elbow limits flexion or extension, surgical treatment is warranted. A wide exposure is necessary to identify vital structures and perform an adequate anterior capsulectomy. A direct approach through the triceps is recommended for posterior capsulectomy. In 6 cases, the results were good when the contracture of the capsule was not associated with skin contracture or bony deformity.