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At least 1,459 records · Page 81Linked to original sources
PubMed1989

Flexion contracture of the thumb: a malignant etiology.

A patient was first seen with a flexion deformity of the thumb interphalangeal joint that was initially diagnosed and treated as traumatic in origin. A painful forearm soft tissue mass was ultimately discovered; biopsy of the flexor pollicis longus tendon showed metastatic adenocarcinoma. Extensive evaluation failed to locate the origin of the primary tumor. Treatment consisted of local radiation and systemic chemotherapy. After 1 year, the patient is alive and well, has no evidence of disease, and refuses correction of the thumb interphalangeal flexion contracture.

Adenocarcinoma↗
PubMed1990

Classification and treatment of postburn metacarpophalangeal joint extension contractures in children.

Two hundred and seventy-eight surgically treated postburn metacarpophalangeal joint extension contractures in children were reviewed. A classification system based on the limitation of passive metacarpophalangeal flexion was devised to direct surgical intervention and assess postoperative results. Type I (47%) digits demonstrated greater than 30 degrees of metacarpophalangeal flexion with the wrist fully extended, and scarring was generally limited to the dorsal skin. Type II (34%) digits demonstrated less than 30 degrees of metacarpophalangeal flexion with the wrist maximally extended, and scarring typically involved skin, dorsal apparatus, and metacarpophalangeal capsule. Type III (19%) digits were fixed in greater than 30 degrees of metacarpophalangeal hyperextension and often demonstrated incongruity or dorsal subluxation of the metacarpophalangeal joint. Improvement after reconstruction was seen in 95% of type I digits, 73% of type II digits, and 47% of type III digits. Failure to improve usually resulted from inadequate scar release/excision or from failure to release deep soft tissues (dorsal apparatus or metacarpophalangeal capsule). Thirty secondary procedures were done to improve an unsatisfactory result after the initial reconstruction. These included deep releases, metacarpophalangeal joint arthrodeses, and amputations. The ring and small fingers accounted for 65% of the digits in this study, 68% of the failures, and all seven amputations.

Adolescent↗
PubMed1992

Basic fibroblast growth factor in cells derived from Dupuytren's contracture: synthesis, presence, and implications for treatment of the disease.

Dupuytren's contracture (DC) is associated with fibroblast and endothelial cell proliferation. We have identified a fibroblast and endothelial cell mitogen, basic fibroblast growth factor (FGF), in cells derived from this tissue and characterized the effects of this growth factor on DC cells. Northern blot analysis of DC cells reveals the presence of basic FGF mRNA species, and the DC cells coexpress multiple forms of basic FGF. Radioreceptor assays establish that the DC cells have high-affinity binding sites for basic FGF and proliferate in response to exogenous recombinant basic FGF. Furthermore, a conjugate between saporin (a ribosome-inactivating protein) and basic FGF, which is cytotoxic to cells possessing the basic FGF receptor, is also cytotoxic to DC cells. The possibility that basic FGF-saporin could be a potential therapeutic agent for prevention of recurrence of the disease after surgery is discussed.

Cell Division↗
PubMed1992

Arthroscopic release of a posttraumatic flexion contracture in the elbow: a case report and review of the literature.

Open arthrotomy has been the standard of treatment for posttraumatic flexion contractures of the elbow. Utilizing standard arthroscopic techniques combined with electrocautery, anterior capsulotomy was performed without complication. Immediate improvement in extension was demonstrated. Multiple cadaveric dissections evidenced the safety of the approach as the humeral capsular attachment is isolated from the neurovascular structures by the brachialis muscle. This technique serves to underscore the utility of elbow arthroscopy in patients with dysfunction previously only amenable to open joint procedures.

Adult↗
PubMed2004

Arthroscopic posteromedial release for osteoarthritic knees with flexion contracture.

PURPOSE: To evaluate the clinical outcomes of a new arthroscopic procedure, arthroscopic posteromedial release (PMR), and its potential use as a treatment option for medial-type osteoarthritic (OA) knees. TYPE OF STUDY: Retrospective analysis of clinical outcomes of a case series. METHODS: Knees with medial-type OA and flexion contracture were treated with PMR. They were classified using the Kellgren and Lawrence (K/L) radiographic grading system and classified using magnetic resonance imaging (MRI) into smooth (S) or irregular (IR) groups, based on the subchondral contour of the medial femoral condyle. Clinical outcome was evaluated using the Japanese Orthopaedic Association knee score (JOA score), verbal rating scale (VRS), and patient satisfaction. RESULTS: Fifty-two patients with 58 OA knees were included in the study. The mean age of the patients at the time of surgery was 71.6 years, the average ROM was from 13 degrees to 129 degrees , and the average follow-up period was 3.3 years. Most of the knees were classified as K/L grade III or IV. Overall, the average JOA score improved to 71.6 points from 56.3 points preoperatively. VRS scores decreased in most patients, and 76% of patients were satisfied at their last follow-up. The JOA score of the K/L grade III knees improved to 76.9 from 60.4 points preoperatively and that of the K/L grade IV knees improved to 69.5 from 55.3 points. The improvement in JOA score was less for the IR group, from 54.5 to 66.2 points, than for the S group, from 62.3 to 79.6 points. Five knees from the IR group and 1 from the S group were converted to total knee arthroplasty. CONCLUSIONS: Knees with relatively advanced OA, for which arthroscopic debridement has conventionally been contraindicated, can be treated with PMR if they are selected properly based on MRI findings. LEVEL OF EVIDENCE: Level IV, case series.

Aged↗
PubMed2006

V-N plasty for the release of severe postburn contractures.

The authors describe a technique for the release of severe postburn contractures of the web spaces by using all the available tissues in the web space as local flaps to avoid using skin grafts or distant flaps. We rely on the central part of the web to raise the main triangular flaps that may be used to create a functional web space. We called it the V-N plasty.

Burns↗
PubMed2003

Expanded occipito-cervico-pectoral flap for reconstruction of burned cervical contracture.

Postburn neck contracture and hypertrophic scarring can cause functional limitation and aesthetic disfigurement. Reconstruction of severe deformities and scar of neck following healing from burns confronts the surgeon with some of the most challenging problems in reconstructive surgery. Through knowledge of available reconstructive technique accurate diagnosis of tissue deficiency and secondary distortion, imaginative planning and definitive, careful execution of ones surgical plan are the bare minimum items for achieving improvement in a burned deformed neck. The aim of this article is to assess the role of expanded occipito-cervico-pectoral (o-c-p) flap for reconstruction in a series of four patients with severe burn scar of neck and involvement of shoulder back but intact anterior aspect of chest. This is an alternative method of reconstruction burn scar of neck area.

Adolescent↗
PubMed2006

The classification and treatment algorithm for post-burn cervical contractures reconstructed with free flaps.

Neck contractures after burn produce restrictions in motion and unacceptable aesthetic outcomes. Proper planning and tissue selection is essential to minimize donor site morbidity while optimizing outcomes. A classification system and treatment algorithm aids in achieving this goal. Between December 1999 and January 2003, 40 burn patients underwent release and reconstruction with free perforator flaps. Neck extensibility and zone of injury were evaluated. Choice of reconstruction was based on available tissue, restriction degree and zones involved. Cervical territories were classified according to movement restrictions and amount of improvement. Reconstructive territories were classified as central above (CA), central below (CB), central above and below (CAB) and lateral (L). Single, split, double and preexpanded free flaps were used for the reconstructions. Maximal gain in motion was noted at 4 weeks and maintained for the average 11 months follow-up. Types of reconstructive territories showed significant effects on range of motion while etiology and time between injury and reconstruction showed no impact on the functional outcome. Classification of neck territories aids in improving outcomes while minimizing donor morbidity. The central above territory, when reconstructed with free flaps, yielded the most rewarding improvement. A classification and treatment algorithm aids in achieving significant improvements in range of neck motion while taking into consideration the donor sites.

Adolescent↗
PubMed2006

Quantification of mentolabial profile using lateral roentgen cephalography and profile reconstruction by mandibular osteotomy in healthy adults and patients with scar contracture following severe facial burns.

Here mentolabial form including lateral facial contour and bony contour in healthy adults was studied to refer to values of normal mentolabial form using lateral roentgen cephalography. In soft tissue of healthy adults, thickness of mentolabial soft tissue was greater for men than for women. Degree of mentolabial curvature was greater for men than for women. In severe facial burn patients, the micrognathia-like deformity was evaluated compared with the reference values. In soft tissue of severe facial burn patients, loss of mentolabial sulcus and eversion of the lower lip were characteristically analyzed, suspecting that the major cause was scar contracture. These statistical data contribute to reconstruction of micrognathia-like deformity after severe facial burn to lead to favorable mentolabial form. It is shown that osteotomized genio-advancement produced ideal mentolabial form in severe facial burn patients, who had not been satisfied with the form by conventional operative methods, free skin flap, skin flap or free skin graft. And that the analyzed data, especially in the parameter of thickness of mentolabial sulcus, was improved.

Adolescent↗
PubMed2006

Congenital contracture of the quadriceps muscle: confirming the diagnosis with magnetic resonance imaging.

Congenital contracture of the quadriceps muscle can be defined as progressive loss of knee flexion due to fibrosis within the muscle without a history of trauma or intramuscular injection into the thighs. In the course of time, secondary changes might develop and vitiate the end result so this rare childhood disease needs particular attention for early diagnosis and treatment. Herein, we report a 14-year-old girl presented with inability to bend her knees completely. The clinical and radiological assessment was detailed with magnetic resonance imaging findings.

Adolescent↗
PubMed2005

A cohort study linked increased mortality in patients treated surgically for Dupuytren's contracture.

OBJECTIVE: Dupuytren's contracture (DC) is a fibromatous disease of the palmar fascia of unknown etiology. The objective of this study was to assess whether individuals treated for DC exhibited an altered standardized mortality ratio. STUDY DESIGN AND SETTING: A total of 16,517 patients operated on for DC between 1965 and 1995 were identified by the Swedish Inpatient Register. For the 7,579 patients who had died during that period, cause of death was obtained from the Swedish Death Register. RESULTS: There was an overall increased mortality (standardized mortality ratio [SMR]=1.06), inversely related to age and significant for both sexes, in patients under 70 years of age. The risk estimate was highest for endocrine diseases (highest value in patients 40-49 years of age at surgery; SMR=2.82), gastrointestinal diseases (highest value in those 40-49 years of age at surgery; SMR=2.69), accidents (highest value in those 30-39 years of age at surgery; SMR=2.40), and respiratory diseases (highest value in those 50-59 years of age at surgery; SMR=1.61). There was also an increased SMR for cardiovascular diseases in patients 40-59 years of age more than 10 years after surgery (highest value in those 40-49 years of age at surgery; SMR=1.65). CONCLUSION: The most probable mechanism for the increased mortality is related to smoking and other lifestyle factors.

Accidents↗
PubMed2006

Corrective osteotomies of the radius and ulna for supination contracture of the pediatric and adolescent forearm secondary to neurologic injury.

PURPOSE: To present the authors' experience with internal fixation of the radius and ulna as a surgical option for correction of supination contracture of the forearm. METHODS: Twelve patients (13 limbs) had an osteotomy of the radius and ulna for a supination deformity secondary to a residual brachial plexus or spinal cord injury. Surgery consisted of proximal ulna and distal radius osteotomies combined with plate fixation. RESULTS: The average age of the patients at the time of surgery was 11 years. Five limbs had fixed supination deformities and 8 limbs lacked pronation beyond neutral. The average preoperative supination deformity (either fixed or measured at midarc) was 76 degrees. The average intraoperative correction was 86 degrees. The average follow-up period was 16 months. The average midrange resting position maintained at final follow-up evaluation was 2 degrees of pronation. All limbs ultimately obtained radiographic and clinical union of the osteotomy sites. Complications included 6 plate fractures; however, only 1 patient required revision internal fixation. CONCLUSIONS: The combination of a proximal ulna and distal radius osteotomy with internal fixation can provide excellent correction, but the implant must be strong enough to hold the osteotomies rigidly in the corrected position during the time needed for union. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adolescent↗
PubMedDate not supplied

Both-bone forearm osteotomy for supination contracture: a cadaver model.

PURPOSE: To quantify the magnitude of rotational correction possible when comparing a single forearm bone osteotomy and fixation with stepwise osteotomy and fixation of both bones in a cadaver model and to determine if the order in which the stepwise osteotomies are performed influences the amount of correction. METHODS: Ten fresh-frozen cadaveric forearms were fixed to a frame positioned in the field of view of a motion-capture system. An experimental supination contracture was induced in full supination. Cadaver forearms were assigned randomly to group I (ulna osteotomy, rotation, plating) or group II (radius osteotomy, rotation, plating). Cadavers in group I were used later in group III (ulna + radius) by completing a radial osteotomy, rotation, and fixation in the forearms with the plated ulna. Similarly the specimens assigned to group II were used later in group IV (radius + ulna) by completing an ulna osteotomy, rotation, and fixation in the forearms with the plated radiuses. Measurements of forearm pronation were made after single-bone (groups I, II) and stepwise both-bone (groups III, IV) rotational osteotomies. RESULTS: Stepwise rotational osteotomy and fixation of the ulna followed by the radius produced significantly more corrective pronation (101 degrees) than rotating the radius followed by the ulna (65 degrees). Rotating the radius gave only moderate correction (58 degrees) and minimal correction was produced by ulna osteotomy alone (15 degrees). CONCLUSIONS: Rotational osteotomy of both forearm bones can create approximately 100 degrees of correction when performed at the proximal ulna followed by the distal radius. If less rotation is needed then the distal radius osteotomy alone can provide approximately 60 degrees of correction.

Biomechanical Phenomena↗
PubMed2006

Fractional flexor tendon lengthening for advanced metacarpophalangeal flexion contracture in rheumatoid hands.

This technical report discusses a subgroup of rheumatoid patients who have minimal ulnar drift but a severe fixed metacarpophalangeal joint flexion contracture for whom conventional metacarpophalangeal joint arthroplasty alone was insufficient to correct the deformity. We describe a surgical technique to deal with this clinical problem that uses fractional flexor tendon lengthening in the forearm to correct the severe flexion deformity at the metacarpophalangeal joint.

Aged↗
PubMed2005

Dupuytren's contracture: an update of biomolecular aspects and therapeutic perspectives.

The so-called fibrogenic cytokines, able to induce the growth of fibroblasts and their differentiation into myofibroblasts and to stimulate their production of extracellular matrix, are involved in the genesis of Dupuytren's contracture. Although many studies have been made of biomolecular aspects of palmar fibromatosis, practical applications from them are still far from imminent because of the real difficulty of blocking their action in vivo, even in a chronic, progressive lesion such as Dupuytren's disease. Consequently, surgical excision of the palmar fascia still remains the treatment of choice.

Dupuytren Contracture↗
PubMed2007

Anterior tenoarthrolysis for severe flexion contracture of the fingers (the "TATA" operation): a review of 50 cases.

The "hook finger", with both proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint flexion contractures, often after multiple previous operations, is difficult to treat. This paper reports the results of 50 fingers in 49 patients in which the TATA (Téno-Arthrolyse Totale Antérieure) salvage procedure, described by Saffar in 1978, was carried out. Thirty-seven of 50 (74%) of these fingers had had at least one previous operation, most on the flexor apparatus. The mean PIP and DIP extension deficit pre-operatively was 133 degrees with a mean PIP lag of extension of 83 degrees . With a mean follow-up of 7.8 years, 45 fingers were improved, five were not and none was worsened. The mean PIP and DIP extension deficit postoperatively was 47 degrees , with a mean PIP lack of extension of 31 degrees . The overall gain in extension deficit of both joints was 86 degrees and of the PIP was 52 degrees . One PIP joint developed septic arthritis immediately after surgery. The benefit of this salvage operation is mainly in the change of the active range of motion to a more functional arc.

Adolescent↗