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Soft tissue distraction in hand surgery: the "pentagonal frame" technique.

Nazerani S, Motamedi MH - Strategies Trauma Limb Reconstr (2009)

Bottom Line: All 33 patients were successfully treated.No major complications were encountered during the follow-up period (3-5 years).The pentagonal frame allows for effective distraction of soft tissues and joint ligaments and maintains the space needed for healing of fractures of the metacarpals and phalanges.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran.

ABSTRACT
Soft tissue distraction (STD) is an increasingly accepted operation in all fields of hand surgery from elbow contracture release to PIP joint release. Current techniques reported lack the ability to distract the joints of the fingers or the hand, maintain the length of released contractures, and hold them in a position while active and passive physiotherapy is possible. We describe a technique by which STD of the hand and fingers is done with no joint or tendon involvement overcoming the aforementioned drawbacks. Thirty-three patients with hand contractures were treated. In this method, a thin 1-1.5-mm Kirschner wire was passed horizontally at the proximal head of the distal phalanx and bent like a frame around the finger, forming a pentagonal shape for anchorage. The distal distraction was exerted at the distal phalanx. Various forms of external fixation were then used to distract a finger, several fingers, or the hand by placing tension on this frame; the distraction was either static (with a wire exerting pressure) or dynamic (using a rubber band to adjust the tension). After obtaining the desired result, the wire or rubber band was temporarily freed to commence active and passive physiotherapy. We maintained the frame for 3-6 weeks. All 33 patients were successfully treated. No major complications were encountered during the follow-up period (3-5 years). The pentagonal frame allows for effective distraction of soft tissues and joint ligaments and maintains the space needed for healing of fractures of the metacarpals and phalanges.

No MeSH data available.


Related in: MedlinePlus

After releasing the contractures, skin grafting and assembling the frame, slow distraction was started and continued until complete finger extension was obtained. During the first 4 weeks, only distraction was applied
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Fig10: After releasing the contractures, skin grafting and assembling the frame, slow distraction was started and continued until complete finger extension was obtained. During the first 4 weeks, only distraction was applied

Mentions: Distraction is being used in all fields from maxillofacial to limb surgery [3–7]. Soft tissue distraction is becoming an increasingly accepted operation in all fields of hand surgery from elbow contracture release to PIP joint release, not only burn contracture release (which has been extensively reported by Joshi et al. or Suzuki) [8–10]. The idea of soft tissue distraction is not new, but the use of the distal phalanx as a distraction point and the pentagonal frame is a new addition to this field. Due to minimal complications and noninvolvement of tendinous structures, this frame can be used in all patients, be it joint contracture or epidermolysis bullosa. Active ROM exercise can begin as soon as possible without removing the frame. In the JESS system (by Dr. Joshi), you remove the frame and begin the exercises. The second advantage of distal phalanx distraction is that it can be used for lengthening the fingers and metacarpals, which we shall present in another article. The techniques reported lack the ability to distract the joints of the fingers or the hand, maintain the released contractures, and hold them in a position constantly without active and passive physiotherapy. The pentagonal frame reported in this paper was used to distract the soft tissues and joints of the hand and fingers. This was done by exerting distraction on a bone without involving tendons and joints with a concomitant physiotherapy regimen made possible. For PIP joint ankylosis due to volar plate contracture, after a healed phalangeal fracture, the volar plate is released through a volar zigzag incision, then the pentagonal frame is assembled and the finger is put under tension. Two to 3 days after surgery, physiotherapy can begin by releasing the rubber band and beginning active and passive exercises. The patient attains nearly a full range of motion (ROM) after 4 weeks. This device can also be used in congenital deformities (Fig. 7). Through volar zigzag incisions, the volar plates are released, and then the frame can be assembled and a plaster cast used to hold the fingers in extension. Two weeks after healing of the wounds, the fingers are in complete extension (Fig. 8). Severe volar contractures of fingers due to burns were also treated (Fig. 9). In such cases, after releasing the contractures, skin grafting, and assembling the frame, slow distraction can be started and continued until complete finger extension is obtained. During the first 4 weeks, only distraction is applied (Fig. 10). The frame may be removed after 6–8 weeks.Fig. 7


Soft tissue distraction in hand surgery: the "pentagonal frame" technique.

Nazerani S, Motamedi MH - Strategies Trauma Limb Reconstr (2009)

After releasing the contractures, skin grafting and assembling the frame, slow distraction was started and continued until complete finger extension was obtained. During the first 4 weeks, only distraction was applied
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2666827&req=5

Fig10: After releasing the contractures, skin grafting and assembling the frame, slow distraction was started and continued until complete finger extension was obtained. During the first 4 weeks, only distraction was applied
Mentions: Distraction is being used in all fields from maxillofacial to limb surgery [3–7]. Soft tissue distraction is becoming an increasingly accepted operation in all fields of hand surgery from elbow contracture release to PIP joint release, not only burn contracture release (which has been extensively reported by Joshi et al. or Suzuki) [8–10]. The idea of soft tissue distraction is not new, but the use of the distal phalanx as a distraction point and the pentagonal frame is a new addition to this field. Due to minimal complications and noninvolvement of tendinous structures, this frame can be used in all patients, be it joint contracture or epidermolysis bullosa. Active ROM exercise can begin as soon as possible without removing the frame. In the JESS system (by Dr. Joshi), you remove the frame and begin the exercises. The second advantage of distal phalanx distraction is that it can be used for lengthening the fingers and metacarpals, which we shall present in another article. The techniques reported lack the ability to distract the joints of the fingers or the hand, maintain the released contractures, and hold them in a position constantly without active and passive physiotherapy. The pentagonal frame reported in this paper was used to distract the soft tissues and joints of the hand and fingers. This was done by exerting distraction on a bone without involving tendons and joints with a concomitant physiotherapy regimen made possible. For PIP joint ankylosis due to volar plate contracture, after a healed phalangeal fracture, the volar plate is released through a volar zigzag incision, then the pentagonal frame is assembled and the finger is put under tension. Two to 3 days after surgery, physiotherapy can begin by releasing the rubber band and beginning active and passive exercises. The patient attains nearly a full range of motion (ROM) after 4 weeks. This device can also be used in congenital deformities (Fig. 7). Through volar zigzag incisions, the volar plates are released, and then the frame can be assembled and a plaster cast used to hold the fingers in extension. Two weeks after healing of the wounds, the fingers are in complete extension (Fig. 8). Severe volar contractures of fingers due to burns were also treated (Fig. 9). In such cases, after releasing the contractures, skin grafting, and assembling the frame, slow distraction can be started and continued until complete finger extension is obtained. During the first 4 weeks, only distraction is applied (Fig. 10). The frame may be removed after 6–8 weeks.Fig. 7

Bottom Line: All 33 patients were successfully treated.No major complications were encountered during the follow-up period (3-5 years).The pentagonal frame allows for effective distraction of soft tissues and joint ligaments and maintains the space needed for healing of fractures of the metacarpals and phalanges.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran.

ABSTRACT
Soft tissue distraction (STD) is an increasingly accepted operation in all fields of hand surgery from elbow contracture release to PIP joint release. Current techniques reported lack the ability to distract the joints of the fingers or the hand, maintain the length of released contractures, and hold them in a position while active and passive physiotherapy is possible. We describe a technique by which STD of the hand and fingers is done with no joint or tendon involvement overcoming the aforementioned drawbacks. Thirty-three patients with hand contractures were treated. In this method, a thin 1-1.5-mm Kirschner wire was passed horizontally at the proximal head of the distal phalanx and bent like a frame around the finger, forming a pentagonal shape for anchorage. The distal distraction was exerted at the distal phalanx. Various forms of external fixation were then used to distract a finger, several fingers, or the hand by placing tension on this frame; the distraction was either static (with a wire exerting pressure) or dynamic (using a rubber band to adjust the tension). After obtaining the desired result, the wire or rubber band was temporarily freed to commence active and passive physiotherapy. We maintained the frame for 3-6 weeks. All 33 patients were successfully treated. No major complications were encountered during the follow-up period (3-5 years). The pentagonal frame allows for effective distraction of soft tissues and joint ligaments and maintains the space needed for healing of fractures of the metacarpals and phalanges.

No MeSH data available.


Related in: MedlinePlus