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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

Satisfactory flexion
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Fig16: Satisfactory flexion

Mentions: After complete healing of the grafts, physiotherapy may be added during the next 2 weeks to increase the range of motion. After a year, the ROM of fingers is near normal and without recurrence of contractures (Figs. 11, 12). By adding a rubber component to the frame, a dynamic traction is introduced into the device, which slowly but persistently distracts the soft tissues without incidence of vascular complication to date. The pentagonal frame allows for constant traction without involvement of tendons and joints and is a useful adjunct in soft tissue distraction for contractures of the hand. Due to the lack of any serious complications, this technique is being utilized as the first line of treatment for any contracture, but especially for contracted joints, such as volar plate release or in children in whom caring for a contracture is extremely difficult by conventional means. The maximum achieved result at the end of distraction can only be maintained by night splints up to 6 months after the operation, after which it will not recur. Thus, careful follow-up is of utmost importance to keep the residual contracture as low as possible. The other indication for using this method is in epidermolysis bullosa patients in whom it is impossible to use a splint due to very sensitive skin. We treated a severe case of epidermolysis bullosa with severe flexion contracture and syndactyly of the fingers (Fig. 13). After releasing the contractures and putting the pentagonal frames in place, no attempt was made to separate the fingers since they were glued together by coagulum only (Fig. 14). The result after 6 months showed satisfactory extension and flexion (Figs. 15, 16).Fig. 11


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

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

Satisfactory flexion
© Copyright Policy
Related In: Results  -  Collection

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

Fig16: Satisfactory flexion
Mentions: After complete healing of the grafts, physiotherapy may be added during the next 2 weeks to increase the range of motion. After a year, the ROM of fingers is near normal and without recurrence of contractures (Figs. 11, 12). By adding a rubber component to the frame, a dynamic traction is introduced into the device, which slowly but persistently distracts the soft tissues without incidence of vascular complication to date. The pentagonal frame allows for constant traction without involvement of tendons and joints and is a useful adjunct in soft tissue distraction for contractures of the hand. Due to the lack of any serious complications, this technique is being utilized as the first line of treatment for any contracture, but especially for contracted joints, such as volar plate release or in children in whom caring for a contracture is extremely difficult by conventional means. The maximum achieved result at the end of distraction can only be maintained by night splints up to 6 months after the operation, after which it will not recur. Thus, careful follow-up is of utmost importance to keep the residual contracture as low as possible. The other indication for using this method is in epidermolysis bullosa patients in whom it is impossible to use a splint due to very sensitive skin. We treated a severe case of epidermolysis bullosa with severe flexion contracture and syndactyly of the fingers (Fig. 13). After releasing the contractures and putting the pentagonal frames in place, no attempt was made to separate the fingers since they were glued together by coagulum only (Fig. 14). The result after 6 months showed satisfactory extension and flexion (Figs. 15, 16).Fig. 11

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