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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

External fixation device used for distraction
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Fig4: External fixation device used for distraction

Mentions: In this method, after appropriate access (multiple Z or zigzag incisions for lengthening), the contracture was released (Fig. 2). A Kirschner wire size 1–1.5 mm (matching the patient’s distal phalanx thickness) was used for anchorage. The wire was passed horizontally, under direct fluoroscopic control, through the head of the phalanx and then bent like a pentagon. Before closing the wire ends, a rubber band or wire was inserted inside the frame (Fig. 3). The frame is shaped such that only the horizontal wire segment exerts the “distraction,” and no vascular compromise or soft tissue encroachment is created. An external fixation device was then used to distract a finger, several fingers, or the entire hand (Fig. 4). After achieving the desired distraction following joint contracture release, the finger or hand was temporarily freed, and active and passive physiotherapy was started while maintaining the frame; the fingers were put back into distraction after exercise to maintain the acquired length, especially with a splint at night. The patient usually develops nearly a full range of motion (ROM) after 4 weeks (Fig. 5). The maximum result (complete flexion and extension) achieved at the end of distraction (Fig. 6) was maintained by using splints at night for up to 6 months. This prevented recurrence of contractures.Fig. 2


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

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

External fixation device used for distraction
© Copyright Policy
Related In: Results  -  Collection

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

Fig4: External fixation device used for distraction
Mentions: In this method, after appropriate access (multiple Z or zigzag incisions for lengthening), the contracture was released (Fig. 2). A Kirschner wire size 1–1.5 mm (matching the patient’s distal phalanx thickness) was used for anchorage. The wire was passed horizontally, under direct fluoroscopic control, through the head of the phalanx and then bent like a pentagon. Before closing the wire ends, a rubber band or wire was inserted inside the frame (Fig. 3). The frame is shaped such that only the horizontal wire segment exerts the “distraction,” and no vascular compromise or soft tissue encroachment is created. An external fixation device was then used to distract a finger, several fingers, or the entire hand (Fig. 4). After achieving the desired distraction following joint contracture release, the finger or hand was temporarily freed, and active and passive physiotherapy was started while maintaining the frame; the fingers were put back into distraction after exercise to maintain the acquired length, especially with a splint at night. The patient usually develops nearly a full range of motion (ROM) after 4 weeks (Fig. 5). The maximum result (complete flexion and extension) achieved at the end of distraction (Fig. 6) was maintained by using splints at night for up to 6 months. This prevented recurrence of contractures.Fig. 2

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