gms | German Medical Science

Objectives/Interrogation: Complex contractures of the hand following traumatic injuries may involve several joints in the same segment, adhesions of both extensor and flexors tendons.

Several surgical procedures may be required in different times: dorsal teno-arthrolysis, flexors tenolysis, treatment of associated complications (fracture's malunions or cartilage loss).

The ideal surgical procedure should allows to treat all issues in one surgical step, with surgical approaches more mini-invasive as possible and allows to evaluate the effectiveness of procedure during surgery.

Methods: We report our experience on nine patients affected of complex contracture of fingers who underwent, in one surgical step to dorsal teno-arthrolysis through mini-invasive approaches with small incisions; tenolysis of flexor tendons through minimal exposure using Allis forceps; release of collateral ligament at MP joint to correct rotation instead of osteotomy. Surgery was performed in wide awake.

Contracture was following proximal phalanx 's fractures (4 cases), PIP joint fractures (2), sub-amputations (2) and burns (1)

Two patients showed fracture's malunion with rotation and 2 patients cartilage loss of PIP joint. They underwent interposition arthroplasty.

All patients started rehabilitation after 48 hours.

Results and Conclusions: Average follow up was 14 months. The mean value of TAM increased from 141,5° before surgery, to 195,23° after surgery; PIP joint active flexion increased from a mean pre-operative value of 38° to 78°, DIP joint active flexion from 10 ° to 43°; lag of extension was shown after DIP joint arthrolysis (mean 25°).

Mean PRWHE score improved from 20,8 to 4,7; grip strengh from 18,9 kg to 29,7 kg.

Even if lateral ligament release didn't allow the complete correction of rotation, function was improved, patients were very satisfied.

The use of wide awake surgery allows to improve effectiveness of mini-invasive incision performing subcutaneous dissection, without wide exposures; reduces post operative bleeding and swelling, avoids excess of release and following instability. Showing to the patient the immediate result improves his motivation.

The flexor tenolysis with Allis forceps could seem a very aggressive procedure, but it is very useful to treat tendons adhesions following fractures or immobilization without adding trauma and scar to the tendon canal.

It's not indicated for release of flexor's tendons adhesions following tendons suture because the risk of tendons rupture is higher.