Article
External fixator with distractor for treatment of the retraction in flexion of fingers
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Authors
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Kleber Oliveira Barboza
- Hand Club Pernambuco, SOS Mão Recife, Hospital Regional do Agreste, Caruaru - Pernambuco, Brazil
| Published: | February 6, 2020 |
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Outline
Text
Introduction: Skin retraction at palmar 2 zone level fingers may happen sometimes in case of injury, burn or infection, when its needs surgical treatment for flexion deformity more than 45 grade. There are any methods to treat it, as zetaplasty, skin flat, expansor, skin autograft, Ilizarov method. That our technic, with external distractor, can be used to treatment at various types of finger flexion contracture. As well as first treatment for botoniere deformity and dupuytren contracture. That technic is very easy, may be used with local anestesia, by day clinic.
Objectives: To describe a serial of patients with retraction in flexion finger, by any reasons, treated by progressive stretch using a mini external fixator as a Hoffa.
Methods: 50 patients were operated from january 2000 to december 2017, 36 male and 14 female, with middle age of 28 years-old, between 15 and 42 years-old. 04 cases in thumb, 16 cases in 2º finger (QD), 08 in 3º QD, 08 in 4º QD and 14 in 5º QD.
The patient, after asepsis, receives a local anesthesia for the finger flexioned. So two pins are putting with a Hoffa fixator articulated with distrator. One pin, perpendicularly, in each side of joint. Hangs the screws for block the pins and gives the tool for the patient or parent that will turn, on clockwise, the principal axis to correct the deformity, by progressive strech of 01 mm per day (one complete turn). After the total correction, the patient goes back to the clinic for withdraw the pins and fixator. So the patients were available by total active motion (TAM) and satisfation.
Results: We had 100% of correction, with TAM recuperated for all patients. About the method, 80% patients are pleased. 10 patients complained about the delay, middle time of 36 days. Had 02 cases with recidive in 5º QD, but retreated with a total correction.
Discussion: That Hoffa fixator is better to use in the thumb, second and fifth finger. In the third and fourth fingers, the interdigital space is more difficult to apply it.
Years ago, an american company produced a model circular very narrow, but they abandoned it, I don't know why. Actually we can use anothers fixators more narrow, as Miniflo.
Conclusions: We conclude that it is a good alternative for treatment of the retraction in flexion of fingers, but to keep the protocol is indispensable, with a attentive and cooperative patient.
