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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Post-traumatic deformities around wrist: two-stage treatment

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  • presenting/speaker Alexander Zolotov - Far Eastern Federal University, Vladivostok, Russia

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1651

doi: 10.3205/19ifssh0598, urn:nbn:de:0183-19ifssh05984

Published: February 6, 2020

© 2020 Zolotov.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Treatment of bone and joint deformities is a challenge for surgeons. Correction of old deformities is associated with the risk of damage of peripheral nerves and blood vessels with subsequent ischemic disorders. In case of severe deformity two-stage treatment with slow distraction using external fixator on the first stage can be an available alternative to acute deformity's elimination.

The purpose of study - to analyze the efficacy and safety of two-stage treatment for the correction of post-traumatic deformities around the wrist with the aid of external fixator at the first stage.

Methods: We analyzed the treatment of 10 patients (from 24 to 42 years) Two-stage treatment was applied for correction of chronic perilunate dislocation (3) and chronic trans-scaphoid perilunate fracture-dislocation (3). Two-stage treatment was applied for correction of severe deformities after distal radius fracture (malunion - 1 patient, nonunion - 3 patients) with ulna head dislocation. Period of time following after trauma varied from 1,5 months to 4 years. Ilizarov apparatus was used at the first stage in all cases. Standard Ilizarov frame with 130-140 mm in diameter rings was used. The rate of distraction was 1 mm per day. Distraction period continued for 3-4 weeks. The second stage surgery procedures included: open reduction of perilunate dislocation (6), screw fixation and bone grafting of scaphoid (3); ORIF and bone grafting of radius (4).

Results: In all cases, severe deformities were corrected with the aid of distraction. Slow distraction provided a gradual lengthening of the skin, muscle, joint capsule, nerves and blood vessels without ischemic and neurological destruction. After the second stage of surgery, perilunate dislocations were reduced in all cases, bone deformities were eliminated in all cases, and bone healing was achieved in all cases. Function was improved in 9 cases, and recovered fully in 1 case. There was a complication after osteosynthesis in one case - K-wire's broken and loosening. Previous "stage I" surgical procedure facilitated the ability to perform "stage II" surgical procedure significantly.

Conclusion: Two-stage treatment of severe post-traumatic deformities around wrist is effective and safe. Pre distraction at the first stage makes it easier to do the second stage surgical procedure.