Injury of the hand has been progressively increasing with industrial development in recent years.
In spite of careful and proper surgical treatment, orthopedic surgeon is frequently faced with a hand which fails to function properly because of limited flexion or extension in the metacarpophalangeal and interphalangeal joints.
The author has experienced 13 cases of stiff fingers from 1~68 to 1973 and the result of the treatment is reported in this paper.
1. 12 cases out of 13 were in age group between 11 to 30 years of age.
2. The types of injury were variable as; 5 cases of laceration, 5 cases of cn~shing injury, 2 cases of wringer injury, and 1 case of open fracture. Those were injuried by roller, glass, pressor, drill and gun-shot.
3. Involved anatomical structurs in stiff finger joints were much variable, mainly depending upon varying degrees of intial injury.
We have classified them roughly in 4 groups;
1. Ruptured or sutured tendon adhesion.
2. Intrinsic muscles and tendon adhesion, and capsule and collatera contracture.
3. Resultant massive scar contracture including joints, and ligaments.
4. Osseus adhesion with soft tissues including tendon.
4. 17 times of reconstructive surgery were performed in 14 stiff joint with skin graft, Z-plasty, adhesiolysis, capsulotomy, capsulectomy, resection of cord portion of collateral ligament, tenolysis and arthroplasty alternatively or unitedly except of tenodesis and arthrodesis in remained 2 joints.
5. Post-operative immobilization was performed with plaster splint, stein mann pin and K-wire accordingly.
The period of immobilization was variable from 2 weeks to 4 weeks.
Physical therapy is enforced to begin as soon as possible.
The period of follow-up was from 2 months to 19 months and average 6 1/2 months.
6. Consequently, the range of active motion is increased to 55 and passive motion to 61 from preoperative status in PIP and MP joints.
7. The preoperative position of the joints and cause of the joint stiffness don´t gave no significant influence to the end result.
Satisfactory end result was obtained by proper, careful and meticulous surgery with early and extensive physical therapy.
|