Interventions palliatives pour correction des griffes des doigts

Abstract

Palliative treatment of palsy of intrinsic muscles of the four fingers classically aims at suppressing claw. But functional restoration is mainly ensured in setting up again the volar flexion, the stage preparing prehension. Three hundred and thirty seven hands have been operated. Each one of the utilized interventions has advantages and drawbacks that have to be known in order to select the best adapted technics, the more or less important stiffness of fingers being the most important criteria. Finally a simple choice is easy and possible, particularly for inexperienced surgeons in the treatment of those paralysis (that become rarer and rarer in the West on account of the success of nervous sutures facing a large number of leprotic hands to operate in endemic countries); it is the metacarpophalangeal stabilization test: the active interphalangeal extension obtained after passive manual stabilization, of metacarpophalangeal joint indicates the degree of proximal interphalangeal residual stiffness, and the indications come in function of these various types of stiffness. Loose PIP joint: residual flexion from 0 degree to 20 degrees: MP capsular shortening, H shaped, and flexor pulley advancement; "Lasso" operation: a single slip of FDS by finger or one FDS for two fingers; Bunnell-Litter's operation: one FDS for 4 fingers; Giraudeau's operation: FCR + fascia lata; Brand's operation: 1st (ECRL) or 2nd (ECRB) + tendon graft; Palande's operation: ECRB + many tailed fascia lata graft fixed at the muscle tendon junction. Stiff PIP Joint: residual flexions from 20 degrees to 60 degrees: modified Bunnell's operation: one FDS for 2 fingers, the FDS of the third used to restaure the opposition; "lasso" operation: one FDS for each finger, or for two fingers. Very stiff PIP joint: residual flexion superior to 90 degrees: proximal interphalangeal joint arthrodesis.