Finger Contractures Research Articles

Magical Relief of Venous Congestion in Finger in Case of Quaba Flap for Finger Contracture

The DMCA flap also known as Quaba flap serves as a valuable option for reconstructive hand surgeons, particularly for addressing dorsal finger defects when other flap options are limited. It aligns with reconstructive principles, offering simplicity, reliability, and minimal donor site morbidity. This report details the case of a female with a contracture on the right index finger and briefly explores various DMCA flap variations to obtain the best mobility of the flexion creases without sacrificing the main artery Keywords: Quaba flap, Contracture, Reconstructive surgery, Intradermal Suture

Two-Stage Flexor Tendon Reconstruction for Finger Contracture Secondary to Phlegmon: A Case Report

Flexor tendon reconstruction is a complex surgical procedure that requires great precision and specialized expertise. It remains a preferred treatment for patients with neglected lacerations of the digital flexor tendon and after the failure of flexor tendon repair. Improvements in tendon repair methods and follow-up techniques have enhanced outcomes after flexor tendon grafting. Case Presentation: A 14-year-old girl with a history of a phlegmon of the 4th finger of the right hand, treated with antibiotics and drainage. The evolution is marked after 2 years by the progressive development of a flexion contracture of the proximal interphalangeal (PIP) joint. On examination, there is a flexion attitude and an inability to extend the PIP joint without vascular or nervous disorders. A two-stage reconstruction was performed using the palmaris longus tendon as a graft. With a follow-up of 3 years, the girl has recovered complete flexion and has limited extension to 25° at the PIP joint. An arthrolysis was proposed, but the girl refused, and she is satisfied with the results.

Development of a new patient-reported outcome measure for Dupuytren disease: A study protocol.

Objectives: Dupuytren disease is a common condition that causes progressive finger contractures resulting in impaired hand function and difficulties in performing daily activities. Patient reported outcome measures (PROMs) are commonly used in research and clinical practice to evaluate treatment outcomes. Both general upper extremity PROMs and Dupuytren-specific PROMs are available, typically developed using conventional methodology based on classical test theory. However, most current PROMs have been shown to have low responsiveness and the relevance of included items have been questioned. In this study we aim to develop a new Dupuytren-specific PROM using modern measurement methodology based on item response theory (IRT). Methods: The study will be performed in three phases. In Phase 1, (completed), an expert group developed a questionnaire with a large number of potentially relevant items derived from existing PROMs and patient collaboration. In Phase 2, the questionnaire will be administered to 300 patients with Dupuytren disease, and their responses will be analyzed with IRT methodology to identify the best performing items to be included in the new PROM. In Phase 3, the new PROM will be administered to 300 additional patients for validation. Conclusion: This new Dupuytren-specific patient-reported outcome measure will help advance clinical research on Dupuytren disease.

Clinical and Genetic Heterogeneity of Nuclear Envelopathy Related Muscular Dystrophies in an Indian Cohort.

Nuclear envelopathies occur due to structural and/or functional defects in various nuclear envelope proteins such as lamin A/C and lamin related proteins. This study is the first report on the phenotype-genotype patterns of nuclear envelopathy-related muscular dystrophies from India. In this retrospective study, we have described patients with genetically confirmed muscular dystrophy associated with nuclear envelopathy. Data on clinical, laboratory findings and muscle MRI were collected. Sixteen patients were included with median age at onset of 3 years (range: 1 month - 17 years). Three genes were involved: LMNA (11, 68.75%), EMD (4, 25%) and SYNE1 (1, 6.25%). The 11 patients with LMNA variants were Congenital muscular dystrophy (MDCL)=4, Limb Girdle Muscular Dystrophy (LGMD1B)=4 and Emery-Dreifuss Muscular Dystrophy (EDMD2)=3. On muscle biopsy, one patient from each laminopathy phenotype (n = 3) revealed focal perivascular inflammatory infiltrate. Other notable features were ophthalmoparesis in one and facial weakness in one. None had cardiac involvement. Patients with EDMD1 had both upper (UL) and lower limb (LL) proximo-distal weakness. Cardiac rhythm disturbances such as sick sinus syndrome and atrial arrhythmias were noted in two patients with EDMD1. Only one patient with variant c.654_658dup (EMD) lost ambulation in the 3rd decade, 18 years after disease onset. Two had finger contractures with EMD and SYNE1 variants respectively. All patients with LMNA and SYNE1 variants were ambulant at the time of evaluation. Mean duration of illness (years) was 11.6±13 (MDCL), 3.2±1.0 (EDMD2), 10.4±12.8 (LGMD1B), 11.8±8.4 (EDMD1) and 3 (EDMD4). One patient had a novel SYNE1 mutation (c.22472dupA, exon 123) and presented with UL phenotype and prominent finger and wrist contractures. The salient features included ophthalmoparesis and facial weakness in LMNA, prominent finger contractures in EMD and SYNE1 and upper limb phenotype with the novel pathogenic variant in SYNE1.

Application of Near Infrared Spectroscopy to Enhance Safety and Individualize Distraction of Severely Contracted Joints in Far-Advanced Dupuytren's Disease.

Background: Slow distraction of contracted joints is a well-established treatment in far-advanced stages of Dupuytren's disease (DD). To assess finger perfusion and avoid malperfusion, we studied near infrared spectroscopy (NIRS) to evaluate the maximum extent of distraction that would not harm microcirculation to the finger. This technique also allows an optimized treatment in accordance with sufficient blood perfusion during distraction. Methods: Eligible patients with stage IV finger contractures who needed treatment for Dupuytren's contracture were included and prospectively investigated. The operation was performed with local anaesthesia. First, the Dupuytren strand of the treated finger was dissected in the palm to allow distraction. Under X-ray control, the distraction device was applied. Then, slow distraction of the treated joint was performed to evaluate the finger perfusion. To assess perfusion of the treated finger, NIRS was used to measure tissue oxygen saturation. If impaired finger perfusion was detected, traction was reduced until sufficient oxygen levels and perfusion patterns were reestablished. Results: NIRS was performed after application of the distraction device in seven cases. We treated six male and one female patient (mean age 70 years, range 51-80 years). Rapid distraction resulted in malperfusion of the treated fingers. Using NIRS proved to render reliable and reproducible information on finger perfusion and oxygenation in all seven patients. Conclusions: Application of NIRS enhances safety in the treatment of far-advanced DD finger contractures with an external skeletal distraction device. It is non-invasive, reproducible, easy to use and allows for an individualized adapted distraction velocity.

A Prospective Study of Contracture of the Finger and its Management in a Tertiary Care Center.

When the range of motion between two finger segments, both active and passive, is restricted, finger contracture occurs. The aim of this study is to investigate the best procedure to eliminate finger contracture and the functional and esthetic results of the different surgical procedures. A total of 31 patients with soft-tissue abnormalities of the hand were included in this prospective study. They underwent either contracture removal with K-wire and skin grafts or various flap procedures in the department of plastic surgery. Complaints of stiffness and discomfort were classified into five categories: none, mild, moderate, marked, and severe. The difficulty a person had in picking up objects, grasping, writing, etc., was used to determine the degree of disability. Absenteeism from work and surgical site infections were also recorded. The mean age was 20.25 years, with a mean age of 23.05 for men and 15.83 for women. Overall, most cases occurred in the age range of 3-10 years. For K-wire surgery with skin grafting, the typical time off work was 24 days. The average recovery time ranged from 15.2 days for skin grafts to 16.9 days for tenolysis, 28.33 days for groyne flaps, and 41 days for abdominal flaps. Of all cases, 12 (38.00%) had a fair result, 10 (31.04%) had a moderate result, and 9 (30.96%) had an excellent result. The most feasible method for treating these situations, which offers the greatest potential for a functional and cosmetic result, is contracture reduction with skin grafting.

Dorso Proximal Interphalangeal Island Flap

Background: This study aimed to demonstrate the clinical application of the dorsoproximal interphalangeal island flap as an alternative approach to skin graft or cross-finger flap to repair lesions at the ventral site at the proximal interphalangeal (PIP) finger joint. Methods: Fifteen patients received flaps (11 men and four women, n = 25 flaps). The repair of volar contracture in finger sequelae after burn injuries was the main indication. Five patients underwent two or more flaps during the same surgical session. The mean patient age was 18 years (range, 7–56 years). Most patients presented with palmar finger contractures of the PIP joint. In three patients, six flaps were rotated to the lateral radial and ulnar proximal surfaces of the finger to treat syndactyly. Results: Most flaps survived and provided satisfactory functional and aesthetic improvement of palmar scar contracture in the PIP region. Postoperative donor site follow-up was normal. The color and pliability of the skin are similar to those of the surrounding area. The follow-up period ranged from 6 months to 12 years. Conclusions: Dorsoproximal interphalangeal island flaps are an option for repairing lesions that lack soft tissue and range in size from 10 × 15 to 12 × 18 mm at the volar site and around the PIP joint. The arch of rotation of this flap allows for lateral, ulnar, and radial rotations around the joint. The indication of six flaps in three patients to repair a proximal lack of tissue caused by syndactyly demonstrated its potential use in this anomaly.

Clinical experience of using loop threads for tendon suturing of injured tendons of finger flexors in children's hands

BACKGROUND: Despite a significant progress in hand surgery, to date, the number of unsatisfactory functional outcomes in patients with injured flexor tendons of fingers still remains high, which underlines the importance and significance of the problem of flexor tendon repair in children. CLINICAL CASE DESCRIPTION: The authors present a series of clinical cases with the application of loop threads for suturing tendons in children with tendon injuries in deep finger flexors at different anatomical sites. They share their experience in using loop threads for tendon suturing in zones II, III, IV, V including tendon end reinsertion in zone I again with a loop thread. The primary task of surgical treatment of children with injured tendons of finger flexors is their restoration. In order to prevent secondary tendon ruptures, finger contractures, infectious complications and scarring of the tendon with surrounding tissues, it is recommended to use optimal suture material and surgical sutures that meets the basic requirements for tendon suturing . Specific pediatric anatomy must be taken into consideration as well. As the authors' clinical experience shows, a new approach to the restoration of injured finger flexor tendons with loop threads allows to avoid complications in 98% of cases. CONCLUSION: The implementation of loop tendon suturing into pediatric practice in combination with appropriate rehabilitation and motivation for the rehabilitation of a child and his/her parents opens up new prospects for the successful treatment of children with injured tendons of deep flexors of hand fingers.

Design, Engineering Analysis, and Fabrication of a Prototype Electromechanical Finger Fixator Control System

This paper investigates a new external fixator system for treating finger contractures. This innovative system is electric and user-friendly, providing precise readings of the angles of diseased finger joints. Accurate measurements of the angles of the diseased finger joints can assist therapists and patients during rehabilitation procedures. The fixator consists of ten parts assembled using polyether-ether-ketone (PEEK) for the plastic components and stainless steel for the metal components. The design model was engineered, drawn, and analyzed using SolidWorks Computer-Aided Design software. The verification process utilizes finite element analysis to demonstrate that the maximum stress was lower than the yield strength of the chosen materials. As a result, the new device design is robust and stable enough to withstand the anticipated loading conditions of human fingers. Subsequently, a prototype was fabricated using advanced additive manufacturing technology, specifically fused deposition modeling (FDM). The proposed fixator is simple to control, reliable, easy to use, and reproducible. It enables device users to exercise their finger joints throughout the day without requiring the assistance of specialists.

Improving cosmetic and functional outcome in case of post burn contracture of hand and fingers by using de-epithelized plantar skin graft

Background: Burn scar contractures in the fingers and hand often lead to debilitating functional and cosmetic issues. Various surgical approaches exist, but achieving optimal outcomes remains a challenge. While grafting glabrous split-thickness skin from the foot's plantar aspect is a well-established method, it remains underutilized, with conventional grafts leading to complications, especially in darker-skinned individuals. Method: This study involved 35 patients with McCauley grade II and III hand burn contractures, spanning various age groups and genders. Surgical procedures encompassed scar removal, contracture release, and plantar skin graft application. Post-operatively, patients received dressing, splinting, and physiotherapy. Donor site healing was evaluated at the 3-week mark. Results: Remarkably, all patients exhibited successful donor site healing within 3 weeks. The surgical technique effectively addressed contractures, enhancing range of motion and function. Post-operative care, featuring physiotherapy, coconut oil massages, and pressure garment use for at least 6 months, significantly contributed to post-burn hand and finger contracture management. Conclusions: De-epithelized plantar skin grafts offer a promising avenue for enhancing both aesthetics and function in individuals with post-burn hand and finger contractures. This technique minimizes complications common with traditional grafts while promoting successful donor site healing and improved range of motion. The study underscores the significance of using like-for-like reconstruction to achieve the best possible results in managing post-burn contractures.

Ain shams burn unit experience with post-burn contracted fingers

Ain shams burn unit experience with post-burn contracted fingers

Flexor Pronator Slide Under Local Anesthesia without a Tourniquet for Non-Ischemic Contractures of the Forearm.

Flexor Pronator Slide Under Local Anesthesia without a Tourniquet for Non-Ischemic Contractures of the Forearm.

Musculoskeletal involvement in systemic sclerosis.

Systemic sclerosis (SSc) is a multi-organ, systemic connective tissue disease, which affects the lungs, heart, gastrointestinal tract, kidneys, skin, and musculoskeletal system. Musculoskeletal involvement is observed in 40-90% of patients with SSc. During the disease, any structure of the musculoskeletal system, such as bones, joints, tendon sheaths, tendons, and muscles, may be affected. The most common symptoms include joint pain, arthritis, tendinitis leading to tendon rupture, acro-osteolysis, calcinosis, myalgia, and myositis. Osteo-articular complications and changes in the soft tissues of the hand lead to finger contracture, which causes deterioration of the patients' quality of life and disability. To sum up, a more detailed understanding of the aetiology leading to progressive changes in the musculoskeletal system may contribute to the introduction of new therapeutic options, and thus improve the quality of life and reduce disability in patients with SSc.

Firecracker (Sutli Bomb) explosion in hand and Diwali celebration: A unique case

This case report focuses on the management and treatment of a ten-year-old boy who suffered extensive hand injuries from a live firecracker explosion during Diwali celebrations. The purpose of the report is to highlight the importance of caution when handling fireworks and to present the approach taken in managing the patient's injuries.The patient underwent a comprehensive assessment, and a treatment plan was formulated. The plan included exploration and debridement, conservative management, thumb and index finger fixation, posterior interosseous flap surgery, and wrist stabilization with JESS. Additionally, a contracture release procedure was performed to address finger contracture. The patient received physical rehabilitation for hand functionality restoration.The case report emphasizes the significance of handling fireworks with care and the need for immediate medical attention in the event of injuries. The successful outcome achieved through the implemented treatment plan underscores the importance of prompt and appropriate management in fireworks-related accidents.

A novel collagenase from Vibrio Alginolyticus: experimental study for Dupuytren's disease.

Dupuytren contracture (DC) is a highly prevalent hand affection in which contracted fingers compromise hand function. It is a benign fibroproliferative condition affecting the hand palmar fascia with a deposition of excess matrix proteins in the extracellular space of the palmar aponeurosis. In particular type III over type I collagen V. Alginolyticus collagenase (CVA), is a new enzyme that is fully active on the collagen filaments and inactive on other components of the dermal extracellular matrix. The aim of this study is to evaluate the safety and effectiveness of an intra-lesional injection of CVA on an animal model of subcutaneous fibrosis mimicking the pathological anatomy of the cord of Dupuytren's disease. We performed an in vivo study on 27 rats that were randomized into four groups, and we evaluated macroscopic and microscopic analysis examining the inflamed cell population and the extracellular matrix. In all cases, no skin necrosis, skin tears or wound dehiscence were recorded, demonstrating the safety of the CVA in contrast to group D which had full-thickness skin necrosis, and this is confirmed by the microscopic analysis of the samples treated with CVA, where no hematomas are found around the fibrotic area with the absence of leukocyte infiltrates and macrophages. CVA is confirmed to be selective for collagens I and III, reducing the risk of vascular lesions or skin ulcerations.

Upper-Extremity Impairments in Type 1 Diabetes: Results From a Controlled Nationwide Study.

This study aimed to identify current and lifetime prevalence of upper-extremity impairments (UEIs) among individuals with type 1 diabetes and explore factors associated with UEIs. In a Danish cross-sectional nationwide case-control study, data on UEIs and health behavior were paired with data on sociodemographics and clinical factors from national registers. Participants included individuals with type 1 diabetes (n = 2,245) and a control group (n = 841). Differences between groups were assessed using binomial proportions and multivariable logistic regression. Compared with controls, individuals with type 1 diabetes were significantly (P < 0.05) more likely to experience frozen shoulder (odds ratio [OR] 3.5), carpal tunnel syndrome (OR 3.5), trigger finger (OR 5.0), and Dupuytren contracture (OR 4.3). They were also more likely to have several coexisting impairments than the control group (P < 0.01). Diabetes duration was associated with all four impairments. UEIs are common, particularly among individuals with type 1 diabetes.

Forensic medical characteristics of bone fractures of the hand

BACKGROUND: The forensic medical aspects of closed bone fractures of the hands are important in connection with the need to establish the nature, mechanism of occurrence, severity, and duration of these injuries.&#x0D; AIM: This study aimed to assess the severity of closed bone fractures of the hands based on the features of the formation, course, and outcomes.&#x0D; MATERIAL AND METHODS: Fractures of wrist bones (n = 24) and metacarpal bones (n = 218) were examined in persons struck by blunt objects.&#x0D; RESULTS: Scaphoid bone fractures (81.8%) most often occurred on the side of the carpals, and fractures of other carpal bones are detected relatively less frequently (18.2%). With closed fractures of the navicular bone, especially in cases of late seeking medical help, complications such as a false joint and aseptic necrosis can be observed, causing pronounced radiocarpal joint dysfunction. In the metacarpal bones, periarticular fractures of the proximal epiphysis (49.1%) are often noted, followed by intra-articular fractures (26.6%) and periarticular diaphyseal fractures (20.6%). Complications such as finger contractures in chronic metacarpal bone fractures were most observed in intra-articular, comminuted with mixed, and transverse fractures.&#x0D; CONCLUSION: Isolated uncomplicated closed fractures of wrist bones have moderate severity. Moreover, scaphoid bone fractures, complicated by a false joint and aseptic necrosis, causing severe wrist joint dysfunction, and ultimately joint immobility in a functionally disadvantageous position, according to the criterion of total disability, qualify as severe injury. The severity of the harm caused to the health of complicated and uncomplicated isolated metacarpal fractures can be classified as moderate.

Preliminary Results of Lidar Technology in Hand Surgery

Introduction: LiDAR is a method for measuring the distance by illuminating the target with laser light and measuring the reflection with a sensor. Differences in laser return times and wavelengths can then be used to make digital 3D representations of the target. The authors used LIDAR technology to scan patient´s hands before surgery to determine baseline values for the range of motion of small hand joints. Materials and Methods: The study involved 10 patients (8 men and 2 women) between the ages of 51-81 years with a median age of 63 years. None of the patients had a thumb or index finger contracture. The most often contracted was IV. finger - in 7 cases, V. finger in 6 cases and III. finger in 1 case. The evaluation was performed with the assistance of experienced physiotherapists, who measured the extent of contracture of individual fingers using a goniometer (accuracy calibrated at 5 °) before surgery. Results: Evaluation was finished on 8 fingers (7 patients) out of a total of 14 fingers (10 patients). The differences between the results using the goniometer and the LiDAR technology are as follows. Difference in MCP: 2°-24° with median of 9°, difference in PIP: 4°-23 ° with median of 6.5°. Different values in the results might be due to inexperience in taking LiDAR scans or incorrect evaluation of the angles on the individual joints of the fingers. Conclusion: A pilot study confirmed the applicability of LiDAR technology for measuring trigonometric functions of small hand joints. In our opinion the biggest disadvantage of LiDAR technology is time delay in obtaining results compared to goniometer measurements. The biggest advantage is the accuracy of measurement to individual degrees. If the evaluation software can be implemented in a scanning application, this will lead to significant increase in speed of results acquisitions.

Mathematical analysis in the design of digital artery-based V–Y advancement flap in treating proximal interphalangeal joint flexion contracture

BackgroundThe digital artery-based V–Y advancement flap is a widely used flap for soft tissue coverage in the treatment of flexion contracture of the proximal interphalangeal (PIP) joint. A standard method for the flap design and a mathematical method to predict the advance distance have not been well established. In this study, we proposed a simplified method for the design of V–Y advancement flaps based on digital arteries and used a geometric model to predict the advance distance for the flexion contracture correction surgery.MethodsAccording to the general concept of hand flap design and law of cosine, we proposed three principles in the design of the digital artery-based V–Y advancement flap that should be followed. Since 2021 to 2022, finger geometric data of 120 fingers (index, middle, ring, and small fingers) from 30 healthy participants were collected and analysed to evaluate the necessary advance distance and flap tip angle for PIP flexion contracture correction of different fingers by our flap design method.ResultsThe middle finger needed a significantly longer advance distance compared to other fingers in the same degree flexion contracture correction. The ring finger had the largest length-to width ratio and smallest flap tip angle among the four fingers in the V–Y flap design. No vertical scar crossed the flexion creases and flap tip angle < 20° was found in the tentative V–Y flap design for the 120 fingers.ConclusionsOur flap design method provides a proper advance distance and flap length-to-width ratio without common skin complications in the flap design for PIP flexion contracture of index, middle, ring and small fingers. This geometric model provides a mathematical basis for prediction of advance distance and flap tip angle in the design of a digital artery-based V–Y advancement flap.

Outcomes of Surgical Treatment for Burn Contracture on the Hand: A Retrospective Study

Objectives: Burn-related contractures in joint regions with a high range of motion in the upper extremities can cause serious functional limitations. This retrospective case-control study aimed to evaluate the outcomes of surgical treatment for burn contracture on the hand. Methods: The study included 20 patients who underwent surgery and had at least 6 months of postoperative follow-up. We analyzed postoperative complications that occurred during the follow-up period and other variables, such as age, gender, follow-up time, the time between the burn injury and surgery, patients' satisfaction from surgery with a scoring system, as well as the affected hand of the patients. We defined the hand deformities of the patients due to contractures and evaluated the surgical methods performed for these deformities. Results: There were 7 females, and 13 males with a mean age of 17 years (SD: 11,98) in our study. The mean age at which the patients were injured due to burns was 13 years (SD: 12,14), and the mean time from injury to surgical treatment was 3.7 years (SD: 2,18). The mean follow-up period was 19.2 months (SD: 12,50). The patients reported a high level of satisfaction, with a mean satisfaction score of 8.7 out of 10 (SD: 1,69). Temporary K-wire fixation was used in two patients, and no complications related to K-wires were observed. Postoperative complications included limited flexion in the fifth finger, recurrence of the second finger contracture, mild recurrence of the fifth finger PIP joint contracture, and scar pain in the second web space. Two patients also experienced partial z-plasty flap necrosis which healed secondarily. Conclusion: Our data suggest that surgical treatment for burn contracture on the hand can provide functional mobility and improve the quality of life with a high level of satisfaction for patients.