The Use of External Skeletal Fixation to Facilitate the Surgical Release of Wrist Flexion and Thumb Web Space Contractures

Acartürk, Tahsin Oğuz; Ashok, Krishnamurthy; Lee, W.P. Andrew

doi:10.1016/j.jhsa.2006.07.021

Cited by 10 publications

(5 citation statements)

References 9 publications

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“…However, in the absence of active control and with fixed flexion contracture, stabilizing the wrist through arthrodesis allows appropriate tensioning of the digits. Our results show promising outcomes of wrist arthrodesis, but further comparative studies are needed to compare similar patient groups undergoing arthrodesis with extensile surgical releases that preserve the wrist joint (Acartürk et al., 2006).…”

Section: Discussionmentioning

confidence: 82%

Wrist arthrodesis and soft tissue rebalancing in the spastic hand

Nixon,

Zreik,

Bakhit

2023

J Hand Surg Eur Vol

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The aim of the present study was to investigate the outcomes of wrist arthrodesis with simultaneous soft tissue rebalancing of the digits in the spastic wrist. In 43 wrists (40 patients) the surgical goals, patient selection, procedures and outcomes were assessed. Preoperatively, mean passive extension was to 44° below neutral and only two patients had volitional control. Postoperatively, 33 and 10 cases reported excellent and good outcomes, respectively. A mean Goal Attainment Score of 62.4 indicated better than expected outcomes. In total, 37 hands required simultaneous finger rebalancing: 24 underwent tendon transfers and 13 surgical releases. A total of 12 thumbs required tendon transfers, three soft tissue releases and five metacarpophalangeal joint stabilization. Ten patients experienced complications, most commonly wound problems and implant failure, predominantly observed in patients with severe wrist and elbow contractures. In conclusion, wrist arthrodesis with simultaneous soft tissue rebalancing of the digits offers a viable approach in patients with severe spasticity. Cautious patient selection and consideration of potential complications are crucial for good outcomes. Level of evidence: IV

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Section: Discussionmentioning

confidence: 82%

Wrist arthrodesis and soft tissue rebalancing in the spastic hand

Nixon,

Zreik,

Bakhit

2023

J Hand Surg Eur Vol

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“…In 1988, Lewis et al described outcomes as “good, satisfactory, or poor.” Although this study has a larger number of subjects, the evaluation was not objective, and all the web space releases were done in syndactyly patients and did not involve the thumb [15]. A smaller study that evaluated the technique of using external fixation for contracture release did look at “thumb abduction” both before and after intervention but did not define “thumb abduction” or how it was measured [1]. Although some studies tried to evaluate functional outcomes of contracture release, they did so to evaluate one technique of contracture release.…”

Section: Discussionmentioning

confidence: 99%

“…These contractures have many etiologies including congenital, traumatic, and post-surgical [14]. They can be treated by several modalities including skin grafts, z-plasties, local–regional flaps, free tissue transfer, intrinsic muscle releases, and trapeziectomy [1,2,19,20]. The aim of these procedures is to increase the overall movement of the thumb and thereby improve hand function.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Successful Outcomes in First Web Space Contracture Release

Masden

Higgins

2010

Hand (New York, N,Y.)

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“…Grafts can be used with external fixators, even in severe contractures. 2 However, when grafting is not possible, flaps are indicated. Local and regional flaps and free tissue transfers can be used depending on the nature of the contraction.…”

Section: Introductionmentioning

confidence: 99%

Managing Severe Postburn Wrist Flexion Contracture by Proximal Row Carpectomy and Abdominal Interpolation Flap

Karatan

Yamak

2022

Plast Surg (Oakv)

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Introduction: Postburn upper extremity contractures can greatly diminish the quality of life. To successfully manage these contractures and achieve successful functional outcomes, an optimal surgical method should be planned to address all affected tissues on the extremities. Conventional soft tissue transfers after releasing the contracture, such as skin grafts or flaps, may be insufficient. In addition to capsulotomy, tendon release, and lengthening procedures, more aggressive modalities may be indicated. Methods: In this retrospective study, patients who developed wrist flexion deformities due to burn injuries and underwent proximal row carpectomy and abdominal interpolation flaps were included. Results: Between January 2019 and June 2020, 5 patients underwent surgery using this technique. All patients were male, 2 had thermal burns, 2 had electrical burns, and 1 had chemical burns. Preoperatively, all patients had severe flexion deformities ranging from 70° to 85°. There were no postoperative complications, and stable wrists with a good and functional alignment were achieved, although the preoperative and postoperative range of motion differences were limited, where a postoperative range of motions were ranging from 5 to 15 in terms of extension, 15 to 20 in terms of flexion. Preoperative QuickDash scores were between 79.5 and 95.5, postoperative scores ranged from 25 to 36.4. Conclusion Proximal row carpectomy shortens the length of the wrist, resurfaces the wrist joint, and provides a release in tendons and other soft tissues. Together with soft tissue transfer, this technique can be used for severe wrist flexion contractures.

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The Use of External Skeletal Fixation to Facilitate the Surgical Release of Wrist Flexion and Thumb Web Space Contractures

Cited by 10 publications

References 9 publications

Wrist arthrodesis and soft tissue rebalancing in the spastic hand

Wrist arthrodesis and soft tissue rebalancing in the spastic hand

Predictors of Successful Outcomes in First Web Space Contracture Release

Managing Severe Postburn Wrist Flexion Contracture by Proximal Row Carpectomy and Abdominal Interpolation Flap

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