Method subcutaneous plastic extensor tendon nail phalanx fingers
Science Articles / / May 10, 2016
Zyablov GI Patrickeyev DV
Among the wide range of problems faced by specialists in the field of hand surgery, tendon damage the device are the most important.Existing at the present stage of their treatment methods do not always lead to the expected result, which is an incentive to search for new and more effective treatments.
One of the urgent is the problem of the variety of damage tendon unit - subcutaneous damage the tendons of the extensor nail phalanxes of fingers.The mechanism of injury - a blow to the socket rectified finger, or a direct blow to the proximal interphalangeal joint.When such damage violated the integrity of the middle portion.
extensor tendon injuries of the nail phalanx fingers are quite common.The number of injuries of the extensor tendons of the fingers and wrist according to initial applications in emergency station, each year up 0.6 - 0.8% of all fresh injuries.In patients hospitalized with grass extensor tendons in all locations, this pathology is necessary from 9 t
Despite the apparent pettiness, extensor tendon damage the nail phalanx fingers bring victims a lot of problems, up to going to the doctor, to remove the "interfering" proximal phalanx.
The experience of surgical treatment of closed injuries of the extensor tendons of nail phalanges patients between 2002 and 2003.When fresh
closed injuries extensor hand held device enclosed in a plastic hypodermic 1 - 5 hours.
On 6 - 7 hours, held open plastic damaged extensor tendon nail phalanx.
Long-term results were followed up in 35 patients, in the period from 1.5 months to 1 year.Despite the fact that the proportion of patients operated on in later periods (over two weeks) after injury, 80% of the positive and satisfactory results were obtained.
Results of surgical treatment of 79 patients with damage to the extensor tendons of the nail phalanx fingers.
Of these women - 55 men - 24.The age group ranged from 26 to 65 years.Injuries in the home got 52 people in the production of 27 victims.
Time from injury to surgery ranged from 1 to 5 days.
late enough recourse to a specialist unit because:
- patient underestimates the seriousness of the damage;
- Errors in the diagnosis of injury tendon extensor nail phalanx fingers prehospital.
in specialized departments to clarify the diagnosis and determine the further tactics of treatment to all victims conducted X-ray examination of the proximal interphalangeal joint.
In most patients, tendon avulsion of the nail phalanx occurred in isolation, in some cases tendon torn off at the base of the nail inert fragment phalanx.All the victims with a separation of tendon with a fragment of stagnant held open plastic tendon with fixing or removing stagnant fragment as postoperative inert fragment acts as a foreign body and joint locks.
absolute indication for subcutaneous plastic tendons and extensor nail phalanx fingers is:
1. Early hospitalization time - up to 5 days;
2. Isolated avulsion of the extensor tendon of the nail phalanx without inert fragment.On the basis of GB number 4 in the department of hand surgery since 1999, used the method of surgical treatment of subcutaneous lesions extensor tendons of nail phalanxes of fingers (We, AB et al. 2000).
Technique operations extensor nail phalanx:
1. The proximal interphalangeal joint was blocked transarticular introduction of spokes in the "writing pen".
2. thin awl at the base of the nail phalanx laterally shaped channel through which carried out the thread and performed reinforcement tendon, both ends of the thread were taken to one side, tied together and dipped under the skin.
The disadvantages of this method are: transarticular needle fixation of the proximal interphalangeal joint, which in some cases have a negative impact on the latter function.Postoperatively, 15% of patients develop arthritis and ligature fistulas.
analyzing lessons learned and studied the long-term results, the technique was improved subcutaneous plastics.
proposed technique of surgical intervention: the nail phalanx fixed in position giperrazgibaniya, minifiksatorom of carpal set Ilizarov.Through apekalnuyu of the intramedullary nail phalanx performed needle to the base of the nail phalanx.The joint is not blocked.At the base of the middle phalanx tranerssalno parallel to each other to hold two needles, the latter was folded and repositioned in a fixed unit, which is carried out through the curved end of the spokes on the nail phalanx giperrazgibaniya in position and secured by a locking screw.Extensor tendon was performed reinforcement thread, the ends of which were taken to the nail plate and the ball on the gauze in a state of tension linked to each other.
patients discharged from hospital to eliminate swelling and relieve pain after 3 - 5 days.
Terms blocking the proximal interphalangeal joint was 5 weeks, suspended removable suture removed after 4 weeks.After removing repositioned in a block and remove the spokes conducted a comprehensive physiotherapy.
distinctive stages of recovery extensor tendons of nail phalanges brushes are as follows:
- The operation is performed subcutaneously;
- mobilize and pulling the tendons to the nail phalanx;
- Ease of implementation and a cosmetic effect;
- Economic attractiveness (short-term patient stays in the hospital);
- High efficiency with minimal complications;
- Absence after the operating period of arthritis and ligature fistulas.
results of treatment in a period of 1.5 months to 1 year were classified as good and satisfactory.
Complications of the proposed method were observed in 8 (6%) patients in the form of:
- an allergic reaction to the metal 1 patient;
- an allergic reaction to the suture material (silk), 2 patients;
- The failure of the tendon suture 2 patients;
- Suppuration in places where the needles and suture in 3 patients (due to the absence in the post operative period after hospital discharge due care).
positive results in 94% of patients demonstrates the effectiveness of the tactics of surgical treatment of closed injuries of the extensor tendon of nail phalanxes of fingers.
Thus, the method of subcutaneous plastic extensor tendon nail phalanx fingers is promising and can be recommended for wide practical application.