Preliminary results of surgical treatment of flexion-adduction contracture of the first ray of the hand in combination with dislocation in the metacarpophalangeal joint in patients with infantile cerebral palsy

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Abstract

Background. Surgical methods of treating flexion–adduction contracture of the first ray of the hand in combination with dislocation in the metacarpophalangeal joint in patients with infantile cerebral palsy are divided into surgical interventions on soft tissues and bone surgeries aimed at stabilizing the metacarpophalangeal joint. We have developed a technique of temporary arthrodesis of the metacarpophalangeal joint in combination with the previously used operation to widen the first intercarpal space, combining the positive effects of both groups of operations: stability of arthrodesis with an installed metal structure that enable active movements in the joint in sufficient amplitude after its removal and early postoperative rehabilitation with a stabilized joint.

Aim. This study aimed to evaluate the effectiveness of a new method of surgical correction of flexion–adduction contracture of the first ray of the hand in combination with metacarpophalangeal joint dislocation in the form of temporary arthrodesis of this joint and widening of the intermetacarpal space in patients with cerebral palsy.

Materials and methods. The study analyzed treatment outcomes of patients (n = 11) who underwent temporary arthrodesis of the metacarpophalangeal joint with an extra-bone plate for a period of 1 year and expansion of the first intermetacarpal space. Comparative analysis of the results was carried out 6 months after the operation, 1 year after the operation, and after hardware removal. The amplitude of passive and active movements in the metacarpophalangeal joint was analyzed. The functionality of the upper limb was assessed according to the international classification system MACS 2002 and the “block and box test.”

Results. At 1 year after surgery and removal of the fixation structure, the amplitude of both passive abduction (32.0°) and extension (9.5°) in the metacarpophalangeal joint increased, and the amplitude of the same movements (leads) increased by 25.5° in abduction and by 4.0° in extension when performed actively. The MACS indicator improved by 1 point. The average dynamics of the “block and box test” was seven additional cubes.

Conclusion. The proposed technique for temporary extra-articular arthrodesis of the metacarpophalangeal joint does not affect the intra-articular structures, unlike intra-articular arthrodesis, and therefore has clear advantages over the latter. This surgical treatment method is effective in increasing the amplitude of active and passive movements of the first ray of the hand and reduces muscle imbalance, which ultimately improves the function of the upper limb as a whole.

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About the authors

Dmitry V. Umnov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: dmitry.umnov@gmail.com
ORCID iD: 0000-0003-4293-1607

MD, PhD, Research Associate of the Department of Infantile Cerebral Palsy

Russian Federation, Saint Petersburg

Valery V. Umnov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: umnovvv@gmail.com
ORCID iD: 0000-0002-5721-8575

MD, PhD, D.Sc., leading researcher of the Department of Infantile Cerebral Palsy

Russian Federation, Saint Petersburg

Vladimir A. Novikov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: novikov.turner@gmail.com
ORCID iD: 0000-0002-3754-4090

MD, PhD, Research Associate of the Department of Infantile Cerebral Palsy

Russian Federation, Saint Petersburg

Margarita V. Savina

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: drevma@yandex.ru
ORCID iD: 0000-0001-8225-3885

PhD, Head of the Laboratory of Physiological and Biomechanical Research

Russian Federation, Saint Petersburg

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Supplementary files

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1. Fig. 1. Palmar radiograph of the hand showing dislocation of the first metacarpophalangeal joint

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2. Fig. 2. Surgical stages of deepening of the first intercarpal space and extra-articular temporary arthrodesis of the metacarpophalangeal joint: a, surgical approach with the formation of two triangular shapes of skin flaps; b, determination of the required volume of excision of the muscles leading the first finger; c, fixation of the extra-bone metal structure of the bones that form the metacarpophalangeal joint; d, intraoperative X-ray of the hand with the first metacarpophalangeal joint, fixed with an extra-bone metal structure

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3. Fig. 3. Dynamics of indicators according to the Manual Ability Classification System for Children with Cerebral Palsy before surgical treatment, 6 months after surgical treatment, and 1 year after surgical treatment. * p < 0.001, ** р = 0.025

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4. Fig. 4. Dynamics of indicators according to the Block and Box test before surgical treatment, 6 months after surgical treatment, and 1 year after surgical treatment. * р = 0,005, ** р = 0,004

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Copyright (c) 2021 Umnov D.V., Umnov V.V., Novikov V.A., Savina M.V.

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