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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
- Authors: Umnov D.V.1, Umnov V.V.1, Novikov V.A.1, Savina M.V.1
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Affiliations:
- H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
- Issue: Vol 8, No 4 (2020)
- Pages: 417-426
- Section: Original Study Article
- URL: https://journals.eco-vector.com/turner/article/view/43115
- DOI: https://doi.org/10.17816/PTORS43115
- ID: 43115
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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 PetersburgValery 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 PetersburgVladimir 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 PetersburgMargarita 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 PetersburgReferences
- Бадалян Л.О. Детская неврология. – М.: Медпресс-информ, 2001. [Badalyan LO. Detskaya nevrologiya. Moscow: Medpress-inform; 2001. (In Russ.)]
- House JH, Gwathmey F, Fidler M. A dynamic approach to the thumb-in-palm deformity in cerebral palsy. J Bone Joint Surg Am. 1981;63(2):216-225.
- Miller F. Cerebral palsy. New York: Springer; 2005.
- Новиков В.А., Умнов В.В. Хирургическое лечение сгибательно-приводящей контрактуры первого пальца кисти у детей с детским церебральным параличом // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2015. – Т. 3. – № 2. – С. 25–31. [Novikov VA, Umnov VV. Surgical treatment of thumb adduction contracture in children with infantile cerebral palsy. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2015;3(2):25-31. (In Russ.)]. https://doi.org/10.17816/PTORS3225-31.
- Özkan T, Tunçer S. Tendon transfers for the upper extremity in cerebral palsy. Acta Orthop Traumatol Turc. 2009;43(2):135-148. https://doi.org/10.3944/AOTT.2009.135.
- Tranchida GV, Van Heest AE. Outcomes after surgical treatment of spastic upper extremity conditions. Hand Clin. 2018;34(4):583-591. https://doi.org/10.1016/j.hcl. 2018.06.014.
- Lawson RD, Tonkin MA. Surgical management of the thumb in cerebral palsy. Hand Clin. 2003;19(4):667-677. https://doi.org/10.1016/s0749-0712(03)00042-8.
- Tonkin M, Freitas A, Koman A, et al. The surgical management of thumb deformity in cerebral palsy. J Hand Surg Eur Vol. 2008;33(1):77-80. https://doi.org/10.1177/1753193407087891.
- Smeulders M, Coester A, Kreulen M. Surgical treatment for the thumb‐in‐palm deformity in patients with cerebral palsy. Cochrane Database Syst Rev. 2005;19(4):CD004093. https://doi.org/10.1002/14651858.CD004093.pub2.
- Goldner JL, Koman LA, Gelberman R, et al. Arthrodesis of the metacarpophalangeal joint of the thumb in children and adults: Adjunctive treatment of thumb-in-palm deformity in cerebral palsy. Clin Orthop Relat Res. 1990;(253):75-89.
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