RU2593743C1 - Method for eliminating flexion contracture of wrist joint in patients with infantile cerebral paralysis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: there is applied a circular plaster bandage from distal phalanxes of fingers to the elbow joint in the position of full extension of fingers and maximum possible extension in the wrist joint. In the circular plaster bandage there is made a cross cut in a projection of carpal fold along the palm surface. Then two distraction elements are plastered along the palm surface of the plaster bandage. There is performed a dosed daily correction of flexion contracture in the wrist joint and, if necessary, ulnar deviation of the hand.

EFFECT: method improves clinical effectiveness due to reduced risk of neurological complications.

1 cl, 4 dwg

Description

The invention relates to medicine, namely to orthopedics.

A known method of conservative treatment of flexion contracture of the wrist in patients with cerebral palsy. The method consists in the gradual correction of the vicious position of the hand with the help of stage gypsum (Kutuzov A.P., 1981; Umkhanov H.A., 1985). The gypsum dressing is applied in the position of full forced extension of the fingers and the maximum possible extension in the wrist joint. After 3-5 days, the plaster cast is removed and a new one is applied with a large extension in the wrist joint. Each time a subsequent plaster cast is applied, a metered force is applied to achieve a possible correction. The number of acts of changing gypsum dressings varies depending on the severity of contracture and its rigidity.

The considered method of conservative treatment of flexion contracture of the wrist joint in patients with cerebral palsy allows to achieve the maximum possible elimination of flexion contracture in the wrist joint, however, it has several disadvantages:

- as a result of changing the plaster cast, the loss of the previous correction of contracture may occur and, therefore, the subsequent plaster cast may not have a corrective effect or have it to a very small extent.

- the complexity of dosing correction. Due to the fact that each time you have to apply the plaster cast again, it is difficult to evenly set the degree of correction and there is a risk of neurological complications (traction neuropathy) as a result of too much correction.

- the correction process is complicated in the case of significant ulnar deviation of the hand, when it cannot be eliminated at once, when applying a bandage. Carrying out simultaneous corrections in two planes is technically difficult.

- the process of performing corrections can be lengthy (up to 1.5 months), so long immobilization of the joints of the limb can lead to pain and difficulties in the subsequent period of rehabilitation. It is impossible to remove the plaster cast at the stage of corrections for the development of joint movements of the upper limb.

The objective of the invention is to increase the effectiveness of treatment by reducing the duration of treatment and reducing the risks of neurological complications.

The technical result of the task is achieved by the fact that in the method of eliminating flexion contracture of the wrist joint in children with cerebral palsy, including: applying a circular gypsum dressing from the distal phalanges of the fingers to the elbow joint in the position of full extension of the fingers and the maximum possible extension in the wrist joint and, if necessary, correction ulnar deviation of the hand, it is proposed in a circular plaster cast to make a transverse cut (Pos. 2) in the projection of the carpal fold on the palmar over Then, at a distance of 1 cm from the cut, gypsum two distraction elements, made in the form of two columns (Pos. 3) and a rod (Pos. 4), fixed with nuts (Pos. 5), with the possibility of dosed and daily correction of flexion contracture in wrist joint and ulnar deviation of the hand.

Fig. 1 is a diagram of a method for eliminating flexion contracture of the wrist in children with cerebral palsy, where:

Pos. 1 - gypsum circular dressing;

Pos. 2 - transverse cut of a plaster cast in the projection of the carpal folds on the palmar surface;

Pos. 3 - racks with holes for the threaded rod of the distraction element;

Pos. 4 - threaded rod of the distraction element;

Pos. 5 - nuts

Photo 2 - the maximum possible active extension in the wrist joint with full extension of the fingers to eliminate contracture.

Photo 3 - view of the applied circular gypsum dressing for daily dosed correction of contracture in the wrist joint in the position of the maximum possible extension.

Photo 4 - the state of the upper limb after elimination of flexion contracture.

A method for eliminating flexion contracture of the wrist joint in patients with cerebral palsy is as follows.

In order to protect the skin from mechanical damage, elements of a plaster cast on the upper limb wound a layer of thin rolled cotton wool. Gypsum dressing is applied using a plaster technician and is performed in two stages.

The first stage is fixing the fingers in a full extension position. After waiting for the fingers to stabilize in the upright position, you can proceed to the second stage. The second stage is the extension of the plaster cast to the upper third of the forearm, while the doctor corrects the ulnar deviation of the hand and flexion in the wrist joint. Applying a plaster cast in two stages allows you to simplify the process of correcting the vicious position of the hand and achieve a greater degree of correction.

After the plaster cast has hardened, the plaster saw cross-cuts the plaster in the projection of the wrist joint (Pos. 2). Using narrow plaster bandages, two pairs of distraction elements are fixed to the plaster bandage along the radial and ulnar sides of the palmar surface of the wrist joint (Fig. 2).

With the help of rods (Pos. 4) drawn through racks with openings (Pos. 3), a gradual daily correction of the flexion contracture of the wrist joint is performed. In the case where there is a need to eliminate residual ulnar deviation of the hand, the distraction along the rods is asymmetric to the full center of the hand.

The positive effect of the claimed invention consists in the ability not only to eliminate the fixed flexion contracture of the wrist joint, but also to eliminate all the disadvantages of the previous method. This technique does not involve changing the plaster cast until a complete correction is achieved. In addition, due to asymmetric distraction, it is possible to simultaneously correct the ulnar deviation of the wrist while eliminating the flexion contracture of the wrist joint. Among the positive aspects of this modification, it is worth noting that the corrections using the distraction elements of the Illizarov apparatus are reversible. In the event of persistent pain or traction neuropathy in response to correction, a reverse correction is possible.

As a result of using the improved technique, complete elimination of the flexion contracture of the wrist joint is achieved, while the main disadvantages of the gypsum staged corrections are completely eliminated.

Claims (1)

A method for eliminating flexion contracture of the wrist joint in children with cerebral palsy, including the application of a circular gypsum dressing from the distal phalanges of the fingers to the elbow joint in the position of full extension of the fingers and the maximum possible extension in the wrist joint, characterized in that a transverse cut is made in the projection in a circular gypsum dressing carpal folds on the palmar surface, then on the palmar surface of the circular gypsum dressing two distraction elements are gypsum plated, dosed and daily correction of flexion contracture in the wrist joint and ulnar deviation of the hand; if necessary, eliminate residual ulnar deviation of the hand by distraction along the rods of the distraction elements asymmetrically to the full center of the brush.

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