RU2753124C2 - Method for surgical treatment of flexor contracture of wrist joint in patients with cerebral palsy - Google Patents

Abstract

FIELD: medicine; traumatology; orthopedics.

SUBSTANCE: invention relates to the field of medicine, namely to traumatology and orthopedics, it can be used for the surgical treatment of flexor contracture of the wrist joint in patients with cerebral palsy. The wrist joint is fixed in a functionally beneficial position with a plate with angular stability and a hinge mechanism. The plate is applied to the wrist joint from the elbow side and fixed with screws to the ulnar, hook-shaped and fifth metacarpal bone.

EFFECT: method provides an anatomically and functionally correct position of the hand, completely correcting the palmar flexion of the hand and preserving the possibility of back flexion by fixing the wrist joint with a plate with angular stability and a hinge mechanism, which is made in such a way that it assumes extensor movements in the wrist joint from the neutral position of the hand and completely eliminates its flexion movements.

1 cl, 1 dwg

Description

The invention relates to medicine, namely to orthopedics.

A known method of correcting severe flexion contractures of the wrist joint using arthrodesis of the wrist joint (Van Heest A.E., Strothman D. Wrist arthrodesis in cerebralpalsy. J Hand Surg Am 34: 1216-1224), in which, after removing the cartilage from the surfaces of the bones forming the joint it is fixed using various metal structures installed on the dorsum or palmar surfaces of the forearm and hand.

The main disadvantage of this method is the irreversible loss of the wrist joint due to its arthrodesis.

The closest analogue is the method of arthrodesis of the wrist joint, in which the wrist joint is fixed with a metal plate (ChM catalog 2018, p. 84). It is installed on the back of the hand and forearm and is secured with screws. The first disadvantage of this method is the trauma of the extensor tendons of the fingers when the plate is installed, which can limit the function of the fingers. In addition, distally the plate is attached with screws only to the meta-shaft of the third metacarpal bone and the lunate bone of the wrist, which can cause instability of fixation and lead to the development of pain syndrome. The second disadvantage of atrodesis treatment is that closure of the wrist joint in the middle position not only corrects unwanted palmar flexion of the hand, but also leads to the impossibility, useful for the patient, of dorsal flexion of the hand.

The objective of the present invention is to develop a method for the surgical treatment of flexion contracture of the wrist joint, providing anatomically and functionally correct position of the hand, completely correcting palmar flexion of the hand and retaining the possibility of dorsal flexion.

The technical result of the task is achieved by the fact that the method of surgical treatment of flexion contracture of the wrist joint in patients with infantile cerebral palsy consists in fixing the wrist joint in a functionally advantageous position with a plate with angular stability and a hinge mechanism applied to the ulnar, hook-shaped and 5 metacarpal surfaces along the ulna fixed to them with screws. 1 shows a diagram of the bony structure of the forearm and hand in the anteroposterior projection with the locations of the fixation plate with angular stability and a hinge mechanism, where:

Pos. 1 - ulna;

Pos. 2 - radius bone;

Pos. 3 - bones of the wrist;

Pos. 4 - metacarpal bones;

Pos. 5 - metal plate;

Pos. 6 - places of passage of screws fixing the plate and brush; Pos. 7 - hinge mechanism.

The method of surgical treatment of flexion contracture of the wrist joint in patients with infantile cerebral palsy is as follows

A linear incision of the skin and subcutaneous tissue is performed along the ulnar surface in the region of the lower third of the forearm and hand. The lateral surfaces of the ulnar, hook-shaped, and also the proximal part of the 5th metacarpal bone are exposed (Fig. 1), positions 1, 3 and 4. The forearm and hand are given a functionally advantageous position (middle rotational position of the forearm with a neutral position of the hand in the wrist joint), in which a plate with angular stability and a hinge mechanism is applied to the ulna, hook-shaped and 5 metacarpal bones (Fig. 1, position 5), which is fixed to them with screws (Fig. 1), position 6. The hinge mechanism is made in such a way that it involves extension movements in wrist joint from the neutral position of the hand and completely excludes its flexion movements. In this case, the screws are passed through the ulna and radius of the forearm, as well as in the plane of the palm through the three bones of the wrist (hook-shaped, capitate and polygonal) and the proximal meta-diaphyseal zones 5, 4 and 3 of the metacarpal bones.

The positive effect of the proposed invention lies in the preservation of the wrist joint, in the limitation of the palmar flexion of the hand while maintaining its dorsal flexion. Correction of the vicious flexion position of the hand can significantly increase the functionality of the hand and the patient's ability to self-care. An important feature of the proposed surgical treatment is the reversibility of the operation, in contrast to intra-articular arthrodesis of the wrist joint.

Claims (1)

A method of surgical treatment of flexion contracture of the wrist joint in patients with infantile cerebral palsy, which consists in the fact that the wrist joint is fixed in a functionally advantageous position with the possibility of extension movements in the wrist joint from the neutral position of the hand, excluding its flexion movements due to the hinge mechanism of the plate with angular stability , which is placed on the ulnar, hook-shaped and fifth metacarpal bones along the ulnar surface and fixed to them with screws.

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