Method for treating finger extensor's tendinous lesion in area of fixation to nail phalanx

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: in case of the suggested method of treating one should isolate extensor's tendon damaged in area of nail phalanx to suture it with a certain suture, the ends of ligature should be directed through oblique canal in nail phalanx to withdraw through the skin and fix them on S-likely curved free end of a needle that fixes the nail phalanx. In case of the present method of therapy it is possible to exclude the pressure upon soft tissues of volar surface of nail phalanx to prevent the development of scar-resulting bedsore and disorder of palpable sensitivity of patient's finger.

EFFECT: higher efficiency of therapy.

1 cl, 2 dwg

 

The invention relates to medicine, namely to traumatology, orthopedics, and can be used in the treatment of injuries to the tendons of the extensors of fingers in the area of attachment to the nail phalanx.

Known methods of surgical treatment of damaged tendons of the extensor tendon in the area of attachment to the nail phalanx with the use of various types of submersible joints (1). The disadvantage of these joints is not uncommon exclusion of threads with the formation of the ligature fistula and rough appearance of the scar, often with severe pain.

There is a method of surgical repair damaged extensor in the area of attachment to the nail phalanx, taken as a prototype. This method includes transosseous suture fixation of the ends of the threads of the gauze on the “ball” on the Palmar surface of the nail phalanx when transarticular fixing her needle in position of the extension for three weeks (2). The disadvantage of this method is the formation of decubitus under the “ball” in the future - the rough skin of the scar, leading to significant disruption of tactile sensitivity (tactile, thermal, painful, sensations degree pressure) finger.

The invention consists in the combination of distinctive features is sufficient to achieve the desired technical result, namely about elastica violations tactile sensitivity Palmar surface of the nail phalanx. This entity is that the fixation of the ends of the yarn withdrawn through the skin, performed on the S-shaped curved free end of the spokes, locking nail phalanx. There is no pressure on the soft tissue of the Palmar surface of the nail phalanx, thereby preventing the formation of decubitus with the outcome in the rumen and a violation of the tactile sensitivity of a finger.

The method is as follows.

From the rear arcuate section, at the level of the distal interphalangeal joint allocate the proximal end of the damaged tendon (extensor, sewed it seam of Bendele the monofilament output end of the tendon. Nail phalanx of the lock pin transarticular in the position of extension and some hyperextension. In the nail phalanx transoxania awl make a channel in an oblique direction, starting proximally from the back and passing the distal to the Palmar surface of the phalanx. Through the channel hold the ends of the threads securing the tendon, Palmar surface of the phalanx (figure 1). The free end of the spokes, locking nail phalanx, bent S-shaped. The traction in the threads of the tendon to tighten the attachment. The ends of the thread link, fixing them to the distal S-shaped curved free end of the spokes (figure 2). The seams on the skin. Aseptic bandage. Plaster of Paris splint is placed. Skin the sutures are removed after 2 weeks tendon suture and Paris splint is placed will be removed after 3 weeks, but spoke through 4 weeks. Then hold and rehabilitation therapy.

Clinical example

Patient N., 32, IB No. 3357. He admitted with a diagnosis of post-traumatic stump both hands at the level of the metacarpophalangeal joint, at the level of the main phalanx 1 finger of the left hand. Chronic damage to the tendon of the long extensor of 1 finger at the level of the interphalangeal joint flexion contracture of interphalangeal joint of right hand.

Before surgery, to correct flexion contractures imposed distraction apparatus 1 finger. After elimination of contractures, three weeks after the device is removed.

Operation: from the rear arcuate incision at the level of the distal interphalangeal joint is allocated to the proximal end of the damaged tendon of the long extensor, sewn seam Bendele the monofilament output end of the tendon. Nail phalanx fixed pin transarticular in the position of extension and some hyperextension. In the nail phalanx transoxania awl done the channel in an oblique direction, starting proximally from the back and passing the distal to the Palmar surface of the phalanx. Through the channel held the ends of the threads securing the tendon, Palmar surface of the phalanx. The free end of the spokes, locking nail phalanx, S-figuratively. The traction in the threads of the tendon fit to the attachment. The ends of the filament are connected and fixed to the distal, S-shaped curved, the free end of the spokes. The seams on the skin. Aseptic bandage. Plaster of Paris splint is placed. The wound healed by first intention. Seams with skin removed on day 15, tendon suture and Paris splint is placed removed on the 22nd day after the operation. The needle is removed in the period of 4 weeks. A course of rehabilitation therapy. Scar has formed. The function of the nail phalanx restored.

Sources of information

1. Kites V.F., Moskvin A.D., Magdiel D.A. Treatment of closed injuries of the tendon-aponeurotic tension fingers at the level of the distal interphalangeal joint. Orthopedics, traumatology and prosthetics 1988, No. 8, p.12-14.

2. 'tseva E.V., Mascara SURDS Surgery of diseases and injuries of the hand. L., “Medicine”, 1975, 312 S.

A method of treating damage to the extensor tendon of the finger brush in the area of attachment to the nail phalanx by separating the proximal end of the tendon, transarticular fixation nail phalanxes in the position of extension, flash tendon suture Biennale with transosseous holding the ends of the threads and their fixation, characterized in that the fixation of the ends of the thread are placed on the skin, performed on the S-shaped curved free end of the spokes, the locking nail of Falun the U.



 

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