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

Background. Surgical methods of treating flexionadduction 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 flexionadduction 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.

Volar perforators of common digital arteries: an anatomical study

The palmar triangle is an area vascularized by perforator arteries arising from the common digital palmar arteries. The aim of this article was to perform an anatomical study of common digital palmar arteries perforators. Twelve injected specimens were included in this study. The purpose was to quantify the number of perforator arteries of each common digital palmar arteries in the 2nd, 3rd, and 4th intermetacarpal space, measure distances between them, between the distal perforator and corresponding commissure, and the distance between the proximal perforator and the superficial palmar arch. Four to eight perforators were arising from common digital palmar arteries of the 2nd, 3rd, and 4th intermetacarpal space. The average distance between perforator arteries was 6.5 mm, between superficial palmar arch and proximal perforator artery – 8.2 mm, between the distal perforator artery and corresponding commissure – 6.3 mm.

IRREDUCIBLE METACARPAL NECK FRACTURE CAUSED BY INTERPOSITION OF JUNCTURA TENDINUM

Most metacarpal neck fractures can be reduced using the close reduction technique. However, if acceptable reduction cannot be achieved by closed reduction, open reduction is indicated. A 37-year-old patient had a third metacarpal neck fracture. We tried to reduce the metacarpal neck fracture by using closed reduction methods, but failed to do so. We performed open exploration and observed that the cause of failure was interposition of the junctura tendinum (JT) connecting the third and fourth extensor digitorum tendons. The JT in the third or fourth intermetacarpal space can interpose between the fragments in cases of third, fourth, or fifth metacarpal neck fractures, because the JT in the third or fourth intermetacarpal space is thick and wide (type 2 or 3). The JT in the third or fourth intermetacarpal space should be considered as a potential obstacle to the reduction in cases of irreducible metacarpal neck fractures.