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II. ХИРУРГИЯ
W 6i6.7i7.9:6i7-089.844 TREATMENT OF DISTAL FINGER INJURIES LEADING TO "MALLET FINGER"
ABOUT THE АUTHORS
Muradov Misil Islamovich - Head of the Department of Reconstructive-Plastic Microsurgery.
Muhammedkerim Kanat Basarbekov-
ich - a microsurgeon of the department of reconstructive-plastic microsurgery.
Baiguzeva Aliya Askarbekovna - a
microsurgeon of the department of reconstructive-plastic microsurgery. St. Zheltokkan 62, Almaty, 05004, Kazakhstan e-mail: [email protected]
Keywords
trauma, hand, extender tendons, hammer deformation, treatment
Muradov M.I.1, Muhamedkerim K.B.1, Baiguzeva A.A.1, Koshkarbayev D.Zh.1, Kazantayev K.E.2, Kalan B.K.1
National Scientific Center of Surgery named after A.N. Syzganov
2National Olympic Committee of the Republic of Kazakhstan, Almaty, Kazakhstan
Abstract
Today, damage to the hand and fingers is the predominant number of injuries of the musculoskeletal system, which is due to the acceleration of the pace of life. Damage of the type "mallet finger" ("hammer finger") is often 1.5-3% among all injuries of the brush.
The urgency of this problem is due not only to the increase in the frequency of injuries among the working-age population, but also to the severity of their consequences for the person and society.
ABTOPMP TyPAflbl
Muradov Misil Islamovich - Head of the Department of Reconstructive-Plastic Microsurgery.
Muhammedkerim Kanat Basarbekov-
ich - a microsurgeon of the department of reconstructive-plastic microsurgery.
Baiguzeva Aliya Askarbekovna - a
microsurgeon of the department of reconstructive-plastic microsurgery. St. Zheltokkan 62, Almaty, 05004, Kazakhstan e-mail: [email protected]
Туйш cвздep
жapaкaт, Kon, жaзFыш cinip, 6anta тэpiздвc двфopмaция, емдеу шарасы
Кол саусактарыныц дисталды белтнщ «MALLET FINGER» жаракатына алып келетш патологиясын емдеу шарасы
Мурадов М.И.1, Мухамедкерим К-Б.1, Байгузева А.А.1, Кошкарбаев Д.Ж.1, Казантаев К-Е.2, Калан Б-К-1
1А.Н. Сызганов атында?ы Улттык, ?ылыми хирургия орталы^ы,
2Казахстан Республикасынык Улттык Олимпиада комитету Алматы, Казакстан
Ацдатпа
БYгiнгi KYHi колдын жэне саусактардын закымдануы щек-кимыл аппаратыныц закымдануы шндеп басым бвлг болып табылады, бул eMip CYpy каркыныныцжогарлауына байланысты. «MALLETFINGER» TypiHiy закымдануы («бал€а тэрiздес деформация») колдын барлык жаракрттарыныц арасында квбнесе 1,5-3% -те кездеседi. Бул проблеманыц e3eiawiri ецбекке кабтет тур€ындар арасында жаракат алу жшлшщ артуымен €ана емес, соны-мен катар олардыц адамдар мен когам Yшiн салдарыныц взект^пмен де байланысты.
ОБ АВТОРАХ
Muradov Misil Islamovich - Head of the Department of Reconstructive-Plastic Microsurgery.
Muhammedkerim Kanat Basarbekov-
ich - a microsurgeon of the department of reconstructive-plastic microsurgery.
Baiguzeva Aliya Askarbekovna - a
microsurgeon of the department of reconstructive-plastic microsurgery. St. Zheltokkan 62, Almaty, 05004, Kazakhstan e-mail: [email protected]
Ключевые слова
травма, кисть, сухожилия разгибателей, молоткообразная деформация, лечение
Лечение повреждений дистальных отделов пальцев кисти, приводящих к «MALLET FINGER»
Мурадов М.И.1, Мухамедкерим К.Б.1, Байгузева А.А.1, Кошкарбаев Д.Ж.1, Казантаев К.Е.2, Калан Б.К.1
Национальный научный центр хирургии им. А.Н. Сызганова, Национальный Олимпийский комитет Республики Казахстан, Алматы, Казахстан
Аннотация
На сегодняшний день, повреждения кисти и пальцев составляет преобладающее количество среди травм опорно-двигательного аппарата, что обусловлено ускорением темпа жизни. Повреждение типа «mallet finger» («молоткообразный палец») встречается нередко 1,5-3 % среди всех травм кисти. Актуальность этой проблемы обусловлена не только ростом частоты повреждений среди трудоспособного населения, но и тяжестью их последствий для человека и общества.
Introduction
Damage to the tendons of the finger extenders of the "mallet finger" ("hammer finger") is often 1.53% among all injuries to the upper limb. [1,2,3]
These, small, at first glance, percentages indicate a huge number of patients, as the brush is the most frequently injured part of the human body, accounting for 30.8% of all musculoskeletal injuries, which suggests that this damage is one of the frequent injuries. [4,5,6]
When treating various variants of this injury, there are still no generally accepted recommendations.
In particular, for the treatment of closed fresh and long-lasting injuries such as "mallet finger," there are completely polar recommendations from "rest" to amputation of the terminal phalanx. Between these extreme points of view are recommendations for the use of various tyres, gypsum bandages, external fixation devices, method of transarticular fixation with a spoke, tendon suture, tendoplasty, arthrodesis. [7,8,9,10]
Purpose
Optimization of the approach to the treatment of injuries of the distal finger, leading to "hammer deformation," taking into account the damage variants and anatomical features of the area.
Materials and methods
In the period from 2016 to 2020, 156 patients with subcutaneous damage to extender tendons were operated on the basis of the A.N Syzganov National Scientific Center of Surgery in the Department of Reconstructive-Plastic and Aesthetic Microsurgery.
The patients were divided into 2 groups. The first group included patients with closed damage to the tendons of long finger extenders who applied for urgent care. The group consisted of 64 people (42 men and 22 women aged 17 to 36). All patients of group 1 were subjected to conservative therapy, in the form of temporary immobilization of the finger in the position of hyperextension for 1.5 months. Longets made from "Safi x plus" gypsum bandage and Hartmann 's "Rhena term" thermoplastic synthetic bandage were used. (Figure 1.2) After 6 weeks, the development of movements in
DIP joint was started, and no special exercises were required. The positive result of conservative treatment was the restoration of the volume of active movements with a deficit of not more than 18 degrees. In other cases, the patient was shown operative treatment.
The second group was made up of patients in need of operative treatment of damage to the tendons of long finger extenders at DIP joint level. It included 92 people (51 men and 41 women between the ages of 17 and 63).
The distribution of patients by type of injury by J.R.Doyle classification is shown in Table 1.
Patients with I and IV types of damage (62 people) applied 2-3 months after the injury. 15 people (24.2%) were not treated for various reasons. 44 patients (71.0%) under trauma centre conditions were applied gypsum longet, but conservative therapy did not lead to a positive effect. Three patients (4.8%) applied more than six months after the injury. 16 patients (76.2%) of type II injuries were received as a matter of urgency, the remaining 5 people (23.8%) - 2-3 months after complete wound healing. All patients with type III damage, arrived as a matter of urgency.
The second group was made up of patients in need of operative treatment of damage to the tendons of long finger extenders at DIP joint level. It included 92 people (51 men and 41 women between the ages of 17 and 63).
Figure 1
Typical mechanism of "mallet finger"
Figure 2
Immobilization option for "mallet finger"
Type of damage Nature of damage Number of patients
Abs. %
I Closed tendon damage - separation from distal phalanx 49 53,3
II Open tendon damage at DIP joint 21 22,8
III Open tendon damage with skin defect 9 9,8
IV Fracture of distal phalanx at tendon attachment site 13 14,1
TOTAL 92 100,0
Table 1
Patient distribution by type of injury
BULLETIN OF SURGERY IN KAZAKHSTAN № 2-2020
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Figure 3
Operative treatment of long finger extension tendon injuries at DIP joint level
Under conductor anesthesia by Oberst - Lu-kashevich under aseptic conditions with solution Novocaine 0.25% - 20.0 ml. After appropriate treatment of the upper limb. At the level of distal interphalangeal joint, Z-shaped incision of skin subject to tissues is made along rear surface of finger. During the inspection, the complete anatomical break of the extender tendon is revealed. Under the magnification of 2.5x thread Prolen 3/0 is made plastic tendon extender. MOS of nail phalanx in position of extension by Kirchner 's spoke. (Figure 3) Hemostasis during the operation. Sutures on the wound with Prolen thread 3/0. Expert. Bandage.
Results and discussion
According to the data available in the literature, in case of closed injuries of tendons of extenders of long fingers at the level of distal interphalan-geal joint, it is advisable to carry out conservative therapy within 14 days after injury. According to our
References
1. Korshunov V. F. Treatment of closed injuries tendon apponeurotic finger stretching at the level of distal interphalangeal joint / V.F. Korshunov, A.D. Moscow, D.A. Magdiyev//Orthopaedia, traumatology and prosthetics. - 2015. - № 8. - P. 12-14
2. Zolotov A.S., Zelenin V.N., Sorokovikov V.A. Treatment of injuries of distal fingers of the hand leading to hammer-shaped deformation. - Irkutsk: NC RVKh CO RAMN, 2016. - P. 150-153
3. Upton J. Primary care of the injured hand, part 1 / J. Upton, J.W. Littler, R.G. Eaton // Postgraduate Medicine. - 1979. - Vol. 66, N 2. - P. 115-120.
4. The most frequent tendon injury: the «mallet finger». Review, therapeutic concept and results / S. Winck-ler, H. Rieger, J. Grunert et al. // Zentralbl Chir. -1991. - Vol. 116, N 22. - P. 1273-1289.
5. Stack H.G. A modified splint for mallet finger / H.G. Stack // J. Hand Surgery. - 1986. - Vol. 11B. - P. 263.
data, when the patient turns up to 24 hours, the effectiveness of conservative therapy is only 52%. As the time interval from the moment of injury to the beginning of treatment increases, the effectiveness of conservative therapy decreases dramatically. Absence of relapses and complications in the form of ligature fistulas after performance of tenoder-modesis indicates high efficiency and safety of this method. Besides, tenodermodesis is technically simple, does not require special tools and can be performed in outpatient conditions.
Conclusions
1. It is advisable to carry out conservative therapy of closed injuries of long finger once-flutter tendons at DMFS level during the first day after injury.
2. In case of open and closed injuries of tendons of long finger extenders at the level of distal interphalangeal joint (type I and II according to Doyle) it is recommended to perform tenodermodesis in combination with arthrodesis of distal interphalangeal joint in position of hyperextension.
3. In type III injuries, an effective treatment method is autodermoplasty with a full layer skin flap in combination with DMFS arthrod-esis in the hyperextension position.
4. In case of type IV injuries, it is recommended to fix the bone fragment of the phalanx and arthrodesis of the distal interphalangeal joint in the position of hyperextension with Kirschner 's spokes.
6. Ashkenazi A.I., Abdulhabirov M.A. Subcutaneous breaks of long thumb extensor (diagnosis, treatment, prevention)//Prevention, diagnosis and treatment of spinal and limb injuries and diseases: st. Tp. CITO. -Moscow, 1984. - P 59-63
7. Magdiyev D.A., Chulovskaya I.G., Lipinsky P.V., etc. Treatment of tendon injuries of finger extenders// Sat.: Modern technologies for diagnosis, treatment and rehabilitation of injuries and diseases of the hand. - Moscow, November 9-10, 2005. - P.148-151.
8. Damron T.A., Lange R.H., Eneber W.D. Mallet fi ngers: a review and treatment algorithm. Int J Orthop Trauma 1991; 1(2): 105-110.
9. Wolfe S.W., Hotchkiss R.N., Pederson W.C., Kozin S.H. Green's operative hand surgery, 6th ed., 2-Vol set. Elsevier Churchill Livingstone 2010.
10. Kardestuncer T., Bae D.S., Waters PMJ Pediatr Orthop. The results of tenodermodesis for severe chronic mallet fingerdeformity in children 2008; 28(1): 81-85
