Orthopedic restoration of thumb opposition in consequences of the upper extremity trauma
Background. The vast majority of patients with consequences of the upper extremity injury require surgical restoration of thumb opposition. The purpose was to determine the effectiveness of surgical restoration of thumb opposition in consequences of the upper extremity trauma, to describe the main factors that determine the degree of opposition recovery and possible causes of poor results. Materials and methods. Thirty nine patients (neglected peripheral nerve trauma (n = 19), brachial plexus lesions (n = 11 patients) and upper extremity ischemic contracture (n = 9)) underwent: opponensplasty (n = 25) and opponodesis (n = 14). Dynamics of thumb function restoration and ability to use it in threefinger grasp were evaluated. Results. Opponensplasty effectiveness in most of the analyzed cases was lower than expected, the techniques using flexor tendons (Thompson, Bunnell) are more effective than methods involving extensors. However, due to initial conditions, they can be realized only in one third of patients, who need this recovery. Methods using extensors (Taylor, Burkhalter) provide a compelling immediate result, but in the postoperative period, their effectiveness is significantly reduced, which requires special approaches to increase their efficacy. The effectiveness of opponodesis is more predictable, but grasp restoration requires correct function of long fingers, and the choice of thumb position — a thorough agreement with patient. Conclusions. It is necessary to create a systematic approach for choosing techniques and taking into account the components of these interventions. In addition, it is important to optimize these interventions by clarifying tendon tension in the motor muscle and the means to reduce the adhesion process.
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Bunnell S. Surgery of the hand. Philadelphia: J.B.Lippincott Co. 3rd cd; 1956.
Burkhalter W, Christensen RC, Brown P compilers and editors. Extensor indicis proprius opponensplasty. J Bone Joint Surg Am. 1973;55:725-732.
Lalonde DH, Wong A compilers and editors. Dosage of local anesthesia in wide awake hand surgery. J Hand SurgAm. 2013;38(10):2025-2028.
Lalonde DH, Martin A compilers and editors. Epinephrine in local anesthesia in finger and hand surgery: The case for wide-awake anesthesia. J Am Acad Orthop Surg. 2013;21(8).
Littler JW, Li CS compilers and editors. Primary restoration of thumb opposition with median nerve compression. Plast Reconstr Surg. 1967;39:74-75.
Taylor RT. Reconstruction of the hand. Surg Gynecol Obstet. 1921;32:237-248.
Thompson TC. A modified operation for opponens paralysis. J Bone Joint Surg. 1942;24:632-640.
Kurinnyi IM. Naslidki polistrukturnoi travmi verhnoi kincivki ta ih hirurgichne likuvannia [Consequences of polystructural upper extremity trauma and their surgical treatment]. K.; 2009. 33 p. (in Ukranian).
Strafun SS, Brusko AT, Liabach AP et al. Profilaktika, diagnostika ta likuvanna ishemichnih kontraktur kisti ta stopi [Prevention, diagnosis and treatment of hand and foot ischemic contractions]. K.: Stilos; 2007. 264 p. (in Ukranian).
Tsimbaliuk VI, Gaiko GV, Suliy MM, Strafun SS. Hirurgichne likuvannia ushkodgen plechovogo spletennia [Surgical treatment of brachial plexus lessions]. Ternopil: Ukrmedkniga; 2001. 212 p. (in Ukranian).
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