Features of conservative treatment of patients with post-traumatic stiff interphalangeal joints
Keywords:post-traumatic contractures, interphalangeal joints of the fingers, dynamic splints
Background. In the structure of complications after a finger injury, contractures of the interphalangeal joints occupy a key place and range from 25 to 38 %. Purpose: to improve the results of treatment of patients with post-traumatic contractures of the interphalangeal joints by optimizing early functional mobilization. Materials and methods. The results of conservative treatment of post-traumatic interphalangeal joints contractures of 60 fingers are analyzed. Patients are divided into two clinical groups: the first group (29 patients) consisted of patients with isolated contractures of the interphalangeal joints of the finger, the second group involved 31 people with multiple contractures of the fingers. Patients are dynamically observed on days 5–7, in 3 months and 1 year after treatment using a point system for assessing the functional state of the hand and the QuickDASH score. Results. Two types of clinical rehabilitation programs of conservative treatment are offered. According to the first, rehabilitation measures are based on the early conduct of dosed functional mobilization, overcoming edema with the use of drug therapy and taping, the minimum amount of physiotherapy treatment for 10–14 days. The second program provides for intensive rehabilitation treatment using dynamic splint, measures for conservative mobilization of the capsule-ligamentous apparatus, which included injections of chondroprotective drugs, physiotherapy, heat therapy, kinesiotherapy, and psychological correction. According to the scoring scale and QuickDASH, on the 5–7th day after the start of treatment, the functional deficit begins to decrease in all examined patients, and after 3 months the indicator decreases by more than half (p < 0.001) in all groups and subgroups of the observation. Comparing the results of treatment after 1 year in groups I and II, we can state a greater number of positive results in the group of isolated contractures — 52.4 % of mild disorders versus 29.2 % in the group of multiple contractures (p = 0.113). Conclusions. Statistically significantly better rates of restoration of the functional state of the hand (p < 0.05), both on a scale of a score system of assessment (reduction of function deficit by 77.5 % after 1 year for isolated and by 68.4 % for multiple contractures) and according to the QuickDASH scale (reduction of function deficit by 75.1 % after 1 year for isolated contractures and by 50.0 % for multiple contractures), when applying the proposed rehabilitation methods, indicate the effectiveness of our approach to rehabilitation.
SYMPOSIUM № 89. Available from: http://www.mif-ua.com/education/symposium/ushkodzhennya-kist-mikrohirur-gya-v-travmatolog-ta-ortopedii. Accessed: 01.01.2020.
Kurinnyy I.M. Surgical treatment of contractures of the joints of the fingers in patients with consequences of poly-structural injuries. Chronicle of traumatology and orthopedics. Litopys travmatolohiyi ta ortopediyi. 2011. 1–2. 55-60 (In Ukrainian).
Wood K.S., Daluiski A. Management of Joint Contractures in the Spastic Upper Extremity. Hand Clin. 2018 Nov. 34(4). 517-528.
Meireles S.M., Jones A., Natour J. Orthosis for rhizarthrosis: A systematic review and meta-analysis. Semin. Arthritis Rheum. 2019 Apr. 48(5). 778-790.
Rongières M. Management of posttraumatic finger contractures in adults. Hand Surg. Rehabil. 2018 Oct. 37(5). 275-280.
Freiberg A. Management of proximal interphalangeal joint injuries. The Canadian journal of plastic surgery. Journal canadien de chirurgie plastique. 2007. 15(4). 199-203. doi: 10.1177/229255030701500407.
Kamnerdnakta S., Huetteman H.E., Chung K.C. Complications of Proximal Interphalangeal Joint Injuries: Prevention and Treatment. Hand Clin. 2018. 34(2). 267-288. doi: 10.1016/j.hcl.2017.12.014.
The Acute Management of Unstable Intra-Articular Fractures of the Base of the Middle Phalanx: A Systematic Review Laura Clare Hamilton (Brighton and Sussex Medical School, University of Brighton, London, UK). The Journal of Hand Surgery (Asian-Pacific Volume). 2018. 23(04). 441-449.
Bohov A.A., Mullin R.I., Fasakhov RPP-therapy and hyaluronic acid in the treatment of patients with osteoarthrosis of the joints of the hand accompanied by contractures. Practical medicine. 2019. 17(6–2). 17-19 (In Russian).
Smith-Forbes E.V., Howell D.M., Willoughby J., Pitts D.G., Uhl T.L. Specificity of the minimal clinically important difference of the quick Disabilities of the Arm Shoulder and Hand (QDASH) for distal upper extremity conditions. J. Hand Ther. 2016. 49(1). 81-88.
Bondaruk D.O. Surgical treatment of patients with deformities of the fingers due to lesions of the extensor tendons: abstract. diss. Cand. honey. Sciences: 14.01.21. Donets’k, 2014. 35 s. (In Ukrainian).
Copyright (c) 2020 TRAUMA
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
- The rights to the article are deemed transferred by the authors to the edition (the publisher) since the moment of the publication of the article in the printed or electronic version of journal.