scholarly journals 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

2021 ◽  
Vol 8 (4) ◽  
pp. 417-426
Author(s):  
Dmitry V. Umnov ◽  
Valery V. Umnov ◽  
Vladimir A. Novikov ◽  
Margarita V. Savina
Keyword(s):  
Cerebral Palsy ◽  
Surgical Treatment ◽  
Upper Limb ◽  
Metacarpophalangeal Joint ◽  
Infantile Cerebral Palsy ◽  
Positive Effects ◽  
Surgical Methods ◽  
First Ray ◽  
Temporary Arthrodesis ◽  
Intermetacarpal Space

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.

scholarly journals Surgical treatment of thumb adduction contracture in children with infantile cerebral palsy

2015 ◽  
Vol 3 (2) ◽  
pp. 25-31
Author(s):  
Vladimir Alexandrovich Novikov ◽  
Valery Vladimirovich Umnov
Keyword(s):  
Cerebral Palsy ◽  
Surgical Treatment ◽  
Tendon Transfer ◽  
Positive Outcome ◽  
Metacarpophalangeal Joint ◽  
Infantile Cerebral Palsy ◽  
Main Criterion ◽  
Abductor Pollicis Longus ◽  
Selection Of Patients ◽  
Selection Of

The purpose of the work is to evaluate the effectiveness of different methods of surgical treatment of thumb adduction contracture in children with infantile cerebral palsy.Materials and methods.The present study is based on diagnostic results of children with infantile cerebral palsy with affected upper limb. The main criterion for selection of patients was the presence of thumb adduction contracture, the absence of significant positive outcome in a patient after conservative treatment, the impossibility of active thumb abduction more than 30° and the instability of the first metacarpophalangeal joint. Total we examined and treated 9 patients with spastic types of cerebral palsy.Results and conclusions.We evaluated the results of the following types of surgical treatment: release of adductor pollisis muscle, release of adductor pollisis muscle and tendon shortening of m.abductor pollicis longus, release of adductor pollisis muscle and tendon transfer of m.extensor indicis in the tendon m. abductor pollicis longus, the fixation of the first metacarpophalangeal joint with extramedullary plate. Based on these data, we were able to confirm the effectiveness of surgical treatment of thumb adduction contracture.

Surgery of the Spastic Hand in Cerebral Palsy

1998 ◽  
Vol 23 (3) ◽  
pp. 334-339 ◽  
Author(s):  
L. B. DAHLIN ◽  
Y. KOMOTO-TUFVESSON ◽  
S. SÄLGEBACK
Keyword(s):  
Cerebral Palsy ◽  
Surgical Treatment ◽  
Upper Limb ◽  
The Other ◽  
Surgical Reconstruction ◽  
Range Of Movement ◽  
Striking Finding ◽  
Hemiplegic Cerebral Palsy

Thirty-six patients with hemiplegic cerebral palsy had surgical treatment for the upper limb and were followed up for 18 months postoperatively. Various operations were done. A striking finding was a significant improvement of stereognosis (ability to describe and recognize objects without vision). Most patients had improvement in different functional grasps following surgical reconstruction. Range of movement in the forearm and wrist also increased in most patients. The thumb-in-palm deformity was completely corrected in 31 of the patients and improved in the other five. Most patients had some or all of their expectations of the procedure fulfilled.

scholarly journals SURGICAL TREATMENT OF PRONATION CONTRACTURE OF THE FOREARM IN PATIENTS WITH INFANTILE CEREBRAL PALSY

2014 ◽  
Vol 2 (1) ◽  
pp. 39-45
Author(s):  
Vladimir Alexandrovich Novikov ◽  
Valery Vladimirovich Umnov ◽  
Alexei Vasilievich Zvozil
Keyword(s):  
Cerebral Palsy ◽  
Surgical Treatment ◽  
Specific Method ◽  
Upper Limbs ◽  
Infantile Cerebral Palsy ◽  
Operative Techniques ◽  
Main Criterion ◽  
Methods Of Treatment ◽  
Wrist Joints ◽  
Early Surgical Treatment

The objective of the work was to evaluate the efficiency of the existing methods of surgical treatment of pronation contracture of the forearm, the modification of the existing methods of treatment, the development of the indications for each specific method of treatment. Materials and methods. This study is based on a survey of children suffering from infantile cerebral palsy affecting the upper limbs. The main criterion for the patient selection was the presence of a fixed pronation contracture of the forearm, both isolated and combined with other contractures of the joints of the upper limb. Total 42 patients with spastic forms of cerebral palsy were examined. Results and conclusions. With age of the patient, the pronation contracture is usually increased, the contractures of the elbow and wrist joints may develop, which leads to the necessity for more and more radical operative techniques. Therefore, the early surgical treatment allows obtaining optimal results with its minimum scope. The investigation data gave an option to simplify, but to increase the efficiency of surgical treatment methods of pronation contractures in children with infantile cerebral palsy.

scholarly journals DIAGNOSTICS AND TREATMENT OF SPASTIC HAND IN CHILDREN WITH INFANTILE CEREBRAL PARALYSIS: THE REVIEW PART II: CONSERVATIVE AND SURGICAL TREATMENT OF THE UPPER LIMB

2011 ◽  
Vol 17 (3) ◽  
pp. 137-145
Author(s):  
V. V. Umnov ◽  
V. A. Novikov ◽  
A. V. Zvozil
Keyword(s):  
Cerebral Palsy ◽  
Surgical Treatment ◽  
Upper Limb ◽  
Domestic Literature ◽  
Results Of Treatment ◽  
Infantile Cerebral Paralysis ◽  
Cerebral Paralysis ◽  
Analysis Of Results ◽  
Conservative And Surgical Treatment

In article authors describe the isolated data of the foreign and domestic literature concerning a problem of conservative and surgical treatment of the upper limb extremity at patients with cerebral palsy. In the publication the features of various techniques gained the greatest distribution and actively applied now are considered. Besides, the analysis of results of treatment is carried out and problems up to the end not solved are sounded till now.

scholarly journals SURGICAL TREATMENT OF PATIENTS WITH DISLOCATION OF HEAD OF THE ARM AND ROTATIONAL CONTRACTURE OF THE FOREARM WITH BIRTH PALSY OF THE UPPER EXTREMITY

2014 ◽  
Vol 2 (1) ◽  
pp. 32-38
Author(s):  
Nikolai Alexandrovich Ovsyankin ◽  
Natalia Anatolievna Naumochkina
Keyword(s):  
Surgical Treatment ◽  
Upper Extremity ◽  
Upper Limb ◽  
Diagnostic Methods ◽  
Pediatric Orthopedics ◽  
Actual Problem ◽  
Surgical Methods ◽  
High Incidence ◽  
Birth Palsy ◽  
Methods Of Treatment

Introduction. The obstetrical upper limb paralysis and its sequelae are an actual problem of pediatric orthopedics and traumatology. Relevance of the problem is due to high incidence of this disease and increase of child disability. Purpose. To present the method of treating patients with a dislocated radius head and forearm rotation contracture in birth paralysis of the upper extremity. ^Materials and Methods. This article presents the clinical material on the survey in the Institute and the surgical treatment of 12 patients aged from three to 15 years with the pathology of the elbow and forearm, developed after the obstetrical upper limb paralysis. Results. We present the clinical picture, diagnostic methods, indications to surgical treatment, as well as new and effective methods of performing the proximal radioulnar joint arthrodesis in young children with obstetrical paralysis of the upper extremity. The use of surgical methods of treatment in such patients has improved the function of the arm and self-care in 95 per cent of cases, reduced their disability and increased their choice for occupation activities.

scholarly journals ACTUAL DIRECTIONS OF THE OPTIMIZATION OF THE SURGICAL TREATMENT OF LOCOMOTOR DISORDERS IN SPASTIC FORMS OF INFANTILE CEREBRAL PALSY

2019 ◽  
Vol 21 (3) ◽  
pp. 175-181
Author(s):  
K. V. Zherdev ◽  
L. A. Pak ◽  
Maria O. Volkova ◽  
P. A. Zubkov ◽  
O. B. Chelpachenko
Keyword(s):  
Cerebral Palsy ◽  
Surgical Treatment ◽  
Intellectual Development ◽  
Muscle Tone ◽  
Knee Joints ◽  
Infantile Cerebral Palsy ◽  
Active Growth ◽  
Surgical Interventions ◽  
Simultaneous Operations ◽  
Locomotor Disorders

The review of actual directions of optimization of surgical treatment of locomotor disorders in spastic forms of infantile cerebral palsy is presented. When choosing the tactics of the treatment for this category of patients, the following criteria should be taken into account: the degree of disturbances in motor activity associated with muscle tone disorders, the spasticity pattern, the presence of joint contractures, limb deformities, the level of intellectual development, the presence and severity of perceptual disorders. The implementation of simultaneous operations allows reducing the period of immobilization of the child and the period of temporary incapacity for work of parents and recommended for the treatment of patients with cerebral palsy at all levels of the Gross Motor Function Classification System (GMFCS). There are considered modern methods of surgical treatment of spastic instability of the hip when the choice of the method of correction of the acetabular component of instability depends on the degree of abnormalities of the anatomy of the acetabulum, mainly from the deficit of the bone covering of the head of the femur and the «slanting» of the roof of the acetabulum. In the treatment of contractures of knee joints in order to prevent сrush syndrome, the elongation of the medial group of tibial flexors is advisable to be used in conjunction with tonus-enhancing operations in the anterior group of femur muscles with their secondary weakness. When treating axial deformities of the knee joints and unequal length of the legs, it is important to observe the timeliness principle (during the active growth of the skeleton) with the use of minimally invasive surgical interventions - hemi and epiphysiodesis - to avoid the need for more traumatic interventions.

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