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Related Experiment Videos

Reconstructive hand surgery for scleroderma joint contractures.

Ananthila Anandacoomarasamy1, Helen Englert, Nicholas Manolios

  • 1Department of Rheumatology, Royal North Shore Hospital, St. Leonards, North South Wales, Australia.

The Journal of Hand Surgery
|September 11, 2007
PubMed
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Systemic scleroderma can lead to severe hand deformities. Successful soft tissue surgery, focusing on joint capsule and skin release, improved function without joint replacement in two patients.

Area of Science:

  • Hand surgery
  • Rheumatology
  • Scleroderma research

Background:

  • Systemic scleroderma frequently causes hand deformities and functional loss.
  • Surgical interventions are often limited by concerns over wound healing complications.
  • Common procedures include digital sympathectomy, arthrodesis, or arthroplasty of interphalangeal and metacarpophalangeal joints.

Observation:

  • This study presents a novel soft tissue surgical approach for scleroderma-related hand deformities.
  • Two patients with scleroderma claw deformities underwent surgical correction without arthrodesis or arthroplasty.
  • The surgical technique involved releasing tight joint capsules, collateral ligaments, and volar plates at the metacarpophalangeal joints, and releasing volar plates and palmar skin at the proximal interphalangeal joints.

Findings:

Related Experiment Videos

  • Tight palmar skin was identified as the primary cause of flexion contractures at the proximal interphalangeal joints.
  • Joint capsule contracture was the primary cause of hyperextension deformities at the metacarpophalangeal joints.
  • The described surgical interventions resulted in significant improvement in joint positioning and hand function, complemented by intensive hand therapy.

Implications:

  • Soft tissue surgery offers a viable alternative to joint replacement for correcting scleroderma hand deformities.
  • Understanding the specific anatomical contributors to contractures (skin vs. capsule) is crucial for targeted surgical planning.
  • This approach may enhance functional outcomes and reduce surgical risks for patients with systemic scleroderma affecting the hands.