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Reconstructive surgery in children to correct ulnar claw hand deformity due to leprosy
Insights
Tendon transfer surgery effectively corrects ulnar claw hand deformity in children with leprosy, significantly improving hand function and daily activities. This reconstructive surgery offers positive outcomes for affected children.
Area of Science:
- Orthopedic Surgery
- Hand Surgery
- Pediatric Leprosy Management
Background:
- Leprosy commonly causes ulnar nerve paralysis, leading to debilitating ulnar claw hand deformity in children.
- This deformity severely impacts daily activities, schoolwork, and social interactions, necessitating effective surgical correction.
Purpose of the Study:
- To evaluate the effectiveness of tendon transfer surgery in correcting ulnar claw hand deformity in pediatric leprosy patients.
- To assess the functional outcomes and impact on daily living post-surgery.
Main Methods:
- A case series included 82 hands from 79 children with ulnar paralysis due to leprosy, treated between 2007-2012.
- Lasso surgery was performed, utilizing flexor digitorum superficialis or palmaris longus/extensor carpi radialis longus with fascia lata graft as motor tendons.
- Outcomes were measured by unassisted angle, grasp/pinch contact, and functional assessment, with consistent pre- and post-operative protocols.
Main Results:
- Tendon transfer surgery resulted in a decreased unassisted angle, indicating successful correction of claw finger deformity in all patients.
- Significant improvement in overall hand function was observed post-surgery, with continued progress during follow-up.
- The study included 82 hands from 79 pediatric leprosy patients, with 83% utilizing flexor digitorum superficialis.
Conclusions:
- Tendon transfer surgery is a highly effective treatment for correcting established ulnar claw fingers in children with leprosy.
- The procedure significantly facilitates hand function, enabling children to perform daily activities and lead more normal lives.
- Early surgical intervention for leprosy-induced hand deformities is crucial for restoring function and improving quality of life.
Objectives:
To study the impact of tendon transfer surgery for ulnar claw hand correction in children with leprosy.
Subjects And Methods:
All the children who underwent reconstructive surgery for ulnar nerve paralysis during the period 2007 to 2012 were included in the study. Unassisted angle, grasp contact, pinch contact and functional assessment were the main outcome measures. All the surgical procedures were performed by the same surgeon and pre- and post-operative therapy protocol was same for all the patients. A common surgical audit form was used to record assessments for all the patients.
Results:
In this case series, 82 hands of 79 patients with ulnar paralysis were included. All the children had lasso surgery. In 83% of hands, flexor digitorum superficialis of middle or ringer finger was used, while in the remaining patients palmaris longus or extensor carpi radialis longus with fascia lata graft was used as the motor tendon. The unassisted angle decreased in all the patients, indicating correction of claw fingers. Hand function improved after surgery and it showed steady progress during follow-up.
Conclusion:
The deformity due to leprosy in the hands of children is a tragedy as it hampers the use of hands in daily routine activities, school work and other social interactions. Tendon transfer surgery should be done on children to correct established clawed fingers as it yields good results and helps in facilitating hand function to complete daily activities and lead a normal life.
