Interphalangeal joint stiffness following claw hand reconstruction

Conventional immobilisation following surgery for claw hand reconstruction necessitates altogether more than six weeks of post-operative physiotherapy. Two to four weeks of physiotherapy was required for re-education of the transferred tendons and an additional period of physiotherapy was needed to overcome the interphalangeal joint stiffness seen in all hands--even those with no pre-operative I.P. stiffness. Fifty hands with no pre-operative I.P. stiffness were immobilised post-operatively following claw hand correction by three different techniques, (Conventional technique 20 hands; Modification type 1, 10 hands and Modification type 2, 20 hands). Modification type 1 produced unsatisfactory results. Modification type 2 however, resulted in near total absence of I.P. stiffness with no additional physiotherapy required to overcome the minimal stiffness, without interfering with the results of reconstructive surgery. Type 2 immobilisation was achieved by a volar plaster slab extending from just below the elbow to the finger tips with circumferential plaster up to just beyond the metacarpophalangeal joints. Modification type 2 is recommended.