Correction of severe spastic flexion contractures in the nonfunctional hand

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Reconstructive Surgery

Background:

• Spasticity in nonfunctional hands often involves severe flexion contractures.
• Traditional treatments like superficialis to profundus transfer do not fully address associated problems.
• Failure of conservative management or chronic skin issues necessitate advanced surgical interventions.

Purpose of the Study:

• To evaluate a single-stage comprehensive surgical protocol for severe hand and wrist flexion contractures.
• To assess the efficacy of combined procedures in improving hand function and appearance.
• To address limitations of previous treatments for spastic nonfunctional hands.

Main Methods:

• A 3-year study involving 15 procedures (14 patients) for severe hand/wrist flexion contractures.
• Procedures included superficialis to profundus transfer, wrist flexor release, FPL lengthening, wrist arthrodesis, carpal tunnel release, and ulnar motor branch neurectomy/intrinsic release.
• Patients had failed nonoperative treatment or had chronic skin problems.

Main Results:

• Successful wrist fusion achieved in 13 of 15 procedures, with two requiring revision or prolonged casting.
• Significant correction of severe contractures and resolution of preoperative hygiene problems and infections.
• Two patients had residual claw hand deformity with partial thumb-in-palm correction.

Conclusions:

• A single-stage comprehensive surgical protocol effectively corrects severe hand and wrist flexion contractures in spastic hands.
• The approach improves hand appearance and resolves associated complications like infections.
• This multi-component surgery offers a viable solution for complex cases unresponsive to conservative care.