Management of an unusual extreme extension contracture of the wrist: role of a custom-designed exercise program in achieving a good range of movement and prevention of recontraction.
An extreme extension contracture of wrist with dorsal contracture of fingers 15 years after burn injury is described. Shortening of extensor tendons, secondary lengthening of flexor tendons, contracted wrist joint capsule, unusual dislocation of carpals, dorsal dislocation of metacarpophalangeal joints of fingers, and provision of sufficient amount of good-quality skin were some of the issues that had to be addressed in treatment. The contracture was released, the carpals and metacarpophalangeal joint dislocations were corrected and fixed with K wires, and the resulting defect was covered with a sheet split-thickness skin graft. An exercise program was designed that consisted of isotonic, isokinetic, and isometric resistance exercises and passive, active, and active-assistive range of motion exercises. These exercises were pursued with the intention of increasing dynamic strength, endurance, and overall functional recovery of the flexor muscles by exploiting the immature nature of early scar tissue. The resultant enhanced flexor muscle power from exercises along with the dynamic splint helped in lengthening of extensor tendons, wrist joint capsule, and split-thickness skin graft. It also helped in resisting the recontracting tendency, with further recovery of good range of wrist and fingers movements, obviating the need of tendon-lengthening surgery and flap coverage. One and half years of follow up didn't show any sign of recontracture, and the patient was able to perform his routine activities. Postburn wrist contractures of such magnitude have been seldom described. Emphasis is put on simple contracture release and a postoperative exercise program.
Saraiya
Hemant
H
Sushrut Plastic Surgery Center and Raj Hospital, Ahmedabad, India.
D000293:Adolescent; D001864:Bone Wires; D002056:Burns / Q000150:complications*; D002921:Cicatrix / Q000150:complications; D003286:Contracture / Q000534:rehabilitation* / Q000628:therapy*; D005081:Exercise Therapy; D006801:Humans; D016268:Internal Fixators; D004204:Joint Dislocations / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D008297:Male; D016059:Range of Motion, Articular; D016038:Skin Transplantation; D013165:Splints; D013997:Time Factors; D016896:Treatment Outcome; D014955:Wrist Joint / Q000473:pathology* / Q000601:surgery