Distraction arthrolysis using an external fixator and flexor tenolysis for proximal interphalangeal joint extension contracture after severe crush injury.
OBJECTIVE
To introduce a technique for distraction arthrolysis with an external fixator followed by flexor tendon tenolysis for extension contracture of the proximal interphalangeal (PIP) joint after severe crush injury. We also assessed the results of this method in all patients treated.


METHODS
Five fingers of 4 men with extension contracture of the PIP joint after severe injury underwent distraction arthrolysis using an external fixator, followed by flexor tenolysis. On the day of attaching the external fixator, moderate distraction was applied to the joint and the gap was widened to approximately 2 mm. From the following day onward, the PIP joint was gradually widened for 10 days until a gap of about 5 mm was attained. After sustaining this amount of distraction for 3 or 4 days, the fixator was removed. Passive range of motion was performed for about one week until swelling of the affected digit subsided. Then, flexor tenolysis was performed. Patients were follow-up for an average of 31 months after surgery.


RESULTS
After tenolysis, the average improvement of active range of motion was 20 degrees, average gain of active flexion was 41 degrees, and average loss of active extension was 21 degrees. The average range of active motion was from 6 degrees to 38 degrees preoperatively, and from 27 degrees to 79 degrees postoperatively. The average median of active motion was 22 degrees preoperatively, and 52 degrees postoperatively. In all fingers, there was no significant difference in the total arc of active motion preoperatively and postoperatively, but there was a significant difference between preoperative and postoperative maximum active flexion. In all patients, painless motion was maintained and arthritic changes of the PIP joint did not worsen during the follow-up period.


CONCLUSIONS
Distraction arthrolysis with an external fixator followed by flexor tenolysis was a useful treatment for our patients with extension contracture of the PIP joint and tendon adhesions after severe crush injury.


METHODS
Therapeutic IV.
Kawakatsu
Motohisa
M
Department of Plastic and Reconstructive Surgery, Sumiya Orthopaedic Hospital, Wakayama-shi, Wakayama, Japan. kawakatsu@sumiya.or.jp
Ishikawa
Kozo
K
Terai
Tsutomu
T
Saito
Susumu
S
D000328:Adult; D003286:Contracture / Q000209:etiology / Q000601:surgery*; D016267:External Fixators; D005383:Finger Injuries / Q000150:complications / Q000601:surgery*; D005384:Finger Joint / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D019857:Osteogenesis, Distraction / Q000295:instrumentation* / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012189:Retrospective Studies; D012494:Sampling Studies; D013710:Tendons / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult