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Re: WRIST FLEXION CONTRACTURE
послал Sudhir Warrier 21 Ноябрь 2006, 02:40
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Dear Odessky Jacob,
A few points and observations:
I have no experience with the Hexapod or the Spatial frames.
I really think we try to simplify the wrist by assigning it a center of rotation (one or two)! The complex movements at the radio-carpal,
inter-carpal and carpo-metacarpal joints formed by bones of varying sizes, shapes and function and servicing dissimilarly sized and shaped fingers
cannot be replicated by placing a hinge or two in a constrained frame.
The distraction frame we use is used to linearly distract the deformities. The angular correction is achieved by dismantling the connecting
rods/distraction rods and performing a manual correction. This correction will proceed along the articular surfaces of opposing bones and will be as near-natural as possible. The distractors are re-assembled and further linear distraction is carried out. And the procedure is repeated until
complete or satisfactory correction is achieved.
Having said that, I must admit that there are many ways to skin a cat!
I must also add that Dr Cherian has not mentioned about the status of the nerves and the function of the tendons. From the looks of the clinical picture, the flap overlies the volar structures which obviously must have been involved. The first web and the MCP joints of the index and middle
fingers also seem to need attention. These can all be simultaneously corrected as the wrist with the UMEX frame by using the extended hand frame
components. I do not embark on tendon surgery until maximum correction has been achieved AND considerable passive and active mobilization/splintage is done. An assessment at this stage will tell us the possibilities and the
requirements. Tendon / nerve surgery can then be planned more meaningfully.
Sudhir Warrier
Hand and Reconstructive Orthopedic Surgeon
Laud Clinic . Lilavati . Jaslok . LH Hiranandani . Shushrusha . Sir HN
Hospitals
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