[Ortho] Нужен совет кистевых хирургов - что делать при отрыве сухожилий разгибателя ногтевой фаланги.

[Александр Ларионов]

п÷п╬я│я┐п╢я┐, п╨п╬п╫п╣я┤п╫п╬ п╤п╣! :)

2016-07-20 0:08 GMT+03:00 п░п╩п╣п╨я│п╟п╫п╢я─ п⌡п╟я─п╦п╬п╫п╬п╡ <alarionov2011 на gmail.com>:

> п╞ п╬п╠я▀я┤п╫п╬ п╨п╩п╟п╢я┐ п©п╣я─я└п╬я─п╦я─п╬п╡п╟п╫п╫я▀п╧ я┌п╣я─п╪п╬п©п╩п╟я│я┌ п╡ п©п╬п╩п╬п╤п╣п╫п╦п╦ пЁп╦п©п╣я─п╨п╬я─я─п╣п╨я├п╦п╦
> п╫п╬пЁя┌п╣п╡п╬п╧ я└п╟п╩п╟п╫пЁп╦ я├п╦я─п╨я┐п╩я▐я─п╫п╬. п п╬пЁп╢п╟ п©п╟п╩п╣я├ я┘я┐п╢п╣п╣я┌ п╦ п╬я─я┌п╣п╥ я│п╬я│п╨п╟п╩я▄п╥я▀п╡п╟п╣я┌ я│п╟п╪,
> п╡п╬п©я─п╬я│ я┐п╤п╣ я─п╣я┬п╣п╫. :) п╒п╣я─п╪п╬п©п╩п╟я│я┌ п╪п╬п╤п╫п╬ п╦я│п©п╬п╩я▄п╥п╬п╡п╟я┌я▄ п©п╬п╡я┌п╬я─п╫п╬. п║ п╫п╦п╪ п╪п╬п╤п╫п╬
> п╪я▀я┌я▄ я─я┐п╨п╦, п©п╩п╟п╡п╟я┌я▄, п╪я▀я┌я▄ п©п╬п╪я┐п╢я┐ п╦ п©я─.
>
> п░п░п⌡
>
> 2016-07-19 10:31 GMT+03:00 SAGo <orthoforum на weborto.net>:
>
>> п╞ п╬я┤п╣п╫я▄ п╫п╣ п╩я▌п╠п╩я▌ "п╤п╣п╩п╣п╥п╬п╠п╣я┌п╬п╫п╫я▀п╣" я│я┌п╟п╫п╢п╟я─я┌я▀ п╡ п╪п╣п╢п╦я├п╦п╫п╣. п²п╬  п╨п╟п╨п╬п╧-я┌п╬
>> п╩п╬пЁп╦я┤п╫п╬ п╬п╠п╬я│п╫п╬п╡п╟п╫п╫п╬п╧ п╩п╦п╫п╦п╦ п╫п╟п╢п╬ п╡я│п╣-я┌п╟п╨п╦ п©я─п╦п╢п╣я─п╤п╦п╡п╟я┌я▄я│я▐. п÷п╬я█я┌п╬п╪я┐,
>> п╫п╟п©я─п╦п╪п╣я─.
>>
>> UpToDate
>> Extensor tendon injury of the distal interphalangeal joint (mallet finger)
>> Author: Rebecca Bassett, MD
>> Literature review current through: Jan 2016. | This topic last updated:
>> Sep 11, 2015.
>>
>> Acute mallet fingerБ─■  The goal of mallet finger treatment is to maximize
>> the function of the distal interphalangeal (DIP) joint while minimizing
>> discomfort. The majority of mallet fingers are amenable to treatment
>> with immobilization (ie, splinting), but some complex injuries warrant
>> surgical referral. (See 'Indications for referral' above.)
>> The general consensus among experts is that uncomplicated mallet finger
>> injuries without DIP joint subluxation are best treated with splinting.
>> The central slip of the proximal interphalangeal (PIP) joint prevents
>> excessive retraction of the damaged tendon, allowing close approximation
>> and healing of the torn tendon sections to occur with splinting [12].
>> Most experts immobilize the DIP joint in full extension or slight
>> hyperextension (5 to 15 degrees), while allowing full range of motion of
>> the PIP joint. Clinical experience and the results of one cadaveric
>> study that assessed the biomechanics of mallet finger injuries support
>> this approach [13,14]. Primary care and emergency clinicians should not
>> attempt to reduce any displaced fractures before splinting because any
>> reduction is unlikely to be maintained without surgery; mallet fingers
>> with associated fractures are referred.
>> An aluminum splint can be applied to either the palmar or dorsal surface
>> of the middle and distal phalanx (picture 3). If possible, the splint
>> should be bent slightly to stabilize the DIP joint in 5 to 10 degrees of
>> hyperextension. Hyperextension may be limited initially by swelling or
>> skin tightness. A stack splint may be used provided the splint is
>> sufficiently tight to prevent any DIP flexion (picture 4). Custom-made
>> perforated splints similar to stack splints can be made for fingers that
>> are difficult to fit and they provide better aeration. An Abouna splint
>> or metal ring splints are generally not used because of patient
>> discomfort.
>> Care should be taken to avoid direct, sustained pressure from the splint
>> on the area of the DIP joint. Excessive pressure or hyperextension can
>> cause skin necrosis. The Kleinert modified dorsal splint attempts to
>> avoid this complication by removing the middle third of the foam padding
>> from the splint, thereby eliminating all direct pressure at the injury
>> site (picture 5 and picture 6) [14].
>> In some instances, a swan neck deformity (indicating involvement of the
>> central slip) accompanies a mallet finger injury. In such cases, both
>> the DIP and the PIP joints should be immobilized in full extension [14].
>> Most cases heal well with splinting [10]. A swan neck deformity appears
>> as a hyperextended PIP joint and a flexed DIP joint (figure 3).
>> A systematic review identified only four randomized or quasi-randomized
>> placebo-controlled trials, involving a total of 278 patients that
>> compared treatments for mallet finger [6]. One trial included in the
>> review found no difference in outcomes or complications between
>> fractures treated with splinting versus surgery using wire fixation.
>> Two systematic reviews found insufficient evidence to determine the best
>> method for splinting a mallet finger, and the results of two subsequent
>> randomized trials are consistent with this conclusion [6,15]. One review
>> found fewer skin complications with custom orthosis versus prefabricated
>> orthosis, but no differences in treatment success, failure, or extensor
>> lag [15]. In a randomized trial involving 116 mallet fingers, patients
>> with custom-made splints had fewer treatment failures compared to those
>> with stack splints [16]. Improved outcomes in patients treated with
>> custom splints were noted in one other randomized trial of 64 patients
>> [17].
>> However, several trials have found that splint type does not affect
>> outcome. A randomized trial involving 60 patients reported that aluminum
>> splints fit better and caused fewer skin-related complications than
>> stack splints, but both splints were equally effective for enabling
>> tendon healing [18]. Another randomized trial of 77 patients reported no
>> significant difference in extensor lag or complications based upon the
>> type of splint selected [19]. We suggest selecting a splint based upon
>> patient comfort in order to maximize compliance, provided the splint is
>> sturdy and ensures adequate immobilization and proper positioning.
>> Follow-upБ─■  DIP joint extension splinting is performed for six to eight
>> weeks. The DIP joint MUST be maintained in full extension throughout the
>> entire period, including during sleep. Adherence to this instruction is
>> essential. The most common reason for treatment failure is
>> noncompliance. Whenever the splint is removed (eg, to clean the finger
>> or change the splint), the patient must support the distal fingertip in
>> full extension at all times. Should DIP joint extension be lost at any
>> point during the initial treatment period, the treatment clock is reset
>> and an additional six weeks of splinting must be performed. The patient
>> should be seen every one to two weeks to check on compliance and
>> complications.
>> After six to eight weeks of continuous extension splinting with the DIP
>> joint maintained in full extension, the joint is reexamined and active
>> extension assessed. If the patient is able to achieve full extension, an
>> additional two to four weeks of nighttime splinting is performed.
>> Splinting should be maintained for ALL athletic events for another six
>> weeks. If necessary, the foam padding of the aluminum splint may be
>> removed and the aluminum secured directly to the dorsum of the finger to
>> allow the returning athlete to fit the finger into a glove [12]. Active
>> range-of-motion exercises are encouraged in these patients to minimize
>> DIP stiffness.
>> If a significant extension lag (ie, volar angulation) persists following
>> the initial six weeks of splinting, the splint is reapplied for up to
>> six additional weeks [12]. As with the initial treatment period, the DIP
>> joint MUST be strictly maintained in full extension throughout the
>> second treatment period. The joint should be reexamined every two weeks
>> during this second treatment period. Once an acceptable outcome is
>> achieved, a night splint is used for two to four additional weeks.
>>
>> SAGo
>>
>>
>>
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