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Background: Severe flexion contractures of proximal interphalangeal joint of fingers can significantly impair hand function, typically after burn injury recovery. Extensive surgical release exposes deep vital structures, which subsequently requires significant skin coverage. The author presents the results of using bilateral side-finger flaps (wing flaps) and full-thickness skin graft for coverage of the defects. Methods: Seven patients (8 fingers) with chronic severe flexion contractures of fingers resulting from burn injury were included. Results: Mean flexion contracture and full flexion angles of the joints were improved from 84.4°/93.7° to 4.7°/92.5° at the last follow-up visit. No major complications were observed during the postoperative follow-up period (range, 6–16 months). Conclusions: This alternative surgical technique can be successfully applied for the treatment of chronic severe flexion contractures of fingers. The advantages of this approach are the use of local flaps from injured digit, and that it can be performed as a one-session procedure.

Contracture involving flexor aspect of the fingers is one of the common sequelae encountered after burns, infection, and trauma. In the treatment of contractures, the surgeon is often challenged by the paucity of skin flaps to cover the joint area. It is then covered with skin grafts , leading to recurrence. When there is a large discrepancy between the required and the available length of skin, traditional Z-plasty techniques fail to overcome this deficiency of the skin. We employ 2 long skin flaps to cover the joint, using all the available skin around the contracture and leaving areas on the sides of the digit that are covered by full-thickness skin grafts.

Hand burns are frequently seen in children, often resulting in digital flexion contractures. Traditional split-thickness or full-thickness skin grafts leave notably different skin texture and hyperpigmentation. The purpose of this study was to describe our operation for treating digital flexion contractures with full-thickness plantar skin grafts, and to evaluate the appearance and function outcomes. Hematoxylin and eosin staining, Masson trichrome staining and Melan A (marker of melanocyte) staining were used to evaluate palmar skin, plantar skin, groin skin and burn scars. Full-thickness plantar skin grafts were performed between 2008 and 2015 in 24 hand burn patients with digital flexion contracture. The average age at the time of surgery was 39.3 months and the average follow-up period was 5.5 years. The functional and cosmetic results were assessed. Plantar skin shared similar attributes with palmar skin histologically. Both plantar skin and palmar skin did not express melan A. All of the skin grafts survived well without hematoma, infection and necrosis. The grafts resembled the adjacent normal skin in regards to appearance and texture. The average TAM (total active movement) degree for the fingers was improved from 152.3° to 238.5°. The average VSS (Vancouver Scar Scale) score decreased dramatically from 10.4 to 1.1. Twenty one of twenty four patients (21/24, 87.5%) were very satisfied with function and appearance, and three in twenty four (3/24, 12.5%) were somewhat satisfied. This study indicates that full-thickness plantar skin grafts can achieve a satisfactory appearance and good function for hand burn child patients with digital flexion contractures.

Arthrofibrosis, as a result of osteoarthritis, after trauma, or after knee surgery, can have significant implications for patient function, satisfaction, and outcomes. When extensive conservative management fails to achieve satisfactory results, surgical intervention may be necessary. Arthroscopic techniques to release anterior adhesions are often viewed as easier and safer than posterior releases required for flexion contractures. We present our technique of a safe, effective, and reproducible arthroscopic complete posterior capsulotomy.

Flexion contractures of the knee result from a variety of perpetual insults in end-stage arthritis. They cause inefficient ambulation and pose a number of challenges for the surgeon who is performing the total knee arthroplasty. The most important aspect of the procedure is establishing the posterior recess of the knee. We provide a grading system for flexion contracture, as well as an algorithm for correcting the deformity in the operating room. Surgery is the best time to obtain full extension, so the surgeon should not leave the operating room if full extension has not been achieved.

Surgeons and resident physicians in a clinic setting often visually estimate Dupuytren flexion contractures of the hand to follow disease progression and decide on management. No previous study has compared visual estimates with a standardized instrument to ensure measurement reliability.Consecutive patients consulted for Dupuytren flexion contractures of the hand had individual joint contractures estimated in degrees (°) by both a resident physician and staff surgeon. Estimates were compared with goniometer measurements to generate intraclass correlation coefficients (ICCs), and residents and surgeons were compared based on their accuracy.Twenty-eight patients enrolled in this study, which provided a total of 80 hand joints for analysis. Resident physicians achieved an ICC of 0.42, which indicates poor reliability. The hand surgeon achieved an ICC of 0.86, which indicates high reliability. The surgeon also had better accuracy than the residents.Hand surgeons should be mindful of the limitations of visual estimates of Dupuytren flexion contractures, particularly when conducted by trainees. Joint angle measurements taken for the purposes of research should be done with a goniometer at minimum.Les chirurgiens et les résidents en milieu clinique font souvent une évaluation visuelle des contractures de Dupuytren pour suivre l’évolution de la maladie et prendre des décisions thérapeutiques. Aucune étude n’a comparé les évaluations visuelles à un instrument standardisé pour garantir la fiabilité de la mesure.Des patients consécutifs qui avaient consulté en raison de contractures de Dupuytren avaient des contractures articulaires individuelles qu’un résident et un plasticien ont évaluées en degrés. Les auteurs ont ensuite comparé les résultats à des mesures goniométriques pour produire des coefficients de corrélation intraclasse (CCI), puis ont comparé la précision des résidents à celle des plasticiens.Vingt-huit patients ont participé à l’étude, pour un total de 80 articulations de la main pouvant être analysées. Les résidents ont obtenu un CCI de 0,42, ce qui fait foi d’une faible fiabilité. Le plasticien de la main a obtenu un CCI de 0,86, ce qui est indicateur d’une fiabilité élevée. Les résultats du plasticien étaient également plus précis que ceux des résidents.Les plasticiens de la main devraient être conscients des limites des évaluations visuelles des contractures de Dupuytren, particulièrement lorsqu’elles sont effectuées par des stagiaires. À tout le moins, il faudrait utiliser un goniomètre pour effectuer les mesures d’angle des articulations obtenues aux fins de la recherche.

In cases of chronic distal biceps ruptures, the combination of muscle atrophy, distal tendon retraction, and fibrosis makes primary anatomic reattachment of the tendon particularly challenging. To regain tendon length and avoid flexion contractures, reconstruction with graft augmentation has been proposed as an alternative for cases not amenable to primary repair. We describe our technique using an Achilles allograft through a modified Henry approach to reconstruct the distal biceps tendon to regain length as well as restore flexion and supination strength. With proper and detailed exposure, chronic distal biceps injuries can be reconstructed safely and efficaciously using an Achilles allograft.

Isolated adrenocorticotropic hormone deficiency (IAD) is a rare disorder with diverse clinical presentations. A 79-year-old man was bedridden for six months due to flexion contractures of the bilateral hips and knees, along with hyponatremia. He was diagnosed with IAD based on the results of endocrine tests. After one month of corticosteroid replacement, he recovered and was able to stand up by himself. Although flexion contracture is a rare symptom of IAD, steroid replacement therapy may be effective, even for seemingly irreversibly bedridden elderly patients. In bedridden elderly patients with flexion contractures, we should consider and look for any signs of adrenal insufficiency.

Case: Knee flexion contractures are difficult to treat effectively. We present the case of a ten-year-old boy with a flexion contracture due to a hypertrophied ligamentum mucosum treated with an arthroscopic posterior capsular release. The patient obtained full extension and maintained it at the time of final follow-up. Conclusion: This case represents a unique cause of an impinging ligamentum mucosum and provides anecdotal support to the concept of an arthroscopic posterior capsular release as a safe and effective option for flexion contractures.

Background: A post-burn flexion contracture of the knee joint is a disabling condition which interferes with an upright posture and a bipedal locomotion. Islanded perforator flaps have been used to resurface the tissue defect which is produced as a result of the contracture release. Despite their various advantages, they are limited by an increased tendency to undergo venous congestion. Perforator-plus flaps can be used to overcome this limitation, while retaining the merits of the islanded perforator flaps. Methods: Ninteen patients with post flame burn flexion contrac tures of the knee joints underwent surgical releases and coverages by various local fasciocutaneous perforator-plus flaps. The patients were followed up for 6 months and the various aspects of the functional and the aesthetic rehabilitations were assessed. Results: All the local fasciocutaneous perforator-plus flaps resurfaced the tissue defect over popliteal fossa with good colour and texture match and maintenance of the contour. None of the flaps had any significant early or delayed complications (which included venous congestions) which necessitated reoperations. All the patients were satisfied with the functional and aesthetic outcomes. Conclusion: Local fasciocutaneous perforator-plus flaps can be considered as one of the primary treatment modalities for the surgical release and reconstruction of post burn flexion contractures of the knee.

Post-traumatic or postsurgical flexion contractures of the knee can significantly limit function and lead to gait abnormalities. In this setting, interventions to regain full extension may include bracing, physical therapy, and open or arthroscopic surgery. Open surgical approaches to restore full motion often demand extensive recovery and promote further adhesions and loss of motion, which has led to the advent of arthroscopic techniques to address these pathologies. We present a safe, effective, and reproducible arthroscopic technique for posteromedial capsular release to address knee flexion contractures.

Background Severe knee flexion contractures greater than 80° are rare and challenging to manage. Previous studies have demonstrated unsatisfactory clinical results after correcting these deformities because residual flexion contractures were not corrected within a short period of time. We herein report the case of a patient with adult-onset Still’s disease with 90° of bilateral knee flexion contracture, which was successfully corrected by total knee arthroplasty and serial casting over a period of five weeks. Case presentation A 47-year-old male was admitted to our orthopedic department for bilateral knee pain and a preoperative fixed flexion contracture of 90°. A diagnosis of adult-onset Still’s disease was made based on the patient’s medical history of a high spiking fever, salmon-colored rash and bilateral knee and wrist pain. Bilateral total knee arthroplasty was carried out to address these deformities, but residual flexion contracture was present. Subsequently, serial casting was used to achieve full extension at four weeks after surgery. Excellent function and patient satisfaction were observed at two years of follow-up. Conclusion The new protocol of total knee arthroplasty with subsequent serial casting seems to be an efficient solution for knee flexion contractures greater than 80°. This report adds to the very small number of reported cases of adult-onset Still’s disease with severe knee flexion contractures and describes a patient who was successfully treated with a new protocol.

In order to release and cover defects in burn contractures over joints, several surgical procedures have been proposed. Skin grafting is easy to do, but it requires immobilization, and tends to contract again, different types of flaps without skin grafting are alternatives. These flaps have their specific indications, limitations and some disadvantages such as a bulky, unattractive appearance in donor or recipient sites, partial necrosis, and sometimes patients dissatisfaction. Considering these points, the authors proposed a new technique composed of a Y-V advancement in the middle and two scar releases proximal and distal to the joint which were covered with full thickness skin grafts. This seems to have some advantages in both case of technique and more patients satisfaction. In the current study, the authors presented their results with different methods of treatment, which they performed for burn flexion contractures in limbs. Ninety-one operations were performed in 74 patients, the method of reconstruction included skin grafting in 43 contractures, local flaps in 16, pediculated flaps in 11, and the new combined approach in 21 cases. Width of scar was one of the main factors for selection of choice option. This proposed technique is especially appropriate for scars which cover 10-60% of joint surface area. Advantages of this combined technique are coverage of joint area with a pretty normal skin flap, and enough scar lengthening due to combination of Y-V advancement and skin grafted released areas.

Burn contractures of the extremities present a clinical challenge. Flexion contractures are more common than extension contractures. The first component of treatment is adequate contracture release. A number of different methods are available for resurfacing the wound and these are reviewed. An algorithm is presented which permits a simple approach to managing burn scar contracture of the extremities.

Background Burns of the hand cause not only the impairment of hand function but also cosmetic deformity. Cases with dysfunctional hands with severe contractures increase if rehabilitation of the acutely burned hand is not done properly. Purpose We present the use of free dorsoulnar perforator flap in the treatment of postburn contractures as an alternative when local flaps cannot be used. Methods Free dorsoulnar perforator flap was used in the treatment of seven hands with postburn contracture. Five of them had multiple digital postburn flexion contractures. Combined use of cross-finger and side finger transposition flaps was preferred when the adjacent finger was suitable for being cross-finger flap donor. When the adjacent finger was not suitable for being cross-finger flap donor, the free dorsoulnar perforator flap was preferred. Two of the patients had postburn web contractures. Free dorsoulnar perforator flap was used to release the web and to form a new web commissure. Conclusion The free dorsoulnar perforator flap could be a good alternative to cover the defects created with the hand contracture release.

Background: In the present study, the authors combined use of the cross-finger flap and the side-finger transposition flap to cover the skin and soft-tissue defect created by contracture release of severely contracted fingers. Methods: Eight patients having Stern type III flexion contractures of the proximal interphalangeal joints were included. The cause of injury was burn in six patients and trauma in two patients. The average follow-up period was 11.6 months. Results: All operations were successful. Lack of extension of the proximal inter-phalangeal joint was improved by approximately 81.2 degrees for all digits. Conclusion: Stern type III contracture of the proximal interphalangeal joint can be released by transverse incision and ample resection of scarred tissue, and the resulting palmar skin defect that cannot be covered by using the finger's own flaps or cross-finger flap can be covered by combined use of cross-finger and side-finger transposition flaps.

A random-pattern cutaneous flap with its base at the highly vascularized dorsal web space has been designed to decrease donor site deformity and to increase securely flap mobilization in contractures involving more than 1 adjacent proximal phalanx base. Rectangular flaps facing each other on the lateral sides of adjacent fingers have been raised on a single pedicle in the second, third, or fourth web space. The anatomic integrity of the web space was maintained and exposure of the metacarpophalangeal joints was avoided. Flap donor sites were reconstructed with full-thickness skin grafts. Since September 2000, 22 flaps were raised during a single-stage operation in 13 patients with an average age of 11 years at the time of surgery, and a total of 38 fingers have been reconstructed. The follow-up period averaged 24 months. The postoperative course was uneventful for all patients; all the flaps survived and the donor sites healed without complications. This flap, with its wide arc of rotation and minimal donor site morbidity, is easy to perform and is a good alternative in the reconstruction of multiple proximal phalanx base region flexion contractures of adjacent second, third, fourth, or fifth fingers.

The most frequent cause of flexion contracture is immobilization, which may occur with or without trauma. Posttraumatic flexion contracture mainly develops from direct injury, intraarticular fluid and the physiological muscle balance. Nontraumatic post-immobilisation stiffness is due to biochemical and biomechanic changes as well as processes, which are determined by the metabolic activities of tissue and the lack of stress. Because of the variable and the changing anatomical substrates, and owing to different prognostic factors, it is necessary to subdivide the group of flexion contractures with regard to their prognostic factors. Thus, we recommend to differentiate between simple periarticular contractures, complex periarticular contractures with tenodesis and/or contractures caused by scars, as well as a corresponding classification of corresponding treatment procedures. The results in the literature will then be categorized accordingly within a metaanalysis. With regard to the reduction of flexion contractures and the range of motion, the group of simple periarticular arthrolysis shows better results than the group of complex periarticular arthrolysis. The mediolateral approach is preferred in the first group.

Volar contractures of the fingers are the commonest sequel to burns of the hands. These have been treated by using various basic techniques of Plastic Surgery. Recently, a combination of these techniques has been used for improving the results more. In the study, two well-known techniques, Y-V advancement and Z-plasty, were combined to improve release of linear flexion contractures of the fingers, including thumbs. Its mathematical representation is presented. Ninety-eight PIP joints (IP for thumb) of 37 patients were treated with this technique and their results were followed-up for about 8 months. The gains were greater using the combined technique than for the usage of either alone. It was concluded that this model could serve as one of the effective combinations of the basic techniques in the treatment of volar finger contractures.

The authors present a surgical method of releasing postburn flexion contracture of the finger by two separate transverse incisions and covering the skin defects by transposing two random-pattern flaps from both sides of the finger. One of the proximally based flaps was transposed from one side of the proximal phalanx and the other flap was transposed from the opposite side of the middle phalanx. Because the flaps were raised from different sides of different phalanxes, the donor sites were closed primarily. A total of 37 fingers (14 hands, 11 patients) were treated with this method. The patients were all men aged 20 to 24 years old. The mean follow-up period was 9 months. The lack of extension of the proximal interphalangeal joints of the fingers was improved by approximately 45 deg using the described method. The authors conclude that this method can be used effectively in the treatment of mild to moderate postburn flexion contractures of the fingers.

RATIONALE Palmoplantar keratoderma (PPK) is a genetically heterogeneous group of skin diseases, which is characterized by erythema and hyperkeratosis. Mal de Meleda (MDM) is a rare type of PPK with an estimated prevalence in the general population of 1 in 100,000. PATIENT CONCERNS In this study, we report a MDM patient with severe lesion in skin and flexion contractures of fingers and toes. DIAGNOSES MDM was diagnosed based on clinical manifestations and gene test. INTERVENTIONS This patient was treated with oral acitretin and topical tazarotene. OUTCOMES Physical examinations indicated that the hyperkeratosis was in remission, but the erythema was expanding to her elbows progressively. Due to the adverse events (e.g., dry eyes and lips), the patient stopped taking the oral drug. LESSONS MDM is a rare subtype of PPK, which is inherited in an autosomal recessive pattern and has characteristics that skin lesions on hands and feet appear soon after birth and develop progressively. MDM can lead to severe flexion contractures in some cases. The reliable method for the diagnosis of MDM is gene test.

A retrospective review of severe flexion contractures (60° or more), involving 51 proximal interphalangeal joints in 40 patients with Dupuytren's disease, was performed. Thirty-two joints underwent aponeurectomy alone, 19 joints additional capsuloligamentous release. Mean follow-up was 12 months. No statistically significant difference was seen in the percentage of contracture correction in the capsulotomy group compared with the noncapsulotomy group.

In burn patients, scar contractures adjacent to or across the joints lead to disabling deformities. In Dupuytren's disease, the proliferative process involves the fascia of the palm and fingers, resulting in disabling flexion contractures of the fingers and the palm. A single insult involving the hand or even a more proximal injury may lead to Dupuytren's disease.

A 33-year-old man consulted for gingival hyperplasia (figure 1A) with extensive nodular lesions of progressive appearance over 20 years. They measured 5 to 10 cm, coalesced into violaceous plaques with ill-defined borders and were very indurated on palpation. They were predominantly located on the palms and were accompanied by flexion contractures of the first and fifth fingers (figure 1B). Similar lesions were symmetrically distributed on the inner aspect of the feet and heel pads (figure 1C). [...]

Suprapubic bladder aspiration is a rarely used technique for obtaining urine samples in the adult Emergency Department (ED). We report a case of an elderly woman in whom suprapubic aspiration (SPA) was safely performed using bedside ultrasound guidance. More conventional urine collection methods were precluded by the constraint on positioning imposed by the patient’s flexion contractures. Ultrasound-guided SPA is a safe technique, that probably should be employed more frequently in the adult ED.

Recently we have extended the use of the V-Y advancement flap for the purposes of releasing flexion contractures of finger joints, improving the appearance of congenitally anomalous fingers and repairing segmental skin defects in fingers, with gratifying results.

The psychoflexed hand is a rare clinical condition characterized by fixed finger contractures undetermined by organic etiology, often associated with a psychiatric pathology. We report a series of 20 patients (nine males and 11 females, mean aged 56.2 years). We have introduced a new classification of the various possible patterns of finger deformities: 1) Type 1: prevalent flexion contracture at the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the last two or three fingers; the thumb and the index are not affected; 2) type 2: prevalent flexion contracture at the PIP and distal interphalangeal (DIP) joints of the last two or three fingers; 3) type 3: flexion contracture of all the long fingers; 4) type 4: flexion contracture of all the fingers of the hand, including the thumb (clenched fist syndrome); 5) type 5: isolated flexus-adductus thumb (the long fingers are not affected); 6) type 6: flexion of digits associated with flexion contractures of other joints of the upper extremity. The treatment was conservative in 14 patients with recent deformities and surgical in six patients. Both forms of treatment were followed by a rigorous rehabilitation program, mostly based on home self-rehabilitation. The correction of the deformities was obtained in all cases and maintained over time.

A method of treatment of chronic flexion contractures of the PIP joint is presented, with the results obtained in 19 patients treated between 1989 and 1992 after a follow-up of from 6 to 53 months. The flexion contractures, with an extension deficit which ranged between 70 and 90°, had been present for a period of between 2 months and 24 years. Our treatment program involves the surgical release of the unreducible PIP joint followed by the use of static and/or dynamic splints. Surgery is performed using a midlateral approach; the accessory collateral ligament and the flexor sheath are incised and, after the volar plate and check-rein ligaments have been excised, forced hyperextension is applied. The main collateral ligaments are carefully spared and freed from the condyle if there are any remaining adhesions. In our 19 patients, complete extension of the finger was achieved in 11 cases (57.9%); in the remaining 8 cases (42.1%) the residual extension deficit ranges from 10 to 15°. In our experience this combined surgical and rehabilitative approach had led to consistently good results with minimal complications.

Summary Although catastrophic vascular complications in vascular Ehlers–Danlos Syndrome (EDS) are well recognized, other complications such as flexion contractures and tendon nodules are rarely reported and poorly characterized. We report a young man with vascular EDS, who developed flexion contractures and tendon nodules, causing considerable disability. Limited management strategies are available for these complications, which have continued to prove a challenge to management.

Closed traumatic flexor injuries of the hand involving the pulley mechanism are a relatively common injury seen in rock climbers but are very rare in nonclimbers, including bowlers. The injury was first described in 1990. Since then, several studies have shed more light on the diagnostic and therapeutic considerations. Early diagnosis of pulley injuries is crucial since delayed diagnosis can lead to limited range of motion, particularly at the proximal interphalangeal joint. Flexion contractures at the proximal interphalangeal joint have also been cited in the literature. We discuss a case of pulley injury in a bowler and briefly review the anatomy of the pulley architecture, mechanism of injury, imaging manifestations, and clinical management of this injury.

Sheehan’s syndrome (SS) is postpartum hypopituitarism caused by necrosis of the pituitary gland following severe obstetric hemorrhage [1]. Advances in obstetric care have greatly reduced the frequency of SS, particularly in developed countries. The syndrome generally initially manifests as lactation failure, followed by failure to resume menses, and genital hair loss [2]. Herein, we report a rare case of SS presenting with flexion contractures of the legs 20 years after delivery. Consent for the publication of this case was obtained from the patient.

Over a 2-year period, 29 patients were identified that had preoperative flexion contractures less than 30 degrees and were not fully corrected to neutral following total knee arthroplasty. They were followed after surgery at 3, 6, and 12 months, and yearly thereafter with complete clinical and roentgenographic examinations to determine the natural history of the flexion contracture and its effect on the clinical outcome. The mean age of the 10 women and 19 men was 66 years (range, 47-80 years). The mean preoperative flexion contracture was 11 degrees (range, 5 degrees-30 degrees). The mean follow-up period was 33 months (range, 24-60 months). The mean values of the flexion contractures at each follow-up period were; immediately after surgery, 10.5 degrees; at 3 months, 5 degrees; at 6 months, 2 degrees; at 12 months, 1 degree; and at 24 months, 1 degree (P < .0001). Resolution of the flexion contracture did not vary between patients under and over the age of 65 years. There was no statistically significant difference in the residual flexion contracture when knees with preoperative contractures from 0 degrees to 14 degrees and 15 degrees to 30 degrees were compared. The clinical outcome was not affected by the residual flexion contracture after 6 months of follow-up evaluations. Significant improvements can occur after surgery with rehabilitation, and it appears that complete intraoperative correction is not necessary. There appears to be no difference in the natural history of flexion contractures with regard to age or severity up to 30 degrees.

Nine patients are described with closed traumatic rupture of the digital flexor pulley system. All presented with significant flexion contractures of the proximal interphalangeal joint and bow-stringing of the flexor tendons. In seven patients, the pathology was verified at surgery and pulley reconstruction provided a good result. The diagnoses in the other patients, treated conservatively, were verified by tenogram and magnetic resonance imaging.

Twenty-seven chronic flexion contractures of the proximal interphalangeal joint were treated with the Compass((R)) hinge external fixator without open surgery. The fixator was removed after a mean of 33 (range, 14-68) days. The mean time from injury to operation was 4 (range, 1-19) years and all patients were reviewed at a mean follow-up of 21 (range, 12-50) months. The mean extension gain was 38 degrees (range, 0-70 degrees), and the mean flexion-extension arc improved by 42 degrees (range, 0-80 degrees). Complications included superficial pin-track infection in 11 cases and pin loosening in four cases.

Post-surgical outcomes in patients with Dupuytren’s disease causing flexion contractures of the proximal interphalangeal joint can be inconsistent and are often associated with protracted rehabilitation, reduced flexion, recurrence of the contracture, and patient dissatisfaction. An alternative treatment option, comprised of splinting and soft tissue mobilization techniques, was introduced to stabilize early contractures of the proximal interphalangeal joint in the hopes of delaying or obviating surgery. Over the course of approximately 12.6 months (±7.8), thirteen patients were followed at the hand clinic at Hotel Dieu Hospital in Kingston. One patient was unable to complete the course of therapy. Of the remaining patients, analysis showed significant improvement in active proximal interphalangeal joint extension of approximately 14.6° (SD: ±5.1°; range: 5–25°) over the course of the treatment ( p

In early 2010, collagenase clostridium histolyticum (CCH) injection(s), 0.58 mg, was approved by the US Food and Drug Administration for the treatment of Dupuytren contracture in adults with a palpable cord. Following injection cord rupture 24 h later was accomplished by finger manipulation in extension. Subsequently, regulatory agencies around the world also approved this treatment method as safe and effective. This study was conducted to evaluate the safety and efficacy of concurrent administration of two collagenase clostridium histolyticum (CCH) injections (each 0.58 mg) into cords in the same hand to concurrently treat two joints with Dupuytren fixed flexion contractures (FFC) with palpable cords.

Congenital syndactyly is one of the most common congenital hand differences and various methods of surgical treatment have been described since the 19th century. Nevertheless, unsatisfactory results including web creep, flexion contractures, and rotational deformities of the fingers are still reported. This study presents the outcome of syndactyly release in 131 webs in 78 patients. The sex ratio was 40 males/38 females. The age ranged from 4 months to 22 years (average: 4 y). In the majority of the webs the result was good or excellent. The type of flaps used for the reconstruction of the web was important as the combination of a dorsal rectangular and 2 volar triangular flaps gave superior results than the use of 2 triangular flaps. The less rewarding overall outcome was obtained in the presence of associated differences of the involved fingers, that is, complex complicated syndactyly and in the cases of delayed correction. Use of a dorsal rectangular flap in combination with 2 volar triangular flaps and use of full thickness skin grafts, ensure a satisfactory outcome and minimize the number of operations per web.

We report the case of a 55-year-old male with flexion contractures of the hips and the knees due to an isolated adrenocorticotropin (ACTH) deficiency, a rare cause of secondary adrenal insufficiency. The presenting symptoms and signs, the laboratory investigations and the treatment are described. The case description is followed by a brief overview of ACTH deficiency and its symptoms and causes. Our case is then compared with other case reports available in the literature. The aetiology of the flexion contractures in adrenal insufficiency is still unclear. The authors want to draw attention to adrenal insufficiency as the cause of unexplained flexion contractures.

Thirty-four patients with ipsilateral fractures of the femur and tibia with intraarticular extension into the knee of at least one fracture were reviewed at an average follow-up of 38 months. Joint involvement was present in 22 (65%) femoral fractures and 23 (68%) tibial fractures. In 11 (32%) patients, both fractures were intraarticular. In 71% of the patients, there were major associated injuries. Open fractures were common, occurring in 21 (62%) extremities. Associated vascular injuries were seen in seven (21%) cases. Ninety percent of the fractures were surgically stabilized. The average time to healing was 39 and 37.5 weeks for the femur and tibia, respectively. The average flexion of the knee was 96 degrees (5-140 degrees) with flexion contractures occurring in five (15%) knees. Results were graded according to criteria established by Karlstrom and Olerud. Only eight (24%) patients had good or excellent results. Complications were frequent, with deep infections occurring in 11 (32%) extremities, leading to above-knee amputations in three (9%) patients. This subgroup of floating knee injuries appears to be associated with a higher degree of systemic trauma, a higher percentage of open injuries, and a much graver prognosis.

The purpose of this article is to report the use of the 5-flap Z plasty in the management of long-standing flexion contractures of the proximal interphalangeal joint of the digits (the 5-flap Z plasty has been originally described by Hirshowitz et al for the lengthening of thumb web contractures). Nine fingers in 5 patients with Stern grade I and II contractures of the proximal interphalangeal joint were included. The defect following release of the contracture was covered with the 5-flap Z plasty and Kirschner wires temporarily maintained the corrected position. The extension lag was measured preoperatively and postoperatively. The preoperative extension lag ranged from 20 to 60 degrees (mean: 43.3 degrees). The improvement in extension lag ranged from 15 to 60 degrees (mean: 40.5 degrees). Minimal complications were encountered. The technique described is useful in the management of Stern grade I and II digital contracture.

Generally in patients that show a contracture in the flexion of the finger flexor apparatus, but also have a good perception, positioning, and sensibility of the hand [1]. Volkmann’s ischemic contractures, flexion contractures in cerebral palsy [2].

Many factors play a role in causing a flexion contracture associated with TKA. The final goal of correction is to achieve and maintain a contracture that is15 degrees. Contractures between 10 degrees and 15 degrees may still be symptomatic, and thoseor = 10 degrees are rarely a problem. Perioperative and intraoperative treatment measures exist to alleviate flexion contractures. Intraoperative correction determines the final result in most cases, except in inflammatory cases where the preoperative contracture is40 degrees. In these cases, under anesthesia the preoperative contracture need only be corrected to within one-third of its initial amount, and the remainder will usually resolve with postoperative physical therapy and serial casting or splinting.

Neonatal Marfan syndrome (MFS) is a severe form of classic MFS caused by mutations in a specific region of the fibrillin 1 gene (FBN1). We report a case of an infant with neonatal MFS who presented with flexion contractures in utero and severe skeletal and cardiovascular manifestations at birth. A novel de novo missense mutation in exon 26 of FBN1 was demonstrated. Because of potential new therapies, it is increasingly important to recognize neonatal MFS in utero as well as shortly after birth to initiate the appropriate diagnostic work-up and management.

Contains fulltext : 71448.pdf (Publisher’s version ) (Closed access) Over the last 6 years, a health care program aimed at the surgical correction of postburn contractures has taken place in Faridpur, Bangladesh. People in this rural region are very poor and often cannot afford medical treatment. Often secondary flexion contractures of the face and chin as well as the upper and lower extremity impede daily functioning and have an enormous psycho-social impact. The application of basic plastic surgical principles such as local transposition of skin flaps as well as skin grafts restores function dramatically and results in stable skin cover. It is quite challenging - both for the surgeon and the anaesthesiologist - to perform these operations within a rather limited infrastructure. In Bangladesh, there is a monumental need for correction of postburn contractures for the social needs of the patient as well as for functional purposes. Future actions should be directed to the training of surgeons and the development of specialized hospitals to demonstrate social as well as political commitment to health care programs.

The goal of knee arthroplasty is to relieve pain and normalize range of motion while providing stability through the gait cycle. Postoperative, significant (>15°) flexion contractures can cause persistent pain and altered gait mechanics. This study evaluated the efficacy of revision surgery for painful flexion contractures. Of the 14 patients included in the study, 10 had complete resolution of their flexion contracture. There was significant improvement in extension (P < .0001), flexion (P=.002), and total arc of motion (P < .0001). Knee Society (KSS) pain scores improved significantly (P < .001), whereas KSS function scores did not significantly improve (P = .66). Revision surgery for symptomatic flexion contractures can improve range of motion and diminish pain. The best form of treatment is avoidance through careful flexion and extension gap balancing during primary surgery.

Arthrogryposis multiplex congenita is a syndrome characterized by the presence of congenital contractures involving multiple joints usually with flexion deformities, with or without pterygia or webbing at the joints. The aim of this case report was to highlight the challenges of management of severe knee contractures in AMC and possible solutions in a resource limited setting like ours. We presented a one-year-old child with bilateral severe knee contractures secondary to arthrogryposes. The involvement of knee is present in about 70% of cases with arthrogryposis, with flexion deformity more common than extension deformity. Knee flexion contractures, as seen in our patient, is one of the most disabling deformities. The surgical option adopted in the case presentedwere met with various challenges including abnormal muscles insertions, shortening and fibosis of the muscles, abnormal position and shortening of the neurovascular structures in the popliteal fossa.