Orteses: um importante recurso no tratamento da mao em garra movel de hansenianos / The helpful use of splints in the rehabilitation of flexible claw hand in leprosy

A utilizaçäo das órteses como um recurso da reabilitaçäo da mäo se baseou no estudo comparativo entre dois tipos de órteses dinâmicas, a confeccionada em couro e a confeccionada em material termoplástico, para correçäo da garra móvel, através da goniometria ativa de extensäo das articulações interfalângicas procimais (IFP). A amostra do estudo foi constituída de 30 hansenianos portadores de garra móvel, ulnar ou ulno-mediana em uma das mäos, de ambos os sexos e com idade entre 20 a 81 anos. A comparaçäo foi realizada pela medida da goniometria sem a órtese e fazendo uso de cada uma delas. Os resultados foram analisados estatísticamente através do teste de Wilcoxon com á=0,005. Ambas as órteses melhoraram o padräo de garra e obteve-se uma correçäo mediana de 85,5 por cento com a órtese de termoplático de 53 por cento com a de couro.

Artoplastia fascial del trapecio del carpo, para tratamiento de la artrosis metacarpofalángica del pulgar: indicaciones y revisión de 14 pacientes / Carpo-metacarpal arthroplasty of the thumb, by sustitution of the trapezium with fascia, for treatment of degenerative arthritis. A serie of 14 patients

Los procesos degenerativos de la articulación basal del pulgar ocasionan problemas funcionales en un gran número de personas. Se presenta una revisión de 14 pacientes con 15 pulgares operados en que se realizó artroplastia de interposición con fascia para tratar la panartrisis del trapecio. Los resultados fueron calificados con base en la fuerza, estabilidad, movilidad y dolor en el pulgar. De los 15 pulgares, 12 tuvieron un resultado excelente y tres, bueno. La artroplastia fascial es una alternativa de tratamiento para estos pacientes, ya que se logra un pulgar estable, fuerte e indoloro, sin los inconvenientes de las artroplastias sintéticas.

Management of long standing post burn deformities of hand.

A study of 50 cases of long standing post burn deformities of hand in respect to their type of deformities, their operative correction, reconstruction and subsequent recovery had been carried out during the period from January 1979 to May 1986. Contractures were mainly due to shortage of skin and soft tissue; joint deformities developed secondary to that. Purpose of this study was to provide the patient with a good functioning hand. Of them 19 cases required skin grafting and 31 cases required different types of skin flap like groin flap in 13, abdominal flap in 12 and transposition flap in 3,Z-plasty in 2 and buttock flap in one case for resurfacing the raw area which was created following release of contracture of skin and soft tissue. Six patients required capsulotomy and collateral ligament excision, 2 required excision arthroplasty and one patient required excision of lower end of ulna along with a flap cover. Deformities corrected at an earlier date showed better functional recovery than those which were treated at a much later date. In this series, 3 children required secondary correction of their contracted flap due to their growing age, 3 adult patients developed contracture to the grafted skin for not using splint or having any physiotherapy, 2 patients had little extension deformities even after correction flap cover of hyperextension deformity, 2 patients with excision arthroplasty had weak grip and 3 patients were not followed up. Rest had good results. Extensive physiotherapy, proper splinting and regular follow-up at least for 3 to 5 years after operation are the secrets of better functional recovery.