RESUMO
In the modern day cities, home treadmill usage is increasing. Toddlers are prone to a special injury by the treadmill, during workout the toddler tries to get on the belt and the roller action pulls the fingers under the belt and get caught between the belt and a ; metal rod under the machine and the belt scrapes the fingers. If untreated some of these injuries will lead to flexion contracture. The usual treatment is release of contracture and skin grafting, however, graft discoloration and recurrence of contracture are the complications of this method and the patients usually seek treatment for the brown discoloration of the grafts at a later age. In this study we assess the results of Z-plasty in combination with soft tissue distraction without skin grafting with long term usage of splint as an alternative treatment for these patients. In this retrograde descriptive cross-sectional study, we evaluated the patients presented with treadmill hand injuries between the years 2006 and 2011. Demographic data including age and sex in addition to other information including location of trauma, severity of trauma, time elapsed between the trauma and treatment, type of treatment including wound care and surgical method and treatment outcomes were assessed. A total of 8 patients [3 girls and 5 boys] following finger treadmill injury were assessed. 15 fingers in 7 patients had volar injury. The middle finger was the most commonly injured finger. In all patients a minimum of 2 fingers were injured and in just l patient 3 fingers were injured. In long-term follow-up all the patients had acceptable volar skin and complete ROM of the fingers. Due to discoloration of the skin graft and recurrence of contracture following skin graft as the sole treatment for the injury, application of Z-plasty with soft tissue distraction and long term splints seems to be a proper alternative treatment for these patients
RESUMO
Soft tissue distraction is an increasingly accepted treatment method in hand surgery which can be applied as a method of contracture release from elbow to proximal phalangeal joints. Common methods have been shown that contracture release alone is not enough and leads to recurrence after a while. Currently, joint and soft tissue distraction and holding them in a proper position in which physiotherapy can be done is the most accepted method. Herein we present a technique named "pentagonal frame" for soft tissue distraction which can help us in reaching the desired outcome. As a result of novelty of this technique and lack of enough data regarding its outcome, we would like to report its treatment results in this article. In this case series study, we report 33 patients that presented with soft tissue contracture in their hands. In this method, a thin 1-1.5 mm Kirschner wire was passed horizontally at the proximal head of the distal phalanx and bent like a frame around the finger, forming a pentagonal shape for anchorage and allowing limb traction without damage to pulp and soft tissues. Two forms of traction were performed: static [with a wire exerting pressure] or dynamic [using a rubber band to adjust the tension]. The wire or rubber band may be temporarily freed to commence active and passive physiotherapy. We maintained the frame for 3-6 weeks which played the role of night splint within final weeks. SPSS V.16 was used for data analysis. In this study, 33 patients [23 male, 10 female] with a mean age of 20.91 years [SD=13.05] were evaluated. The patients underwent surgery for a mean of 3 times. After the surgery and removing the frame, patients were followed up every 6 months for a maximum of 5 years. The difference between flexion contracture in PIP, before and after the surgery was statistically significant [65.15 +/- 37.44 vs. 7 +/- 4.74, p<0.001]. Except for one case of pin infection that was treated using antibiotic administration and its removal, no other major complications were encountered during the follow-up period [3-5 years]. The pentagonal frame with its effective traction on soft tissues and ligaments and additional physiotherapy may be used as an effective treatment for soft tissue adhesions. Moreover, it provides traction to the fingers and even the hand without complications on distal phalanx and joints and allows concurrent physiotherapy