The 2004 Annual Meeting (January 14-20, 2004) of OASYS_NEW

Not yet assigned to a slot - 2:40 AM

Clinicoradiological Classification for Posttraumatic First Web Space Contracture: A Usuful Guide for Management

Jain V1, Wei F2, Lin CH3, Huang WC3, and Lin YT3. (1) Orthopaedics, Lewisham University Hospital, 75 Imperial Road, Gillingham, Kent, United Kingdom, (2) Plastic Surgery, Chang Gung Memorial Hospital, 5, Fu-Shing Street, Kuei-Shan, Taoyuan, Taiwan, (3) Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 199, Tung Hwa North Road, Taipei, Taiwan

SUMMARY:

This classification of posttraumatic first web space contracture better reflects its severity, indicates tissues involved and provides management guide. It consists of two clinical and a radiological parameter. For severe contractures, we prefer soft tissue release and ipsilateral lateral arm free flap reconstruction.

INTRODUCTION

First web contributes to width of palm and allows full thumb abduction; its contractures restrict thumb movements (1,2). In this classification, the clinical parameters are angle between thumb and index rays in maximal palmar and in maximal radial abduction, normal values 90o and 100o respectively (1,2). The radiological parameter is angle between first and second metacarpals, with normal value 40- 45o (3). Contractures are then graded.

TABLE :

GRADE I GRADE II GRADE III

SKELETAL ANGLE > 30 o 15-30 <15 o PALMAR ABDUCTION >60 o 30-60 <30 o RADIAL ABDUCTION >60 o 30-60 <30 o

Grade I contractures can be managed by local procedures such as z-plasty. Grades II contractures need adequate soft tissue release followed by either a pedicled or ideally free flap. Grade III contracture requires extensive soft tissue and basal joint release followed by free flap coverage.

MATERIALS, METHODS AND RESULTS

Fifty two patients having grade II and III post traumatic contracture were managed using ipsilateral lateral arm free flap following soft tissue release. Flap survival was 98 %, the failed flap was reconstructed with free groin flap. Follow up at average 66 months revealed radial abduction at least 75 o and palmar abduction of 70 o in all cases.

DISCUSSION

This classification is uncomplicated, reproducible and provides relevant clinical informations. For severe grades, skin grafts and local flaps are not indicated. Ipsilateral lateral arm free flap has a number of advantages.

CONCLUSION

This classification offers better practical assessment as well as guidelines to the management.

REFERENCES 1.Jensen CB, Ghazi M R, Davidson R. First web space contracture and hand function. J Hand Surg: 18 A :516 - 20, 1993. 2.Bhattacharya S, Pandey S D, Chandra R et al. Documentation of the first web space angle. J Hand Surg ; 14 B : 298 - 300, 1989. 3.Caroli A, and Zansi S. First web space reconstruction by Caroli`s technique in congenital hand deformities with severe thumb ray adduction. Br J Plast Surg ; 42 : 653 - 659, 1989. .


Back to Concurrent Scientific Paper Session A-1
Back to American Association for Hand Surgery

Back to The 2004 Annual Meeting (January 14-20, 2004)