Fractional Tendon Lengthening and Swanson Silastic Metacarpophalangeal Joint Replacement (Wright Medical) for Spasticity surgical technique
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The following procedure demonstrates the application of the Swanson silastic joint arthroplasty in the treatment of a longstanding, fixed flexion, MCPJ contracture resulting from spasticity. These implants have a well established role in the surgical treatment of the rheumatoid hand but they remain a versatile implant with a wider range of useful indications.
The adult spastic hand commonly results from traumatic brain injury or anoxic insult resulting in an upper motor neurone lesion.
In mild cases this may result in loss of dexterity or coordination. In severe cases, spasticity within extrinsic and/or intrinsic muscle groups results in contractures of the wrist or digits. The most severe contractures present with a clasped hand, fixed skeletal deformities and joint subluxation. They are often associated with poor hygiene and an associated risk of skin breakdown.
The management of this unique group of patients requires a careful evaluation of the factors driving the deformity, the potential reversibility of each, and any residual function that may be expected. An understanding of the patients specific expectations is central to a satisfactory outcome.
The surgical technique demonstrated here is only one possible technique, and was very much tailored to the unique nursing and functional needs of this particular patient. There is clearly great variation between patients with spasticity affecting hand function.
The implants used in this case are the Swanson small finger joints manufactured by Wright Medical.
Author: Mr Tahseen Chaudhry (FRCS Tr & Orth), Consultant Hand and Peripheral Nerve Surgeon
Institution: Queen Elizabeth Hospital, Birmingham, UK
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
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