Fractional Tendon Lengthening and Swanson Silastic Metacarpophalangeal Joint Replacement (Wright Medical) for Spasticity
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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
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Question 1 of 15
The clasped hand in a patient with spasticity may present with which one of the following problems?CorrectIncorrect
Question 2 of 15
Swansons silastic joint replacements are most commonly indicated in the treatment of which one of the following conditions affecting the MCP joints?CorrectIncorrect
Question 3 of 15
Spasticity in adulthood most commonly results from which of the following?CorrectIncorrect
Question 4 of 15
According to the SALGOT study, which one of the following is the best predictor of future severe spasticity?CorrectIncorrect
Question 5 of 15
Which one of the following therapeutic/diagnostic agents may help guide surgical management of the spastic hand?CorrectIncorrect
Question 6 of 15
Which one of the following is a recognised complication of silastic MCPJ arthroplasty?CorrectIncorrect
Question 7 of 15
Which one of the following is NOT an acceptable surgical technique for the treatment of the spastic hand?CorrectIncorrect
Question 8 of 15
After incising the skin which one structure should be careful protected?CorrectIncorrect
Question 9 of 15
Which one volar soft tissue structure often requires partial release to allow the MCPJ to extendCorrectIncorrect
Question 10 of 15
The neck cut must be made at which one of the following angles?CorrectIncorrect
Question 11 of 15
Which one of the following describes division of tendonous tissue at the musculo-tendinous interface?CorrectIncorrect
Question 12 of 15
Which one of the following is the correct use for the awl?CorrectIncorrect
Question 13 of 15
On the Wright Medical Set used in this operation which one of teh following does the code P stand for?CorrectIncorrect
Question 14 of 15
Which one of teh following is the most suitable instrument with which to handle the silastic implant?CorrectIncorrect
Question 15 of 15
Which one of the following procedures is described in the literature as a treatment option for intractable spasticity affecting the intrinsic muscles?CorrectIncorrect