176. SURGICAL MANAGEMENT OF THE MIXED INSTRINSIC AND EXTRINSIC SPASTIC HAND IN THE BRAIN INJURY ADULT: A SERIES OF 69 OPERATED HANDS

Abstract

Purpose of the study: From November 2001 to January 2008, among 110 patients who underwent surgery for spastic hands due to a central neurological disorder, the management involved surgical treatment of long finger intrinsic and extrinsic deformities in 57 brain injury adults.

Material and methods: At least one procedure for the intrinsics and one for the extrinsics was performed during the same operative. Twelve patients had bilateral operations. The goal of the surgery and the treatment was established during multidisciplinary consultations with rehabilitation physicians, neurologists, surgeons and anaesthesists after a minute physical examination with selective neuromuscular blocks to differentiate muscle spasicity and tendon retraction from extrinsic and intrinsic disorders. The objective was established in the form of a contract with the patient and the family: hygiene and analgesia (47 patients), aesthetic aspect (15 patients, and/or function (21 patients.) For the spasticity and/or retraction of the exrinsics, we used 23 transfers of the FCP to the FCS, 6 Z lengthening of the FCP and the FCS, 14 intramuscular lengthening of the FCP and 11 of the FCS, 10 Page interventions, 10 selecive muscle disinsertions from the epitrochlears and one FCS tenotomy. Concerning the spasticity and/ol retraction of the intrinsic, we performed 4 neurotomies of the deep motor branch of the ulnar nerve, 48 interosseous tenotomise, 6 proximal disinsertions with mobilisation of the interosseous, 18 tenotomies of the 5th adductor, and 29 distal tenotomise of the extensor system.

Results: Outcome was good for 60 of the 69 operated hands (achievement of contract: function 18, aesthetic 14, hygiene 44). Seven hands required revision with a good final result for six of them. One patient developed reflex dystrophy.

Discussion: In adults, despite the modest functional results achieved in only one-third of the patients, corrective surgery for spastic mixed extrinsic and intrinsic deformities provides an important improvement for these patients.