Crooked finger (toe) deformity correction

The characteristics of the deformity are as follows: 1. The deformed shape of the finger side can occur on any finger, and it is biased toward the squat or the ulnar side. Most occur at the distal end of the little finger and point to the metatarsal side of the joint. A few occur in the indicator. It has been reported that the incidence rate is between 1% and 19.5%. 2. The malformation may be one of the signs of certain syndromes, with more than 30 syndromes and more with such malformations. Often combined with and refers to, short finger deformity and so on. 3.x line shows that the distal interphalangeal joint bone is underdeveloped, triangular, or the joint surface is oblique or the middle phalanx is skewed. Through detailed physical examination, electromyography and neurological studies and imaging studies, the etiology of more than 80% of children can be determined. In children with mature bones, the cause is often neuromuscular disease or trauma. Common neuromuscular diseases include progressive neuromuscular atrophy and polio, and trauma is caused by the sequelae of deep fascial compartment syndrome in the posterior aspect of the calf after fracture of the tibia. Spinal insufficiency, cerebral palsy, primary cerebellar disease, joint contracture or severe congenital clubfoot can also develop high arch deformity. Some sick children can not find a clear cause, and are idiopathic high arch deformity. The treatment plan should be determined according to the age of the sick child, the type of deformity, and the degree. Early and mild malformation cases are suitable for non-surgical treatment. Passive traction can be performed on the constricted aponeurosis and the radial side of the small muscle group. The sole is raised 0.3cm behind the humeral head to raise the humeral head, and 0.1 is added to the lateral side of the heel. ~0.15cm high heel to prevent hind foot varus. Moderate and severe high bow deformities should be treated with surgery. Patients with non-bone deformities are treated with soft tissue surgery. After the bones of the feet are mature, the tibia and forefoot have fixed horseshoe deformities, which can be corrected by bone surgery. Treating diseases: multiple finger deformities Indication Severe malformation affects the function of the diseased side after 6 years of age can be surgically corrected. The toe and other toe-toe-toe corrections are not suitable for the high-bone foot disease in children with low bone deformity, mainly in the case of claw-toed and aponeurotic contracture rather than surgical treatment. Preoperative preparation 1. Before the operation, the X-ray film of the standing position of the foot should be taken to understand the position and deformity of the forefoot, midfoot and hindfoot, especially the plantar flexion and claw-toe deformity of the first metatarsal. . 2. The skin preparation of the affected foot begins 3 days before surgery. Surgical procedure Incision A longitudinal incision is made between the first toe, and the proximal end of the first toe is extended proximally to the middle of the corresponding humerus, and the extensor tendon of the toe and the second toe is exposed, and the deep deep nerve of the tendon is protected. The terminal branch and its accompanying first dorsal artery. 2. Correction of the toe claw toe deformity Exposed to the iliac crest, short extensor tendon and the second toe long, short extensor tendon, coronal (preferred) or sagittal "Z"-shaped sacral long extensor tendon about 3cm, resected 4 ~ 8mm long toe short extensor tendon and short Extensor tendon. A single tendon extension can generally achieve good orthopedics. If the deformity is not satisfactory, the metatarsophalangeal joint is not in the neutral position. The dorsal joint capsule of the metatarsophalangeal joint and the lateral collateral ligaments on both sides should be cut, and the metatarsal metatarsophalangeal joint should be passively flexed. When the dorsiflexion joint is in the neutral position, the metatarsophalangeal joint can flex beyond the neutral position. An inverted "L" shaped incision is used to reveal the interphalangeal joint of the metatarsophalangeal, and the transverse arm of the "L" shaped incision passes through the joint line. The dorsal joint capsule (including the terminal ankle of the long extensor muscle) and the lateral collateral ligaments were dissected, and the distal phalanx was flexed slightly. The proximal attachment of the tarsal plate was released and the interphalangeal joint was dorsiflexed with a stripper. If the joint can maintain a neutral position, use an oblique Kirschner wire or two longitudinal Kirschner wires to extend the joint between the toes through the joint; if the joint does not reach the neutral position, remove enough bone. To fuse the joint to the neutral position. The Kirschner wire should be retrogradely inserted into the distal phalanx, piercing from the iliac crest side 2 to 3 mm, and then worn to the proximal side, through the joint to the subchondral bone of the proximal phalanx. Sometimes the Kirschner wire must pass through the first metatarsophalangeal joint, but in general, the forefoot is wrapped with more dressing to maintain the joint in the proper position. 3. The second toe and the third, fourth, and fifth toe claw toe deformity correction Extend the second toe long extensor tendon, cut the short extensor tendon of the toe, and open the dorsal joint capsule and collateral ligament of the metatarsophalangeal joint. The posterior interphalangeal joint was exposed through the dorsal elliptical incision, and the dorsal joint capsule and the collateral ligament were dissected. Open the extensor tendon and remove the distal third of the proximal phalanx. The length of the osteotomy should be sufficient to make the interphalangeal joint in the middle position without causing a bone impact. The third, fourth, and fifth toe deformities were corrected by a similar method. The third and fourth toe deformities were corrected, with a longitudinal incision at the third toe, and a lateral straight incision at the fifth toe. If the iliac crest under the fifth metatarsal head is more prominent than the other parts, the temporal humeral protrusion of the fifth metatarsal head can be removed to make it flush with the humerus. The small toe abductor tendon was sutured at the metatarsophalangeal joint to avoid the fifth toe medial subluxation. 4. Guanchuang Maintain the metatarsophalangeal joint extension 0 ° ~ 10 °, repair the long extensor tendon and long extensor tendon with 4-0 non-absorbent suture, suture the skin. For the interphalangeal joint incision, the needle is passed through the skin and tendon from one side of the incision, through the tendon and skin on the other side, and then back through the skin on both sides, and the interphalangeal joint can be made by the suture technique. At a suitable position of 0° or 15° flexion.

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