Management of Flexion Contractures of the Wrist by Differential Distraction

Abstract

Flexion contractures of the wrist are a dreaded complication of Volkmann's ischemic contracture, postinfective/posttraumatic destruction of the wrist, or tuberculosis of the wrist joint. Most of the times, the patient is advised an amputation with prosthetic replacement as the treated limb also is like a dead limb. To avoid it, a simple alternative is to use the principle of controlled differential fractional distraction histogenesis. Joshi's external stabilization system (JESS) distractors allow gradual distraction of contracted soft tissues and align all the joints of the hand so as to bring corrections of all aspects of hand and wrist deformity simultaneously. This study was done with the aim to analyze the role of differential distraction in correcting cases of flexion contractures of the wrist in terms of cosmetic, functional, and anatomical outcome. Three flexion contractures of the wrist and hand underwent differential fractional distraction. Patients were assessed preoperatively for morphology, functionality, and radiology period of correction varied from 5 to 8 weeks. Once correction was obtained, then apparatus for differential distraction (JESS) is locked in that position for the same period and later converted to plaster cast for maintenance and followed up regularly. Excellent-to-good results were obtained in all the cases as assessed with patient-rated wrist evaluation. There were only minor complications in patients. Differential distraction by JESS frame is a simple, versatile, and cheap method suited for correcting flexion contractures of the wrist and hand, which were neglected and resistant.

Keywords

• differential distraction
• flexion contractures of wrist
• joshi's external stabilization system
• patient-rated wrist evaluation