PMC5228695_01
Preoperative findings of the left hand. (A, B) The long finger shows severe flexion contracture, and the ring finger shows a mild flexion contracture with the wrist in the neutral position. (C) The flexion contractures of these 2 fingers are reduced with the wrist in the palmar flexion position.
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F1
On physical examination, the long finger of the left hand demonstrated severe flexion contractures, and the ring finger demonstrated a mild flexion contracture with the wrist in the neutral position (Fig. 1 A and B). However, the flexion contractures of these 2 fingers were reduced with the wrist in the palmar flexion position (Fig. 1C).
Intraoperative findings. (A) The FDP tendon to the long finger has lost its mobility because of muscle contracture. (B) By transecting the FDP tendon to the long finger, the flexion contracture of the long finger is reduced. (C) The distal stump of the transected tendon has been transferred to the FDP tendon to the index finger. FDP = flexor digitorum profundus.
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F2
The FDP tendons to the long and ring fingers were explored via a 4-cm longitudinal skin incision, and the FDP tendon to the long finger was found to have lost its mobility because of muscle contracture (Fig. 2A). By doing this procedure, the flexion contracture of the long finger was reduced (Fig. 2B). FDP tendon to the index finger using end-to-side interlacing suture after adjusting the tonus of these 2 tendons (Fig. 2C). For the FDP tendon to the ring finger, no surgical intervention was performed because the contracture was mild.
Tension-reduced early mobilization. The tension-reduced position is maintained by taping the long finger to the volar side of the index finger, with active ROM exercise started immediately after the surgery. ROM = range of motion.
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F3
During the day, the wrist was fixed in the neutral position with a dorsal plastic splint to prevent excessive extension stress to the flexor tendons (Fig. 3).
To prevent recurrence of flexion contracture of the fingers, the extension position of the fingers is maintained with a night splint.
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F4
At night, the wrist and MP joints were fixed at 20 degrees of palmar flexion, and the PIP and DIP joints were fixed at 0 degrees with a night splint to prevent recurrence of flexion contractures of the fingers (Fig. 4).
Physical findings at final observation. Full finger flexion and extension have been obtained in all fingers.
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F5
The flexion contracture of the ring finger had also improved, even though no surgical intervention was performed for the FDP tendon to the ring finger (Fig. 5).