Factors affecting functional outcome of surgical correction of claw hand in leprosy.

The objective of this paper is to study the results and the factors that impact the results of claw hand surgery in leprosy. 110 patients who underwent claw hand correction between 2002 and 2006 were followed up and studied. Brand's criteria for objective assessment and a visual analog scale for subjective assessment were used. The factors studied were age, sex, clinical, duration of paralysis, long flexor tightness, degree of contracture and type of surgery. Objective assessment showed Excellent or Good results in 76.6%, Fair in 20% and Poor in 3.4%. Subjective assessment showed that 80.8% were fully satisfied or satisfied. Regression analysis showed that age, degree of contracture,duration of paralysis and long flexor contracture were seen as significant factors impacting results of claw hand correction.

Assessment of results of opponensplasty.

One hundred and fifty-six opponensplasties carried out on 115 patients at Anandaban Hospital between 1987 and 1997 were reviewed. In most cases a flexor digitalis superficialis opponensplasty was performed. The outcome was assessed by measuring the finger to which the thumb could obtain a pinch grip, the gap between the thumb and little metacarpophalangeal joints, and the satisfaction of the patient. The objective assessments demonstrated excellent or good results in 89%. Good or fair patient satisfaction was obtained in 93%. Early complications were seen in seven cases (4%). Objective measurements of outcome and patient satisfaction were not always in agreement, indicating that objective measures do not adequately assess the success of surgery from the patient's perspective. We thus conclude that subjective measurements of results are an important measure of success and should be included in the evaluation of surgical results.

Comparative evaluation of effectiveness of different motor muscles in modified lasso procedure for correction of finger clawing.

A retrospective study was carried out to compare the effectiveness of different muscles as motors in modified lasso procedures for correction of finger clawing in leprosy. It was observed that palmaris longus and extensor carpi radialis longus were more suitable than the flexor digitorum superficialis. In some patients, removal of superficialis is associated with complications which could not be predicted before surgery. Extensor carpi radialis longus has advantages over palmaris longus in selected cases.

Joshi External Stabilising System (JESS) in proximal interphalangeal joint (PIP) contractures in leprosy.

The authors present their experience in the use of the JESS (Joshi External Stabilising System) for correction of proximal interphalangeal joint (PIP joint) contracture deformity in 68 fingers. The use of the JESS has made this surgery easier, faster in releasing contractures and it has given better correction than the methods so far used by the same authors, like capsulotomy, local flaps and free skin grafting. The procedure is simple and has no serious side effects; it can be repeated if need be. The JESS is easy to apply, economical, reliable, reusable, well accepted by the patient. Compared to the other distractors made in USA and Europe, the JESS has an added advantage in that it costs so very much less (US $5-10), that our leprosy hospitals can afford it. In our patients, we have achieved full extension in 75% and good extension in 10.3% of the cases. These figures are much better than what was possible, in the past, with local flaps and free skin grafting. With those procedures we had excellent results in only 53% of the cases and poor result in 28%.

Partial flexor carpi radialis many-tailed transfer for correction of claw fingers.

The method described shows, that correction of claw fingers is possible using a portion of the flexor carpi radialis as motor. Usually, this method is indicated, whenever it is desired to do a Palmaris Longus many-tailed transfer in the absence of palmaris longus (e.g. for correction of hyper-mobile claw fingers).

Correction of ulnar claw hand by a loop of flexor digitorum superficialis motor for lumbrical replacement.

The current dynamic procedures for correction of ulnar claw hand are extensor carpi radialis longus many tail graft, palmaris longus four finger many tail graft and extensor by pass operation. Each of these procedures takes a minimum of one and a half hours and needs extensive post operative re-education and training. These procedures employ a graft of plantaris tendon, fascia lata or extensor tendon, with the disadvantages of operating at another site and adhesion of grafts. The procedure described in this article obviates these disadvantages. The operation is simple to perform and has given good results even when performed at leprosy camps where no extensive re-education physiotherapy was available. This operation also tends to correct the reversal of transverse arch. The technique and observations are discussed in detail.

Manifestations articulaires, musculaires et cutanees des etats reactionnels au niveau de la main du lepreux

The reactional states seen in lepromatous form (Erythema nodosum, exacerbation) and in interpolar forms (tuberculoid exacerbation and tuberculoid reversal reaction) result in cutaneous, nervous, lymphatic, visceral and polvarhritic acute manifestations. The successif relapses result in articular, cutaneous and muscular, sequelae of the hand but a paralysis of medial and ulnar nerves, often associated with leprosy, make them different from rheumatoid arthritis. They can be summarized thus: 1. Fexed claws hand associated with stiffness, erosions and sometimes subluxations of interphalangeal joints, mainly proximal and metacarpophalangeal joints. 2. Thickening and retractions of the skin of the dorsal face of the hand resulting in a trouble of the flexion of the fingers. 3. Contracture of the intrinsic muscles of the fingers and swan neck deformity. The treatment of the articular acute manifestations prevents the formation of sequelae. The authors study also the possibility of a curative treatment of fixed claws hand, skin retractions and swan neck deformities of the fingers, in hansenian patients