Arthrogryposis multiplex congenita and spontaneous carpal fusion

Bilateral Spontaneous Bony Ankylosis of the Elbow Following Burn: A Case Report and Review of the Literature

Introduction:

Ankylosis of a joint could be intra-articular or extra-articular. Intra-articular ankylosis may be fibrous or bony. Soft tissue contracture and heterotopic ossification area common finding in patients with a deep burn around the joints. Intra-articular bony ankylosis after burn is uncommon, but a possible complication and we present a rare case with bilateral elbow involvement.

Case Report:

A 35-year-old female presented to us with contracture of both the elbows. She had a history of severe accidental thermal burn involving mainly the front of both the upper limbs 6months back. She developed burn contracture of both elbows. X-rays of both elbows showed bony fusion.

Conclusion:

Spontaneous bony fusion occurs in various pathologies, some are well known, but some are rare and unusual. Development of soft tissue contracture in deep burn is quite typical, followed by extra-articular ankylosis, but true spontaneous bony fusion can also occur. The possibility of spontaneous bony fusion in deep burn injuries around the joint should be kept in mind by both plastic surgeons and orthopedic surgeons.

Biplanar carpal wedge osteotomy in the treatment of the arthrogrypotic patients

Objective

To describe the results of the surgical treatment of patients with congenital arthrogryposis with wrist deformity through biplanar carpal wedge osteotomy.

Method

This study analyzed nine patients through a retrospective evaluation with severe deformity in flexion and ulnar deviation of the wrist in the period between January 2004 and December 2009. They were submitted to carpal osteotomy with a biplanar dorsal resection wedge, with a minimum evaluation of 48 months of postoperative evolution. In three patients the osteotomy was bilateral, totalling 12 cuffs analyzed. The indication for the technique described was deformity and stiffness for over six months, without improvement with the conservative treatment.

Results

The mean age of the patients on the day of surgery was five years and eight months. The initial mean wrist mobility was 35°, and the joints presented a mean flexion of 72.5° in a resting position. Osteotomy union occurred in all patients at an average period of 5.7 weeks. The final position of the resting wrist was 12° of flexion and the mean mobility was 26.6°, slightly lower than preoperatively but in a much better position. No serious complications arising from surgery or in the immediate postoperative period were observed.

Conclusions

Carpal osteotomy with biplanar dorsal resection wedge was useful and effective in helping to correct the deformities in flexion and ulnar deviation of the wrist, maintaining a reasonable mobility. It is a preservation surgery, which has low morbidity and avoids the progression of deformity and future degenerative changes.