Serebral Palsili Yetişkin Bir Hastada Thumb-in-Palm Deformitesinin Düzeltilmesi: Farklı Bir Endikasyon ve Farklı Bir Yaklaşım English

Yıl 2013, Cilt: 10 Sayı: 3, 144 - 147, 01.12.2013

M Erol Demirseren , Candemir Ceran Kasim Kilicarslan İzzet Korkmaz

Öz

“Thumb-in-palm” deformitesi olan serebral palsili hastalarda, baş parmak hareketlerindeki kayıp nedeniyle fonksiyonel bir eksiklik söz konusudur. Cerrahi tedavideki en önemli amaçlar baş parmağın estetik görünümü ve fonksiyonunun daha iyi bir hale getirilerek diğer parmakların hareketlerine engel teşkil etmemesidir. Bununla beraber baş parmağın avuç içindeki veya ikinci parmak aralığındaki fikse pozisyonu, Türk toplumunda kültürel olarak küfür veya hakaret anlamına da gelebilmektedir. Otuzdört yaşındaki bir erkek hasta kliniğimize baş parmağının avuç içindeki pozisyonunun diğer insanlar tarafından yanlış anlaşılma şikayeti ile başvurdu. Hastaya aynı seansta birinci parmak aralığı serbestleştirilmesi, miyonörotomi ve tendon transferi işlemi yapıldı. Böylece toplum içindeki iletişimi ve el hijyeni daha iyi bir hale geldi

Anahtar Kelimeler

El, “thumb-in-palm” deformitesi, endikasyonlar

Correction of “Thumb-in-Palm” Deformity in an Adult Patient with Cerebral Palsy: A Different Indication and a Different Approach

Öz

Thumb-in-palm deformity in patients with cerebral palsy is functionally disabling because of lacking thumb motion. The major reasons for selecting surgical treatment are to effect improvement in the performance of thumb activities and to produce aesthetic appearance so that it no longer interferes with the function of the other digits. However, this deformity as itself in Turkish culture is so close to an abusive act which can be defined as shaking of the hand with the thumb hidden in palm or in the second web space. A 34 year old male patient, whose main complaint was the position of his thumb being misunderstood by other people as an abusive gesture, was consulted to our clinic. Web-space releasing, myotenotomy, and tendon transfer operations were performed simultaneously. The patient gained grasping function by maintaining his thumb out of his palm. Communicative skills were improved and better hand hygiene was acquired

Anahtar Kelimeler

hand, thumb-in-palm deformity, indications

Kaynakça

• ) Carlson MG. Cerebral Palsy. In: Green DP, editor. Green's operative hand surgery. 5 ed., vol. 2. Philadelphia: Elsevier Churchill Livingstone; 2005. P. 234.
• ) Matev I. Surgery of the spastic thumb-in-palm deformity. J Hand Surg 1991;16(2): 127-32.
• ) Tonkin MA. Thumb deformity in the spastic hand: Classification and surgical techniques. Tech Hand Up Extrem Surg. 2003; 7(1): 18-25.
• ) Smeulders M, Coester A, Kreulen M. Surgical treatment for the thumb-in-palm deformity in patients with cerebral palsy. Cochrane Database Syst Rev. 2005; (4): CD004093.
• ) House JH, Gwathmey FW, Fidler MO. A dynamic approach to the thumb-in palm deformity in cerebral palsy. J Bone Joint Surg Am. 1981; 63(2): 216-25.
• ) Lawson RD, Tonkin MA. Surgical management of the thumb in cerebral palsy. Hand Clin 2003; 19(4): 667-77.
• ) Ozkan T, Tuncer S. Tendon transfers for the upper extremity in cerebral palsy. Acta Orthop Traumatol Turc ; 43(2): 135-48. ) Manske PR. Redirection of extensor pollicis longus in the treatment of spastic thumb-in-palm deformity. J Hand Surg 1985; 10(4):553-60.