Post-Traumatic Contracture

Abstract

Contracture after injuries to the hand and wrist is not uncommon, affecting particularly the wrist, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. Fortunately, in most cases the contracture either resolves or is not clinically significant and can be ignored. In others, however, treatment is required. The nature of a contracture depends very much on the severity of the initial injury, the treatment received and perhaps most importantly the patient’s attitude. For the latter, a patients understanding of the nature of the injury, the treatment received and what is expected of them is paramount. Even if treatment is optimal, an unresponsive patient will more than likely have a poor outcome, including an ongoing contracture. With regard to the injury itself, the more severe the trauma; the more likely it is that a patient will develop a contracture. For this reason it is important that the clinician appreciates what particular structures have been damaged; is there any bony injury, has the articular cartilage been damaged, or is there mal-alignment? For the soft tissues again it is important to ascertain which have been permanently damaged; the dorsal or volar capsule (volar plate), or the collaterals. In addition, have any of the surrounding structures been injured, particularly the tendons including the central slip, but also the neurovascular structures as well as the skin and underlying soft tissues. All of these may need attention if the contracture is to be addressed.