Surgical Treatment of Deformity and Loss of Function
Deformities and loss of function left after old injuries, congenital conditions or disease in the hand and arm can be improved with the right surgical methods.
The hand and arm are used in almost every moment of daily life and need precise movement. After fractures, tendon and nerve injuries, burns, rheumatic diseases or congenital conditions, deformities and loss of function can develop. The aim of surgery is to restore the hand’s ability to grip, hold and perform fine tasks, more than to change its appearance.
Conditions treated
- Malunited fractures: Wrist, forearm or finger fractures that have healed with a deformity
- Joint contractures: Stiffness in the fingers and wrist after injury or long immobilisation
- Dupuytren’s disease: Thickening of the tissue in the palm that pulls the fingers into a bent position
- Late effects of tendon and nerve injuries: Inability to bend or straighten fingers
- Nerve palsies: Loss of function because certain muscles do not work
- Hand deformities caused by rheumatoid arthritis
- Congenital hand differences
Assessment
The movement of every joint, muscle strength, sensation and everyday use of the hand are assessed in detail. X-rays, CT and, when needed, EMG identify the source of the problem. The treatment plan is tailored to the patient’s daily and work needs.
Surgical methods
- Corrective osteotomy: A malunited bone is cut and refixed in the right position.
- Contracture release: Stiff joint capsule and ligaments are released.
- Dupuytren’s surgery: The thickened tissue is removed or divided.
- Tendon transfer: The tendon of a healthy muscle is moved to take over the job of a muscle that does not work.
- Tendon grafting and reconstruction: A new tendon path is created for long-standing tendon loss.
- Joint fusion (arthrodesis) and joint replacement: Painful, damaged joints are placed in a functional position.
Recovery
The outcome of these operations depends largely on hand therapy afterwards. Splints and special exercise programmes continue for weeks, sometimes months, to maintain the movement gained and to learn new functions.
About Dupuytren’s disease
In Dupuytren’s disease, the tissue in the palm (the palmar fascia) thickens into nodules and cords. Over time the cords pull the fingers into the palm and stop them straightening fully. The ring and little fingers are usually affected, and there is a clear family tendency. Treatment is considered when the hand cannot be laid flat on a table or daily tasks become difficult. The cord can be removed surgically or, in suitable patients, divided with a needle. Because the disease is progressive, new nodules can develop after treatment.
How tendon transfers work
After nerve injuries or palsies, some muscles may stop working permanently. In a tendon transfer, the tendon of a healthy muscle whose job another muscle can also do is moved to a new point to restore the lost movement. For example, if the muscles that lift the wrist and fingers are paralysed, tendons from the front of the forearm can be moved to the back of the hand. After surgery, the patient learns to use these muscles for their new job with a hand therapist.
Malunited wrist fractures
A wrist fracture that heals in the wrong position can cause wrist pain, stiffness, difficulty turning the forearm and weaker grip. With a corrective osteotomy, the bone is brought back into the right alignment and fixed with a plate. These operations are planned in detail with CT.
Setting realistic goals
The aim of these operations is to restore the functions the patient needs most in daily life. Before surgery, we discuss in detail which tasks have become difficult, which movements are priorities and what can be expected.
Frequently asked questions
Can an injury from years ago still be corrected?
In many cases, yes. Function can often be improved even after old injuries, although expectations are set individually.
Will my hand be completely normal?
The aim is to restore as much everyday function as possible. The result depends on the type and duration of the problem.
How long is hand therapy needed after surgery?
It depends on the procedure; after tendon transfers and contracture releases, hand therapy usually lasts a few months.
Does Dupuytren's disease come back?
Because the disease is progressive, new cords can develop in the treated finger or in others. The tendency to recur varies from person to person.
Will my hand be as before after a tendon transfer?
A tendon transfer can restore much of the lost movement, but the hand may not be exactly as before. Expectations are agreed together before surgery.
What anaesthesia is used?
Most hand and forearm operations can be done under regional anaesthesia that numbs the arm. General anaesthesia may be preferred for extensive surgery.
How long should I wait before surgery?
After injuries, we wait for the tissues to heal and swelling to settle completely. Timing depends on the problem.
Does smoking affect healing?
Yes. Smoking delays bone and tissue healing. Stopping before and after surgery is recommended.
The information on this page is general and does not replace an examination. An examination is needed to decide which treatment suits you.