REDRESSMENT (to straighten fr. redresser) — violent anemic elimination of contractures of joints and axial deformations of extremities by stretching and a partial rupture of soft tissues.
Distinguish single-step R. — correction of deformation in one step, stage — with repetition of manipulations through certain periods, and gradual. Rubles of the first two types, as a rule, make manually (manual R.). Gradual (long) R. is made with the help distraktsionno-compression devices (see), or extension (see).
R.'s receptions are known from an extreme antiquity: e.g., extension according to Hippocrates by means of special devices, the redressiruyushchy methods for correction of cicatricial contractures used by the Arab physicians, etc. In 19 century special techniques of R. at a wryneck, a clubfoot, congenital dislocation of a hip, the acquired contractures of joints and other diseases were developed; various devices for manual R. V simplification in connection with more and more extending use of operational techniques of treatment of deformations are offered 20 century and implementation of distraktsionno-compression devices range of application of manual R. became considerably already, however this reception remains in an arsenal of orthopedics as one of the main conservative methods of correction of deformations.
During single-step or stage R. fabrics stretch to a limit of their elasticity, and then at the continuing influence there is a rupture of commissures, cicatricial unions, the wrinkled capsule of a joint, etc.
Indications and Contraindications
River. it is shown at desmogenny, myogenetic and artrogenny, and also neurogenic contractures (see), at clubfoot (see), to a wryneck (see), arthrogryposis (see), poliomyelitis (see), Littl's diseases (see. Children's paralyzes ), pseudorheumatism (see), arthroses (see), etc. It is made sometimes at incorrectly growing together fractures of long tubular bones (see. Changes ).
Contraindications: existence of specific or nonspecific active inflammatory process in a zone P. (in a joint or soft tissues), lack of congruence of joint surfaces at artrogenny contractures, considerable osteoporosis (see) the joint ends of bones of a kontragirovanny joint, contracture with the expressed restriction of movements.
As a rule, manual R. is carried out under anesthetic with relaxation of muscles. Most often it will be out at a contracture of a knee joint. At a flexion contracture (i.e. at restriction of extension) a knee joint of the patient stack on the operating table in situation on spin. The operator gets up on a support, has one hand on a back surface of the lower third of a shin of the patient, and another — on a front surface of a knee joint and makes the short tolchkoobrazny movements straightening a leg in a knee joint. The patient can lie on a stomach when the redressiruyushchy movements make, pressing from above on the lower third of a shin, at the same time one hand of the operator is placed under a knee joint. At an extensive contracture of the patient lies on spin, the operator two hands takes a shin and manipulates it as the lever, tolchkoobrazno bending a leg in a knee joint. The assistant fixes a basin or a hip of the patient. At R. of a hip joint the assistant hands presses a basin of the patient to the plane of a table, and the operator manipulates, fixing hands a hip and a shin. At R. of joints of a brush one hand fix its proximal segment, and another is made by the redressiruyushchy movements. At R. of foot the operator the left hand fixes a shin, and right, occupying front department of foot, makes the redressiruyushchy movements.
Having reached nek-ry correction of deformation, do a pause for 1 — 2 min., after a cut repeat the same receptions. With each new reception gradually increase redressiruyushchy force, and art of the operator consists in a soizmereniya of the efforts with the received feelings. So, at R. the sound of the broken-off commissures is sometimes heard, about their gap it is also possible to judge by sudden small increase in volume of movements in a joint.
During R. and during the first 3 — 5 days after it overseeing by blood circulation and an innervation of peripheral departments of an extremity is necessary. After R. of a joint an extremity quite often fix on a nek-swarm time in the reached situation a circular cutting plaster bandage.
If completely R. is not possible to correct deformation of a joint for one session, repeat. Such stage redressment gives the chance to eliminate heavier contractures.
The river can be applied in combination with operative measures: arthrolysis (see), synovectomy (see), myotomy, tenotomy (see), etc. Stage R. in plaster bandages is applied also after operations on an occasion scoliosis (see). R. using distraktsionno-compression hinged devices is considerably facilitated.
After R. can arise such complications as a recurrence of deformation, damage (restretchings, gaps) of the main vessels and nerves at the level of deformation, intra joint or circumarticular a change (epiphysiolysis). R. developing later hypostasis of fabrics in the presence of a plaster bandage can cause a prelum of large venous trunks with the subsequent vein thrombosis and disturbance of blood circulation in an extremity. Sometimes after R. there comes the aggravation of inflammatory process in a joint.
Bibliography: Zamansky Ya. L. An orthopedic method of recovery of function of a joint at a pseudorheumatism, Ortop. and travmat., No. 9, page 48, 1980; Friedland M. O. Orthopedics, page 242, M., 1954.
V. F. Pozharisky.