TALIPOMANUS (manus vara, manus valga) — a resistant deviation of a brush from an axis of a forearm in beam (beam To.) or elbow the parties (elbow To.). Happens inborn and acquired.
Inborn talipomanus is most often caused by absence or an underdevelopment of bones of a forearm.
Beam talipomanus arises at total absence of a beam bone or its distal department. The ulna at the same time is usually bent or (much more rare) is not deformed. The brush of a pronirovan also forms with a forearm the corner opened to a beam surface (fig. 1, 2), from here and the widespread name of deformation — manus vara. The brush is always displaced proksimalno the head of an ulna which is rather acting to the back and rotates around its distal department as a tag of a weather vane. Except the wrong provision of a brush, at most of patients signs of its underdevelopment — lack of the I metacarpal bone, the I finger and its eminence attract attention. Quite often II and III fingers are absent also. Fingers in most cases are in a condition of a flexion contracture. Sometimes the I finger is shortened, consists of one phalanx or hangs on a skin leg in the absence of the I metacarpal bone. The forearm is shortened and in most cases bent by camber dorsalno. G.F. Ivanov, G. A. Ilyin at an anatomic research found signs of an underdevelopment of almost all muscles of a forearm and shoulder. Usually there are no humeroradial muscle, long muscles of the I finger, instep supports and pronators of a forearm; in proximal department of a forearm all muscles are merged in lump. Often there is no long head of a biceps of a shoulder. The beam nerve is underdeveloped, up to its total absence on a forearm. At total absence of a beam bone there is no beam artery also.
At rentgenol, inspection total absence or a rudiment of a beam bone, lack of carinate and polygonal bones is found; it is sometimes observed synostosis (see) bones of a wrist, defects of metacarpal bones (fig. 1, 2).
Funkts, the state is caused by disturbance of prehensile ability of a brush as a result of lack of the I finger, restriction of mobility of other fingers, lack of rotational movements of a forearm and the brush which is in the least advantageous position — pronations. Lack of stability of a brush aggravates funkts, disturbances.
Problems of treatment beam To. — removal of a brush in average position, ensuring its stability and the prevention of a recurrence of deformation. Removal of a brush in the correct situation in early children's age is reached by conservative actions: stage plaster bandages with change in 7 — 14 days, massage to lay down. gymnastics since the first months of life. At children 2 years effectively skeletal traction are more senior. It is possible to hold a brush on average situation only at constant carrying the corrective tire from polyethylene or orthoses.
It is possible to stabilize a brush and to warn a recurrence of deformation only in the operational way. More than 50 ways of interventions are offered at beam To., but almost all of them do not give lasting effect. Various osteotomies of an ulna are suitable only for elimination of its curvature, but do not eliminate instability and shift of a brush. Splitting of the distal end of an ulna with formation of «fork» is inapplicable at children's age because of inevitable injury of a rostkovy cartilage with the subsequent lag of growth of a forearm. Operation of loktezapyastny artificial ankylosis (see) provides the resistant korrigirovanny provision of a brush, but sharply breaks growth of a forearm at children and considerably limits its function. This operation is applicable only at adults with the cosmetic purpose at unilateral deformation. The different types of bone plastics (cortical auto-and the allotransplants, transplants taken with a rostkovy zone — a head of a fibular bone, a plusnevy bone) made at children's age with growth of a forearm also lead to a recurrence of deformation and not always provide stability of a brush because of incongruence of joint surfaces of transplants and bones of a wrist.
The most lasting effect gives creation of a loktezapyastny sheaf from lavsan after preliminary elimination of deformation by skeletal traction. Operation consists in carrying out a mylar tape via the channel in a distal third of an ulna and around the basis of the V metacarpal bone with a tension and its decussation on elbow side of a wrist. With growth of a forearm the brush tends to elbow deviation at preservation of stability. Such operations can be made at children 5 years are more senior.
Elbow talipomanus is caused by an underdevelopment or lack of an ulna, at the same time the beam bone is bent, its head or is dislocated, or a sinostozirovana with a humeral bone, the brush together with distal department of a forearm is rejected towards an ulna. From here the distributed name of deformation — manus valga. At bilateral deformation of a brush are similar to flippers of a seal. There are also signs of inferiority of a brush — there are no III—IV-V fingers, sometimes and the II finger. Usually there are also no corresponding metacarpal bones, pea-shaped, trihedral and ankyroid bones. The forearm is bent, shortened, the shape of an elbow joint in connection with dislocation of a head of a beam bone is changed. Funkts, disturbances are connected with absence or restriction of movements in an elbow joint, with lack of rotation of a forearm and anatomofunktsionalny inferiority of a brush.
At elbow To. treatment can be shown to hl. obr. with the cosmetic purpose and for the purpose of removal of a brush from the provision of pronation in average situation what the osteotomy or a resection of a beam bone in the lower third is sufficient for.
The acquired talipomanus — secondary deformation after the postponed injury with closing of region of growth or as a result of diseases, napr, ekzostozny chondrodysplasias (see), Ollye's diseases (see. Chondromatosis of bones ). In it also distinguish beam and elbow To.
Other types acquired To. are one of elements of difficult deformations after poliomyelitis, spastic disturbances, and treatment them is carried out by the principles of treatment of effects of these diseases.
Beam talipomanus meets more often. It arises after the complicated course of fractures distal department of a beam bone with premature closing of region of growth, formation of nearthroses and defects in its lower third. At long existence of defect of a beam bone deformation gains looking alike inborn To., at the same time expressed funkts, disturbances are connected with instability of a brush and rapprochement of points of the beginning and an attachment of muscles of a forearm that reduces their force and complicates function of a brush.
Treatment acquired beam To. it has to be directed not only to elimination of deformation, but also to normalization of function of a brush for what it is necessary to recover an integrity and usual length of a beam bone. For this purpose apply two-stage treatment: in the beginning during 3 — 5 weeks make distraction on 1 — 2 mm a day before reposition of an incomplete dislocation of an ulna on distraktsionno-compression device (see), spokes to-rogo are carried out through the basis of the I—IV metacarpal bones or distal fragment of a beam bone and through both bones of a forearm in proximal department (fig. 2), Then, without removing the device, make bone plastics of defect of a beam bone. Fixing in the device continues before full consolidation of fragments and a transplant.
Elbow talipomanus arises usually at cartilaginous osteodysplasias (see) with localization of the cartilaginous center in distal department of an ulna and at an ekzostozny osteoarticular osteodysplasia with emergence of an exostosis in distal department of an ulna. With growth of the child the deformation similar inborn elbow develops To. The same treatment that at acquired beam To., with that difference that the distraktsionno-compression device is imposed on an ulna and after an osteotomy make distraction before elimination of its curvature.
See also Brush .
Bibliography: Andrianov V. L. ides of river. Inborn deformations of upper extremities, M., 1972, bibliogr.; M. V. wolves and D e d about in and V. D. Children's orthopedics, page 78, M., 1972; Gudushauri O. N. and With and at r about in and N. K. Operational treatment of the defects of a beam bone complicated by talipomanus, Ortop, and travmat., No. 7, page 65, 1968, bibliogr.; Doletsky S. Ya., Gavryushov V. V. and And to about p I am V. G. Hirurgiya's N of newborns, page 241, M., 1976; Kuzmenko V. V. About operational treatment of inborn beam talipomanus, Ortop, and travmat., No. 1, page 22, 1971; M about in sh the island and the p I. And. and In and l of e of N with to and y V. Ya. Polymers in traumatology and orthopedics, page 285, M., 1978; P r about to about p about in and L. V. Treatment of inborn talipomanus at children, Klin, hir., No. 1, page 27, 1963, bibliogr.; V. F. Ortopediya's pipe manufacturers and traumatology, page 110, M., 1971.
V. V. Kuzmenko.