Article

The term Rollover hands (ROHs) corresponds to a loss of compound tissue from the
back of the hand. Our aim was to specify the injuries associated with this type
of accident and codify the therapeutic strategy.
METHOD: Twenty-one
ROHs were reviewed with an average follow-up of 38 months. Skin coverage included
15 pedicle flaps (two posterior interosseous, 13 pedicled groin flaps), and three
free flaps (two external brachial or one parascapular). RESULTS: We identified:
seven stage IA injuries where the extensor apparatus could be directly sutured;
Seven stage IB injuries requiring a tendon graft; Stage II, like stage 1B but
with bone and joint lesions or damage to the wrist extensors as well, and Stage
III for which over 50% of the intrinsic muscles had been destroyed. All patients
recovered their grasp. The mean active extension deficit for each finger was
-20.9 degrees for the whole digital chain and a 194.4 degrees TAM. Palmo-digital
grip strength was 51.3% on the controlateral side, and the mean DASH score was
16.1. DISCUSSION: Our study demonstrates the prognostic value of the proposed
classification and importance of restoring high-quality skin covering.
Reconstruction of the extensor apparatus must be envisaged once the condition of
the bone and joints has become stable. Vascularised tendon grafts may be
indicated when early mobilisation allowing restoration of a glliding surface
around the tendon is impossible, or for loss of substance of over 5 cm. Damage to
the intrinsic muscles is a very poor prognostic factor.
CI - Copyright (c) 2011 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS