This article is more than 5 years old. Information may no longer be current.
Clinicoradiological Classification for Post-Traumatic First Web Space Contracture: A Useful Guide for Management
Click Here to Manage Email Alerts
ABSTRACT
This classification of post-traumatic first web space contracture reflects its severity, indicates the involved tissues, and provides management guidelines. It consists of two clinical parameters and one radiographic parameter. For severe contractures, soft-tissue release and ipsilateral lateral arm free flap reconstruction is preferred.
The first web space contributes to palm width and allows full thumb abduction; contracture restricts thumb movements. In this classification, the clinical parameters are the angle between the thumb and index rays in maximal palmar and radial abduction, with normal values of 90° and 100º, respectively. The radiographic parameter is the angle between the first and second metacarpals, with a normal value of 40º-45º. Contractures are then graded.
Grade I contractures can be managed by local procedures such as z-plasty. Grade II contractures need adequate soft-tissue release followed by a pedicled or free flap. Grade III contractures require extensive soft-tissue and basal joint release followed by free flap coverage.
Fifty-two patients with grade II and III post-traumatic contracture were managed using ipsilateral lateral arm free flap following soft-tissue release. Flap survival was 98%; the failed flap was reconstructed with free groin flap. Average 66-month follow-up revealed 75º radial abduction and 70º palmar abduction in all cases.
This classification is uncomplicated, reproducible, and provides relevant clinical information. For severe grades, skin grafts and local flaps are not indicated. Ipsilateral lateral arm free flap has a number of advantages.