TENOLYSIS AND CAPSULECTOMY AFTER HAND FRACTURES

There are well established operative procedures for salvage of functio n after fracture healing. When hand therapy measures have not achieved a satisfactory range of motion, it is reasonable to remove any hardwa re, if present, and lyse tendon adhesions that prevent tendon gliding. The exact cause of restricted motion and the location of adhesions ar e not always predictable preoperatively, so the surgeon should anticip ate additional procedures such as dorsal/palmar capsulectomies in comb ination with extensor and/or flexor tenolysis. The use of local anesth esia for direct patient input during the procedure offers great advant ages. In the ideal situation there should be a demonstrable functional need in a compliant patient with a well healed fracture and workable articular surfaces. Competent hand therapy should be available postope ratively. The patient's main risk is worsening of the situation if sur gery is unsuccessful. A marginal finger with poor neurovascular status may be better served by going to arthrodesis or even amputation. Teno lysis and capsulectomy, when indicated, are useful procedures in the s alvage of these difficult problems.