Tenolysis and capsulectomy after hand fractures.

There are well established operative procedures for salvage of function after fracture healing. When hand therapy measures have not achieved a satisfactory range of motion, it is reasonable to remove any hardware, if present, and lyse tendon adhesions that prevent tendon gliding. The exact cause of restricted motion and the location of adhesions are not always predictable preoperatively, so the surgeon should anticipate additional procedures such as dorsal/palmar capsulectomies in combination with extensor and/or flexor tenolysis. The use of local anesthesia for direct patient input during the procedure offers great advantages. 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 postoperatively. The patient's main risk is worsening of the situation if surgery is unsuccessful. A marginal finger with poor neurovascular status may be better served by going to arthrodesis or even amputation. Tenolysis and capsulectomy, when indicated, are useful procedures in the salvage of these difficult problems.