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Haddara MM, Kadar A, Ferreira LM, Suh N. Effect of a Flexor Digitorum Superficialis Hemitenodesis on Reducing Volar Plate Strains for Swan Neck Deformities. Hand (N Y) 2023; 18:421-429. [PMID: 34420424 PMCID: PMC10152534 DOI: 10.1177/15589447211040877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Flexor digitorum superficialis (FDS) hemitenodesis is a common procedure to treat swan neck deformity (SND). We hypothesize that this surgical technique is a biomechanically effective way to reduce strain in the volar plate at the proximal interphalangeal joint (PIPJ). METHODS Fifteen digits from 5 cadaveric specimens were tested using a novel in vitro active finger motion simulator under 4 finger conditions: intact, SND, FDS hemitenodesis, and FDS hemitenodesis with distal interphalangeal (DIP) joint fusion. Tensile loads in FDS and flexor digitorum profundus (FDP) and joint ranges of motion were measured by electromagnetic tracking. In addition, strain gauges were inserted under the volar plate to measure strain during PIPJ hyperextension. Results were analyzed using 1-way repeated-measures analysis of variance tests. RESULTS The SND condition increased volar plate strain by 176% ± 25% (P < .001) compared with the intact condition. The FDS hemitenodesis repair relieved more than 50% of the SND strain, restoring it to within no statistical difference from intact. The DIP fusion further reduced strain with no further statistical significance. At full flexion, FDS and FDP tendon loads diverged as a function of the test condition (P < .001). With the FDS hemitenodesis, the FDP load increased by 2.1 ± 1.5 N from the SND condition (P < .001), whereas the FDS load decreased by 1.3 ± 1.3 N (P = .012). CONCLUSION The FDS hemitenodesis repair restored strains to within 3.0 milli-strain of the intact condition with no significant difference. Application of DIP fusion did not further protect the PIPJ from increased hyperextension and further exacerbated the imbalance of flexor tendon loads.
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Affiliation(s)
| | | | - Louis M. Ferreira
- Western University, London, ON, Canada
- St. Joseph’s Health Care London, ON, Canada
| | - Nina Suh
- Western University, London, ON, Canada
- St. Joseph’s Health Care London, ON, Canada
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Siegler S, Taghvaei M, Zegarski R, Palmese G, Mathew R, Schayes J, Schaer T, Najafi A. A porous swelling copolymeric material for improved implant fixation to bone. J Biomed Mater Res B Appl Biomater 2023; 111:1342-1350. [PMID: 36815442 DOI: 10.1002/jbm.b.35238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
Most metallic commercial bone anchors, such as screws and suture anchors achieve their fixation to bone through shear of the bone located between the threads. They have several deficiencies, potentially leading to failure, which are particularly evident in low-density bone. These include stress-shielding resulting from mechanical properties mismatch; lack of mechanically induced remodeling and osteointegration; and when the pullout force on the anchor, during functional activities, exceeds their pullout strength, catastrophic failure occurs leaving behind large bone defects that may be hard to repair. To overcome these deficiencies, we introduced in this study a porous swelling co-polymeric material and studied its swelling and compressive mechanical characteristics as bone anchor under different configurations. Porosity was achieved by adding a non-dissolvable agent (NaCl) during the process of polymerization, which was later dissolved in water, leaving behind a porous structure with adequate porosity for osteointegration. Three different groups of cylindrical samples of the swelling co-polymer were investigated. Solid, fully porous, and partially porous with a solid core and a porous outer layer. The results of the swelling and simple compression study show that the partially porous swelling co-polymer maintains excellent mechanical properties matching those of cancellous bone, quick swelling response, and an adequate porous outer layer for mechanically induced osteointegration. These suggest that this material may present an effective alternative to conventional bone anchors particularly in low-density bone.
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Affiliation(s)
- Sorin Siegler
- Department of Mechanical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Moein Taghvaei
- Department of Mechanical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ryan Zegarski
- Department of Mechanical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Giuseppe Palmese
- College of Engineering, Rowan University, Glassboro, New Jersey, USA
| | - Rena Mathew
- Department of Mechanical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
| | - Julia Schayes
- School of Veterniary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas Schaer
- School of Veterniary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ahmad Najafi
- Department of Mechanical Engineering, Drexel University, Philadelphia, Pennsylvania, USA
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Vishwanathan K, Ganjiwale D. A novel surgical correction and innovative splint for swan neck deformity in hypermobility syndrome. J Family Med Prim Care 2018; 7:242-245. [PMID: 29915767 PMCID: PMC5958577 DOI: 10.4103/jfmpc.jfmpc_14_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Splinting is a great domain of occupational therapy profession. Making a splint for the patient would depend on the need or requirement of the problems and deformities. Swan neck deformity is an uncommon condition, and it can be seen in rheumatoid arthritis, cerebral palsy, and after trauma. Conservative treatment of the swan neck deformity is available by different static splints only. There are very few reports of surgical correction of swan-neck deformity in benign hypermobility syndrome. This case report describes the result of novel surgical intervention and an innovative hand splint in a 20-year-old female with a history of cardiovascular stroke with no residual neurological deficit. She presented with correctable swan neck deformity and failed to improve with static ring splints to correct the deformity. She underwent volar plate plication of the proximal interphalangeal joint of the left ring finger along with hemitenodesis of ulnar slip of flexor digitorum superficialis (FDS) tendon whereby, the ulnar slip of FDS was passed through a small surgically created rent in A2 pulley and sutured back to itself. Postoperatively, the patient was referred to occupational therapy for splinting with the instruction that the splint would work sometimes for as static and some time as dynamic for positional and correction of the finger. After occupational therapy intervention and splinting, the patient had a full correction of the swan-neck deformity with near full flexion of the operated finger and can work independently.
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Affiliation(s)
| | - Deepak Ganjiwale
- Department of Physiotherapy, KMPIP, Shree Krishna Hospital, Anand, Gujarat, India
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4
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Kiziridis G, Giddins GEB. Volar Tenodesis for the Treatment of Swan-neck Deformity; A Systematic Review. J Hand Surg Asian Pac Vol 2017; 22:267-274. [PMID: 28774244 DOI: 10.1142/s0218810417300030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Swan-neck deformity is a common problem particularly in patients with Rheumatoid arthritis. Mobile swan-neck deformities (Nalebuff types I,II) can be treated non-operatively and operatively. In this paper we report on a systematic review of the treatment of swan-neck deformities with volar tenodesis. METHODS We performed a literature search and analysed the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only eight papers were eligible. None was of high quality. The data reporting was very variable. Therefore, no meta-analysis could be performed, but only a descriptive analysis. RESULTS The techniques work in preventing proximal inter-phalangeal joint hyperextension between 60 and 100% in these studies. There appears to be some recurrence of hyper-extension with time so that papers with longer follow-up tend to have poorer results. CONCLUSIONS There is no good evidence that one technique is superior to another. The choice of technique is likely to remain based on surgeon preference for the foreseeable future. Future studies should be at least comparative and preferably part of a trial.
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Affiliation(s)
- Georgios Kiziridis
- * Department of Trauma & Orthopaedics, University Hospital Southampton, Southampton, UK
| | - Grey E B Giddins
- † Department of Trauma & Orthopaedics, Royal United Hospital, Bath, UK
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5
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de Soras X, de Mourgues P, Pradel P, Urien JP, Beaudoin E. Extra-articular subcutaneous “inverted king post-truss” ligament reconstruction for severe swan neck deformity (snapping finger). HAND SURGERY & REHABILITATION 2017; 36:48-52. [DOI: 10.1016/j.hansur.2016.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 09/11/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
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Lui TH. "Swan neck deformity" of the second toe corrected by flexor digitorum longus to flexor digitorum brevis tenodesis. Foot Ankle Spec 2015; 8:135-8. [PMID: 25142920 DOI: 10.1177/1938640014546860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED "Swan neck deformity" of the second toe is a rare deformity. It is a hyperextension of the proximal interphalangeal joint. The patient may complain of painful callosity underneath the proximal interphalangeal joint. Surgical correction should be considered if conservative treatment fails to relieve the pressure point. The optimal surgical option for this deformity has not yet been defined. We report a case of swan neck deformity of the second toe that was successfully corrected by flexor digitorum longus to brevis tenodesis. LEVELS OF EVIDENCE Therapeutic Level IV: Case Report.
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Affiliation(s)
- Tun Hing Lui
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong, SAR, China
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Xie R, Tang J, Wang G, Liu G. Passive correction of Mallet deformity with a MicrofixQuickanchor Plus: a cadaveric study. J Plast Reconstr Aesthet Surg 2014; 67:e171-2. [PMID: 24703515 DOI: 10.1016/j.bjps.2014.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 02/06/2014] [Accepted: 03/08/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Renguo Xie
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu 226001, China.
| | - Jinbo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu 226001, China
| | - Guheng Wang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu 226001, China
| | - Guofeng Liu
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu 226001, China
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Brulard C, Sauvage A, Mares O, Wavreille G, Fontaine C. Traitement des déformations des doigts longs en col-de-cygne dans les affections rhumatismales par ténodèse de l’articulation interphalangienne proximale à l’aide d’un hémi-tendon fléchisseur superficiel. À propos de 23 doigts à 61 mois de recul. ACTA ACUST UNITED AC 2012; 31:118-27. [DOI: 10.1016/j.main.2012.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 03/28/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
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Chan JCY, Purcell EM, Kelly JL. SURGICAL REPAIR OF CENTRAL SLIP AVULSION INJURIES WITH MITEK BONE ANCHOR — RETROSPECTIVE ANALYSIS OF A CASE SERIES. ACTA ACUST UNITED AC 2011; 12:29-34. [PMID: 17613181 DOI: 10.1142/s0218810407003377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 05/08/2007] [Indexed: 11/18/2022]
Abstract
The purpose of this study is to describe our technique of central slip repair using the Mitek bone anchor and to evaluate the treatment outcome. Eight digits in eight patients were reconstructed using the bone anchor: three little fingers, two middle fingers, two index fingers and one ring finger. There were two immediate and six delayed repairs (range from one day to eight months). Four patients had pre-operative intensive splinting and physiotherapy to restore passive extension of the proximal interphalangeal joint prior to central slip reconstruction. All patients have made good progress since surgery. No patient requires a second procedure and none of the bone anchors have dislodged or loosened. We conclude that the Mitek bone anchor is a reliable technique to achieve soft tissue to bone fixation in central slip avulsion injuries. We recommend that this technique be considered as a treatment option for patients requiring surgical repair.
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Affiliation(s)
- Jeffrey C Y Chan
- Department of Plastic, Reconstructive and Hand Surgery, University College Hospital Galway, Newcastle Road, Galway, Republic of Ireland.
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Metcalf CD, Notley SV. Modified kinematic technique for measuring pathological hyperextension and hypermobility of the interphalangeal joints. IEEE Trans Biomed Eng 2011; 58:1224-31. [PMID: 21233039 DOI: 10.1109/tbme.2011.2106126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dynamic finger joint motion is difficult to measure using optical motion analysis techniques due to the limited surface area allowed for adequate marker placement. This paper describes an extension of a previously validated kinematic measurement technique using a reduced surface marker set and outlines the required calculations based on a specific surface marker placement to calculate flexion/extension and hyperextension of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints. The modified technique has been assessed for accuracy using a series of static reference frames (absolute residual error = ±3.7°, cross correlation between new method and reference frames; r=0.99). The method was then applied to a small group of participants with rheumatoid arthritis (seven females, one male; mean age = 62.8 years ± 12.04) and illustrated congruent strategies of movement for a participant and a large range of finger joint movement over the sample (5.8-71.1°, smallest to largest active range of motion). This method used alongside the previous paper provides a comprehensive, validated method for calculating 3-D wrist, hand, fingers, and thumb kinematics to date and provides a valuable measurement tool for clinical research.
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Affiliation(s)
- Cheryl D Metcalf
- Faculty of Health Sciences, University of Southampton, Southampton, SO17 1 BJ, UK.
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Long-term results of lateral band translocation for the correction of swan neck deformity in cerebral palsy. J Pediatr Orthop 2010; 30:67-70. [PMID: 20032745 DOI: 10.1097/bpo.0b013e3181c6c363] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to evaluate the long-term effect of lateral band translocation for correcting swan neck deformity in patients with cerebral palsy at a minimum follow-up of 5 years. METHODS Swan neck deformities of 62 fingers were corrected using a modified lateral band translocation. At 1-year and 5-year follow-up, any recurrence of hyperextension was recorded through nonconstrained evaluation. Active extension of the proximal interphalangeal joint beyond 0 degree was considered a recurrence. RESULTS Correction was successful for 84% of the operated fingers at 1-year follow-up. After 5 years, the success rate had decreased to 60%. Furthermore, no relationship was found between any of the concomitant surgical procedures and the number of patients with recurrences. CONCLUSIONS The long-term result of lateral band translocation is disappointing in our series, and it should not be advocated as a procedure with long-lasting success in patients with cerebral palsy.
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Abstract
Congenital swan neck deformity of the fingers is an uncommon congenital disorder. It is sporadic and not associated with other malformations. We report a case of congenital swan neck deformity of the fingers in a 16-year-old boy, with associated ulnar deviation of the fingers, bilateral simian creases and soft tissue syndactyly.
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