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Chang CC, Lin SY, Lu CK, Jupiter JB, Fu YC, Liu WC. Minimum 5-Year Follow-Up Assessment of Volar Plate Interposition Arthroplasty for Post-Traumatic Osteoarthritis in Proximal Interphalangeal Joints. J Clin Med 2023; 12:4760. [PMID: 37510875 PMCID: PMC10381317 DOI: 10.3390/jcm12144760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/16/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
This is a retrospective study to evaluate the outcome of volar plate interposition arthroplasty for proximal interphalangeal joint post-traumatic osteoarthritis with a minimum 5-year follow-up. We identified patients receiving volar plate interposition arthroplasty for post-traumatic osteoarthritis in proximal interphalangeal joints. The measurements included the numeric pain scale (on a scale of 0-10), the proximal interphalangeal joint active range of motion, the Michigan Hand Outcomes Questionnaire, the perioperative radiograph of the involved digit, proximal interphalangeal joint stability, and pinch strength. Eight patients with a median age of 44 years old (interquartile range (IQR): 29.3-56.8) were included in this study. The median follow-up period was 6.5 years (range of 5-11 years). The median numeric pain scale improved from 5 (IQR: 4.3-6.0) preoperatively to 0 (IQR 0-0.8) at the follow-up evaluation (p = 0.011). All digits demonstrated stability during manual stress testing compared to their noninjured counterparts. The median active proximal interphalangeal joint arc of motion improved from 25° to 55° (p = 0.011). The pinch strength of the fingers on the injured hand was weaker than those on the contralateral hand (2.2 Kg vs. 3.7 Kg, p = 0.012). We suggested that volar plate interposition arthroplasty may be an alternative surgical option for post-traumatic osteoarthritis in the proximal interphalangeal joints.
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Affiliation(s)
- Chung-Chia Chang
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Sung-Yen Lin
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
| | - Chun-Kuan Lu
- Department of Orthopedic, Park One International Hospital, Kaohsiung 813017, Taiwan
| | - Jesse B Jupiter
- Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Yin-Chih Fu
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
- Department of Orthopedic Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 801735, Taiwan
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
| | - Wen-Chih Liu
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
- Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
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Ikeda M, Serigano K, Kobayashi Y, Saito I, Ishii T, Nakajima D. Open Reduction and Internal Fixation of Dorsal Fracture-Dislocation of the Proximal Interphalangeal Joint Using a Plate: A Series of 37 Patients. J Hand Surg Asian Pac Vol 2023; 28:34-44. [PMID: 36803473 DOI: 10.1142/s2424835523500066] [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: 02/23/2023]
Abstract
Background: Open reduction and internal fixation with a plate is one of the alternative treatments for fracture-dislocation of the proximal interphalangeal (PIP) joint. However, it does not always lead to satisfactory results. The aim of this cohort study is to describe the surgical procedure and discuss the factors affecting the treatment results. Methods: We retrospectively reviewed 37 cases of consecutive unstable dorsal fracture-dislocation of the PIP joint treated using a mini-plate. The volar fragments were sandwiched with a plate and dorsal cortex, and screws were used as subchondral support. The average rate of articular involvement was 55.5%. Five patients had concomitant injuries. The mean age of the patients was 40.6 years. Mean time between injury and operation was 11.1 days. The average postoperative follow-up duration was 11 months. Active ranges of motion, % total active motion (TAM) were evaluated postoperatively. The patients were divided into two groups according from Strickland score and Gaine score. Fisher's exact test, Mann-Whitney U test and a logistic regression analysis were used to evaluate the factors affecting the results. Results: The average active flexion, flexion contracture at the PIP joint, and % TAM were 86.3°, 10.5° and 80.6%, respectively. Group I included 24 patients who had both excellent and good scores. Group II included 13 patients who had neither excellent nor good scores. When the groups were compared, there was no significant relationship between the type of fracture-dislocation and the extent of articular involvement. There were significant associations between outcomes and patient age, period from injury to surgical intervention and presence of concomitant injuries. Conclusions: We concluded that meticulous surgical technique leads to satisfactory results. However, factors, including the patient's age, time from injury to surgery and the presence of concomitant injuries needing adjacent joint immobilisation, contribute to unsatisfactory outcomes. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Masayoshi Ikeda
- Department of Orthopaedic Surgery, Shonan Central Hospital, Fujisawa, Kanagawa, Japan
| | - Kenji Serigano
- Department of Orthopaedic Surgery, Shonan Central Hospital, Fujisawa, Kanagawa, Japan
| | - Yuka Kobayashi
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Ikuo Saito
- Department of Orthopaedic Surgery, Isehara Kyodo Hospital, Isehara, Kanagawa, Japan
| | - Takayuki Ishii
- Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Daisuke Nakajima
- Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
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Kamble P, Prabhu RM, Mohanty S, Keny S. Hemi-hamate arthroplasty for the management of chronic proximal interphalangeal joint fracture dislocations: Analysis of 21 cases in Indian population and review of the literature. J Clin Orthop Trauma 2023; 37:102109. [PMID: 36743977 PMCID: PMC9894919 DOI: 10.1016/j.jcot.2023.102109] [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] [Received: 08/12/2022] [Revised: 01/02/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
Background Chronic fracture-dislocations involving the proximal interphalangeal (PIP) joint are challenging cases. We conducted this study to analyze the outcomes following hemi-hamate autograft reconstruction of such injuries and to compare our results with the existing literature. Methods A retrospective analysis of 21 patients with chronic dorsal PIP fracture-dislocations that were managed with hemi-hamate autograft reconstruction was done. The average articular surface involvement was 64%. The average duration between injury and surgery was 9.4 weeks (range, 6-16). Quick DASH (Disabilities of Shoulder and Hand) scores, VAS (Visual Analog Scale) scores, range of motion of the PIP joints, DIP (distal interphalangeal) joints, and MCP (metacarpophalangeal) joints were measured during serial follow-up visits. Results Union and graft incorporation was seen in all cases. The average Quick DASH score at four weeks post-surgery was 66 and it improved to eight at one year (p-value<0.05). The average VAS score at four weeks post-surgery was 7.66 and it improved to 2.09 at one year (p-value<0.05). The mean flexion of the MCP joint improved from 52.85° at the end of four weeks to 72.38° at one year (p-value<0.05). The average flexion at the PIP joint improved from 10.47° at the end of four weeks to 70.47° at one year (p-value<0.05). The average DIP flexion improved from 38.33° at the end of four weeks to 62.38° at one year (p-value<0.05). The average hand grip strength was 85% of the normal side. Conclusion Hemihamate autograft reconstruction is a suitable procedure for the management of chronic PIP joint fracture-dislocations, especially in cases with extensive involvement of the articular surface. Level of evidence III.
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Affiliation(s)
| | | | | | - Swapnil Keny
- Seth GS Medical College and KEM Hospital, Mumbai, India
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4
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Murayama A, Watanabe K, Ota H, Kurimoto S, Hirata H. Volar plating versus external fixation for unstable dorsal fracture-dislocations of the proximal interphalangeal joint. J Hand Surg Eur Vol 2022; 47:308-313. [PMID: 34812077 DOI: 10.1177/17531934211059300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We retrospectively compared the results of volar plating and dynamic external fixation for acute unstable dorsal fracture-dislocations of the proximal interphalangeal joint with a depressed fragment. We treated 31 patients (31 fingers), 12 with volar buttress plating and 19 with dynamic external fixation. Follow-up averaged 35 and 40 months in the two groups, with a minimal 6-month follow-up. Average active flexion of the proximal interphalangeal joint was 95° after plate fixation and 87° after external fixation, with an active extension lag of -6° and -9°, respectively. Active flexion at the distal interphalangeal joint averaged 67° in the plate group and 58° in the external fixation group, with active extension lags of 0° and -5°, respectively. We conclude that both methods can obtain a good range of motion at the proximal interphalangeal joint. A limitation of the extension of the distal interphalangeal joint occurred with dynamic external fixation but not with volar buttress plating.Level of evidence: IV.
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Affiliation(s)
- Atsuhiko Murayama
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kentaro Watanabe
- Department of Health Sciences, Aichi Shukutoku University, Nagoya, Japan
| | - Hideyuki Ota
- Department of Orthopaedic Surgery and Hand Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Shigeru Kurimoto
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Oflazoglu K, de Planque CA, Guitton TG, Rakhorst H, Chen NC. Dorsal Subluxation of the Proximal Interphalangeal Joint After Volar Base Fracture of the Middle Phalanx. Hand (N Y) 2022; 17:60-67. [PMID: 31971012 PMCID: PMC8721804 DOI: 10.1177/1558944719895621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Treatment decisions regarding volar base fractures of the middle phalanx depend on whether the proximal interphalangeal (PIP) joint is reduced. Our aim was to study the agreement among hand surgeons in determining whether the PIP joint fractures are subluxated and to study the factors associated with subluxation of these fractures. Methods: In this retrospective chart review, 413 volar base fractures of the middle phalanx were included. Demographic and injury-related factors were gathered from medical records and radiographs. Using a Web-based survey, interobserver agreement was determined among 105 hand surgeons on the assessment of PIP joint subluxation of a series of 26 cases. Using the cohort of 413 fractures, a threshold for percent articular involvement and relative fracture displacement that corresponds with subluxation of the PIP joint was analyzed. Results: We found moderate to substantial agreement between hand surgeons on subluxation (κ = 0.59, P < .0001) and an overall percent agreement of 85%. Percent articular involvement and relative fracture displacement were independently associated with subluxation of the PIP joint (P < .001). Percent articular involvement of 35% had a specificity of 90% and a negative predicting value (NPV) of 92% for joint subluxation. Relative fracture displacement of 35% had a specificity of 92% and an NPV of 94% for joint subluxation. Conclusions: Surgeons generally agree on whether a PIP joint is subluxated. Percent articular involvement and relative fragment displacement are objective measurements that can help characterize joint stability and assist with decision-making.
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Affiliation(s)
- Kamilcan Oflazoglu
- Amsterdam University Medical Center, VU Medical Center, The Netherlands,Kamilcan Oflazoglu, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, VU Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands.
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Nizzero D, Tang N, Leong J. A novel technique for proximal interphalangeal joint fracture-dislocations: the second toe middle phalanx osteochondral graft. J Hand Surg Eur Vol 2021; 46:941-945. [PMID: 34256617 DOI: 10.1177/17531934211029225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Many different surgical techniques have been used to treat unstable dorsal proximal interphalangeal joint fracture-dislocations. The authors have used the base of the middle phalanx of the second toe base as an alternative autograft to treat this type of injury. This retrospective study assessed the clinical outcomes of this procedure in 11 patients. Range of motion, grip strength, Disability of the Arm, Shoulder and Hand score and donor site morbidity were assessed at regular intervals postoperatively. Nine patients had acute injuries and two had chronic injuries. The mean range of motion in the proximal interphalangeal joint at final review was 65° for patients with acute injuries and 41° for patients with chronic injuries. Other outcomes were satisfactory and there were no complications.Level of evidence: IV.
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Affiliation(s)
- Danielle Nizzero
- Department of Plastic & Reconstructive Surgery, Monash Health, Dandenong, VIC, Australia
| | - Nicholas Tang
- Department of Plastic & Reconstructive Surgery, Monash Health, Dandenong, VIC, Australia
| | - James Leong
- Department of Plastic & Reconstructive Surgery, Monash Health, Dandenong, VIC, Australia
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Gianakos A, Yingling J, Athens CM, Barra AE, Capo JT. Treatment for Acute Proximal Interphalangeal Joint Fractures and Fracture-Dislocations: A Systematic Review of the Literature. J Hand Microsurg 2020; 12:S9-S15. [PMID: 33335365 DOI: 10.1055/s-0040-1713323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Proximal interphalangeal joint (PIPJ) fractures and fracture-dislocations are common hand injuries and recognition of this injury pattern is essential in the management of these fractures. Although a variety of treatment options have been reported in the literature, the optimal treatment remains controversial. MEDLINE, EMBASE, and The Cochrane Library Database were screened for treatment strategies of PIPJ fracture and fracture-dislocation. Demographic data and outcome data were collected and recorded. A total of 37 studies including 471 patients and 480 fingers were reviewed. PIPJ range of motion (ROM) was greatest postoperatively in patients who underwent volar plate arthroplasty at 90.6 degrees. Dynamic external fixation resulted in the lowest PIP joint ROM with an average of 79.7 degrees. Recurrent pain and osteoarthritis were most often reported in extension block pinning at 38.5 and 46.2%, respectively. Open reduction and internal fixation had the highest rate of revision at 19.7%. Overall, the outcomes of PIP fractures and fracture-dislocations are based on the severity of injury, and the necessary treatment required. Closed reduction with percutaneous pinning and volar plate arthroplasty had good clinical and functional outcomes, with the lowest complication rates. Hemi-hamate arthroplasty and dynamic external fixation were utilized in more complex injuries and resulted in the lowest PIPJ ROM. This is a therapeutic, Level III study.
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Affiliation(s)
- Arianna Gianakos
- Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, Jersey City, New Jersey, United States
| | - John Yingling
- Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, Jersey City, New Jersey, United States
| | - Christian M Athens
- Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, Jersey City, New Jersey, United States
| | - Andrew E Barra
- Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, Jersey City, New Jersey, United States
| | - John T Capo
- Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, Jersey City, New Jersey, United States
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Harmon D, Spirtos M. An investigation of the acute management of closed intra-articular fractures of the proximal interphalangeal joint in Ireland. IRISH JOURNAL OF OCCUPATIONAL THERAPY 2020. [DOI: 10.1108/ijot-09-2019-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
Many treatment methods for intra-articular fractures of the proximal interphalangeal (PIP) joint are described in the literature without a consensus on the most effective approach. The purpose of this study was to investigate the methods of treatment of PIP joint fractures being used by trauma surgeons in the Republic of Ireland currently and the timing of referral to therapy.
Design/methodology/approach
A cross-sectional descriptive study methodology was used to survey trauma surgeons, occupational therapists and physiotherapists in Ireland. An online platform was used. A total of 21 surveys were returned by surgeons and 37 by therapists. Descriptive statistical analysis was used to present the results.
Findings
Buddy strapping was reported as the primary treatment method for stable PIP joint fractures. All levels of fracture severity were reported to be treated using traction constructs, which include static and dynamic fixation and orthoses. Unstable fractures were managed using open reduction with internal fixation by 50 per cent of surgeons. Early timing of referral to therapy is reported by more surgeons than therapists. The majority of therapists indicated that they did not have the resources to see patients at the optimal time.
Originality/value
To the authors’ knowledge, this study provides the first description of the management of PIP joint fractures across the Irish health service. The findings of this study suggest that additional therapy resources are required within the health service executive to facilitate the desired early referral to therapy and to enable service development for this category of hand fractures.
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Federer AE, Guerrero EM, Dekker TJ, Mithani SK, Aldridge JM, Ruch DS, Richard MJ. Open Reduction Internal Fixation With Transverse Volar Plating for Unstable Proximal Interphalangeal Fracture-Dislocation: The Seatbelt Procedure. Hand (N Y) 2020; 15:201-207. [PMID: 30056754 PMCID: PMC7076617 DOI: 10.1177/1558944718790063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Unstable intra-articular proximal interphalangeal (PIP) joint fracture-dislocations present a difficult problem that requires congruous joint reduction and stable internal fixation or distraction. Though fractures with limited articular involvement may be treated successfully with less invasive procedures, fracture-dislocations with a volar shear component may benefit from joint reduction with subchondral support for maintenance of stability. The purpose of this article is to describe a volar transverse plate and screw technique and report the short-term postoperative results. Methods: Seventeen patients with volar shear PIP dorsal fracture-dislocations were treated with transverse plate and screw constructs at an average of 21 days (range, 2-52) after injury. Information on postoperative stability, range of motion at PIP and distal interphalangeal (DIP) joints, and radiographic outcomes and complications were retrospectively collected. Results: At a mean of 7.3 months post-operation (range, 1.5-24), there were no recurrent dislocations and an average PIP arc of 77.4° and DIP arc of 61.5°. Sixteen of 17 patients had radiographically concentric joints, with 1 patient showing slight radiographic dorsal subluxation not apparent clinically. Two of 17 patients (11.8%) had revision surgery for tenolysis and removal of hardware to improve range of motion at 4 and 9 months post-operation. Conclusions: In the setting of PIP dorsal fracture-dislocations with volar shear component >40% of the articular surface, the Seatbelt procedure allows for concentric joint and articular surface reduction with subchondral support for maintenance of stability. This volar transverse plating technique allows for highly functional range of motion without PIP dorsal subluxation clinically in the setting of comminution and delayed presentation.
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Affiliation(s)
- Andrew E. Federer
- Duke University Medical Center, Durham, NC, USA,Andrew E. Federer, Hand Division, Department of Orthopaedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA.
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10
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Valdes K, Boyd JD, Povlak SB, Szelwach MA. Efficacy of orthotic devices for increased active proximal interphalangeal extension joint range of motion: A systematic review. J Hand Ther 2020; 32:184-193. [PMID: 30025844 DOI: 10.1016/j.jht.2018.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 03/26/2018] [Accepted: 05/17/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION/PURPOSE OF THE STUDY To determine the efficacy of orthotic devices for increased active proximal interphalangeal (PIP) joint range of motion and optimal wearing schedule of the devices to guide clinical practice. The secondary purpose is to capture the outcome measures used by the authors. The final purpose was to determine if recent studies addressed patient satisfaction and adherence in the orthotic management of a PIP joint injury. METHODS A comprehensive literature search was conducted using the search terms splint, orthotic device, hand orthotic, brace, proximal interphalangeal joint, occupational therapy, and physical therapy using PubMed, CINAHL, MEDLINE, and ProQuest. The following data were extracted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines: background statement, objectives, data sources, study eligibility criteria, participants, and interventions, study appraisal and synthesis methods, results, limitations, conclusions, and implications of key findings. RESULTS Best results were achieved when the PIP orthoses were worn for a longer duration especially for the treatment of extension deficits. DISCUSSION Studies that provided a wearing schedule of a minimum of 6 hours obtained the greatest improvements in extension deficits of the PIP joint. CONCLUSION Recommended orthotic dosage to treat PIP joint injury is at least 6 hours a day for 8-17 weeks.
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Affiliation(s)
- Kristin Valdes
- Gannon University, Ruskin, FL, USA; Hand Works Therapy, Venice, FL, USA
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11
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Oflazoglu K, Wilkens SC, Rakhorst H, Eberlin KR, Ring D, Chen NC. Postoperative Dorsal Proximal Interphalangeal Joint Subluxation in Volar Base Middle Phalanx Fractures. J Hand Microsurg 2019; 12:32-36. [PMID: 32280179 DOI: 10.1055/s-0039-1697063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/09/2019] [Indexed: 10/25/2022] Open
Abstract
Introduction This study was designed to assess factors associated with postoperative dorsal proximal interphalangeal (PIP) joint subluxation after operative treatment of volar base middle phalanx fractures. Our second purpose was to study the association between postoperative dorsal subluxation with postoperative arthritis. Materials and Methods We identified 44 surgically treated volar base PIP joint fractures with available pre- and postoperative radiographs between 2002 and 2015 at two academic medical systems with a median follow-up of 3.5 months. Demographic, injury, radiographic, and treatment data that might be associated with postoperative dorsal subluxation were collected. Three hand surgeons independently assessed subluxation and arthritis on radiographs. Bivariate analysis was performed to analyze our two study purposes. Results Six of 44 (14%) had postoperative dorsal subluxation after initial surgery. Bivariate analysis showed no factors with statistically significant association with postoperative subluxation, assessed independently by three hand surgeons on radiographs. Fifty per cent of the joints with postoperative arthritis had postoperative subluxation compared with 21% of joints without postoperative subluxation. No significant association was found between postoperative dorsal subluxation with postoperative arthritis. Conclusion The association of persistent subluxation and early arthrosis in dorsal PIP joint fracture dislocations needs further study. At this time, it is unclear in what ways persistent subluxation or arthrosis affects the rate of reoperation. Level of Evidence This is a therapeutic level IV study.
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Affiliation(s)
- Kamilcan Oflazoglu
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
| | - Suzanne C Wilkens
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Hinne Rakhorst
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
| | - Kyle R Eberlin
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas, United States
| | - Neal C Chen
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Abstract
Proximal interphalangeal joint (PIPJ) injuries are common and challenging to treat, involving a spectrum of conditions ranging from isolated ligamentous injuries to severe fracture dislocations. The main goal of treatment is to achieve a congruent, stable joint, which is key to achieving early range of motion and a favorable outcome. Injuries that do not compromise the stability of the joint may be treated nonsurgically, whereas those that render the joint unstable may be managed with one of many surgical strategies available. This article focuses on the current practices of treatment of injuries around the PIPJ.
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Affiliation(s)
- Ruth En Si Tan
- Department of Hand and Reconstructive Microsurgery, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, 119228, Singapore
| | - Andre Eu Jin Cheah
- Department of Hand and Reconstructive Microsurgery, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, 119228, Singapore.
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13
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Singh T, Jayawardhana R, Craigen M, Rajaratnam V. Volar Buttress Plating for Unstable Dorsal Fracture-Dislocations of the Proximal Interphalangeal Joint. J Hand Microsurg 2019; 11:106-110. [PMID: 31413495 DOI: 10.1055/s-0038-1677319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/15/2018] [Indexed: 10/27/2022] Open
Abstract
The authors present a series of 11 patients. All of them sustained an unstable dorsal fracture-dislocation of the proximal interphalangeal joint (PIPJ). These were managed with open reduction and internal fixation (ORIF) by use of an eight-hole, 1.3-mm oblique-angled strut plate, cut to shape to produce a four-hole plate, acting as a buttress plate. The operations were performed by orthopaedic surgeons with a special interest in hand surgery. Range of motion (ROM) and fixed flexion deformity (FFD) were measured postoperatively. Outcomes were assessed using the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) scoring system. Bony union, articular step-off, degenerative changes, persistent subluxation, or dislocation were confirmed by review of radiographs at latest follow-up. One patient developed a superficial infection and another developed complex regional pain syndrome. However, all patients were pain free at final follow-up. Radiographs at final follow-up confirmed bony union with no step-off, except for one patient who had a 1-mm step-off of the articular surface. Our attractive and novel technique of ORIF allows articular congruity to be restored anatomically with early active mobilization of the affected digit and early return to function.
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Affiliation(s)
- Talvinder Singh
- Department of Trauma and Orthopaedics, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Roshenka Jayawardhana
- Department of Orthopaedics, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
| | - Michael Craigen
- Department of Trauma and Orthopaedics, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Vaikunthan Rajaratnam
- Department of Trauma and Orthopaedics, Queen Elizabeth Hospital, Birmingham, United Kingdom
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Najd Mazhar F, Jafari D, Taraz H, Mirzaei A. Treatment of dorsal fracture-dislocations of the proximal interphalangeal joint using the shotgun approach. J Hand Surg Eur Vol 2018; 43:499-505. [PMID: 29591322 DOI: 10.1177/1753193418766274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study assessed the outcome of open reduction and internal fixation of proximal interphalangeal joint fracture-dislocations through a shotgun approach, while keeping hemi-hamate arthroplasty as a back-up plan. After using the shotgun approach, fixation was carried out when the anterior fragment was large enough to accept two 1.5 mm screws. Sixty-three fracture-dislocations were treated in 61 patients, of whom 30 underwent internal fixation. Twenty-one of these were assessed in the final study. At a mean follow-up of 29 months, the mean range of joint motion was 80° and 102° for the injured and contralateral hand, respectively. The mean pinch and grip strengths of injured hand were 82% and 83% of contralateral hand, respectively. The mean disabilities of the arm, shoulder and hand score was 5.5. The mean visual analogue pain score was 1.6. Surgery through the versatile shotgun approach allows excellent intra-operative assessment and acceptable outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Farid Najd Mazhar
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Davod Jafari
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Taraz
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran
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15
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Abstract
Proximal interphalangeal joint injuries are one of the most common injuries of the hand. The severity of injury can vary from a minor sprain to a complex intra-articular fracture. Because of the complex anatomy of the joint, complications may occur even after an appropriate treatment. This article provides a comprehensive review on existing techniques to manage complications and imparts practical points to help prevent further complications after proximal interphalangeal joint injury.
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Affiliation(s)
- Sirichai Kamnerdnakta
- Department of Surgery, Section of Plastic Surgery, University of Michigan, NCRC, Building 18, G200, 2800 Plymouth Road, Ann Arbor, MI 48109, USA; Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 12th Floor, Siamintr Building, Bangkok-noi, Bangkok 10700, Thailand
| | - Helen E Huetteman
- Department of Surgery, Section of Plastic Surgery, University of Michigan, NCRC, Building 18, G200, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Kevin C Chung
- Section of Plastic Surgery, University of Michigan, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
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16
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Giugale JM, Wang J, Kaufmann RA, Fowler JR. Mid-Term Outcomes After Open Reduction Internal Fixation of Proximal Interphalangeal Joint Dorsal Fracture-Dislocations Through a Volar, Shotgun Approach and a Review of the Literature. Open Orthop J 2017; 11:1073-1080. [PMID: 29151999 PMCID: PMC5676008 DOI: 10.2174/1874325001711011073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/24/2017] [Accepted: 08/12/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Proximal interphalangeal (PIP) fracture dislocations remain a complex injury pattern to treat. There are several treatment methods available aimed to restore stability, preserve range of motion, and reconstitute the articular surface. This study looked at the mid-term clinical and radiographic results of open reduction internal fixation through a shotgun approach of comminuted PIP fracture dislocations. Methods: A retrospective review was conducted of all PIP fracture dislocations treated through a volar, shotgun approach at a single institution over a 15-year period. Patients identified were contacted and asked to return to the office for clinical and radiographic evaluation. Patient reported outcomes were assessed with the Michigan hand questionnaire (MHQ) and visual analog scale (VAS) for pain. Results: 5 patients returned to the office for further evaluation with average follow-up of 69 months (range, 33-133 months). 3 patients were found to have post traumatic arthritis on radiographs. 1 case had recurrent instability and one case had a deep infection, both necessitating further surgical intervention. Average PIP arc of motion was found to be 79°. Average VAS score of 0 and MHQ result of 95 (out of a possible score of 100) indicating no residual pain and excellent functionality of the affected hand. Conclusion: Open reduction internal fixation of comminuted PIP fracture dislocations utilizing the volar, shotgun approach provides excellent mid-term functional results despite the high incidence of post traumatic arthritis.
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Affiliation(s)
- Juan Marcelo Giugale
- Orthopaedic Surgery Resident Department of Orthopaedic Surgery University of Pittsburgh Medical Center Pittsburgh, PA, USA
| | - Juntian Wang
- Medical Student University of Pittsburgh - School of Medicine Pittsburgh, PA, USA
| | - Robert A Kaufmann
- Associate Professor Department of Orthopaedic Surgery University of Pittsburgh Medical Center Pittsburgh, PA, USA
| | - John R Fowler
- Assistant Dean for Medical Student Research Assistant Professor Department of Orthopaedic Surgery University of Pittsburgh Medical Center Pittsburgh, PA, USA
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17
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Burnier M, Awada T, Marin Braun F, Rostoucher P, Ninou M, Erhard L. Treatment of unstable proximal interphalangeal joint fractures with hemi-hamate osteochondral autografts. J Hand Surg Eur Vol 2017; 42:188-193. [PMID: 27765865 DOI: 10.1177/1753193416671886] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The primary aim of this study was to assess the clinical and radiological results after hemi-hamate resurfacing arthroplasty in patients with acute or chronic unstable fractures of the base of the middle phalanx and to describe technical features that can facilitate the surgical procedure. Hemi-hamate arthroplasties were done in 19 patients (mean age 39 years) with an isolated fracture at the base of the middle phalanx that involved more than 40% of the articular surface. We assessed ten chronic cases (treated >6 weeks after fracture) and nine acute ones (<6 weeks) at a mean of 24 months. Pain scores, QuickDASH scores, grip strengths, range of motion and radiological findings were recorded at follow-up. At follow-up, the mean active flexion at the proximal interphalangeal joint was to 83° with a mean fixed flexion of 17° (active range of motion 66°). The mean active distal interphalangeal motion was 41°. The mean visual analogue scale score was 1.1. The mean QuickDASH score was 11. The mean pinch strength was 82% of the opposite side. Radiographs revealed one partial graft lysis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- M Burnier
- 1 Institut Chirurgical de la Main et du Membre Supérieur, Villeurbanne, France
| | - T Awada
- 2 Service de chirurgie de la main des diaconesses, Strasbourg, France
| | - F Marin Braun
- 2 Service de chirurgie de la main des diaconesses, Strasbourg, France
| | - P Rostoucher
- 1 Institut Chirurgical de la Main et du Membre Supérieur, Villeurbanne, France
| | - M Ninou
- 1 Institut Chirurgical de la Main et du Membre Supérieur, Villeurbanne, France
| | - L Erhard
- 1 Institut Chirurgical de la Main et du Membre Supérieur, Villeurbanne, France
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18
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Carruthers KH, Skie M, Jain M. Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience. Sports Health 2016; 8:469-78. [PMID: 27421747 PMCID: PMC5010131 DOI: 10.1177/1941738116658643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Context: Jam injuries of the finger are frequently encountered in general orthopaedic and sports medicine practice. The finger joints in particular are very susceptible to traumatic injury, but in the absence of severe deformity, digital trauma is often downplayed in the hopes of a more rapid return to game play. Evidence Acquisition: Articles published from 1966 to 2015 were reviewed to capture historical and current views on the presentation, diagnosis, and treatment of jam injuries in athletes. Study Design: Clinical review. Level of Evidence: Level 5. Results: Although jam injuries are frequently grouped together, they represent a host of injuries that can be challenging to differentiate. A thorough knowledge of finger joint anatomy and injury mechanism is critical to perform an appropriate examination, establish an accurate diagnosis, and identify a treatment plan for each patient. Conclusion: Every member of the athletic care team must be aware of the spectrum of digital injuries, including the basic signs present on examination, which may indicate the need for more formal workup. Additionally, preventing injury through athlete education is paramount to athletic care.
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Affiliation(s)
| | - Martin Skie
- Department of Orthopedic Surgery, The University of Toledo, Toledo, Ohio
| | - Margaret Jain
- Department of Orthopedic Surgery, The University of Toledo, Toledo, Ohio
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19
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Extension Block Pinning for Unstable Proximal Interphalangeal Joint Dorsal Fracture Dislocations. J Hand Surg Am 2016; 41:196-202. [PMID: 26718071 DOI: 10.1016/j.jhsa.2015.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 11/11/2015] [Accepted: 11/11/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the outcomes of extension block pinning used to treat unstable dorsal fracture dislocations of the proximal interphalangeal (PIP) joint. The factors affecting the functional outcome were analyzed. METHODS A series of 53 patients with 55 dorsal fracture dislocations of the PIP joint treated with closed reduction and extension block pinning were retrospectively reviewed. Additional percutaneous intramedullary fracture reduction (16 cases) or open fracture reduction (4 cases) had been performed. The radiological and clinical evaluations were included. RESULTS At a mean follow-up of 5.2 years (range, 1.0-10.6 years), 39 patients with 41 injured fingers were evaluated. The fracture fragments involved 30% to 69% (mean, 50%) of the articular surface of the middle phalanx. The mean range of motion was 80° (range, 35° to 115°) at the PIP joint with a mean extension loss of 6° (range, 0° to 50°) excluding 2 joints that were salvaged with arthrodesis. The mean range of motion of the distal interphalangeal joint was 68° (range, 5° to 90°). The mean visual analog scale for digit pain was 1.5/10. The reduction of the joint was achieved intraoperatively in all cases. However, after the hardware removal, recurrent minimal subluxation was observed in 12 cases (29%). Recurrent subluxation was associated with increased residual pain. The length of follow-up time had a positive correlation, whereas the patient age had a negative correlation with the range of motion of the injured PIP joint. CONCLUSIONS The extension block pinning technique is a simple and valuable technique for treating unstable dorsal PIP fracture-dislocation injuries producing satisfactory long-term results.
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20
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Bindra R, Colantoni Woodside J. Treatment of Proximal Interphalangeal Joint Fracture-Dislocations. JBJS Rev 2015; 3:01874474-201512000-00001. [PMID: 27490993 DOI: 10.2106/jbjs.rvw.o.00019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Randy Bindra
- Orthopaedic Surgery, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD 4215, Australia
| | - Julie Colantoni Woodside
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Suite 1700, Maywood, IL 60153
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21
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MacFarlane RJ, Gillespie S, Cashin F, Mahmood A, Cheung G, Brown DJ. Treatment of fracture subluxations of the proximal interphalangeal joint using a ligamentotaxis device: a multidisciplinary approach. J Hand Surg Eur Vol 2015; 40:825-31. [PMID: 26056129 DOI: 10.1177/1753193415578305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 02/28/2015] [Indexed: 02/03/2023]
Abstract
Complex fracture subluxations of the proximal interphalangeal joint are often difficult to treat and their outcome variable. A number of methods for treatment of these injuries have been described. We have used a ligamentotaxis device (Ligamentotaxor, Arex, Palaiseau Cedex, France) since 2008. We performed 28 operations in 28 patients with complex proximal interphalangeal joint injuries over a 3-year period. Patients followed a standardized postoperative rehabilitation regime, including fixator adjustment as necessary. The mean age was 33 years (range 18-67). The mean time to surgery was 7 days. At final follow-up (mean 22 months, range 6-52) the mean proximal interphalangeal joint range of motion was 85° (range 60°-110°). The mean QuickDASH functional outcome score was 4.8 (range 0-36.4). Our results compare favourably with other devices reported in the literature.
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Affiliation(s)
- R J MacFarlane
- Liverpool Upper Limb Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - S Gillespie
- Liverpool Upper Limb Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - F Cashin
- Liverpool Upper Limb Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - A Mahmood
- Liverpool Upper Limb Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - G Cheung
- Liverpool Upper Limb Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - D J Brown
- Liverpool Upper Limb Unit, Royal Liverpool University Hospital, Liverpool, UK
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22
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de Haseth KB, Neuhaus V, Mudgal CS. Dorsal fracture-dislocations of the proximal interphalangeal joint: evaluation of closed reduction and percutaneous Kirschner wire pinning. Hand (N Y) 2015; 10:88-93. [PMID: 25767425 PMCID: PMC4349844 DOI: 10.1007/s11552-014-9660-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study is to evaluate the outcome of closed reduction and percutaneous Kirschner wire pinning in acute dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint. METHODS Eight men and one woman were treated with closed reduction and percutaneous Kirschner wire pinning by one orthopaedic surgeon. The ring finger was injured in six patients, the small finger in two patients and the middle finger in one patient. The mean joint surface involvement was 36 % (range, 26-49 %). The Kirschner wires were removed after an average of 28 days (range, 24-37 days). RESULTS All patients demonstrated a painless, but fusiform, swollen PIP joint after a mean follow-up of 6.5 months. The average flexion of the PIP joint was 106° (range, 80-110), and the average extension of the PIP joint was 4° short of full extension (range, 10 hyperextension-15 flexion contracture). All patients had a concentrically reduced PIP joint with a healed fracture on radiographs. Two patients had radiographic evidence of degenerative changes, but were asymptomatic. One patient developed a superficial pin track infection, which quickly resolved with a short course of antibiotics, and avascular necrosis affecting one of the condyles of the proximal phalanx. CONCLUSIONS In agreement with previous studies, closed reduction and percutaneous Kirschner wire pinning in dorsal fracture-dislocations of the PIP joint is a minimally invasive and simple technique which appears to give satisfactory outcomes in the short to intermediate term.
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Affiliation(s)
- Kristin B. de Haseth
- />Orthopaedic Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA , />Plastic, Reconstructive and Hand Surgery Department, Medisch Centrum Leeuwarden, 8934 Leeuwarden, Netherlands
| | - Valentin Neuhaus
- />Orthopaedic Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA , />Division of Trauma Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Chaitanya S. Mudgal
- />Orthopaedic Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
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23
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Treatment of a fractured juxta-articular enchondroma of the middle phalanx with a Suzuki external fixator: a case report. Tech Hand Up Extrem Surg 2015; 19:46-9. [PMID: 25706150 DOI: 10.1097/bth.0000000000000074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report the case of a 47-year-old man who presented with a pathologic fracture of the middle phalanx of the fourth finger. The treatment of this juxta-articular lesion close to the proximal interphalangeal joint was performed in 2 stages. First, a biopsy was carried out combined with fixation of the fracture by a Suzuki dynamic external fixator. After 6 weeks, a curettage of the confirmed enchondroma was performed with iliac crest grafting, leaving the external fixator for another 4 weeks. With a follow-up of 48 months, a satisfying functional result has been obtained with a remarkable remodeling of the painless proximal interphalangeal joint.
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24
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Tyser AR, Tsai MA, Parks BG, Means KR. Biomechanical characteristics of hemi-hamate reconstruction versus volar plate arthroplasty in the treatment of dorsal fracture dislocations of the proximal interphalangeal joint. J Hand Surg Am 2015; 40:329-32. [PMID: 25542433 DOI: 10.1016/j.jhsa.2014.10.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/30/2014] [Accepted: 10/02/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare stability and range of motion after hemi-hamate reconstruction versus volar plate arthroplasty in a biomechanical proximal interphalangeal (PIP) joint fracture-dislocation model. METHODS Eighteen digits from 6 cadaver hands were tested. We created defects of 40%, 60%, and 80% in the palmar base of each digit's middle phalanx, simulating an acute PIP joint fracture-dislocation. Each defect scenario was reconstructed with a hemi-hamate arthroplasty followed by a volar plate arthroplasty. A computer-controlled mechanism was used to bring each digit's PIP joint from full extension to full flexion via the digital tendons in each testing state, and in the intact state. During each testing scenario we collected PIP joint cinedata in a true lateral projection using mini-fluoroscopy. A digital radiography program was used to measure the amount of middle phalanx dorsal translation (subluxation) in full PIP joint extension. We recorded the angle at which subluxation, if present, occurred during each testing scenario. RESULTS Average dorsal displacement of the middle phalanx in relation to the proximal phalanx was 0.01 mm for the hemi-hamate reconstructed joints and -0.03 mm for the volar plate arthroplasty, compared with the intact state. Flexion contractures were noted in each of the specimens reconstructed with volar plate arthroplasty. Degree of contracture was directly correlated with defect size, averaging 20° for 40% defects, 35° for 60% defects, and 60° for 80% defects. We observed no flexion contractures in the hemi-hamate reconstructions. CONCLUSIONS Surgeons can use both hemi-hamate and volar plate arthroplasty to restore PIP joint stability following a fracture dislocation with a large middle phalanx palmar base defect. Use of volar plate arthroplasty led to an increasing flexion contracture as the middle phalanx palmar base defect increased. CLINICAL RELEVANCE Clinicians can use the information from this study to help with surgical decision-making and patient education.
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Affiliation(s)
- Andrew R Tyser
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Michael A Tsai
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Brent G Parks
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Kenneth R Means
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
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25
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Current concepts in treatment of fracture-dislocations of the proximal interphalangeal joint. Plast Reconstr Surg 2015; 134:1246-1257. [PMID: 25415092 DOI: 10.1097/prs.0000000000000854] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Proximal interphalangeal joint fracture-dislocations are common injuries that require expedient and attentive treatment for the best outcomes. Management can range from protective splinting and early mobilization to complex surgery. In this review, the current concepts surrounding the management of these injuries are reviewed. METHODS A literature review was performed of all recent articles pertaining to proximal interphalangeal joint fracture-dislocation, with specific focus on middle phalangeal base fractures. Where appropriate, older articles or articles on closely related injury types were included for completeness. The methodology and outcomes of each study were analyzed. RESULTS When small avulsion fractures are present, good results are routinely obtained with reduction and early mobilization of stable injuries. Strategies for management of the unstable dorsal fracture-dislocation have evolved over time. To provide early stability, a variety of techniques have evolved, including closed, percutaneous, external, and internal fixation methods. Although each of these techniques can be successful in skilled hands, none has been subjected to rigorous, prospective, comparative trials. Volar dislocations fare less well, with significant loss of motion in many studies. Pilon fractures represent the most complicated injuries, and return of normal motion is not expected. CONCLUSIONS The best outcomes can be achieved by (1) establishing enough stability to allow early motion, (2) restoring gliding joint motion rather than noncongruent motion, and (3) restoring the articular surface congruity when possible. Although the majority of literature on this topic consists of expert opinion and retrospective case series, the consensus appears to favor less invasive techniques whenever possible.
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26
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Liodaki E, Xing SG, Mailaender P, Stang F. Management of difficult intra-articular fractures or fracture dislocations of the proximal interphalangeal joint. J Hand Surg Eur Vol 2015; 40:16-23. [PMID: 25427554 DOI: 10.1177/1753193414559464] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Intra-articular fractures or fracture dislocations of the proximal interphalangeal joint are difficult clinically because the bone and soft tissue structures are small and intricate. Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand. This article reviews the current methods of treatment, together with the senior author's experience in treating difficult proximal interphalangeal joint fractures and dislocations. Besides conservative treatments, surgical treatments include open or closed reduction with traditional Osteosynthesis, such as K-wires, screws or plates. Among recent developments are the percutaneous application of thin cannulated compression screws and novel dynamic external fixators. After a preferred minimally invasive treatment with stable reconstruction of the articular surface, sufficient aftercare is necessary to improve surgical outcomes.
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Affiliation(s)
- E Liodaki
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - S G Xing
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
| | - P Mailaender
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - F Stang
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Luebeck, Germany
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27
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The Mohawk homeobox transcription factor regulates the differentiation of tendons and volar plates. J Orthop Sci 2014; 19:172-80. [PMID: 24166359 PMCID: PMC3943675 DOI: 10.1007/s00776-013-0485-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 10/08/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Mohawk (Mkx) is a homeodomain-containing transcription factor that is expressed in various mesoderm-derived tissues, particularly in developing tendons. In this study, we investigate the exact expression pattern and functions of Mkx in forelimbs. METHODS We analyzed the forelimbs of Mkx knockout mice [from embryonic day (E) 18.5 to postnatal day (P) 28 weeks] by using knocked-in Venus signals, Masson trichrome staining, and hematoxylin and eosin (H&E) staining. RESULTS We detected Venus signals in forelimb tendons, pulleys, and volar plates (VPs) in P21 mice. In-depth histological analysis showed that compared to the wild-type mice, the Mkx knockout mice showed significant hypoplasia in the flexor digitorum profundus tendons from E18.5. The VPs and pulleys appeared normal until P0; however, by P14, they became increasingly thicker in Mkx-null mice compared to wild-type mice. The fiber alignment was particularly disrupted in VPs of Mkx-null mice. CONCLUSIONS These results suggest that Mkx is an important regulator of the differentiation of VPs and pulleys, as well as of tendon differentiation.
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28
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Tyser AR, Tsai MA, Parks BG, Means KR. Stability of acute dorsal fracture dislocations of the proximal interphalangeal joint: a biomechanical study. J Hand Surg Am 2014; 39:13-8. [PMID: 24211175 DOI: 10.1016/j.jhsa.2013.09.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE We performed a cadaveric biomechanical study to characterize proximal interphalangeal joint stability after an injury to different amounts of the volar articular base of the middle phalanx (intact, 20%, 40%, 60%, and 80% volar defects). METHODS Eighteen digits on 6 hands were tested through full proximal interphalangeal joint range of motion using computer-controlled flexion and extension via the digital tendons. We collected proximal interphalangeal joint kinematic cine data in a true lateral projection with mini-fluoroscopy. We measured the amount of dorsal middle phalanx translation in full proximal interphalangeal joint extension. As we cycled the joint from full flexion into extension, we recorded the angle at which subluxation occurred. RESULTS No specimens with 20% volar bony defect subluxated. All specimens in the 60% and 80% groups subluxated at an average flexion angle of 67° (range, 10° to 90°) in the 60% group and at all degrees of flexion in the 80% group. In the 40% group, 28% of specimens demonstrated subluxation at an average flexion angle of 14° (range, 4° to 40°). Mean dorsal translation of the middle phalanx in relation to the proximal phalanx at full digital extension was 0.2 mm in the 20% group, 0.8 mm in the 40% group, 3.2 mm in the 60% group, and 3.1 mm in the 80% group. CONCLUSIONS Simulated volar articular bony defects of 20% were stable, whereas those with 60% and 80% defects were unstable during digital motion. Stability in the 40% group was variable and appeared to be the threshold for stability. CLINICAL RELEVANCE Knowledge of the typical amount of middle phalanx defect and degree of proximal interphalangeal joint extension that can lead to joint instability may improve management of mechanically important proximal interphalangeal joint fracture dislocations.
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Affiliation(s)
- Andrew R Tyser
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Michael A Tsai
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Brent G Parks
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Kenneth R Means
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
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29
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Open Reduction of Proximal Interphalangeal Fracture-Dislocation through a Midlateral Incision Using Absorbable Suture Materials. Arch Plast Surg 2013; 40:397-402. [PMID: 23898438 PMCID: PMC3724002 DOI: 10.5999/aps.2013.40.4.397] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/08/2013] [Accepted: 04/29/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Fracture-dislocation of the proximal interphalangeal (PIP) joint is a relatively common injury. Various treatments for fracture-dislocation of the PIP joint have been reported. In the present study, we performed open reduction through a midlateral incision using absorbable sutures to reduce the small bone fragments and performed volar plate repair. METHODS We treated nine patients with fracture-dislocation of the PIP joint with small fractured bone fragments too small for pinning or screw fixation. Patients with volar plate injury were treated with open reduction and volar plate repair at the periosteum of the middle phalangeal bone base by the modified Kessler method using absorbable sutures. All patients were placed in a dorsal aluminum extension block splint, which maintained the PIP joint in approximately 30 degrees of flexion to avoid excessive tension on the sutured volar plate. RESULTS At a mean final follow-up of postoperative 9 months, all patients were evaluated radiographically and had adequate alignment of the PIP joint and reduction of the displaced bone fragments. Range of motion was improved and there were no complications. CONCLUSIONS This technique is an excellent alternative to the current method of treating patients with fracture-dislocations that include small fragments that are too small for pinning or screw fixation. It is a less invasive surgical method and enables stable reduction and early exercise without noticeable complications.
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Abstract
Fracture-dislocations of the proximal interphalangeal joint encompass a spectrum of injury severity, ranging from injuries that require little intervention to those that require advanced reconstructive surgery for optimal outcome. Three fracture-dislocation patterns are recognized: dorsal, volar, and pilon. Acceptable outcome is dependent on achieving and maintaining a well-aligned and well-reduced joint, re-establishing normal joint kinematics, and restoring motion. Anatomic articular surface reduction is desirable but not absolutely necessary for a good outcome. Treatment depends on both the type of injury and patient-dependent factors. Optimal outcome for a specific injury is predicated on expedient diagnosis and recognition of injury severity, which enables initiation of appropriate management.
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Gillespie S, Cashin F, Macfarlane RJ, Brown DJ. Prevention of extension lag using a sling attachment for Ligamentotaxor ® devices in complex proximal interphalangeal joint injuries. Ann R Coll Surg Engl 2012. [PMID: 22943248 PMCID: PMC3954394 DOI: 10.1308/003588412x13373405385214n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- S Gillespie
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
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Maalla R, Youssef M, Ben Jdidia G, Khimiri C, Essadam H. Extension-block pinning for fracture-dislocation of the proximal interphalangeal joint. Orthop Traumatol Surg Res 2012; 98:559-63. [PMID: 22884121 DOI: 10.1016/j.otsr.2012.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 01/27/2012] [Accepted: 02/28/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Dorsal fracture-dislocation of the proximal interphalangeal joint is an unstable fracture that associates the anterior marginal fracture of the second phalangeal base and the dorsal dislocation of the proximal interphalangeal joint under the influence of the median band traction of the extensor apparatus. Stiffness and residual pain are frequent sequelae. Treatment involves choosing between the various methods with the objective of providing stable reduction allowing early mobilization. HYPOTHESIS We relate our experience concerning treatment by proximal interphalangeal extension-block pinning. It consists in reduction by external manipulation and stabilization by extension-block pinning. MATERIALS AND METHODS This technique was used in 22 Trojan-type fractures. The average age of our patients was 36 years, with a predominance of males. In half of the cases, the fracture involved more than 40% of the second phalangeal articular surface. RESULTS The mean follow-up in this series was 2 years and 7 months. Assessed based on functional, clinical, and radiological criteria, the results were good in 82% of the cases. The proximal interphalangeal joint was painless and the active mobility sector mean was greater than 85°. DISCUSSION The dorsal dislocation fracture of the proximal interphalangeal joint is an unstable lesion. Its treatment must provide stable reduction allowing early mobilization. Various therapeutic means are described. We opted for extension-block pinning, a simple and reproducible technique with encouraging results. LEVEL OF EVIDENCE Level IV retrospective study.
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Affiliation(s)
- R Maalla
- La Rabta Teaching Hospital Center, Faculty of Medicine, Tunis, Tunisia.
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Abstract
Treatment of professional baseball players with PIP injuries requires careful evaluation and prompt treatment. Stability of the injury dictates treatment and return to play. The majority of injuries can be managed with minimal splinting or buddy taping, but the most complex injuries require operative intervention to ensure stable reduction. Consideration of players' position and handedness is important in determining return to practice and play.
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Phalangeal fractures of the hand. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31825e705f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Goudie S, Dreyer S, Siddiqi R. Modified mattress suture. Ann R Coll Surg Engl 2012; 94:366. [DOI: 10.1308/rcsann.2012.94.5.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Granville-Chapman J, Elliott DS. Use a ball-ended anterior cruciate ligament reamer to protect patella tendon during minimal access tibial nailing. Ann R Coll Surg Engl 2012; 94:371. [DOI: 10.1308/rcsann.2012.94.5.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - DS Elliott
- Ashford and St Peter’s Hospitals NHS Foundation Trust,UK
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Kazi HA, Thomas TG. Use of a sharps bin to provide lower limb traction. Ann R Coll Surg Engl 2012; 94:360. [DOI: 10.1308/rcsann.2012.94.5.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- HA Kazi
- Wirral University Teaching Hospital NHS Foundation Trust,UK
| | - TG Thomas
- Wirral University Teaching Hospital NHS Foundation Trust,UK
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MacDonald ER, Renwick AA, Molloy RG. Laparoscopic hepatic flexure mobilisation. Ann R Coll Surg Engl 2012; 94:360. [DOI: 10.1308/rcsann.2012.94.5.360a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - RG Molloy
- Gartnavel General Hospital, Glasgow,UK
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Gillespie S, Cashin F, Macfarlane RJ, Brown DJ. Prevention of extension lag using a sling attachment for Ligamentotaxor® devices in complex proximal interphalangeal joint injuries. Ann R Coll Surg Engl 2012; 94:367-8. [DOI: 10.1308/rcsann.2012.94.5.367a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- S Gillespie
- Royal Liverpool and Broadgreen University Hospitals NHS Trust,UK
| | - F Cashin
- Royal Liverpool and Broadgreen University Hospitals NHS Trust,UK
| | - RJ Macfarlane
- Royal Liverpool and Broadgreen University Hospitals NHS Trust,UK
| | - DJ Brown
- Royal Liverpool and Broadgreen University Hospitals NHS Trust,UK
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Cheung A. Soft tissue protection from exposed K-wires. Ann R Coll Surg Engl 2012; 94:372. [DOI: 10.1308/rcsann.2012.94.5.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Cheung
- West Hertfordshire Hospitals NHS Trust,UK
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Leong E, Lemon M. A knot quicker and easier than Whip stitching in anterior cruciate ligament reconstruction. Ann R Coll Surg Engl 2012. [DOI: 10.1308/rcsann.2012.94.5.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- E Leong
- Royal Surrey County Hospital nHS foundation Trust,UK
| | - M Lemon
- Royal Surrey County Hospital nHS foundation Trust,UK
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Affiliation(s)
- J Krysa
- Guy’s and St Thomas’ NHS Foundation Trust,UK
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Affiliation(s)
- RP Walter
- South Devon Healthcare NHS Foundation Trust,UK
| | - S James
- South Devon Healthcare NHS Foundation Trust,UK
| | - JR Davis
- South Devon Healthcare NHS Foundation Trust,UK
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Storey RL, Gouda MR, Smith AM. A simple exercise to encourage precise suture placement. Ann R Coll Surg Engl 2012; 94:370. [DOI: 10.1308/rcsann.2012.94.5.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- RL Storey
- Leeds Teaching Hospitals NHS Trust,UK
| | - MR Gouda
- Leeds Teaching Hospitals NHS Trust,UK
| | - AM Smith
- Leeds Teaching Hospitals NHS Trust,UK
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Travers H, Mansfield S. A technique to maintain pneumoperitoneum and allow easy inspection of the abdomen after specimen delivery in laparoscopic colorectal surgery. Ann R Coll Surg Engl 2012; 94:362. [DOI: 10.1308/rcsann.2012.94.5.362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- H Travers
- Royal Devon and Exeter NHS Foundation Trust,UK
| | - S Mansfield
- Royal Devon and Exeter NHS Foundation Trust,UK
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Weddell C, McMurtrie A, Hamad AK. A simple aid to fracture reduction in the digit. Ann R Coll Surg Engl 2012; 94:369-70. [DOI: 10.1308/rcsann.2012.94.5.369a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- C Weddell
- Shrewsbury and Telford Hospital NHS Trust,UK
| | - A McMurtrie
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust,UK
| | - AK Hamad
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust,UK
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Middleton PR, Ng L, Humphrey A. A technique to aid the insertion of distal locking screws. Ann R Coll Surg Engl 2012; 94:364-5. [DOI: 10.1308/rcsann.2012.94.5.364a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- PR Middleton
- County Durham and Darlington NHS Foundation Trust,UK
| | - L Ng
- Newcastle upon Tyne Hospitals NHS Foundation Trust,UK
| | - A Humphrey
- County Durham and Darlington NHS Foundation Trust,UK
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Ellis G, Pridgeon S, Graham S. A technique for optimal manipulation of rotation of the flexible ureterorenoscope. Ann R Coll Surg Engl 2012; 94:365-6. [DOI: 10.1308/rcsann.2012.94.5.365a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - S Graham
- Whipps Cross University Hospital NHS TrustUK
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Haughton D, Jordan D, Malahias M, Hindocha S, Khan W. Principles of hand fracture management. Open Orthop J 2012; 6:43-53. [PMID: 22423303 PMCID: PMC3296112 DOI: 10.2174/1874325001206010043] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 10/28/2011] [Accepted: 10/29/2011] [Indexed: 01/17/2023] Open
Abstract
The hand is essential in humans for physical manipulation of their surrounding environment. Allowing the ability to grasp, and differentiated from other animals by an opposing thumb, the main functions include both fine and gross motor skills as well as being a key tool for sensing and understanding the immediate surroundings of their owner. Hand fractures are the most common fractures presenting at both accident and emergency and within orthopaedic clinics. Appropriate evaluation at first presentation, as well as during their management, can significantly prevent both morbidity and disability to a patient. These decisions are dependant on a wide range of factors including age, hand dominance, occupation and co-morbidities.A fracture is best described as a soft tissue injury with an associated bony injury. Despite this being the case, this paper intends to deal mainly with the bone injury and aims to discuss both the timing, as well as the methods available, of hand fracture management.
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Affiliation(s)
- Dn Haughton
- Department of Plastic Surgery, Countess of Chester Hospital, Liverpool Road Chester, CH21UL. UK
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