1
|
Guerra E, Licciardi L, Van Veenendaal P, Robinson LS. Reliability and clinical utility of a novel telehealth-based goniometry approach to measure range of motion of the digits of the hand. J Hand Ther 2024; 37:83-93. [PMID: 37591726 DOI: 10.1016/j.jht.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 03/21/2023] [Accepted: 05/01/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Range of motion (ROM) is an outcome measure commonly used when treating acute and chronic hand injuries and conditions. Increased adoption of telehealth service provision in hand therapy practice, influenced by the advent of COVID-19, has led to the need for a valid and reliable approach to measure the range of motion of the digits of the hand when providing hand therapy services using telehealth. PURPOSE To determine if performing manual goniometry during a livestream teleconsultation is reliable and clinically useful to measure the range of motion of the fifth digit when providing hand therapy services using telehealth. STUDY DESIGN Clinical measurement, repeated-measures study. METHODS According to a measurement protocol, 12 independent raters (who currently provide hand therapy services) each obtained several screen-based goniometric range of motion measurements of the fifth digit at 2-time points. Raters were surveyed on the clinical utility of the telehealth-based goniometry approach. Measures of relative and absolute reliability were calculated to evaluate test-retest and inter-rater reliability. Free-text responses were analyzed using content analysis. RESULTS Inter-rater reliability was excellent for all flexion and extension measures (intraclass correlation coefficient [ICC] ≥ 0.89) but poor for the arc of motion (ICC ≤ 0.67). Test-retest reliability was poor (ICC ≤ 0.43). No statistically significant differences between test and retest measurements were observed (P ≥ 0.24). The overall coefficient of variation indicated good precision (14.69%). Measurement error (≤6.07º) and limits of agreement (≤6.33) had acceptable levels to support clinical use. Content analysis revealed several practical considerations. CONCLUSIONS This study suggests that performing manual goniometry during a livestream teleconsultation is unreliable for measuring the range of motion of the fifth digit. However, when combined with patient-reported and functional outcomes, this approach may be suitable to facilitate a range of motion assessment for certain functions of telehealth service provision in hand therapy practice.
Collapse
Affiliation(s)
- Emiliana Guerra
- Department of Occupational Therapy, Monash University-Peninsula Campus, Frankston, Victoria, Australia.
| | - Lisa Licciardi
- Department of Occupational Therapy, Monash University-Peninsula Campus, Frankston, Victoria, Australia
| | - Penny Van Veenendaal
- Department of Occupational Therapy, Alfred Health, Melbourne, Victoria, Australia
| | - Luke Steven Robinson
- Department of Occupational Therapy, Monash University-Peninsula Campus, Frankston, Victoria, Australia
| |
Collapse
|
2
|
Startseva X, Marks M, Schweizer A, Herren DB, Schindele S. Does distal interphalangeal joint arthrodesis affect proximal interphalangeal joint arthroplasty outcomes in the same finger? J Hand Surg Eur Vol 2023; 48:1056-1061. [PMID: 37751222 DOI: 10.1177/17531934231191255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The purpose of this study was to analyse the 1-year outcomes after combining a surface replacing proximal interphalangeal joint arthroplasty and a distal interphalangeal screw arthrodesis and to compare the combined surgery with proximal interphalangeal joint arthroplasty alone. To obtain two groups with similar baseline data from our prospective registry, propensity score matching was used to match 23 fingers with the combined operations with 115 fingers with proximal interphalangeal joint arthroplasty alone. One year after surgery, the mean ranges of motion were 60° (95% CI: 53° to 67°) in the combined group and 63° (95% CI: 60° to 66°) in the control group and did not differ significantly. Grip strength, the brief Michigan Hand Questionnaire and pain also did not differ between the groups 1 year after surgery. All the proximal interphalangeal implants in patients treated with a distal interphalangeal screw arthrodesis remained in situ. Combining proximal interphalangeal joint arthroplasty with distal interphalangeal arthrodesis leads to 1-year outcomes that are similar to those achieved by proximal interphalangeal joint replacement alone.Level of evidence: III.
Collapse
Affiliation(s)
- Xenia Startseva
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | | | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | | |
Collapse
|
3
|
Hesse N, Reidler P, Schmitt R. [Sports-related injuries of the thumb and fingers]. Radiologie (Heidelb) 2023; 63:284-292. [PMID: 36917239 DOI: 10.1007/s00117-023-01127-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 03/16/2023]
Abstract
Finger and thumb injuries are common in established and trend sports. Imaging plays an important role in acute trauma care, further therapy planning, and ultimately for a rapid return to play. Sound knowledge of the complex anatomy of the fingers and thumb is indispensable for accurate diagnosis. This article presents the ligament anatomy of the metacarpophalangeal and interphalangeal joints of the finger and the thumb, the extensor and flexor tendon apparatus, and the diagnosis of typical sports injuries using x‑rays and magnetic resonance imaging. Furthermore, imaging findings of typical sports-associated injuries are illustrated.
Collapse
Affiliation(s)
- N Hesse
- Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität (LMU) München, Ziemssenstr. 5, 81377, München, Deutschland.
| | - P Reidler
- Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität (LMU) München, Ziemssenstr. 5, 81377, München, Deutschland
| | - R Schmitt
- Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität (LMU) München, Ziemssenstr. 5, 81377, München, Deutschland.,Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| |
Collapse
|
4
|
Löw S, Spies CK, Erne HC. Long-term preservation of metacarpophalangeal joint function in traumatic defects by metatarsophalangeal osteochondral transplantation. Arch Orthop Trauma Surg 2023; 143:1109-15. [PMID: 35680689 DOI: 10.1007/s00402-022-04492-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/18/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The integrity of the metacarpophalangeal (MCP) joints is essential for finger and hand function. Preservation of range-of-motion is one of the aims in reconstruction of complex injuries to these joints. Osteochondral transplants have shown to be reliable in reconstruction of various joint defects. This series presents three patients with traumatic injuries to four MCP joints, which were reconstructed by seven avascular osteochondral transplants of metatarsophalangeal (MTP) joints. The joints were examined for radiographic signs of resorption or joint space narrowing, and if this would affect the joints' function in the long term. METHODS In three patients (40, 45 and 48 years) with complex injuries to their MCP joints (one milling, two saw injuries), four joints were reconstructed by three metatarsal head and four osteochondral transplants of the base of the proximal toe phalanges. Beside the joint itself, various soft tissue defects were reconstructed in each patient. The patients were clinically and radiographically examined after 9, 6, respectively, 7 years. RESULTS All patients were satisfied with the result without any pain in the MCP joints. Range-of-motion in the four affected joints rated 25, 60, 75, and 80°, DASH scores rated 13, 29, and 17, respectively. None of the patients complained of problems at their feet. Radiographic examination revealed moderate joint space narrowing in one of the four joints. In another patient, localized osteolysis was found around the screws' heads, so that the screws were removed 7 years post-op. CONCLUSIONS Osteochondral transplants for reconstruction of MCP defects are able to preserve function in severely injured joints even in the long term. Joint space narrowing may occur, which is not accompanied by pain, however. Since localized osteolysis can cause screw head prominence, mid-term radiographic follow-up is necessary to prevent damage to the joint. In the long term, remaining bone stock may be adequate for total joint replacement.
Collapse
|
5
|
Getzmann JM, Kaniewska M, Rothenfluh E, Borowka S, Guggenberger R. Comparison of AI-powered 3D automated ultrasound tomography with standard handheld ultrasound for the visualization of the hands-clinical proof of concept. Skeletal Radiol 2022; 51:1415-23. [PMID: 34970704 DOI: 10.1007/s00256-021-03984-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/18/2021] [Accepted: 12/23/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the ability of a newly developed AI-powered ultrasound 3D hand scanner to visualize joint structures in healthy hands and detect degenerative changes in cadaveric hands. MATERIALS AND METHODS Twelve individuals (6 males, 6 females, age 43.5 ± 17.8 years) underwent four scans with the 3D ultrasound tomograph (right and left hand, dorsal and palmar, respectively) as well as four sets of handheld ultrasound of predefined anatomic regions. The 3D ultrasound tomographic images and the standard handheld ultrasound images were assessed by two radiologists with regard to visibility of bone contour, joint capsule and space, and tendons. In addition, three cadaveric hands were scanned with the 3D ultrasound tomograph and CT. RESULTS Mean scan time for both hands was significantly faster with handheld ultrasound (10 min 30 s ± 95 s) compared to 3D ultrasound tomography (32 min 9 s ± 6 s; p < 0.001). Interreader and intermodality agreement was moderate (0.4 < κ ≤ 0.6) to substantial (0.6 < κ ≤ 0.8). Overall visibility of joint structures was comparable between the modalities at the level of the wrist (p = 0.408), and significantly better with handheld ultrasound at the level of the finger joints and the thumb (both p < 0.001). The 3D ultrasound tomograph was able to detect osteophytes in cadaveric hands which were confirmed by CT. CONCLUSION The AI-powered 3D ultrasound tomograph was able to visualize joint structures in healthy hands and singular osteophytes in cadaveric hands. Further technical improvements are necessary to shorten scan times and improve automated scanning of the finger joints and the thumb.
Collapse
|
6
|
Woo SH, Kwak SH, Jang HS, Kim DH, Seo JH, Lee SH. Distal interphalangeal joint arthrodesis with nonaxial multiple small screws: a biomechanical analysis with axial headless compression screw and clinical result of 15 consecutive cases. BMC Musculoskelet Disord 2022; 23:504. [PMID: 35624461 PMCID: PMC9137156 DOI: 10.1186/s12891-022-05473-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background The axial headless compression screw (AHCS) technique is a widely used method for distal interphalangeal joint (DIPJ) and thumb IPJ arthrodesis. However, it might not be suitable for cases over 10° flexion of fusion angle and extremely small-sized phalanx. Here, the authors describe the nonaxial multiple small screws (NMSS) technique, compare the mechanical strength of the NMSS technique with the AHCS technique, and suggest clinical outcomes of the NMSS technique. Methods DIPJ and thumb IPJ arthrodesis models were simulated in the 4th generation composite bone hand. Fixation with three 1.5 mm cortical screws (NMSS) or one HCS (AHCS) was performed in each pair of the phalanx. The bending stiffness and load to failure were tested in 10 pairs of each specimen, and the torsional stiffness and torque to failure were tested in seven pairs of each specimen. Moreover, 15 consecutive clinical DIPJ and thumb IPJ arthrodesis cases were reviewed retrospectively. Results The NMSS specimens showed significantly higher bending load to failure, torsional stiffness, and torque to failure than the AHCS specimens. All 15 arthrodesis cases were united without severe complications. The mean fusion angle was 16.3° for the nine cases of the flexed target position. Conclusions The NMSS technique showed biomechanical stability comparable to that of the AHCS technique in DIPJ and thumb IPJ arthrodesis. Thus, the NMSS technique could be used as a feasible option in DIPJ and thumb IPJ arthrodesis, especially when a small finger is indicated and a significant flexion angle is required. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05473-9.
Collapse
Affiliation(s)
- Seung Hun Woo
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sang Ho Kwak
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
| | - Hyo Seok Jang
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Dong Hee Kim
- Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 58, Paryong-ro, Masanhoewon-gu, Changwon-si, 513-53, Republic of Korea
| | - Jang Hyeon Seo
- Jeil Medical Corporation, Digital-ro 34, Seoul, Republic of Korea
| | - Sang Hyun Lee
- Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Pusan, Korea, 602-739, Busan, Republic of Korea.
| |
Collapse
|
7
|
Hohendorff B, Neubrech F, Spies CK, Unglaub F, Müller LP, Ries C. [Minimally invasive procedures in the early stages of trapeziometacarpal joint osteoarthritis : Denervation, arthroscopy and autologous fat transplantation]. Orthopade 2022; 51:13-22. [PMID: 35015097 DOI: 10.1007/s00132-021-04198-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Resection arthroplasty of the trapezium with or without tendon interposition is the standard procedure in the treatment of advanced, symptomatic thumb carpometacarpal joint osteoarthritis. Treatment recommendation in the early stages without visible or minimal radiographic changes is often difficult, especially when conservative treatment methods have already been exhausted. In these cases, there is the possibility of the minimally invasive methods of denervation, arthroscopic procedures and autologous fat transplantation. OBJECTIVES Which minimally invasive procedures are available for the treatment of thumb carpometacarpal joint osteoarthritis and how is their value to be assessed? METHODS The minimally invasive methods of denervation, arthroscopic procedures and autologous fat transplantation for the treatment of thumb carpometacarpal joint osteoarthritis are described and current results from the literature are discussed. RESULTS Good results have been reported with all three procedures. However, the reports are almost exclusively based on retrospective studies with small numbers of patients, which lack control groups, so the results cannot be regarded as definitive. CONCLUSIONS Denervation, arthroscopic procedures and autologous fat transplantation appear to be suitable methods in the early stages of thumb carpometacarpal joint osteoarthritis. Further studies, especially comparative randomised trials that report medium and long-term results, would allow further assessment of these methods.
Collapse
|
8
|
Ahangar P, Rahimnia A, Mokhtari M, Rahimnia A. Treatment of Fracture-Dislocations of Proximal Interphalangeal Joint by Applying of Dynamic Mini External Fixator: Clinical and Radiographic Results. Arch Bone Jt Surg 2021; 9:695-701. [PMID: 35106335 PMCID: PMC8765209 DOI: 10.22038/abjs.2021.54249.2709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/04/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Fracture-dislocations of the proximal interphalangeal joint of fingers are believed to be challenging injuries that usually lead to residual pain and stiffness. To date, several treatment options have been applied. Dynamic traction-external fixation is a safe and easy technique offering good results in many works of literature. The dynamic mini external fixator using K-wires and mini rods provide sufficient dynamic traction and facilitate early mobilization of the injured joint. The present study was conducted to evaluate the results of a dynamic mini external fixator for the treatment of those lesions. METHODS In total, 40 patients who suffered from proximal interphalangeal fracture-dislocations were treated at our institution between November 2017 and November 2019. Dynamic mini external fixator device was utilized for their treatment. Clinical and radiographic parameters were evaluated at 2, 4, 6, 12, and 24 weeks after surgery. RESULTS This study included 30 (75%) males and 10 (25%) females with a mean age of 38.7±9.9 years. In total, 6 (15%) patients had concomitant fractures or fractures in their hands. All the fractures, including 27 (67.5%) dorsal fracture-dislocations and 13 (32.5%) Pilon fractures, were united without the occurrence of any malunion or major residual subluxation. One Pilon fracture needed to be realigned by reassembling the device at the second week of follow-up. Furthermore, 36 (90%) patients achieved full range of joint motion, and 4 (10%) patients had mild loss of motion arc. In addition, 8 (20%) patients developed mild pin site infection treated with oral antibiotics without device removal. Following six months, one (2.5%) patient mentioned minimal residual pain. CONCLUSION The dynamic mini external fixator was found to be a safe and applicable technique to manage proximal interphalangeal fracture-dislocations. To obtain significantly accurate results, regular follow-up and accurate device care are of great necessity.
Collapse
Affiliation(s)
- Parviz Ahangar
- Department of Orthopedic Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran., Trauma Research center, Department of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Alireza Rahimnia
- Department of Orthopedic Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran., Trauma Research center, Department of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Masoud Mokhtari
- Department of Orthopedic Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
9
|
Fröhlich S, Schweizer A, Reissner L, Pastor T, Spörri J, Pastor T. Long term evolution of soft tissue response in the fingers of high-level sport climbers: A cross-sectional 10 Year follow-up study. Phys Ther Sport 2021; 52:173-9. [PMID: 34547601 DOI: 10.1016/j.ptsp.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Sport climbing induces physiological changes in the body of high-level climbers. In 2012, our study group demonstrated adaptions of elite climbers' soft tissues with thicker A2/A4-pulleys, flexor tendons and palmar plates compared to non-climbers. OBJECTIVES To assess these adaptations over time we examined all 31 (follow up 100%) climbers that participated in that baseline study again using ultrasonography after a follow-up of 10 years. MAIN FINDINGS (1) In climbers, a significant increase in A2 and A4-pulley and flexor tendon thickness over the last 10 years was observed (p < 0.001), while PIP&DIP palmar plate thickness remained unchanged (p > 0.05); (2) at 10-years follow-up, all soft tissue thickness parameters (incl. palmar plates) were still significantly larger in climbers than in age-matched controls (p < 0.05); (3) as for the association with anthropometrics and climbing performance/experience, a significant association of the current climber's soft tissue thickness could only be found between palmar plate and reached climbing level(p = 0.032) as well as climber's body weight(p = 0.004). CONCLUSION An accumulation of repetitive climbing-related stress to the fingers of elite sport climbers over the career induces mechano-adaptation of the A2/A4-pulleys, flexor tendons and palmar plates. At later stages, there is a further significant increase in flexor tendon and pulley thickness, but not for palmar plate thickness.
Collapse
|
10
|
Reischenböck V, Marks M, Herren DB, Schindele S. Surface replacing arthroplasty of the proximal interphalangeal joint using the CapFlex-PIP implant: a prospective study with 5-year outcomes. J Hand Surg Eur Vol 2021; 46:496-503. [PMID: 33270488 DOI: 10.1177/1753193420977244] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this prospective study was to evaluate the 5-year outcomes in patients after proximal interphalangeal joint arthroplasty using the surface replacing implant, CapFlex-PIP. Ninety-two prosthesis were implanted and 65 patients with 68 implants were available for follow-up. The brief Michigan Hand Outcomes Questionnaire score improved significantly from 45 (SD 15) before surgery to 71 (SD 17) at 5 years. On the numeric rating scale, pain during activities decreased significantly from 6.4 (SD 1.9) to 1.8 (SD 1.9). Range of motion of the joints increased significantly from 45° (SD 21) to 54° (SD 24). An axis deviation of more than 5° was found in 65% of the joints before surgery, but only in 25% at 5 years. Soft tissue reoperations were performed on eight patients. Four out of 92 implants underwent revision for stiffness or implant loosening. In three implants, the distal component migrated without needing revision. Overall, the CapFlex-PIP implant demonstrates favourable medium-term results in surface replacing arthroplasty of the proximal interphalangeal joint.Level of evidence: IV.
Collapse
Affiliation(s)
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | | |
Collapse
|
11
|
Pillukat T, Windolf J, Schädel-Höpfner M, Fuhrmann RA, van Schoonhoven J. [Extensor tendon injuries at the level of the proximal interphalangeal joint]. Unfallchirurg 2021; 124:265-274. [PMID: 33616682 DOI: 10.1007/s00113-021-00984-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 11/27/2022]
Abstract
Closed and open injuries of the extensor mechanism at the proximal interphalangeal (PIP) joint can involve the central slip, the lateral slips or both. They are classified as zone III injuries. All open injuries on the dorsal side of the PIP joint should raise suspicion of an extensor tendon injury that is frequently overlooked. The operative strategy consists of wound revision with extensor tendon suture or refixation of the central slip. Acute closed central slip injuries are clinically diagnosed (Elson test) after ruling out bony injuries to the joint. Nondisplaced avulsions of the central slip insertion or lacerations can be treated nonoperatively by splinting. For displaced avulsions and complex injuries the treatment is surgical. In overlooked injuries a typical deformity (buttonhole/Boutonnière deformity) develops within 1-2 weeks that is characterized by an extension lag of the PIP joint and hyperextension at the distal interphalangeal joint. In early cases, when passive extension is still complete (mobile buttonhole deformity) the central slip can be immediately reconstructed. In fixed deformities complete passive extension of the PIP joint has to be restored before surgery by hand therapeutic measures or PIP joint release. Depending on the pattern of the injury and the resulting defects, a number of reconstructive techniques have been established that are summarized in this article. The functional results can be limited by tendon adhesions, imbalance within the reconstructed extensor apparatus and stiff joints that can all restrict the range of motion. Therefore, active rehabilitation protocols are mandatory for optimal results.
Collapse
Affiliation(s)
- Thomas Pillukat
- Klinik für Handchirurgie, Campus Bad Neustadt an der Saale, Bad Neustadt an der Saale, Deutschland.
- Klinik für Handchirurgie, Von Guttenbergstr. 11, 97616, Bad Neustadt an der Saale, Deutschland.
| | - J Windolf
- Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - M Schädel-Höpfner
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Lukaskrankenhaus Neuss, Rheinland Klinikum, Neuss, Deutschland
| | - R A Fuhrmann
- Klinik für Fuß- und Sprunggelenkchirurgie, Campus Bad Neustadt an der Saale, Neuss, Deutschland
| | - J van Schoonhoven
- Klinik für Handchirurgie, Campus Bad Neustadt an der Saale, Bad Neustadt an der Saale, Deutschland
| |
Collapse
|
12
|
Abstract
BACKGROUND Unrestricted gliding of extensor and flexor tendons is essential for normal functioning of the hand. If tendon gliding is impaired, a restricted range of motion of finger joints and, finally, joint stiffness result. OBJECTIVES To answer the questions about the causes of tenodesis in the hand, which examinations are most informative, how tenolysis is technically performed, and what results can be expected. METHODS The reasons, examinations, surgical technique, and results of extensor and flexor tendon tenolysis are presented. RESULTS Based on the data in the literature tenolysis of flexor tendons leads to range of motion that is only 50-60% of the preoperative range of motion. In about 20% of patients, deterioration as serious as secondary tendon rupture is observed. Meaningful results of extensor tendon tenolysis have not yet been published. CONCLUSIONS Tenolysis of extensor and flexor tendons in the hand is a demanding surgical procedure, and in addition to detailed knowledge of anatomy and biomechanics, it requires sufficient experience-especially following the primary repair of tendon injuries. The earliest indication for tenolysis can occur at about 3 months, usually after 6 months, if continuous intensive hand therapy and splinting have not been successful. General and individual benefits and risks must be carefully weighed. The key to successful tenolysis is the patient's access to and unrestricted participation in competent postoperative treatment, ideally performed by a specialist in hand therapy, which may last for weeks or months.
Collapse
Affiliation(s)
- B Hohendorff
- Abteilung für Hand‑, Ästhetische und Plastische Chirurgie, Elbe Klinikum Stade, Bremervörder Straße 111, 21682, Stade, Deutschland.
| | - H Kaya
- Abteilung für Hand‑, Ästhetische und Plastische Chirurgie, Elbe Klinikum Stade, Bremervörder Straße 111, 21682, Stade, Deutschland
| | - C K Spies
- Handchirurgie, Vulpius Klinik, Bad Rappenau, Deutschland
| | - F Unglaub
- Handchirurgie, Vulpius Klinik, Bad Rappenau, Deutschland.,Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - L P Müller
- Unfall‑, Hand- und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum zu Köln, Köln, Deutschland
| | - C Ries
- Klinik und Poliklinik für Orthopädie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| |
Collapse
|
13
|
Abstract
The proximal interphalangeal joint (PIPJ) is a complex anatomical structure. In managing fracture dislocations about the PIPJ, the aim is to restore a congruent joint that allows for smooth gliding motion. Detailed knowledge of the anatomy and biomechanics of the PIPJ is necessary in managing these injuries with predictable success. The breadth of techniques previously described in the treatment of such injuries is testament to the difficulties faced in achieving optimal clinical and radiological outcomes. In this article we detail the anatomy and biomechanics of the PIPJ and summarize current literature and principles for the treatment of dorsal fracture dislocations.
Collapse
Affiliation(s)
- Ruth En Si Tan
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Andre Eu Jin Cheah
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| |
Collapse
|
14
|
Barrios SAD, Serrano AFDJS, Herrera JAG, Berumen MFR, Atanasio JMP. OUTCOME OF NON-SURGICAL TREATMENT OF MALLET FINGER. Acta Ortop Bras 2020; 28:172-176. [PMID: 32788858 PMCID: PMC7405845 DOI: 10.1590/1413-785220202804230335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To establish the association between initial and residual angulation of the distal interphalangeal joint (DIJ) in mallet finger treated conservatively. METHODS An observational, prospective, descriptive and analytical research developed with uncomplicated closed mallet finger patients between January and December 2017. A total of two measurements of the DIJ were done, at the initial trauma and 6 weeks after conservative treatment. All measurements were ranked according to the Crawford Classification and Relative Risk was measured. RESULTS In total, 43 patients were studied, in which 53.48% of outcomes obtained were excellent. The sample was divided in two groups; one with less than 30º of DIJ initial angulation, which had 28% of residual angulation. The second group with more than 30º presented 72.22% of residual angulation. The Relative Risk to present a residual angulation in patients that had 30º of DIJ initial angulation was 2.99 (CI 95%) with p = 0.0059. CONCLUSION It is suggested that patients with an initial DIJ angulation more than 30º are more likely to present residual angulation with conservative treatment. Level of Evidence IV, Case series.
Collapse
|
15
|
Saul D, Roch J, Lehmann W, Dresing K. [Oberst's block anesthesia]. Oper Orthop Traumatol 2019; 32:18-22. [PMID: 31650198 DOI: 10.1007/s00064-019-00633-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/05/2019] [Accepted: 05/08/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Complete anesthesia of the phalanges of the fingers and toes. INDICATIONS All lesions distal to the metacarpophalangeal/metatarsophalangeal joint. CONTRAINDICATIONS Local infections at the injection site. Lesions proximal to the metacarpophalangeal/metatarsophalangeal joint. TECHNIQUE A subcutaneous deposit of a 0.5-2% local anesthetic is administered dorsoradially and dorsoulnarly at the base of the metacarpophalangeal/metatarsophalangeal joint. With the cannula advanced to palmar, an additional 0.5-1.5 ml is then administered to achieve complete anesthesia. POSTOPERATIVE MANAGEMENT The effect of the local anesthesia is self-limiting. RESULTS The Oberst block results in reliable anesthesia of the finger and toe. All surgical procedures distal to the metacarpophalangeal/metatarsophalangeal joint can be performed without pain.
Collapse
Affiliation(s)
- Dominik Saul
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Georg-August-Universität, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
| | - Jonathan Roch
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Georg-August-Universität, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Wolfgang Lehmann
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Georg-August-Universität, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Klaus Dresing
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Georg-August-Universität, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| |
Collapse
|
16
|
Hohendorff B, Spies CK, Unglaub F, Müller LP, Ries C. [Anatomy of the metacarpophalangeal and proximal interphalangeal finger joint with respect to arthroplasty]. Orthopade 2019; 48:368-377. [PMID: 30911776 DOI: 10.1007/s00132-019-03716-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Precise knowledge of the anatomy and biomechanics of the metacarpophalangeal and proximal interphalangeal joint is the basis for both indication and implantation of a finger joint prosthesis. Currently available finger joint prostheses inadequately take into account individual, ethnological, gender, age, and side differences. They can remain compromised despite the possible combination of their components. OBJECTIVES To elucidate which problems of finger joint arthroplasty exist due to the anatomy and biomechanics of the metacarpophalangeal and proximal interphalangeal joints. METHODS The anatomy and biomechanics of the metacarpophalangeal and proximal interphalangeal joint are described, and the problems and solutions of finger joint arthroplasty are presented. RESULTS Despite precise knowledge of the anatomy and biomechanics of the metacarpophalangeal and proximal interphalangeal joint, not all problems of finger joint arthroplasty have been solved. However, a modular surface replacement appears promising for the proximal interphalangeal joint. CONCLUSIONS Artificial joint replacement of the metacarpophalangeal and proximal interphalangeal joint is difficult with regard to morphology, small bone dimensions, complex biomechanics, and the strain of the hand. Further improvements, especially in design, should be achieved by exact anatomical imitation.
Collapse
Affiliation(s)
- B Hohendorff
- Abteilung für Hand‑, Ästhetische und Plastische Chirurgie, Elbe Klinikum Stade, Bremervörder Straße 111, 21682, Stade, Deutschland.
| | - C K Spies
- Handchirurgie, Vulpius Klinik, Bad Rappenau, Deutschland
| | - F Unglaub
- Handchirurgie, Vulpius Klinik, Bad Rappenau, Deutschland
| | - L P Müller
- Unfall‑, Hand- und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum zu Köln, Köln, Deutschland
| | - C Ries
- Unfall‑, Hand- und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum zu Köln, Köln, Deutschland
| |
Collapse
|
17
|
Hohendorff B, Unglaub F, Spies CK, Wegmann K, Müller LP, Ries C. [Surgical approaches to the hand]. Oper Orthop Traumatol 2019; 31:372-383. [PMID: 31359070 DOI: 10.1007/s00064-019-0622-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/19/2018] [Accepted: 11/01/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Accessibility of any anatomical structure of the hand via surgical approach. INDICATIONS Any surgical treatment of the hand. CONTRAINDICATIONS Any contraindication to surgical treatment of the hand. SURGICAL TECHNIQUE Skin incision at the hand with access to any anatomical structure. POSTOPERATIVE MANAGEMENT Postoperative treatment depends on the disease and hand surgery performed.
Collapse
Affiliation(s)
- B Hohendorff
- Abteilung für Hand‑, Ästhetische und Plastische Chirurgie, Elbe Klinikum Stade, Bremervörder Straße 111, 21682, Stade, Deutschland.
| | - F Unglaub
- Handchirurgie, Vulpius Klinik, Bad Rappenau, Deutschland
| | - C K Spies
- Handchirurgie, Vulpius Klinik, Bad Rappenau, Deutschland
| | - K Wegmann
- Unfall‑, Hand- und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum zu Köln, Köln, Deutschland
| | - L P Müller
- Unfall‑, Hand- und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum zu Köln, Köln, Deutschland
| | - C Ries
- Unfall‑, Hand- und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum zu Köln, Köln, Deutschland
| |
Collapse
|
18
|
Langer MF, Oeckenpöhler S, Spies CK, Grünert JG, Breiter S, Glasbrenner J, Wieskötter B. [Dorsal plate arthrodesis of the thumb metacarpophalangeal joint]. Oper Orthop Traumatol 2019; 32:47-57. [PMID: 30806716 DOI: 10.1007/s00064-019-0592-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Elimination of pain or instability by arthrodesis of the thumb joint in functional position by dorsal plateosteosynthesis. INDICATIONS Painful primary or secondary arthrosis of the thumb, nonreconstructable ulnar, radial or palmar instability, posttraumatic dislocation, defect injuries, bone tumors in the region of the thumb metacarpophalangeal joint. CONTRAINDICATIONS Local infection of the thumb metacarpophalangeal joint area. SURGICAL TECHNIQUE Dorsal approach to the thumb metacarpophalangeal (MP) joint, splitting of the extensor aponeurosis between the extensor pollicis longus and extensor pollicis brevis tendon. Opening of the anterior capsule and separation of the collateral ligaments, open up the joint, narrow concave and convex joint surface resections, adjustment of the arthrodesis position in 10-20° flexion and K‑wire transfixation, dorsal plateosteosynthesis, fine adjustment of the flexion, axis and pronation position. Closure of the capsule and the periosteal gliding tissue over the plate, reconstruction of the extensor aponeurosis. POSTOPERATIVE MANAGEMENT Splint for 3 weeks. Full load after 6-8 weeks. RESULTS The dorsal plate arthrodesis of the thumb MP joint is a reliable surgical method with very good functional results.
Collapse
Affiliation(s)
- M F Langer
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland.
| | - S Oeckenpöhler
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland
| | - C K Spies
- Handchirurgie, Vulpiusklinik, Bad Rappenau, Deutschland
| | - J G Grünert
- Klinik für Hand‑, Plastische und Wiederherstellungschirurgie, Kantonsspital Sankt Gallen, Gallen, Schweiz
| | - S Breiter
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland
| | - J Glasbrenner
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland
| | - B Wieskötter
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland
| |
Collapse
|
19
|
Sato K, Iwamoto T, Matsumura N, Suzuki T, Nishiwaki Y, Nakamura T. Total finger joint arthroplasty with a costal osteochondral autograft: up to 11 years of follow-up. J Hand Surg Eur Vol 2019; 44:167-174. [PMID: 30348043 DOI: 10.1177/1753193418806195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the mid- to long-term clinical outcomes of total finger joint arthroplasty using a costal osteochondral autograft for joint ankylosis. Twenty-three joints (three metacarpophalangeal joints, 20 proximal interphalangeal joints) in 23 patients (19 men and four women) were treated with a costal osteochondral autograft and were evaluated after a mean follow-up of 77 months (60-138). Mean age was 33 years (18 to 55). Significant improvement in active finger extension/flexion was seen from a preoperative mean of -24°/26° (arc: 2°) to -13°/75° (arc: 63°) at latest follow-up. Mean preoperative Japanese Society for Surgery of the Hand version of the Disability of the Arm, Shoulder and Hand score was initially 24 and improved significantly to 5 at latest follow-up. Conclusion: total finger arthroplasty using a costal osteochondral autograft gave an anatomical and biological reconstruction and provided stable improvement at a mean follow-up of 77 months. Level of evidence: IV.
Collapse
Affiliation(s)
- Kazuki Sato
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takuji Iwamoto
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taku Suzuki
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuji Nishiwaki
- 2 Department of Environmental and Occupational Health, Toho University, Tokyo, Japan
| | - Toshiyasu Nakamura
- 3 Clinical Research Center, International University of Health and Welfare, Tokyo, Japan
| |
Collapse
|
20
|
Kim YW, Roh SY, Kim JS, Lee DC, Lee KJ. Volar plate avulsion fracture alone or concomitant with collateral ligament rupture of the proximal interphalangeal joint: A comparison of surgical outcomes. Arch Plast Surg 2018; 45:458-65. [PMID: 30282417 DOI: 10.5999/aps.2018.00346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/03/2018] [Indexed: 11/18/2022] Open
Abstract
Background Volar plate avulsion fracture of the proximal interphalangeal (PIP) joint is one of the most common hand injuries. In this study, we divided patients into two groups: patients with pure volar plate avulsion fracture, and patients with volar plate avulsion fracture concomitant with collateral ligament rupture. The purpose of this study was to compare long-term surgical outcomes between the two groups. As a secondary measure, the Mitek bone anchoring and polydioxanone (PDS) bone suturing techniques were compared. Methods A single-institutional retrospective review of the surgical treatment of volar plate avulsion fracture was performed. The cases were divided into those with pure volar plate avulsion fracture (group A, n=15) and those with volar plate avulsion fracture concomitant with collateral ligament rupture (group B, n=15). Both groups underwent volar plate reattachment using Mitek bone anchoring or PDS bone suturing followed by 2 weeks of immobilization in a dorsal protective splint. Results The average range of motion of the PIP joint and extension lag were significantly more favorable in group A (P<0.05). Differences in age; follow-up period; flexion function; visual analog scale scores; disabilities of the arm, shoulder, and hand scores; and the grip strength ratio between the two groups were non-significant. No significant differences were found in the surgical outcomes of Mitek bone anchoring and PDS bone suturing in group A. Conclusions Overall, the surgical outcomes of volar plate reattachment were successful irrespective of whether the collateral ligaments were torn. However, greater extension lag was observed in cases of collateral ligament injury.
Collapse
|
21
|
Hara A, Yokoyama M, Ichihara S, Kudo T, Maruyama Y. Masquelet technique for the treatment of acute osteomyelitis of the PIP joint caused by clenched-fist human bite injury: A case report. Int J Surg Case Rep 2018; 51:282-7. [PMID: 30243260 DOI: 10.1016/j.ijscr.2018.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/03/2018] [Accepted: 09/12/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The Masquelet technique is a well-known and efficient procedure for lower limb soft tissue reconstruction after severe osteomyelitis requiring bone excision. However, this technique is rarely used in the hand. PRESENTATION OF CASE The patient was 38-year-old man. We used this technique to reconstruct a proximal interphalangeal (PIP) joint osteochondral defect after osteomyelitis caused by clenched-fist human bite injury. The pathogen was Prevotella intermedia, which is an anaerobic pathogenic bacterium involved in periodontal infections and is a black-pigmented periodontal pathogen. Following completion of the Masquelet method, the bone remodeled at an angle at the PIP joint. DISCUSSION Prevotella intermedia is known as Bacteroides melaninogenicus subsp. intermedius. When the infection site is black-pigmented, this pathogen is highly suspected. The Masquelet technique is rarely used in the hand, and when used, it has been in a straight fashion in the hand. We were able to reconstruct a more anatomical, bent PIP joint, and the fixed angle of the PIP joint at 40° of flexion using Masquelet technique. CONCLUSION The angled joint resulting from this technique created a relatively normal permanently bent PIP joint.
Collapse
|
22
|
Wachter NJ, Mentzel M, Häderer C, Krischak GD, Gülke J. Change in the temporal coordination of the finger joints with ulnar nerve block during different power grips analyzed with a sensor glove. Hand Surg Rehabil 2017; 37:30-37. [PMID: 29274823 DOI: 10.1016/j.hansur.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 06/08/2017] [Accepted: 09/21/2017] [Indexed: 11/19/2022]
Abstract
Ulnar nerve injuries can cause deficient hand movement patterns. Their assessment is important for diagnosis and rehabilitation in hand surgery cases. The purpose of this study was to quantify the changes in temporal coordination of the finger joints during different power grips with an ulnar nerve block by means of a sensor glove. In 21 healthy subjects, the onset and end of the active flexion of the 14 finger joints when gripping objects of different diameters was recorded by a sensor glove. The measurement was repeated after an ulnar nerve block was applied in a standardized setting. The change in the temporal coordination of the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints with and without the nerve block was calculated within the same subject. In healthy subjects, the MCP joints started their movement prior to the PIP joints in the middle and ring finger, whereas this occurred in the reverse order at the index and little finger. The DIP joint onset was significantly delayed (P<0.01). With the ulnar nerve block, this coordination shifted towards simultaneous onset of all joints, independent of the grip diameter. The thumb and index finger were affected the least. With an ulnar nerve block, the PIP joints completed their movement prior to the MCP joints when gripping small objects (G1 and G2), whereas the order was reversed with larger objects (G3 and G4). The alterations with ulnar nerve block affected mainly the little finger when gripping small objects. With larger diameter objects, all fingers had a significant delay at the end of the PIP joint movement relative to the MCP and DIP joints, and the PIP and DIP joint sequence was reversed (P<0.01). Based on the significant changes in temporal coordination of finger flexion during different power grips, there are biomechanical effects of loss of function of the intrinsic muscles caused by an ulnar nerve block on the fine motor skills of the hand. This can be important for the diagnosis and rehabilitation of ulnar nerve lesions of the hand.
Collapse
Affiliation(s)
- N J Wachter
- Clinic of hand, plastic and microsurgery, Katharinenhospital, Kriegsbergstraße 60, 70174 Stuttgart, Germany.
| | - M Mentzel
- Clinic of traumatology, hand, plastic and reconstructive surgery, University of Ulm, Helmholtzstraße 16, 89081 Ulm, Germany
| | - C Häderer
- Clinic of traumatology, hand, plastic and reconstructive surgery, University of Ulm, Helmholtzstraße 16, 89081 Ulm, Germany
| | - G D Krischak
- Clinic of orthopedics and traumatology, Schlossklinik Bad Buchau, Schloßpl. 2, 88422 Bad Buchau, Germany
| | - J Gülke
- Clinic of traumatology, hand, plastic and reconstructive surgery, University of Ulm, Helmholtzstraße 16, 89081 Ulm, Germany
| |
Collapse
|
23
|
Cornelissen AJM, van Onna MA, Keuter XHA, van der Hulst RR. Innervated full thickness grafts in distal finger amputations. Chin J Traumatol 2017; 20:355-8. [PMID: 29032911 DOI: 10.1016/j.cjtee.2017.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/03/2017] [Accepted: 06/13/2017] [Indexed: 02/04/2023] Open
Abstract
Innervated full thickness graft will be presented as an option to reconstruct a fingertip defect which might result in better sensibility than standard reconstruction using a full thickness graft without innervation. Also, anastomosing the nerve stumps can decrease the chance of developing neuroma.
Collapse
|
24
|
Choi IC, Park JW, Lee KS, Kim DM. Distraction Arthroplasty in an Osteochondral Defect of the Middle Finger in a Juvenile Patient. J Hand Surg Asian Pac Vol 2017; 22:512-515. [PMID: 29117842 DOI: 10.1142/s0218810417720352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 13-year-old female patient visited our hospital with a painful distal interphalangeal joint and deformity on her right middle finger. Initial plain radiographs uncovered ulnar-sided subluxation of the distal interphalangeal joint of the right middle finger, and an osteochondral defect was also noted at the articular surface of the distal and middle phalanges. We decided to attempt distraction arthroplasty with an external fixator. Finally postoperative 12-month follow-up plain radiographs showed complete osteochondral regeneration and phalangeal alignment. To our knowledge, this is the first report to assess the use of a distraction arthroplasty concept for treating an osteochondral defect in the finger.
Collapse
Affiliation(s)
- In Cheul Choi
- * Department of the Orthopaedic Surgery, Seoul Barunsesang Hospital, Seoul, Korea
| | - Jong Woong Park
- † Department of the Orthopedic Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Kwang Suk Lee
- ‡ Department of the Orthopaedic Surgery, Barunsesang Hospital, Seongnam, Korea
| | - Dong Min Kim
- † Department of the Orthopedic Surgery, Korea University Anam Hospital, Seoul, Korea
| |
Collapse
|
25
|
Abstract
There are increasing numbers of proximal interphalangeal (PIP) arthroplasties performed in Europe. Meanwhile, most surgeons prefer arthroplasty over arthrodesis. Silastic arthroplasties remain the most widely used implants. The main disadvantage of the Silastic implants is the limited stability they provide. Correction of pre-existing deformation is difficult. Soft tissue handling and postoperative scarring have an influence on the results of PIP arthroplasty. Different surgical approaches are possible. The most popular approach in Europe is dorsal. Different surface replacement implants are on the market in Europe. The main advantage of these implants is the lateral stability provided through their more anatomic form.
Collapse
Affiliation(s)
- Daniel B Herren
- Hand Surgery Department, Schulthess Klinik, Lenggahlde 2, Zurich 8008 CHE, Switzerland.
| |
Collapse
|
26
|
Borisch N. [Arthroscopy of the proximal interphalangeal joint]. Oper Orthop Traumatol 2017; 29:353-9. [PMID: 28608150 DOI: 10.1007/s00064-017-0506-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/14/2016] [Accepted: 11/28/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Pain reduction in the affected proximal interphalangeal joint (PIP joint) by synovectomy, loose body extraction, dorsal arthrolysis. INDICATIONS Therapy-resistant synovitis in rheumatoid arthritis (RA), early stage primary and secondary degenerative arthritis, loose bodies, capsular contracture. CONTRAINDICATIONS Established biomechanic changes in RA (boutonniere and swanneck deformity). Large dorsal synovial cysts. Advanced radiologic changes in degenerative arthritis. Joint instability. Fresh skin lesion near portals. SURGICAL TECHNIQUE Vertical traction of the affected finger in a Chinese finger trap if arthroscopy of a metacarpophalangeal joint is also planned, otherwise the joint can be placed on a hand table. Fill joint with Ringer solution. A radial and ulnar dorsal portal is created at joint space level, between the lateral band of the extensor tendon and the collateral ligament. Diagnostic arthroscopy. With insufficient visibility, "blind" shaving in dorsal recess. Completion of synovectomy under vision; 1.9 mm arthroscope with 30° angle of vision; 2.0 mm shaver (aggressive cutter). Closure of portals. Soft padded dressing. POSTOPERATIVE MANAGEMENT Immediate postoperative mobilization for full range of finger movement. RESULTS From 2009-2011, 91% of the patients treated with arthroscopic PIP joint synovectomy interviewed by telephone about pain reduction and satisfaction with the operation. Half of the 22 patients had RA and the other half degenerative arthritis, each with 14 joints treated. In all, 9 RA patients (11 treated joints, 79%) and only 1 patient with degenerative arthritis (2 treated joints, 14%) were content. The procedure achieves good pain reduction and functional improvement of the hand in RA. It can however not be recommended for degenerative arthritis except in selected cases.
Collapse
|
27
|
Hohendorff B, Franke J, Spies CK, Müller LP, Ries C. [Arthrodesis of the proximal interphalangeal joint of fingers with tension band wire]. Oper Orthop Traumatol 2016; 29:385-394. [PMID: 27783110 DOI: 10.1007/s00064-016-0471-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 07/25/2016] [Accepted: 08/17/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Arthrodesis of the proximal interphalangeal joint of fingers in a functional and pain-free position. INDICATIONS Primary and secondary osteoarthritis, traumatic joint destruction, posttraumatic malposition, instability, joint destruction due to infection, irreparable extensor and/or flexor tendon lesion, recurrent flexion deformity in Dupuytren's disease, arthritis (e. g., rheumatoid arthritis, psoriatic arthritis), failed resection arthroplasty, failed prosthesis, congenital disorder (e. g., camptodactyly). CONTRAINDICATIONS Persistent joint infection. SURGICAL TECHNIQUE Resection of the proximal phalanx head and the middle phalanx base, arthrodesis with figure-of-eight tension band wire in a functional position. POSTOPERATIVE MANAGEMENT Plaster of Paris cast with arthrodesis position of the affected finger and intrinsic plus position of at least one adjacent finger for 2 weeks, custom-made finger splint for 4 weeks. RESULTS A total of 15 of 16 patients with an arthrodesis of the proximal interphalangeal finger joint of the dominant hand by tension band wire were followed up after an average of 31 months. None was affected by the arthrodesis in everyday live. All patients were very satisfied with the result. Nine of 15 patients were free of pain both at rest and with activity. The average DASH score was 48 points. Grip strength averaged 29 kg, 7 % stronger than the contralateral hand.
Collapse
Affiliation(s)
- B Hohendorff
- Handchirurgie, Abteilung für Hand-, Ästhetische und Plastische Chirurgie, Elbe Klinikum Stade, Bremervörder Straße 111, 21682, Stade, Deutschland.
| | - J Franke
- Klinik für Unfallchirurgie und Orthopädie, Elbe Klinikum Stade, Stade, Deutschland
| | - C K Spies
- Handchirurgie, Vulpius Klinik, Bad Rappenau, Deutschland
| | - L P Müller
- Unfall-, Hand- und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum zu Köln, Köln, Deutschland
| | - C Ries
- Unfall-, Hand- und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum zu Köln, Köln, Deutschland
| |
Collapse
|
28
|
Unglaub F, Langer MF, Hahn P, Müller LP, Ahrens C, Spies CK. [Fractures of the proximal interphalangeal joint: Diagnostic and operative therapy options]. Unfallchirurg 2016; 119:133-43; quiz 144-5. [PMID: 26826026 DOI: 10.1007/s00113-016-0142-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Joint fractures of the fingers often entail operative interventions in contrast to extra-articular fractures. These types of fracture are inclined to dislocate in addition to the actual fracture. The proximal interphalangeal (PIP) joint in particular often shows comminuted fractures due to the long leverage of the finger and a relatively small diameter of the joint. The clinical examination, X-ray diagnostics and if necessary computed tomography allow the classification into stable and unstable fractures. Unstable fractures must be treated by surgical reduction and fixation. A multitude of operative techniques are available for these mostly complicated fractures. The foremost goal is a stable osteosynthesis of the fracture with repositioning of the dislocation, which enables early physiotherapy in order to prevent tendon adhesion and contracture. This article presents the different types of PIP joint fractures, their specific surgical treatment and postoperative treatment regimens.
Collapse
Affiliation(s)
- F Unglaub
- Handchirurgie, Vulpiusklinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland. .,Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland.
| | - M F Langer
- Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - P Hahn
- Handchirurgie, Vulpiusklinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - L P Müller
- Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - C Ahrens
- Handchirurgie, Vulpiusklinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - C K Spies
- Handchirurgie, Vulpiusklinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| |
Collapse
|
29
|
Hohendorff B, Biber F, Sauer H, Ries C, Spies C, Franke J. [Supplementary arthrolysis of the proximal interphalangeal joint of fingers in surgical treatment of Dupuytren's contracture]. Oper Orthop Traumatol 2015; 28:4-11. [PMID: 26631405 DOI: 10.1007/s00064-015-0427-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 05/25/2015] [Accepted: 05/26/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Correction of residual flexion deformity of the proximal interphalangeal (PIP) joint after excision of diseased connective tissue in Dupuytren's contracture by stepwise arthrolysis. INDICATIONS Flexion deformity of the PIP joint of 20° or more after excision of the diseased connective tissue in Dupuytren's contracture. CONTRAINDICATIONS Joint deformities, osteoarthrosis, intrinsic muscle contracture, instability of the PIP joint. SURGICAL TECHNIQUE Arthrolysis of the PIP joint is performed by six consecutive steps: dissection of the remaining skin ligaments, opening the flexor tendon sheath by transverse incision at the distal end of the A2 pulley, dissection of the checkrein ligaments, dissection of the accessory collateral ligaments, releasing the palmar plate proximally, releasing the palmar plate up to its insertion at the middle phalanx base. POSTOPERATIVE MANAGEMENT Dorsal plaster of Paris with extended fingers and compressive dressing in the palm for 2 days, occupational/physical therapy, static and possible dynamic extension splint several weeks/months. RESULTS A total of 31 fingers in 28 patients with Dupuytren's contracture were evaluated an average of 22 months after arthrolysis of the PIP joint. In all, 26 joints with an average recurrent flexion contracture of 29° were improved compared to the preoperative flexion contracture of 81°; 4 PIP joints with a recurrent flexion contracture averaging 60° were worse. In one patient, PIP flexion contracture of 90° was unchanged at follow-up although the joint could be extended intraoperatively to 10° of flexion.
Collapse
Affiliation(s)
- B Hohendorff
- Abteilung für Hand-, Ästhetische und Plastische Chirurgie, Elbe Klinikum Stade, Bremervörder Strasse 111, 21682, Stade, Deutschland.
| | - F Biber
- Abteilung für Hand-, Ästhetische und Plastische Chirurgie, Elbe Klinikum Stade, Bremervörder Strasse 111, 21682, Stade, Deutschland
| | - H Sauer
- Abteilung für Hand-, Ästhetische und Plastische Chirurgie, Elbe Klinikum Stade, Bremervörder Strasse 111, 21682, Stade, Deutschland
| | - C Ries
- Unfall-, Hand- und Ellenbogenchirurgie, Universitätsklinikum zu Köln, Köln, Deutschland
| | - C Spies
- Handchirurgie, Vulpius Klinik, Bad Rappenau, Deutschland
| | - J Franke
- Klinik für Unfallchirurgie und Orthopädie, Elbe Klinikum Stade, Stade, Deutschland
| |
Collapse
|
30
|
Joyce KM, Joyce CW, Conroy F, Chan J, Buckley E, Carroll SM. Proximal interphalangeal joint dislocations and treatment: an evolutionary process. Arch Plast Surg 2014; 41:394-7. [PMID: 25075363 DOI: 10.5999/aps.2014.41.4.394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/29/2014] [Accepted: 04/21/2014] [Indexed: 11/08/2022] Open
Abstract
Background Proximal interphalangeal joint (PIPJ) dislocations represent a significant proportion of hand clinic visits and typically require frequent follow-ups for clinical assessment, orthotic adjustments, and physiotherapy. There are a large number of treatment options available for PIPJ dislocations, yet no prospective or controlled studies have been carried out, largely due to the diversity of the various types of injuries. Methods We retrospectively reviewed all the PIPJ dislocations in our institution over a five-year period and directly compared the different splinting techniques that we have used over this time frame. Results There were a total of 77 dislocations of the PIPJ (57 men and 20 women) that were included in our study. We found that our management has shifted gradually from complete immobilisation to controlled early mobilisation with figure-of-eight splints. Following treatment, the range of motion of the PIPJ in the figure-of-eight group was significantly greater than that in the other three methods (P<0.05) used. There were significantly fewer hospital visits in the figure-of-eight splint group than in the other treatment groups. Conclusions The treatment of PIPJ dislocations has undergone a significant evolution in our experience. Early controlled mobilisation has become increasingly important, and therefore, splints have had to be adapted to allow for this. The figure-of-eight splint has yielded excellent results in our experience. It should be considered for all PIPJ dislocations, but careful patient selection is required to achieve optimum results.
Collapse
|
31
|
Lee JJ, Park HJ, Choi HG, Shin DH, Uhm KI. Open Reduction of Proximal Interphalangeal Fracture-Dislocation through a Midlateral Incision Using Absorbable Suture Materials. Arch Plast Surg 2013; 40:397-402. [PMID: 23898438 DOI: 10.5999/aps.2013.40.4.397] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
Collapse
|
32
|
Heers G, Springorum HR, Baier C, Götz J, Grifka J, Renkawitz T. Proximal interphalangeal joint replacement with an unconstrained pyrocarbon prosthesis (Ascension(R)): a long-term follow-up. J Hand Surg Eur Vol 2013; 38:680-5. [PMID: 23234765 DOI: 10.1177/1753193412469898] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There have been limited publications that report long-term outcomes of pyrocarbon implants. This report describes both clinical and radiographic long-term results for patients who have been treated with pyrocarbon proximal interphalangeal implants. Thirteen implants in ten patients are reported for an average follow-up of 8.3 years (range 6.2-9.3). All patients were suffering from degenerative joint disease. Five of the 13 digits were free of pain, the remaining eight digits had mild to moderate pain (visual analogue scale 2-5). The average active range of motion was 58° (SD 19°) at latest examination. X-ray results were unremarkable in six digits with an acceptable position of the prosthesis. However, in seven patients significant radiolucent lines (≥ 1 mm) were observed. Three prostheses demonstrated a migration of the proximal component, and one a subsidence of the distal component. Our study does not support the use of this implant for treatment of osteoarthritis of the finger joint owing to high complication rates and limited range of motion.
Collapse
Affiliation(s)
- G Heers
- Division of Orthopedics, University of Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany.
| | | | | | | | | | | |
Collapse
|
33
|
Kim BS, Yoon HG, Kim HT, Park KH, Kim CG, Song HS. Subluxation of the extensor carpi ulnaris tendon associated with the extensor digitorum tendon subluxation of the long finger. Clin Orthop Surg 2013; 5:82-6. [PMID: 23467477 PMCID: PMC3582875 DOI: 10.4055/cios.2013.5.1.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 10/29/2012] [Indexed: 11/09/2022] Open
Abstract
A twenty-year-old male visited our clinic with wrist and long finger metacarpophalangeal (MP) joint pain. Dynamic ultrasonography revealed sagittal band (SB) ulnar subluxation and extensor carpi ulnaris (ECU) volar subluxation. Magnetic resonance imaging showed longitudinal splitting and dislocation of the volar half slip of the ECU tendon. The redundant radial SB was augmented and ECU sheath was advanced to the periosteum using suture anchors. He was able to perform his previous activities at the last follow-up. We encountered a case of "simulateous" ECU dislocation with extensor tendon subluxation of the long finger at the MP joint. Therefore, we report this case with a review of the relevant literature.
Collapse
Affiliation(s)
- Byung-Sung Kim
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Busheon, Korea
| | | | | | | | | | | |
Collapse
|