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Barrera-Ochoa S, Cavaca R, Sapage R, Martínez-Garza J, Prieto-Mere J, Mendez-Sanchez G. Biological Versus Nonbiological Reconstruction of the Ulnar Collateral Ligament of the Thumb Metacarpophalangeal Joint: A Retrospective Study. J Hand Surg Am 2024; 49:432-442. [PMID: 38506782 DOI: 10.1016/j.jhsa.2024.01.008] [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: 07/12/2023] [Revised: 12/28/2023] [Accepted: 01/17/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE The purpose of this study was to compare clinical and radiologic outcomes of biological ligament reconstruction (BLR) versus nonbiological ligament reconstruction (NBLR) for chronic injuries involving the ulnar collateral ligament of the thumb's metacarpophalangeal joint. METHODS Forty-two patients who underwent static BLR (n = 24) or NBLR (n = 18) were included in this retrospective analysis. Preoperative, postoperative, and contralateral thumb measurements (clinical evaluation, radiographs, and subjective outcome questionnaires) were compared over a mean of 38 months of follow-up. RESULTS Average postoperative thumb metacarpophalangeal and interphalangeal joint ranges of motion were 2° to 54° and 0 to 71°, respectively, for BLR and 0° to 58° and 0° to 71°, respectively, for NBLR. Average grip and pinch strengths, relative to the unaffected hand, were 102% and 84% versus 103% and 89%, respectively. All patients demonstrated stability with a firm end point, compared with the unaffected thumb. The average Quick Disabilities of the Arm, Shoulder, and Hand score among all patients was 12 for the disability/symptom module, 0 for the sports module, and 17 for the work module. Stiffness was reported among four patients, and no patient sustained wound-related issues or other complications. CONCLUSIONS Nonbiological ligament reconstruction of the thumb ulnar collateral ligament generates short-term outcomes comparable with those of BLR, potentially allowing for expedited recovery and rehabilitation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Sergi Barrera-Ochoa
- Institut de la Mà, Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Rita Cavaca
- Institut de la Mà, Hospital Universitari General de Catalunya, Barcelona, Spain; Orthopedic and Traumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Rita Sapage
- Institut de la Mà, Hospital Universitari General de Catalunya, Barcelona, Spain; Orthopedic and Traumatology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | | | - Jose Prieto-Mere
- Institut de la Mà, Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Gerardo Mendez-Sanchez
- Institut de la Mà, Hospital Universitari General de Catalunya, Barcelona, Spain; Orthopedic and Traumatology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
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Baek JH, Lee JH, Ku KH. Novel figure-of-eight reconstruction with free tendon graft for unrepairable collateral ligament of the thumb metacarpophalangeal joint. Hand Surg Rehabil 2024:101696. [PMID: 38657737 DOI: 10.1016/j.hansur.2024.101696] [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] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES This study aimed to report surgical technique and clinical outcomes for a novel figure-of-eight collateral ligament reconstruction technique using palmaris longus autograft for chronic irreparable collateral ligament injury of the thumb metacarpophalangeal joint. MATERIAL AND METHODS The Jobe elbow collateral ligament reconstruction method was adapted for thumb metacarpophalangeal joint collateral ligament reconstruction. Sixteen reconstructions (7 ulnar collateral ligament, 9 radial collateral ligament) using palmaris longus autograft were reviewed retrospectively. Surgery was performed at a mean 12 months post-injury. All 16 patients were followed up for more than 1 year. Metacarpophalangeal joint radial and ulnar deviation, metacarpophalangeal and interphalangeal joint range of motion, key pinch and grip strength, Glickel functional grade and QuickDASH score were evaluated. RESULTS Preoperative radial or ulnar deviation improved from 19.3° to 5.3° postoperatively. Metacarpophalangeal range of motion improved from 31.5° to 46.6°, and interphalangeal range of motion from 48.4° to 65.6°. Preoperative key pinch and grip strength were respectively 49% and 81% of contralateral values and improved to 82% and 87%. On Glickel grade, 9 cases were excellent and 7 good. CONCLUSION The novel Jobe-like figure-of-eight reconstruction technique using palmaris longus graft was useful for reconstructing irreparable thumb metacarpophalangeal joint instability without an incision on the opposite side or an additional implant. LEVEL OF EVIDENCE Therapeutic study, level IV.
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Affiliation(s)
- Jong Hun Baek
- Department of Orthopedic Surgery, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, Korea.
| | - Jae Hoon Lee
- Department of Orthopedic Surgery, Yeson Hospital, 206 Bucheon-ro, Bucheon-si, Gyeonggi-do, 14555, Korea.
| | - Ki Hyeok Ku
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Graduate School, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Korea.
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Xu J, Han L, Zhang B, Cao S, Zhu D, Yin Z, Gong K, Zhan H. The Application of Sesamoid Position in Diagnosing Thumb Metacarpophalangeal Joint Dorsal Dislocation: A Retrospective Study. Orthop Surg 2024; 16:984-988. [PMID: 38311800 PMCID: PMC10984806 DOI: 10.1111/os.14001] [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: 07/30/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
OBJECTIVES The position of sesamoid of thumb metacarpophalangeal (MCP) joint changed clearly when the joint was dislocated dorsally. However, the significance of sesamoid location in diagnosing joint dislocation was unclear. The present study aimed to explore the positional relationship between sesamoid bone and thumb metacarpophalangeal joint in normal and dorsal dislocation joints. METHODS Between January 2018 and August 2023, we collected 60 isometric plain films from sixty outpatients and reviewed 56 anisometric plain films from twenty-eight emergency patients with dorsal dislocation of thumb MCP joint at Tianjin Hospital, then took measurements on the hand X-ray images. The sesamoid length on its longitudinal axis was defined as DP, the distance between the distal edge of sesamoid and thumb MCP joint was defined as DJ, and the ratio of DJ and DP was R. An independent-samples t-test and paired-samples t-test was utilized to analyze difference among data groups. RESULTS The 60 isometric images were from 30 male and 30 female outpatients with normal bone structure in their hands, and the 56 anisometric images of the 28 emergency patients included both preoperative and postoperative materials. Among the outpatients, the actual distance between the distal edge of sesamoid and thumb MCP joint space (DJ) was 2.09 mm and 1.40 mm in males and females, respectively. The authentic average length of sesamoid (DP) was 4.46 mm in males and 4.22 mm in females. The average value of R (the ratio of DJ and DP) in males and females was 0.49 and 0.34, respectively. There were gender-related statistical differences in DJ (p < 0.01) and R (p=0.01), but no statistical difference in DP (p > 0.05). For the 28 emergency patients, the mean value of R was -0.47 before joint reduction and 0.58 after joint reduction, with statistical difference between them (p < 0.01). CONCLUSIONS There was significant difference in the relative position between sesamoid and thumb MCP joint when joint dislocation and joint reduction. The distal edge of sesamoid beyond thumb MCP joint could be an evidence in diagnosing joint dorsal dislocation. The distal edge of sesamoid below thumb MCP joint could be an evidence of joint reduction.
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Affiliation(s)
- Jianhua Xu
- Hand MicrosurgeryTianjin HospitalTianjinChina
| | - Li Han
- Hand MicrosurgeryTianjin HospitalTianjinChina
| | - Bo Zhang
- Hand MicrosurgeryTianjin HospitalTianjinChina
| | - Shuming Cao
- Hand MicrosurgeryTianjin HospitalTianjinChina
| | - Dake Zhu
- Hand MicrosurgeryTianjin HospitalTianjinChina
| | | | - Ketong Gong
- Hand MicrosurgeryTianjin HospitalTianjinChina
| | - Haihua Zhan
- Hand MicrosurgeryTianjin HospitalTianjinChina
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Ma S, Zuo J, Hu Y. U-shaped kirschner wire transfixation: effective treatment for Skier's thumb. BMC Surg 2024; 24:91. [PMID: 38491501 PMCID: PMC10941620 DOI: 10.1186/s12893-024-02382-7] [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] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Skier's thumb is a type of injury to the ulnar collateral ligament of the metacarpophalangeal joint of the thumb, which can result in bone fragmentation and joint instability. OBJECTIVE The objective of this study was to compare the traditional Kirschner wire fixation method with the U-shaped Kirschner wire method for treating small bone fragments with displacement, rotation, or instability in skier's fractures. METHOD A retrospective study was conducted on 30 patients with skier's thumb who were treated at Tianjin Hospital from January 2019 to December 2021. Patients were divided into two groups: Group A received traditional Kirschner wire fixation, while Group B received U-shaped Kirschner wire fixation. Functional assessments and complications during the perioperative period were evaluated. RESULTS Both surgical methods significantly reduced postoperative pain and increased joint range of motion. Group B had a lower incidence of pain during follow-up and showed significant functional improvement in Tip-pinch and Grip tests compared to Group A. U-shaped Kirschner wire fixation significantly reduced complications during the perioperative period. CONCLUSION The U-shaped Kirschner wire internal fixation is a safe and effective treatment for the thumb proximal phalanx base ulnar side avulsion fracture.
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Affiliation(s)
- Shuwei Ma
- Graduate School of Tianjin Medical University, No. 22 QiXiangTai Road, Heping District, Tianjin, 300070, P. R. China
| | - Jinzeng Zuo
- Graduate School of Tianjin Medical University, No. 22 QiXiangTai Road, Heping District, Tianjin, 300070, P. R. China
- The Second Hospital of Tangshan, Tangshan, 063000, Hebei, P. R. China
| | - Yongcheng Hu
- Department of Orthopaedic, Tianjin Hospital, Jiefang South Road, Hexi District, Hospital, Tianjin, 300211, P. R. China.
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Gorani A, Ruijs ACJ. Metacarpal Joint Arthroplasty in the Acute Setting: A Case Report. J Orthop Case Rep 2023; 13:147-151. [PMID: 38025369 PMCID: PMC10664227 DOI: 10.13107/jocr.2023.v13.i11.4040] [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] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/20/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Traumatic bone loss at the metacarpal phalangeal joint level can be a challenging clinical situation. Not many cases have been described in the literature for this specific articulation. Case Report Our patient presented with a work-related accident of his hand with loss of the metacarpophalangeal joint of the index finger. After temporary external fixation and wound closure, a prosthetic joint arthroplasty was chosen to allow a reconstruction of his lost joint. Conclusion After traumatic articular bone destruction in the hand, there are several possibilities to reflect on. Taking into consideration the patient's characteristics and the degree of bone loss, implanting a prosthesis can be a safe option with acceptable results.
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Affiliation(s)
- Amel Gorani
- Department of Orthopaedic Surgery, Cliniques Universitaires Saint-LUC, Avenue Hippocrate, 1200 Brussels, Belgium
- Department of Orthopaedic Surgery, Centre Hospitalier de Wallonie Picarde, 7500 Tournai, Belgium
| | - Aleid C J Ruijs
- Department of Orthopaedic Surgery, Centre Hospitalier de Wallonie Picarde, 7500 Tournai, Belgium
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Stevens CS, Pavano C, Rodner CM. Collagenase Treatment for Dupuytren Contracture of the Metacarpophalangeal Joint After Arthrodesis of the Proximal Interphalangeal Joint. J Hand Surg Glob Online 2023; 5:843-844. [PMID: 38106945 PMCID: PMC10721531 DOI: 10.1016/j.jhsg.2023.07.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/29/2023] [Indexed: 12/19/2023] Open
Abstract
Successful collagenase (Xiaflex) treatment of Dupuytren's contracture in the metacarpophalangeal joint is possible in the presence of previous arthrodesis of the proximal interphalangeal joint.
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Affiliation(s)
| | - Colin Pavano
- Department of Orthopedic Surgery, University of Connecticut, Farmington, CT
| | - Craig M. Rodner
- Department of Orthopedic Surgery, University of Connecticut, Farmington, CT
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Jordaan PW, Klumpp R, Zeppieri M. Triggering, clicking, locking and crepitus of the finger: A comprehensive overview. World J Orthop 2023; 14:733-740. [PMID: 37970625 PMCID: PMC10642400 DOI: 10.5312/wjo.v14.i10.733] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/13/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023] Open
Abstract
Triggering, locking, clicking, and crepitus of the fingers are common symptoms patients present with. Even though crepitus and triggering can occur as part of the same underlying diagnosis, it is important to differentiate between them, as they usually indicate different possible diagnoses. The differential diagnoses that should be considered include trigger finger, metacarpophalangeal joint (MCPJ) arthritis, fractures or dislocations, extensor digitorum communis subluxation or dislocation, locked MCPJ, avascular necrosis of the metacarpal head, and Dupuytren's disease. A thorough clinical examination with appropriate special investigations can permit the clinician to make the correct diagnosis. Appropriate management of a confirmed diagnosis is successful in providing symptomatic improvement.
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Affiliation(s)
- Pieter W Jordaan
- Department of Orthopaedic, Garden Route Hand Unit, George 6530, South Africa
| | - Raymond Klumpp
- UOC Ortopedia e Traumatologia, Ospedale Treviglio-Caravaggio ASST, Bergamo Ovest 24047, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
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Meyer Zu Reckendorf G, Artuso M, Kientzi M, Rouzaud JC. Collateral ligament sprains of the metacarpophalangeal joint of the long fingers: Results of a surgical series of 15 patients. Orthop Traumatol Surg Res 2023; 109:102952. [PMID: 33951542 DOI: 10.1016/j.otsr.2021.102952] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/16/2021] [Accepted: 01/26/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Collateral ligament sprains of the metacarpophalangeal joint (MP) of the long fingers are rare and mostly treated conservatively. Clinical examination to diagnose the severity of these injuries is mandatory. The purpose of our study is to report the results of 15 patients treated surgically. METHODS Twenty-three patients, mean age 48, underwent surgery for Stage 3 radial collateral ligament (RCL) injuries of the middle finger (12), the ring finger (4) and the little finger (7). The mean time from trauma to surgery was 53 days. The clinical evaluation consisted of measuring active joint motion, performing laxity tests at 0°, 30° and 90° of MP flexion, testing for laxity and rotation, looking for a spontaneous overlapping finger (or hyperabducted little finger) in relaxed position and measuring the strength (Jamar). RESULTS Among the 23 operated patients, RCL lesions were distal in 8 cases, proximal in 9, and mid-substance in 6. There were 2 Stener-like lesions. Preoperatively, 16 patients presented an overlapping finger over the next one and 7 had spontaneous hyperabduction of the fifth finger. Mean follow-up of the 15 patients reviewed was 24 months (8-56). Mean MP flexion-extension range of motion was 86°/11° (71-99/0-29). Mean MP ulnar laxity of the injured finger was 18°, 14° and 11° respectively at 0°, 30° and 90° and 19°, 16°and 13°on comparison to the same digit on the opposite side. Mean MP radial laxity of the injured finger was 28°, 22° and 10° respectively at 0°, 30°, 90°, same digit on opposite side was 29°, 21°, 11°. There were no postoperative overlapped or hyperabducted fingers concerning spontaneous lateral laxity in extension. The postoperative rotational laxity test showed differences of arc in supination and pronation between operated finger and healthy side of respectively -12% and +8%. CONCLUSION The postoperative results of RCL repair of the MP in the long fingers are good in spite of some residual ligamentous distension, revealed by the laxity tests. The lateral laxity sign as a simple painless clinical sign for diagnosing complete RCL tears requiring surgery needs a validating study in order to spread its use. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Gero Meyer Zu Reckendorf
- Institut Montpelliérain de la main et du membre supérieur, clinique Saint-Roch, 560, avenue du Colonel Pavelet, 34070 Montpellier, France
| | - Mickaël Artuso
- Institut Montpelliérain de la main et du membre supérieur, clinique Saint-Roch, 560, avenue du Colonel Pavelet, 34070 Montpellier, France.
| | - Mylène Kientzi
- Institut Montpelliérain de la main et du membre supérieur, clinique Saint-Roch, 560, avenue du Colonel Pavelet, 34070 Montpellier, France
| | - Jean-Claude Rouzaud
- Institut Montpelliérain de la main et du membre supérieur, clinique Saint-Roch, 560, avenue du Colonel Pavelet, 34070 Montpellier, France
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Guo M, Qi B, Li J, Shi X, Ni H, Shi H, Ren J, Zhou X, Ye T, Yao L, Xu Y, Zhang M, Li C. Mechanical properties evaluation of metacarpophalangeal joint prosthesis with new titanium-nickel memory alloy: a cadaver study. BMC Musculoskelet Disord 2023; 24:738. [PMID: 37715199 PMCID: PMC10504783 DOI: 10.1186/s12891-023-06859-z] [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: 05/31/2023] [Accepted: 09/06/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE Ni-Ti memory alloys are unusual materials for hard-tissue replacement because of their unique superelasticity, good biocompatibility, high strength, low specific gravity, low magnetism, wear resistance, corrosion resistance and fatigue resistance. The current study aims to evaluate its mechanical properties and provide biomechanical basis for the clinical application of the prosthesis. METHODS Ten adult metacarpophalangeal joint specimens were randomly divided into a prosthesis group (n = 5, underwent metacarpophalangeal joint prosthesis) and a control group (n = 5, underwent sham operation). Firstly, the axial compression strength was tested with BOSE material testing machine to evaluate its biomechanical strength. Secondly, these specimens were tested for strain changes using BOSE material testing machine and GOM non-contact optical strain measurement system to evaluate the stress changes. Thirdly, fatigue test was performed between groups. Lastly, the mechanical wear of the metacarpophalangeal joint prosthesis was tested with ETK5510 material testing machine to study its mechanical properties. RESULTS Axial compression stiffness in the prosthesis group was greater than that in the control group in terms of 30 ° and 60 ° flexion positions (P < 0.05). There was no statistically significant difference between two groups with regards to axial compression stiffness and stress change test (P > 0.05). In the fatigue wear test, the mean mass loss in the prosthesis group's prosthesis was 17.2 mg and 17.619 mm3, respectively. The mean volume wear rate was 0.12%. There was no statistically significant difference in the maximum pull-out force of the metacarpal, phalangeal, and polymer polyethylene pads between the prosthesis group and the control group specimens. CONCLUSIONS Ni-Ti memory alloy metacarpophalangeal joint prosthesis conforms to the biomechanical characteristics of metacarpophalangeal joints without implants, and the fatigue strength can fully meet the needs of metacarpophalangeal joint activities after joint replacement.
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Affiliation(s)
- Minzheng Guo
- Kunming Medical University, 650500, Kunming, China
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force, No. 212 Daguan Road, Xishan District, 650118, Kunming, China
| | - Baochuang Qi
- Kunming Medical University, 650500, Kunming, China
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force, No. 212 Daguan Road, Xishan District, 650118, Kunming, China
| | - Jun Li
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force, No. 212 Daguan Road, Xishan District, 650118, Kunming, China
| | - Xiangwen Shi
- Kunming Medical University, 650500, Kunming, China
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force, No. 212 Daguan Road, Xishan District, 650118, Kunming, China
| | - Haonan Ni
- Kunming Medical University, 650500, Kunming, China
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force, No. 212 Daguan Road, Xishan District, 650118, Kunming, China
| | | | - Junxiao Ren
- Yunnan University of Chinese Medicine, 650500, Kunming, China
| | - Xizong Zhou
- Department of Orthopedics, Yanjin County Hospital, 657500, Zhaotong, China
| | - Tao Ye
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force, No. 212 Daguan Road, Xishan District, 650118, Kunming, China
| | - Ling Yao
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force, No. 212 Daguan Road, Xishan District, 650118, Kunming, China
| | - Yongqing Xu
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force, No. 212 Daguan Road, Xishan District, 650118, Kunming, China
| | - Meichao Zhang
- Anatomy department, School of Basic Medical Science, Southern Medical University, No. 1023-1063 Shatai South Road, Baiyun District, 510515, Guangzhou, China.
| | - Chuan Li
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force, No. 212 Daguan Road, Xishan District, 650118, Kunming, China.
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Moran SL, Rizzo M. Managing Difficult Problems in Small Joint Arthroplasty: Challenges, Complications, and Revisions. Hand Clin 2023; 39:307-320. [PMID: 37453759 DOI: 10.1016/j.hcl.2023.02.006] [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: 07/18/2023]
Abstract
Small joint arthroplasty of the hand has been an established means of joint preservation and pain relief for over a half a century. Despite this, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint arthroplasty has not achieved the long-term success seen with hip and knee arthroplasty. Problems following MCP, PIP, and carpometacarpal (CMC) joint arthroplasty can include intraoperative fracture, postoperative dislocation, recurrent pain, limitation of motion, and instability. The hand surgeon needs to be prepared for these problems and their management. This article addresses the management of the most common complications seen following MCP, PIP, and CMC arthroplasty.
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Affiliation(s)
- Steven L Moran
- Department of Orthopedics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Marco Rizzo
- Department of Orthopedics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Cavalcanti Kußmaul A, Ayache A, Unglaub F. [Trigger finger-pitfalls and differential diagnosis]. Orthopadie (Heidelb) 2023; 52:604-608. [PMID: 37233746 PMCID: PMC10299928 DOI: 10.1007/s00132-023-04390-6] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/27/2023]
Abstract
The differential diagnosis of a trigger finger presents a clinical challenge. This case depicts a 32-year-old male patient who presented with persistent snapping of the right index finger at the metacarpophalangeal joint without localized tenderness despite previous surgical A1-annular ligament release. CT diagnostics demonstrated a prominent articular tuberosity. The MRI showed no pathological findings. Surgical revision with concomitant excision of the tuberosity restored smooth mobility of the index finger.
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Affiliation(s)
- A Cavalcanti Kußmaul
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
| | - A Ayache
- Handchirurgie, Vulpius Klinik, Bad Rappenau, Deutschland
| | - F Unglaub
- Handchirurgie, Vulpius Klinik, Bad Rappenau, Deutschland
- Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland
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Portenard AC, Pegot A, Lievain L, Michelin P, Angot É, Beccari R, Duparc F, Auquit-Auckbur I. The distal dorsal intermetacarpal ligament: characterization of an overlooked structure-an anatomical study of 25 hands. Surg Radiol Anat 2023; 45:673-679. [PMID: 37017796 DOI: 10.1007/s00276-023-03139-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE Exhaustive literature is available on the metacarpophalangeal joints of the long fingers, but the dorsal ligamentous structure overlaying the interosseous muscles and joining the metacarpal heads of the long fingers remains to be fully characterized. Previously, our surgical hand team observed a non-classically reported structure connecting the metacarpal heads of the long fingers, in the dorsal part of the intermetacarpal spaces. Therefore, the aim of this anatomical study was to characterize this ligamentous structure in terms of size, insertions, and anatomical position. METHODS Twenty-five hands were dissected for a total of 75 long finger intermetacarpal spaces. A ligamentous structure was exposed after cellular tissue excision and dorsal superficial fascia opening. The length and thickness were measured and anatomical position and insertions were studied. Histological analysis was performed on five specimens and ultrasound analysis in one healthy subject. RESULTS All 25 dissections revealed a dorsal ligamentous structure, hereafter named distal dorsal intermetacarpal ligament, which was inserted in the lateral tubercle of each adjacent long finger metacarpal head. This distal dorsal intermetacarpal ligament surrounded interosseous tendons. It was more proximal compared to oblique and transversal interosseous muscle fibers. Histological analysis confirmed the ligamentous nature of the structure. Ultrasound analysis showed that this structure was well identified under the dorsal aspect of the hand. CONCLUSION All dissections revealed a tense ligamentous structure between each metacarpal head of the long fingers. This was a constant structure meeting the definition of a ligament. The distal dorsal intermetacarpal ligament seems to stabilize the metacarpal heads at the second and fourth spaces by limiting hyperabduction.
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Affiliation(s)
- Anne-Carole Portenard
- Department of Plastic, Reconstructive and Hand Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000, Rouen, France
| | - Alexandre Pegot
- Plastic and Aesthetic Surgery Department, Hôpital Privé Océane, 11 rue du Docteur-Audic, 56000, Vannes, France
| | - Ludovic Lievain
- Plastic and Aesthetic Surgery Department, Saint-Hilaire Clinic, 26 bis Boulevard Gambetta, 76044, Rouen Cedex, France
| | - Paul Michelin
- Department of Medical Imaging, Rouen University Hospital, 37 Boulevard Gambetta, 76000, Rouen, France
| | - Émilie Angot
- Department of Pathology, Normandy Centre for Genomic and Personalized Medicine, Rouen University Hospital, 76031, Rouen, France
| | - Roberto Beccari
- Department of Plastic, Reconstructive and Hand Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000, Rouen, France
| | - Fabrice Duparc
- Laboratory of Anatomy, Faculty of Medicine and Pharmacy of Rouen, University of Normandy, 22 Boulevard Gambetta, 76000, Rouen, France.
| | - Isabelle Auquit-Auckbur
- Department of Plastic, Reconstructive and Hand Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000, Rouen, France
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Funamura K, Ishikawa H, Abe A, Ito S, Otani H, Takamura S, Sudo M, Nakazono K, Murasawa A. More than 10 years' follow-up of the Swanson metacarpophalangeal joint arthroplasty for the rheumatoid hand. J Orthop Sci 2023:S0949-2658(23)00083-0. [PMID: 37012139 DOI: 10.1016/j.jos.2023.03.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/21/2023] [Accepted: 03/15/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND In recent years, advances in pharmacotherapy for rheumatoid arthritis have dramatically improved the control of disease activity. However, a significant number of patients still develop hand deformity and require surgical reconstruction. The objective of this study was to evaluate the long-term efficacy and drawbacks of the Swanson metacarpophalangeal joint arthroplasty for patients with rheumatoid arthritis over 10 years. METHODS Clinical and radiological evaluations were performed for 87 joints of 29 hands in 27 patients who underwent metacarpophalangeal joint arthroplasty using the Swanson implant, and who were followed up for an average of 11.4 (10-14) years. RESULTS The number of operated tender and swollen metacarpophalangeal joints decreased from 24 (27.6%) and 28 (32.2%) to 1 (1.1%) and 2 (2.3%), respectively. The patients' general health and disease activity score 28-erythrocyte sedimentation rate improved at the last survey. Mild recurrence of ulnar drift was observed, but the deformity was generally well-corrected. Implant fracture was noted in eight joints (9.2%), and revision surgery was performed in two joints (2.3%). The average active range of extension/flexion changed from -46.3°/65.9° to -32.3°/56.6°. While a significant change was not noted in grip or pinch strength, patients were satisfied with the operation especially in terms of pain relief and improved hand appearance. CONCLUSIONS The long-term results of Swanson metacarpophalangeal joint arthroplasty were good in pain relief and correction of deformity, but some problems remain with regard to implant durability and mobility.
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Affiliation(s)
- Kei Funamura
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8 Shibata City, Niigata 957-0054, Japan
| | - Hajime Ishikawa
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8 Shibata City, Niigata 957-0054, Japan.
| | - Asami Abe
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8 Shibata City, Niigata 957-0054, Japan
| | - Satoshi Ito
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8 Shibata City, Niigata 957-0054, Japan
| | - Hiroshi Otani
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8 Shibata City, Niigata 957-0054, Japan
| | - Sayuri Takamura
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8 Shibata City, Niigata 957-0054, Japan
| | - Masanori Sudo
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8 Shibata City, Niigata 957-0054, Japan
| | - Kiyoshi Nakazono
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8 Shibata City, Niigata 957-0054, Japan
| | - Akira Murasawa
- Department of Rheumatology, Niigata Rheumatic Center, 1-2-8 Shibata City, Niigata 957-0054, Japan
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Tan SHS, Pan F, Sirisena R, Tan RES, Sebastin SJ. Histology of the volar plate of the thumb metacarpophalangeal joint. Hand Surg Rehabil 2023; 42:141-146. [PMID: 36813164 DOI: 10.1016/j.hansur.2023.02.004] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND The aim of the study was to describe the histology of the thumb MCPJ volar plate. METHODS Five fresh-frozen thumbs were dissected. The volar plates were harvested from the thumb MCPJ. Histological analyses were performed using 0.04% Toluidine blue and counterstained with 0.005% Fast green. RESULTS The thumb MCPJ volar plate comprised two sesamoids, dense fibrous tissue and loose connective tissue. The two sesamoids were connected by dense fibrous tissue, with collagen fibers oriented transversely (perpendicular to the long axis of the thumb). In contrast, the collagen fibers within the dense fibrous tissue on the lateral sides of the sesamoid were oriented longitudinally in line with long axis of the thumb. These fibers blended with the fibers of the radial and ulnar collateral ligaments. The collagen fibers in the dense fibrous tissue distal to the sesamoids ran transversely, perpendicular to the long axis of the thumb. The proximal aspect of the volar plate showed only loose connective tissue. The volar plate of the thumb MCPJ was largely uniform with no division of layers from the dorsum to the palmar surface. There was no fibrocartilaginous component in the thumb MCPJ volar plate. CONCLUSIONS The histology of the volar plate of the thumb MCPJ differs significantly from the conventional understanding of the volar plate, based on the volar plate of finger proximal interphalangeal joints. The difference is likely due to the presence of the sesamoids, which confer additional stability, reducing the need for a specialized trilaminar fibrocartilaginous structure with the lateral check-rein ligaments found in the volar plate of finger proximal interphalangeal joints to confer additional stability.
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Affiliation(s)
- Si Heng Sharon Tan
- Department of Hand Reconstructive and Microsurgery, National University Health System (NUHS), Singapore.
| | - Feng Pan
- Department of Anatomy, National University of Singapore, Singapore
| | - Renita Sirisena
- Department of Hand Reconstructive and Microsurgery, National University Health System (NUHS), Singapore
| | - Ruth En Si Tan
- Department of Hand Reconstructive and Microsurgery, National University Health System (NUHS), Singapore
| | - Sandeep Jacob Sebastin
- Department of Hand Reconstructive and Microsurgery, National University Health System (NUHS), Singapore
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15
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Jang MG, Heo YM, Kim AY. Intracapsular Chondroma Occurring in Metacarpophalangeal Joint of the Hand: A Rare Presentation. J Hand Surg Asian Pac Vol 2023; 28:134-138. [PMID: 36803477 DOI: 10.1142/s2424835523720062] [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: 02/23/2023]
Abstract
Extraskeletal chondroma comprises synovial chondromatosis, intracapsular chondroma and soft tissue chondroma, its presentation in the hand, however, is very rare. A 42-year-old woman presented with a mass around right fourth metacarpophalangeal (MCP) joint. She had no pain or discomfort in activities. The radiographs showed soft tissue swelling, but no calcification or ossifying lesions. The magnetic resonance imaging (MRI) showed a lobulated juxta-cortical encircling mass existing around the fourth MCP joint. We did not suspect any cartilage-forming tumour in MRI. The mass was easily removed because there was no adhesion with surrounding tissues and the specimen had the appearance of a cartilage. The histological diagnosis was chondroma. Based on the tumour location and histological results, we diagnosed it as intracapsular chondroma. Although intracapsular chondroma is very rare-ly seen in the hands, it is important to consider an intracapsular chondroma when differentiating a tumour in the hand because it is difficult to diagnose one in an imaging examination. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
- Min Gu Jang
- Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon, Republic of Korea
| | - Youn Moo Heo
- Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon, Republic of Korea
| | - A Youn Kim
- Department of Orthopaedic Surgery, Konyang University Hospital, Daejeon, Republic of Korea
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16
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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.
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Ledoux P. Metacarpophalangeal hyperextension in thumb basal joint osteoarthritis: Radiological study and implications for treatment. Hand Surg Rehabil 2023; 42:56-60. [PMID: 36396115 DOI: 10.1016/j.hansur.2022.11.004] [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: 08/29/2022] [Revised: 10/25/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
We report a series of 95 consecutive patients operated on for total trapeziometacarpal joint replacement, screening for radiological characteristics to differentiating patients with and without preoperative MCP hyperextension. Loss of thumb column length and metacarpal head circularity on lateral view were quantified. Statistically, a combination of reduced length and circular metacarpal head was a determining factor for MCP hyperextension. We therefore believe it is essential to restore thumb column length in surgery for trapeziometacarpal osteoarthritis and to avoid trapeziectomy in patients with a circular head on lateral view. LEVEL OF EVIDENCE: III; prospective cohort study.
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18
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Zhao M, Tse JJ, Kuczynski MT, Brunet SC, Yan R, Engelke K, Peters M, van den Bergh JP, van Rietbergen B, Stok KS, Barnabe C, Pauchard Y, Manske SL. Open-source image analysis tool for the identification and quantification of cortical interruptions and bone erosions in high-resolution peripheral quantitative computed tomography images of patients with rheumatoid arthritis. Bone 2022; 165:116571. [PMID: 36174928 DOI: 10.1016/j.bone.2022.116571] [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: 07/19/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022]
Abstract
Identification of bone erosions and quantification of erosion volume is important for rheumatoid arthritis diagnosis, and can add important information to evaluate disease progression and treatment effects. High-resolution peripheral quantitative computed tomography (HR-pQCT) is well suited for this purpose, however analysis methods are not widely available. The purpose of this study was to develop an open-source software tool for the identification and quantification of bone erosions using images acquired by HR-pQCT. The collection of modules, Bone Analysis Modules (BAM) - Erosion, implements previously published erosion analysis techniques as modules in 3D Slicer, an open-source image processing and visualization tool. BAM includes a module to automatically identify cortical interruptions, from which erosions are manually selected, and a hybrid module that combines morphological and level set operations to quantify the volume of bone erosions. HR-pQCT images of the second and third metacarpophalangeal (MCP) joints were acquired in patients with RA (XtremeCT, n = 14, XtremeCTII, n = 22). The number of cortical interruptions detected by BAM-Erosion agreed strongly with the previously published cortical interruption detection algorithm for both XtremeCT (r2 = 0.85) and XtremeCTII (r2 = 0.87). Erosion volume assessment by BAM-Erosion agreed strongly (r2 = 0.95) with the Medical Image Analysis Framework. BAM-Erosion provides an open-source erosion analysis tool that produces comparable results to previously published algorithms, with improved options for visualization. The strength of the tool is that it implements multiple image processing algorithms for erosion analysis on a single, widely available, open-source platform that can accommodate future updates.
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Affiliation(s)
- Mingjie Zhao
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Justin J Tse
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Michael T Kuczynski
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott C Brunet
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ryan Yan
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Klaus Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Michiel Peters
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Kathryn S Stok
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia
| | - Cheryl Barnabe
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Yves Pauchard
- Department of Electrical and Software Engineering, University of Calgary, Calgary, Canada
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada; Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
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19
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Oliver WM, Place ZJ, Bell KR, Molyneux SG, Duckworth AD. Outcome Following Acute Suture Anchor Repair of the Ulnar Collateral Ligament of the Thumb. J Hand Surg Asian Pac Vol 2022; 27:982-990. [PMID: 36476090 DOI: 10.1142/s2424835522500874] [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: 12/12/2022]
Abstract
Background: The aim of this study was to evaluate the outcomes following acute repair of the ulnar collateral ligament of the thumb metacarpophalangeal joint (thumb UCL) using a suture anchor technique. Methods: From 2011 to 2019, we retrospectively identified 40 adult patients from a single centre who had undergone an acute thumb UCL repair (≤6 weeks post-injury). The mean age of the study cohort was 37 years (range 16-70) and 68% (n = 27/40) were male. The short-term outcomes included postoperative complications and failure of repair. The long-term outcomes were QuickDASH, the EuroQol 5-Dimension (EQ-5D), Visual Analogue Scale (EQ-VAS), return to sport and work and satisfaction with outcome. Results: The outcomes survey was completed at a mean of 4.3 years (range 1.0-9.2) for 33 patients (83%). Postoperative complications included self-limiting sensory disturbance (7.5%, n = 3/40), superficial infection (requiring oral antibiotics; 5%, n = 2/40) and wound dehiscence (requiring surgical debridement and re-closure; 2.5%, n = 1/40). No failures of repair were reported. The mean QuickDASH was 3.7 (range 0-27.3), EQ-5D 0.821 (range -0.041 to 1) and EQ-VAS 84 (range 60-100). Of the 32 employed patients, all returned to work at a median of 0.5 weeks (range 0-416) and the mean QuickDASH Work Module was 4.1 (range 0-50). Of the 24 patients playing sport prior to injury, 96% (n = 23/24) returned at a median of 16 weeks (range 5-52) and the mean QuickDASH Sport Module was 4.6 (range 0-25). All the patients were satisfied with their outcome (mean satisfaction score 9.8/10 [8-10O]). Conclusions: Thumb UCL repair using a suture anchor technique is safe and effective up to 6 weeks post injury. Pain and stiffness may persist in the longer term, but most patients report excellent upper limb function and health-related quality of life. The majority return to work and sport and are highly satisfied with their outcome. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- William M Oliver
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Zach J Place
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Katrina R Bell
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Andrew D Duckworth
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
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20
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Lipatov KV, Asatryan A, Melkonyan G, Kazantcev AD, Solov’eva EI, Cherkasov UE. Septic arthritis of the hand: Current issues of etiology, pathogenesis, diagnosis, treatment. World J Orthop 2022; 13:622-630. [PMID: 36051375 PMCID: PMC9302027 DOI: 10.5312/wjo.v13.i7.622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/19/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
Septic arthritis of the hand is a serious disease that often results in dysfunction of the joint or even the need to perform amputation of the finger. They rank second in the frequency of occurrence after lesions of the knee joint. Many points concerning the etiology, the timing of the development of cartilage destruction and the development of osteomyelitis, approaches to surgical treatment, the duration of antibiotic therapy, and the start of rehabilitation measures remain the subject of numerous discussions. Based on a search in the PubMed, Web of Science and Google Scholar databases down to 1990-2021, publications on septic arthritis of the hand were found and analyzed. The following inclusion criteria were used in our review: (1) Septic arthritis of the hand; (2) Published in a peer review journal; (3) Written in English; and (4) Full text version available. Studies were excluded if they met any of the following criteria: (1) Letters; (2) Articles published in abstract form only; and (3) Cadaveric studies. Septic arthritis of the hand was characterized by the most frequent damage to the joints of the index and middle fingers (> 50% of cases). Up to 90% of cases, the infection enters the joint as a result of penetrating trauma, animal bites, etc. Staphylococcus aureus became the most frequently isolated microorganism (30%-55%), and its polyantibiotic-resistant form Methicillin-resistant Staphylococcus aureus was found, according to various sources, from 0% to 73% among all isolated Staphylococcus aureus. In arthritis, Pasteurella multocida (6%-11%) is often isolated as a result of animal bites. Articular cartilage destruction in the experiment developed within 24-48 h after infection. In clinical studies, the development of osteomyelitis was noted when treatment was delayed by more than 10 d. X-ray data during the first two weeks were uninformative. Priority of surgical treatment of septic arthritis. Drainage and surgical treatment, and with the development of osteomyelitis, the implementation of arthrodesis. Antibacterial therapy for 2-4 wk and early start of rehabilitation measures. Timely surgical treatment in combination with antibiotic therapy and rehabilitation makes it possible to obtain a positive result in the treatment of septic arthritis of the hand.
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Affiliation(s)
- Konstantin V Lipatov
- Department of General Surgery, Institute of Clinical Medicine named after N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119021, Russia
| | - Arthur Asatryan
- Wound and Wound Infection Surgery, State Budgetary Institution “City Clinical Hospital named after S.S. Yudin of Moscow Healthcare Department”, Moscow 115446, Russia
| | - George Melkonyan
- Department of General Surgery, Physician of The Hospital for War Veterans No 3, Moscow 129336, Russia
| | - Aleksandr D Kazantcev
- Department of General Surgery, Institute of Clinical Medicine named after N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119021, Russia
| | - Ekaterina I Solov’eva
- Department of General Surgery, I.M. Sechenov First Moscow State Medical University, Moscow 119048, Russia
| | - Urii E Cherkasov
- Department of General Surgery, I.M. Sechenov First Moscow State Medical University, Moscow 119048, Russia
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21
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Itadera E, Okamoto S. Outcomes of a Trans-Web Approach to Fractures around the Finger Metacarpophalangeal Joint. J Hand Surg Asian Pac Vol 2022; 27:534-540. [PMID: 35674258 DOI: 10.1142/s2424835522500564] [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
Background: A fracture around the finger metacarpophalangeal joint (MCPJ) can be difficult to access. We developed a trans-web approach that could lead surgeons directly to this site. An incision across the web is believed to result in a web contracture. The aim of this study is to present the outcomes of the trans-web approach. Methods: This is a retrospective study of all patients in whom a trans-web approach was used to fix fractures around the MCPJ in the period from October 2008 and September 2020. The outcomes of the trans-web approach were evaluated by appearance of the scar, presence of pain in relation to the scar, grading web creep, range of motion at the MCPJ and degree of abduction and adduction of the finger. Any complications of surgery were also recorded. Results: This study included 10 patients with 11 fractures around the MCPJ (6 avulsion fractures and 5 extra-articular fractures). The mean follow-up was 5 months. Skin contractures did not occur in any avulsion fracture case where original or extended trans-web skin incisions were used. However, they occurred in 2 extra-articular cases treated via a trans-web plus a mid-lateral approach. The mean range of motion of the MCP joint in all the patients was 80° (range, 70°-95°). There was a 10° loss of abduction in one patient and temporary sensory disturbance in another patient. Both these patients had been treated with extended incisions. Conclusions: The trans-web incision is a useful approach for the open reduction of fractures around the finger MCPJ, especially in avulsion fractures of the lateral volar base of the proximal phalanx with minimal risk of scar contracture. The risk of scar contracture is higher when the trans-web incision is combined with a mid-lateral incision for extra-articular fractures. Levels of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Eichi Itadera
- Department of Orthopaedic Surgery, Japanese Red Cross Narita Hospital, Narita, Chiba Pref., Japan
| | - Seiji Okamoto
- Department of Orthopaedic Surgery, Japanese Red Cross Narita Hospital, Narita, Chiba Pref., Japan
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22
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Hattori Y, Hayashi K, Chia DSY, Sakamoto S, Doi K. Arthrodesis for Primary Osteoarthritis of Trapeziometacarpal Joint Using Multiple Kirschner Wires and Tension Band Wire in Female Patients Older than 40. J Hand Surg Asian Pac Vol 2022; 27:524-533. [PMID: 35674263 DOI: 10.1142/s2424835522500539] [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
Background: The purpose of this study was to evaluate the results of arthrodesis with multiple Kirschner (K)-wires and tension band wire for primary osteoarthritis of trapeziometacarpal (TM) joint in female patients aged 40 years or older. Methods: We retrospectively obtained data regarding all female patients 40 years or older who underwent TM joint arthrodesis for TM joint osteoarthritis with K-wires and tension band wire over a 10-year period from 2009 till 2019. Thumb length, active range of motion (ROM) at the metacarpophalangeal (MCP) joint, active ROM of radial and volar adduction and abduction and key pinch strength was measured. Patient-reported outcomes were assessed using a pain and satisfaction questionnaire and the DASH score. We also recorded postoperative complications. Results: The study included 60 thumbs in 49 patients with an average age 60 years and a mean follow-up of 40 ± 21 months. All but one thumb had radiographic evidence of fusion within 6 months and the union rate was 98%. Key pinch strength increased from 2.3 to 4.9 kg after surgery. Total arc of motion in radial adduction-abduction decreased from 16° to 10°. Total arc of motion in volar adduction-abduction decreased from 25° to 9°. One patient experienced attritional rupture of the flexor pollicis longus tendon attributed to a K-wire penetration into the carpal tunnel. Although 46 thumbs (77%) had no or mild hardware-related symptoms, they underwent hardware removal after solid bone union. In 23 thumbs with follow-up period longer than 48 months, two thumbs developed scaphotrapeziotrapezoid joint arthritis and two thumbs developed metacarpophalangeal joint arthritis. Conclusions: We found that arthrodesis with multiple K-wires and tension band wire is a valuable option in the management of trapeziometacarpal joint osteoarthritis in female patients aged 40 years or older. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Yasunori Hattori
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Yamaguchi, Japan
| | - Kota Hayashi
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Yamaguchi, Japan
| | - Dawn Sinn Yii Chia
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Yamaguchi, Japan
| | - Sotestu Sakamoto
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Yamaguchi, Japan
| | - Kazuteru Doi
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Yamaguchi, Japan
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Sapa MC, Xavier F, Facca S, Willaume T, Liverneaux P. Diagnostic value of dynamic imaging in MCP blockage: case report (with video). Hand Surg Rehabil 2022; 41:518-519. [PMID: 35487413 DOI: 10.1016/j.hansur.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/09/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Affiliation(s)
- M-C Sapa
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France
| | - F Xavier
- Department of Orthopedic Pediatric Surgery, Morvan Hospital, 2 Avenue Foch, 29200 Brest, France
| | - S Facca
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France; ICube CNRS UMR7357, Strasbourg University, 2-4 Rue Boussingault, 67000 Strasbourg, France
| | - T Willaume
- Department of Radiology, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France
| | - P Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 Avenue Molière, 67200 Strasbourg, France; ICube CNRS UMR7357, Strasbourg University, 2-4 Rue Boussingault, 67000 Strasbourg, France
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Oag EC, Stirling PHC, McEachan JE. Long-term outcomes following surgical repair of acute injuries of the thumb metacarpophalangeal joint ulnar collateral ligament. Hand Surg Rehabil 2021:S2468-1229(21)00631-9. [PMID: 34864217 DOI: 10.1016/j.hansur.2021.11.007] [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: 10/19/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 11/23/2022]
Abstract
The primary aim of this study was to describe the long-term patient reported outcomes following surgical repair of acute injuries to the thumb metacarpophalangeal (MCP) joint ulnar collateral ligament (UCL). The secondary aims were to describe the long-term health related quality of life, patient satisfaction and complication rate. From a single surgeon series, 30 patients were identified over an 11 year period (February 2000-February 2011). QuickDASH, EQ-5D-5L, and satisfaction scores were collected from 22 patients (73%) at mean 183 month follow up. The median QuickDASH score was 2.27. Median EQ-5D-5L was 0.88. Satisfaction rate was 82%, Net Promotor Score was 90. Significantly worse QuickDASH scores were seen in patients that developed MCP joint arthrosis or had had subsequent ipsilateral hand injuries (median 39.7 vs 2.27; p = 0.002). All the patients employed at the time of surgery returned to work without long-term adaptations. Surgical repair of acute UCL injury generally provides an excellent long-term functional outcome and satisfaction rate. Complications are rare but where MCP joint arthrosis develops functional outcomes can be significantly worse.
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Mazaleyrat M, Chaves C, Roulet S, Laulan J, Bacle G. Surgical treatment of chronic instability of the metacarpophalangeal finger joint based on the intraoperative condition of the collateral ligament: Results of a single-center study with 7years' follow-up. Orthop Traumatol Surg Res 2021; 107:102969. [PMID: 34044171 DOI: 10.1016/j.otsr.2021.102969] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/05/2020] [Accepted: 06/09/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Severe traumatic injuries to the collateral ligaments of the metacarpophalangeal (MCP) joints of the fingers are rare and often missed. There is no consensus on how to treat neglected, chronic, and symptomatic ligament tears. The two main options are ligament reinsertion and ligament reconstruction, but no criteria exist to help surgeons choose between them. HYPOTHESIS The structure and intraoperative appearance of the collateral ligament can be used to select between reattachment and ligament reconstruction; when the ligament is repairable, effective reattachment with a suture anchor is possible in chronic forms more than 3months after the injury event. PATIENTS AND METHODS Thirteen patients (14 consecutive cases) who underwent surgical treatment for a traumatic complete symptomatic tear of an MCP joint collateral ligament that was at least 3months old were included retrospectively. Six patients (7 fingers) had been treated by anchor reinsertion (group A) and seven patients (7 fingers) by ligament reconstruction as described by Hsieh (group B). Clinical and radiographic assessment consisted of the QuickDASH questionnaire, measurements of strength and active range of motion of the MCP compared to the other hand, and AP and lateral radiographs over the MCP joint. RESULTS Twelve patients (13 fingers) were reviewed after a mean follow-up of 84±49months. The mean QuickDASH was 4.7±5.4 for group A and 23.8±16.0 for group B (p=0.008). There was a significant decrease in the flexion/extension motion (64°/-6°) in group B relative to the healthy contralateral hand and group A fingers (p=0.012 and p=0.014). There were no visible degenerative joint lesions at the final assessment; however, three patients in group B had undergone revision surgery to address chronic pain. Two of them had a preoperative volar subluxation that was not corrected by the ligament reconstruction. DISCUSSION When a ligament is determined to be repairable based on intraoperative findings, reinsertion on bone provides satisfactory and long-lasting stabilization of the MCP joint even if the procedure is not done immediately after the injury occurs. If it is not repairable and no preoperative volar subluxation is found, the ligament reconstruction technique described by Hsieh restores stability to the MCP joint in the medium term with no signs of degeneration. LEVEL OF EVIDENCE IV; case series.
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Affiliation(s)
- Matthieu Mazaleyrat
- Department of Orthopaedic Surgery, Hand Surgery Unit, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Camilo Chaves
- Department of Orthopaedic Surgery, Hand Surgery Unit, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Steven Roulet
- Department of Orthopaedic Surgery, Hand Surgery Unit, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Jacky Laulan
- Department of Orthopaedic Surgery, Hand Surgery Unit, Hôpital Trousseau, CHRU de Tours, Tours, France
| | - Guillaume Bacle
- Department of Orthopaedic Surgery, Hand Surgery Unit, Hôpital Trousseau, CHRU de Tours, Tours, France; UMR 1253 (iBrain), Inserm Unit, équipe Imagerie, Biomarqueurs, Thérapie (IBT), Université de Tours, Tours, France.
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George S, Rizkallah M, Leviet D, Leclercq C, El Abiad R. Early vs late surgical treatment of radial instability of the thumb metacarpophalangeal joint. A retrospective cohort study. Hand Surg Rehabil 2021; 40:771-776. [PMID: 34455102 DOI: 10.1016/j.hansur.2021.08.008] [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] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/14/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
There is no clear evidence in the literature whether treating thumb radial collateral ligament (RCL) injury in the acute phase improves outcome. The purpose of the present study was to compare the clinical and radiological results of RCL repair in acute and chronic settings. Fourteen patients were included. Clinical range of motion (ROM) of the thumb, Kapandji score and radiological parameters were compared pre- and post-operatively to the contralateral uninjured thumb (control group) to evaluate the results of the surgical technique. Patients were then divided into two groups according to early versus late repair and outcomes were compared between the two groups and the control group. Preoperatively, mean spontaneous angle between first metacarpal (M1) and proximal phalanx (P1) (spontaneous M1P1 angle), ulnar stress M1P1 angle, ROM and Kapandji score differed significantly between injured and uninjured sides. Postoperatively these parameters for the injured side improved, reaching values similar to those on the uninjured side, especially with acute phase treatment; late treatment also tended to provide clinical improvement in ROM, Kapandji score and ulnar stress angle, but with significant improvement only for spontaneous deviation of the thumb. This study showed the late and immediate repair of the RCL of the thumb both gave good results, with slightly better outcome with acute phase repair. LEVEL OF EVIDENCE: Therapeutic, Level III.
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Affiliation(s)
- S George
- Saint Joseph University, Faculty of Medicine, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon.
| | - M Rizkallah
- Saint Joseph University, Faculty of Medicine, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon.
| | - D Leviet
- Hôpital de la Croix Rouge Henry Dunant, 95 Rue Michel Ange, 75016 Paris, France.
| | - C Leclercq
- Institut de la Main, Clinique Bizet, 21 Rue Georges Bizet, 75016 Paris, France.
| | - R El Abiad
- Saint Joseph University, Faculty of Medicine, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon.
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Aly AM, Nabil AM. Thumb metacarpophalangeal joint palmar plate chronic avulsion in children: diagnosis and treatment. Arch Orthop Trauma Surg 2021; 141:1419-23. [PMID: 33689019 DOI: 10.1007/s00402-021-03770-x] [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: 05/14/2020] [Accepted: 01/04/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Thumb metacarpophalangeal joint instability can have a considerable functional impairment. Acute injuries are usually overlooked in children due to the high pain threshold and the presence of ligamentous laxity. Chronicity of the injury results in failure of conservative treatment. Literature is poor in defining such injuries. The purpose of our study is to determine the clinical and radiological tools for the diagnosis of metacarpophalangeal joint instability and we propose a simple surgical technique for their management. METHODS From 2015 till 2019, we present a case series of four patients with chronic post-traumatic thumb metacarpophalangeal joint instability. Patients were assessed for palmar plate avulsion clinically and radiologically using plain X-ray and sonography. Surgical repair through a palmar approach with direct repair of the palmar plate was done in all patients. Patient demographics, complications, and clinical outcomes were recorded. RESULTS Mean follow-up was 22.5 months. At the latest follow-up the metacarpophalangeal joint was stable in all patients. They were all pain free except one patient suffered from temporary pain at the dorsum of the metacarpal due to prominence of the suture anchor, which disappeared at 1-year follow-up. They had improvement in pinch strength. Full range of motion was obtained and all the patients have returned to full activity without limitations. CONCLUSION Chronic post-traumatic thumb metacarpophalangeal joint instability results in functional impairment. Clinical suspicion and sonographic assessment can verify the diagnosis. Surgical repair with transosseous sutures or anchors yields satisfactory results in the paediatric age group with the preservation of normal range of motion.
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Komura S, Hirakawa A, Masuda T, Nohara M, Kimura A, Matsushita Y, Akiyama H. Does trapeziectomy with ligament reconstruction and tendon interposition arthroplasty correct the metacarpophalangeal joint hyperextension associated with trapeziometacarpal osteoarthritis? Arch Orthop Trauma Surg 2021; 141:1261-1268. [PMID: 33649913 DOI: 10.1007/s00402-021-03838-8] [Citation(s) in RCA: 3] [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] [Received: 11/19/2020] [Accepted: 02/15/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Trapeziometacarpal osteoarthritis sometimes results in hyperextension of the thumb metacarpophalangeal (MCP) joint, which could negatively impact outcomes following trapeziectomy with ligament reconstruction and tendon interposition (LRTI) arthroplasty. Although algorithms on performing trapeziectomy with LRTI for the management of this deformity are available, they lack clear evidence. Here, we investigate the function of the thumb MCP joint after trapeziectomy with LTRI and whether this procedure alone corrects preoperative MCP hyperextension, and also analyze clinical factors correlated with MCP hyperextension post-surgery. MATERIALS AND METHODS Twenty-eight patients who underwent trapeziectomy with LRTI and followed up for at ≥ 1 year (mean, 27.2 months) were retrospectively analyzed. No patient had concomitant surgery to the thumb MCP joint at the time of trapeziectomy with LRTI. Patients were divided into the < 30° (n = 19) and > 30° (n = 9) hyperextension groups as per their preoperative passive range of motion (ROM) of the MCP joint. Changes in ROM of the MCP joint post-surgery, clinical factors correlated with postoperative MCP hyperextension, and correlations between clinical outcomes and postoperative MCP extension were analyzed. RESULTS In the < 30° MCP hyperextension group, active and passive extensions of the MCP joint did not significantly change after surgery, and no worsening of postoperative MCP hyperextension was observed. In the > 30° hyperextension group, passive extension of the MCP joint significantly decreased (mean, 49.6°-29.8°). Preoperative MCP hyperextension improved in seven patients, was unchanged in 1, and worsened in 1. Postoperative passive MCP extension was negatively correlated with active/passive radial abduction, MCP flexion, trapezial space height, subjective outcomes, and hand strength post-surgery. CONCLUSIONS Trapeziectomy with LRTI alone could prevent postoperative thumb MCP hyperextension deformity for patients with thumb MCP extension < 30° and improve preoperative thumb MCP hyperextension. However, for patients with loss of radial abduction and MCP flexion due to the contracture, indirect correction of the MCP hyperextension was improbable.
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Affiliation(s)
- Shingo Komura
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Japan.
| | - Akihiro Hirakawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Tomihiro Masuda
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Marie Nohara
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Ayaka Kimura
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Yasuharu Matsushita
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu, 501-1194, Japan
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Cipolletta E, Mandl P, Di Matteo A, Mirza RM, Passarini G, Grassi W, Filippucci E. Sonographic assessment of cartilage damage at metacarpal head in rheumatoid arthritis: qualitative versus quantitative methods. Rheumatology (Oxford) 2021; 61:1018-1025. [PMID: 34097001 DOI: 10.1093/rheumatology/keab472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/25/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To test the validity of the Outcome Measure in Rheumatology (OMERACT) semiquantitative score by comparing with a quantitative method in the sonographic (US) assessment of hyaline cartilage at the metacarpal head (MH) in patients with rheumatoid arthritis (RA) and healthy subjects (HS). METHODS The hyaline cartilage from second to fifth MHs of both hands was scanned. Hyaline cartilage was scored semiquantitatively and quantitatively (by measuring cartilage thickness and comparing with reference values). In RA patients, radiographic joint space narrowing (JSN) was scored on the same joints using the Simple Erosion Narrowing Score (SENS). RESULTS Four-hundred and eight MHs in 51 RA patients and 320 MHs in 40 HS were evaluated. The OMERACT semiquantitative score was quicker to perform than the quantitative method (6.0 ± 0.5 vs 8.0 ± 1.5 min, p< 0.01). A significant correlation between the US scores (R = 0.68), and between the US scores and the JSN-SENS (R = 0.61 and R = 0.63, for semiquantitative and quantitative method, respectively) was found. The frequency of cartilage abnormalities was similar between the two US methods in RA patients (58.8% and 51.0% RA patients for semiquantitative and quantitative method, p= 0.46), while the former revealed more abnormalities in HS (27.5% and 7.5% of HS, p= 0.02). CONCLUSION The higher feasibility of the OMERACT semiquantitative score suggests its use as first-choice method in the evaluation of cartilage damage. However, despite its limits, the quantitative assessment of HC, providing patient-tailored information due to age- and sex-corrected cut-off values, may represent a valid supplement for optimizing the evaluation of cartilage damage in selected cases.
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Affiliation(s)
- Edoardo Cipolletta
- Rheumatology Unit, Polytechnic University of Marche, Jesi (Ancona), Italy
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Andrea Di Matteo
- Rheumatology Unit, Polytechnic University of Marche, Jesi (Ancona), Italy
| | | | | | - Walter Grassi
- Rheumatology Unit, Polytechnic University of Marche, Jesi (Ancona), Italy
| | - Emilio Filippucci
- Rheumatology Unit, Polytechnic University of Marche, Jesi (Ancona), Italy
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O'Neill ES, Qin MM, Chen KJ, Hansdorfer MA, Doscher ME. Dislocation of the metacarpophalangeal joint of the index finger requiring open reduction due to the presence of an intra-articular sesamoid bone. SAGE Open Med Case Rep 2021; 9:2050313X211021180. [PMID: 34158946 PMCID: PMC8182208 DOI: 10.1177/2050313x211021180] [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] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/09/2021] [Indexed: 11/16/2022] Open
Abstract
Complex dislocation of the metacarpophalangeal joint of the index finger is rare and
often requires surgical intervention. Here, we present a case of an index finger
metacarpophalangeal joint dislocation requiring open reduction due to obstruction by a
displaced volar plate and the intra-articular entrapment of a sesamoid bone. Surgical
approach was performed dorsally, allowing easy visualization of the volar plate and
sesamoid bone as well as minimizing risk to the radial digital nerve to the index finger.
Postoperatively, the patient reported good functional return despite the delay in
definitive management.
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Affiliation(s)
- Elizabeth S O'Neill
- Division of Plastic & Reconstructive Surgery, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.,Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mia M Qin
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| | - Kevin J Chen
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Marek A Hansdorfer
- Division of Plastic & Reconstructive Surgery, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.,Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew E Doscher
- Division of Plastic & Reconstructive Surgery, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
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Straticò P, Guerri G, Palozzo A, Di Francesco P, Vignoli M, Varasano V, Petrizzi L. Elastosonographic features of the metacarpophalangeal joint capsule in horses. BMC Vet Res 2021; 17:202. [PMID: 34051815 PMCID: PMC8164309 DOI: 10.1186/s12917-021-02897-8] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/04/2021] [Indexed: 12/31/2022] Open
Abstract
Background Capsulitis leads to the release of inflammatory mediators in the joint, causing capsular fibrosis and osteoarthritis (OA). Strain elastosonography (SE) measures the elasticity of tissue by evaluating its strain in operator-dependent deformation. The aims of the study were to assess the feasibility, repeatability, and reproducibility of SE for imaging the distal attachment of the joint capsule (DJC) of metacarpophalangeal joints in sound horses (Group S) and in horses with metacarpophalangeal OA (Group P) and to evaluate differences in the elastosonographic patterns of these horses. After a whole lameness examination, fore fetlock DJCs were assigned to Group S and Group P and were thereafter examined by two operators using SE. Qualitative (i.e., colour grading score) and semi-quantitative (i.e., elasticity index (EI) and strain ratio (SR)) methods were used to evaluate the elastograms. The inter-rater reliability (IRR), intraclass correlation coefficient (intra-CC) and interclass correlation coefficient (inter-CC) were used to compare colour grading scores and the repeatability and reproducibility of EI and SR outcomes. The same parameters were compared between groups. P < 0.05 indicated a significant finding. Results Forty-one horses were included: 11 were in Group S and 30 were in Group P (16 with bilateral OA, 8 with left OA and 6 with right OA). IRR outcomes ranged from good to excellent. For transverse and longitudinal ultrasound scans, the colour grading score of Group S was significantly higher than the metacarpophalangeal DJCs of Group P. Both Inter-CC and intra-CC were higher in Group S than in Group P, with values always > 0.8. Significative differences in EI and SR were detected between groups and between Group S and the affected limb of Group P; values were lower in Group S than in Group P. Conclusions SE can be a useful technique for evaluating DJCs, with good repeatability and reproducibility. DJCs appear softer in sound horses. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-021-02897-8.
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Affiliation(s)
- Paola Straticò
- Faculty of Veterinary Medicine, University of Teramo, Loc. Piano D'Accio, 64100, Teramo, Italy
| | - Giulia Guerri
- Faculty of Veterinary Medicine, University of Teramo, Loc. Piano D'Accio, 64100, Teramo, Italy
| | - Adriana Palozzo
- Faculty of Veterinary Medicine, University of Teramo, Loc. Piano D'Accio, 64100, Teramo, Italy.
| | - Paola Di Francesco
- Faculty of Veterinary Medicine, University of Teramo, Loc. Piano D'Accio, 64100, Teramo, Italy
| | - Massimo Vignoli
- Faculty of Veterinary Medicine, University of Teramo, Loc. Piano D'Accio, 64100, Teramo, Italy
| | - Vincenzo Varasano
- Faculty of Veterinary Medicine, University of Teramo, Loc. Piano D'Accio, 64100, Teramo, Italy
| | - Lucio Petrizzi
- Faculty of Veterinary Medicine, University of Teramo, Loc. Piano D'Accio, 64100, Teramo, Italy
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Singh N, Saini M, Kumar N, Srivastava MVP, Mehndiratta A. Evidence of neuroplasticity with robotic hand exoskeleton for post-stroke rehabilitation: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:76. [PMID: 33957937 PMCID: PMC8101163 DOI: 10.1186/s12984-021-00867-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/20/2021] [Indexed: 01/09/2023] Open
Abstract
Background A novel electromechanical robotic-exoskeleton was designed in-house for the rehabilitation of wrist joint and Metacarpophalangeal (MCP) joint. Objective The objective was to compare the rehabilitation effectiveness (clinical-scales and neurophysiological-measures) of robotic-therapy training sessions with dose-matched conventional therapy in patients with stroke. Methods A pilot prospective parallel randomized controlled study at clinical settings was designed for patients with stroke within 2 years of chronicity. Patients were randomly assigned to receive an intervention of 20 sessions of 45 min each, five days a week for four weeks, in Robotic-therapy Group (RG) (n = 12) and conventional upper-limb rehabilitation in Control-Group (CG) (n = 11). We intended to evaluate the effects of a novel exoskeleton based therapy on the functional rehabilitation outcomes of upper-limb and cortical-excitability in patients with stroke as compared to the conventional-rehabilitation. Clinical-scales– Modified Ashworth Scale, Active Range of Motion, Barthel-Index, Brunnstrom-stage and Fugl-Meyer (FM) scale and neurophysiological measures of cortical-excitability (using Transcranial Magnetic Stimulation) –Motor Evoked Potential and Resting Motor threshold, were acquired pre- and post-therapy. Results No side effects were noticed in any of the patients. Both RG and CG showed significant (p < 0.05) improvement in all clinical motor-outcomes except Modified Ashworth Scale in CG. RG showed significantly (p < 0.05) higher improvement over CG in Modified Ashworth Scale, Active Range of Motion and Fugl-Meyer scale and FM Wrist-/Hand component. An increase in cortical-excitability in ipsilesional-hemisphere was found to be statistically significant (p < 0.05) in RG over CG, as indexed by a decrease in Resting Motor Threshold and increase in the amplitude of Motor Evoked Potential. No significant changes were shown by the contralesional-hemisphere. Interhemispheric RMT-asymmetry evidenced significant (p < 0.05) changes in RG over CG indicating increased cortical-excitability in ipsilesional-hemisphere along with interhemispheric changes. Conclusion Robotic-exoskeleton training showed improvement in motor outcomes and cortical-excitability in patients with stroke. Neurophysiological changes in RG could most likely be a consequence of plastic reorganization and use-dependent plasticity. Trial registry number: ISRCTN95291802 Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00867-7.
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Affiliation(s)
- Neha Singh
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India
| | - Megha Saini
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All Indian Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India. .,Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Della Tommasa S, Winter K, Seeger J, Spitzbarth I, Brehm W, Troillet A. Evaluation of Villus Synovium From Unaffected Metacarpophalangeal Joints of Adult and Juvenile Horses. J Equine Vet Sci 2021; 102:103637. [PMID: 34119205 DOI: 10.1016/j.jevs.2021.103637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 11/24/2022]
Abstract
Horses are a widely accepted model for osteoarthritis (OA) research. Synovial tissue sampling is commonly used in studies to evaluate and grade the progress of OA or to assess treatment effects. Synovial explants play an important role in ex-vivo studies, increasingly replacing the use of living animals. To understand histomorphological changes in the process of joint-related diseases such as OA, detailed information about histomorphometric parameters of unaffected synovial villi is necessary. The objective of the present study was to evaluate the mean width of the intimal synovial lining and its cellularity as well as the vascularization of the subintimal layer in juvenile and adult horses not affected by a joint-related disease. One hundred synovial samples from both metacarpophalangeal joints from 25 horses (one day to 24 years old) were collected to evaluate the following parameters on digitalized hematoxylin-eosin stained samples: Width of intimal synovial lining measured by the distance from the inner joint surface to the subintimal layer; density of the cells making up the intimal synovial lining by counting cell nuclei; vascularization of the subintimal layer measured by the number and size of vessels in relation to the subintimal area. The median width of the intimal lining did not differ among juvenile (22.34 µm) and adult (23.34 µm) horses. The cellularity of the intimal lining was significantly lower in juvenile (one cell/143.8 µm2) than in adult (one cell /188.7µm2), (P < .001) horses as well as the density of blood vessels per mm2 within the subintimal layer (juveniles 1/mm2 vs. adults 0.05/mm2), (P < .001). This study provides morphometric data regarding synovial intimal width, intimal cellularity, and vascularization of equine synovial villi of unaffected horses. For future studies, age-related characteristics should be taken into consideration when synovial tissue samples are used for in-vivo and in-vitro studies.
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Affiliation(s)
- Simone Della Tommasa
- Deparment for horses, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany.
| | - Karsten Winter
- Institute of Anatomy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Johannes Seeger
- Institute of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
| | - Ingo Spitzbarth
- Institute of Veterinary Pathology, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
| | - Walter Brehm
- Deparment for horses, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
| | - Antonia Troillet
- Deparment for horses, Faculty of Veterinary Medicine, Leipzig University, Leipzig, Germany
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Singer E, Garcia T, Stover S. How does bone strain vary between the third metacarpal and the proximal phalangeal bones of the equine distal limb? J Biomech 2021; 123:110455. [PMID: 34004392 DOI: 10.1016/j.jbiomech.2021.110455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
Strain parameters at injury prone sites of the equine third metacarpal (MC3) and proximal phalangeal (P1) bones were investigated with the aim of improving understanding of injury pathogenesis. We hypothesized that dorsal principal and shear strain patterns, magnitudes and directions would differ from proximal-to-distal; and would be similar from medial-to-lateral across each bone. Unilateral limbs from nine equine cadavers were instrumented with rosette strain gauges during limb loading to 10,500 N. Gauges were attached at seven dorsal sites: middle MC3, distal MC3 (medial, middle, lateral) and proximal P1 (medial, middle, lateral). Outcome measures were analysed with repeated measures analysis of variance. Distal MC3 had the greatest, and proximal P1 the smallest magnitude of minimum principal and shear strains. Directions of maximum and minimum principal strain were similar at the middle and distal MC3 sites with a 20-40° direction difference compared to proximal P1. The patterns of strain magnitude and direction were similar from medial-to-lateral on distal MC3 but varied in pattern and magnitude among the P1 sites. Overall, as load reached maximum, direction of minimum principal strain became more axial in orientation, converging from opposite directions between bones, potentially maximising stability of the distal limb. The difference in strain parameters and strain ratio for adjacent anatomic sites on distal MC3 and proximal P1 was not anticipated, in light of the anatomic congruity of the metacarpophalangeal joint. Based on the predominance of shear strain across proximal P1, shear forces are likely the predominant biomechanical contributor to sagittal fractures of P1.
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Affiliation(s)
- Ellen Singer
- E Singer Equine Orthopaedics and Surgery, 14 Brooklands Rd, Parkgate, Neston, Cheshire, CH646SW, UK.
| | - Tanya Garcia
- JD Wheat Veterinary Orthopedic Research Laboratory, School of Veterinary Medicine, University of California, One Shields Avenue, Davis, CA, USA
| | - Susan Stover
- JD Wheat Veterinary Orthopedic Research Laboratory, School of Veterinary Medicine, University of California, One Shields Avenue, Davis, CA, USA
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Maximen J, Ropars M, Dréano T, Kim W. Three concomitant locked finger metacarpophalangeal joints caused by degenerative metacarpal heads: Case report. Hand Surg Rehabil 2021; 40:529-531. [PMID: 33852966 DOI: 10.1016/j.hansur.2021.03.018] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/06/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
A locked metacarpophalangeal joint (LMCP) is a rare condition often confused with trigger finger. Its causes are numerous and typically divided into two broad categories: acquired LMCP in younger patients, and degenerative LMCP in older patients. This pathology usually affects only one MCP. Even though several external reduction techniques have been described, the main risk of non-surgical reduction treatment is recurrence. Thus, its management is most often surgical. We report the case of a 60-year-old woman with 3 simultaneous LMCP (3rd, 4th, and 5th rays of the left hand) due to degenerative metacarpal heads. Surgical treatment was performed and found that locking was due to entrapment of the radial collateral ligament on metacarpal head osteophytes. Full extension was regained at the end of the surgery. The follow-up was uneventful, no recurrence occurred. This case highlights the need for careful examination to prevent medical and surgical wandering for a rare but well-described and easy to treat condition.
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Affiliation(s)
- J Maximen
- Department of Orthopedic Surgery, Pontchaillou University Hospital, 2 Rue Henri Le Guilloux, 35033, Rennes, France.
| | - M Ropars
- Department of Orthopedic Surgery, Pontchaillou University Hospital, 2 Rue Henri Le Guilloux, 35033, Rennes, France.
| | - T Dréano
- Department of Orthopedic Surgery, Pontchaillou University Hospital, 2 Rue Henri Le Guilloux, 35033, Rennes, France.
| | - W Kim
- Department of Orthopedic Surgery, Pontchaillou University Hospital, 2 Rue Henri Le Guilloux, 35033, Rennes, France.
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Manneck S, Del Grande F, Hirschmann A. Ulnar collateral ligament injuries of the first metacarpophalangeal joint: prevalence of associated injuries on radiographs and MRI. Skeletal Radiol 2021; 50:505-513. [PMID: 32815041 PMCID: PMC7811990 DOI: 10.1007/s00256-020-03575-w] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the prevalence of associated findings at the first metacarpophalangeal joint on radiographs and MRI following acute ulnar collateral ligament (UCL) injuries. MATERIALS AND METHODS This retrospective study included 25 patients with an injury of the UCL at MRI. Presence of associated injuries to the volar ligaments (checkrein and phalangoglenoid ligaments and volar plate) was assessed on radiographs and MRI independently by two musculoskeletal radiologists. Wilcoxon signed-rank test was used to compare frequencies of injuries between both modalities (p < 0.05). Interreader variability was calculated. RESULTS Complete tears of the UCL (48%/60%, reader 1/2) were more common than partial tears (24%/16%) on MRI. Dislocation of the UCL ≥ 3 mm was detected in 40%/56% on MRI. UCL avulsion fractures were more frequently seen on MRI (28%) compared with radiographs (12%) for reader 1. Associated avulsion injuries of the phalangoglenoid ligament were evident in 12%/8% on radiographs and in 80%/76% on MRI. Almost all patients (100%/79%) with a dislocated UCL tear showed a concomitant volar ligament injury; and even two-thirds (66%/72%) of the non-displaced UCL tears had an injury to the volar ligaments. Interreader agreement was moderate to excellent (κ = 0.60-1.0). CONCLUSION UCL tears are often associated with volar ligament injuries, even in lesser degrees of an UCL injury.
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Affiliation(s)
- Sebastian Manneck
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Petersgraben 4, 4031 Basel, Switzerland
| | - Filippo Del Grande
- Department of Radiology, Ospedale Regionale di Lugano, 6900 Lugano, Switzerland
| | - Anna Hirschmann
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Petersgraben 4, 4031 Basel, Switzerland
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Abrar DB, Schleich C, Brinks R, Goertz C, Schneider M, Nebelung S, Sewerin P. Differentiating rheumatoid and psoriatic arthritis: a systematic analysis of high-resolution magnetic resonance imaging features-preliminary findings. Skeletal Radiol 2021; 50:531-41. [PMID: 32845377 DOI: 10.1007/s00256-020-03588-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/23/2020] [Revised: 08/07/2020] [Accepted: 08/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Because of overlapping phenotypical presentations, the diagnostic differentiation of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) remains challenging. Thus, this study aimed to examine the diagnostic value of distinct imaging features obtained by high-resolution 3-T MRI for the diagnostic differentiation. MATERIALS AND METHODS Seventeen patients with PsA and 28 patients with RA were imaged at high resolution using 3-T MRI scanners and a dedicated 16-channel hand coil. All images were analyzed according to the outcome measures in rheumatology clinical trials' (OMERACT) RAMRIS (Rheumatoid Arthritis Magnetic Resonance Imaging Score) and PsAMRIS (Psoriatic Arthritis Magnetic Resonance Imaging Score) for the presence and intensity of synovitis, flexor tenosynovitis, bone edema, bone erosion, periarticular inflammation, bone proliferation, and joint space narrowing. Next, odds ratios (OR) were calculated to determine the strength of the associations between these imaging features, demographic characteristics, and the outcome RA vs. PsA. RESULTS PsA could be differentiated from RA by extracapsular inflammatory changes (PsAMRIS sub-score "periarticular inflammation"), with low odds for the presence of RA (OR of 0.06, p < 0.01) at all metacarpophalangeal (MCP) joints. A prediction model informed by the items that were strongest associated with the presence of RA or PsA demonstrated excellent differentiating capability with an area under the curve of 98.1%. CONCLUSION High-resolution imaging is beneficial for the identification of relevant imaging features that may assist the clinical differentiation of inflammatory conditions of the hand. At the MCP level, extracapsular inflammatory changes were strongly associated with PsA and may consequently allow the imaging differentiation of PsA and RA.
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Pomares G, Jager T. Emergency metacarpophalangeal arthroplasty with bone grafting for traumatic joint destruction: a report on two cases. Hand Surg Rehabil 2020; 40:104-108. [PMID: 33309791 DOI: 10.1016/j.hansur.2020.07.008] [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] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022]
Abstract
Traumatic destruction of the metacarpophalangeal joints with bone defect is a technical challenge for surgeons when maintaining joint mobility is a priority for the patient. An emergency metacarpophalangeal arthroplasty with bone graft has been described in the literature for dorsal defects in the proximal phalanx. We have adapted this technique to allow us to perform this arthroplasty with bone graft in all defects of the proximal phalanx.
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Affiliation(s)
- G Pomares
- Institut Européen de la Main - Luxembourg, Hôpital Kirchberg, 9, rue Edward Steichen, L2540 Luxembourg, Luxembourg.
| | - T Jager
- Institut Européen de la Main - Luxembourg, Hôpital Kirchberg, 9, rue Edward Steichen, L2540 Luxembourg, Luxembourg
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Ishii K, Oki S, Iwamoto T, Jinzaki M, Nagura T, Matsumoto M, Nakamura M. Quantitative analysis of metacarpophalangeal joints during active flexion using four-dimensional computed tomography. Clin Biomech (Bristol, Avon) 2020; 80:105188. [PMID: 33080527 DOI: 10.1016/j.clinbiomech.2020.105188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/12/2020] [Revised: 08/27/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The metacarpophalangeal joint has a unique morphology with a high degree of freedom. However, few studies have analyzed the kinematics of fingers owing to the rapid movement of the small bones involved. The in-vivo kinematics of metacarpophalangeal joints were analyzed by four-dimensional computed tomography (4DCT) and associated with its morphology. METHODS The flexion motion of the fingers of bilateral hands in 10 volunteers were examined using 4DCT. Iterative surfaces were registered to trace the surface of the proximal phalanges with respect to metacarpals. Rotation angles were calculated using Euler/Cardan angles. FINDINGS In the index finger, the proximal phalange supinated to a maximum flexion of 40° and then pronated, and its range of rotation was larger than the previous reports. In the other fingers, the proximal phalanges continued to supinate during flexion. The helical axis of the proximal phalange passed a point extremely close to the center point of bilateral condyles, and it moved toward the proximal and palmar directions until the middle stage of flexion and toward the proximal and dorsal directions during the late stage of flexion. The translation of the rotation axis was larger in the ring and little fingers. INTERPRETATION The rotation in the index finger was larger than previously reported. The helical axes moved in the dorsal direction and proximally during the latter phase of the flexion. These results can be employed to better understand the causes of implant failure of the metacarpophalangeal joints.
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McCoy AM, Kemper AM, Boyce MK, Brown MP, Trumble TN. Differential gene expression analysis reveals pathways important in early post-traumatic osteoarthritis in an equine model. BMC Genomics 2020; 21:843. [PMID: 33256611 DOI: 10.1186/s12864-020-07228-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/14/2020] [Accepted: 11/16/2020] [Indexed: 12/16/2022] Open
Abstract
Background Post-traumatic osteoarthritis (PTOA) is a common and significant problem in equine athletes. It is a disease of the entire joint, with the synovium thought to be a key player in disease onset and progression due to its role in inflammation. The development of effective tools for early diagnosis and treatment of PTOA remains an elusive goal. Altered gene expression represents the earliest discernable disease-related change, and can provide valuable information about disease pathogenesis and identify potential therapeutic targets. However, there is limited work examining global gene expression changes in early disease. In this study, we quantified gene expression changes in the synovium of osteoarthritis-affected joints using an equine metacarpophalangeal joint (MCPJ) chip model of early PTOA. Synovial samples were collected arthroscopically from the MCPJ of 11 adult horses before (preOA) and after (OA) surgical induction of osteoarthritis and from sham-operated joints. After sequencing synovial RNA, Salmon was used to quasi-map reads and quantify transcript abundances. Differential expression analysis with the limma-trend method used a fold-change cutoff of log2(1.1). Functional annotation was performed with PANTHER at FDR < 0.05. Pathway and network analyses were performed in Reactome and STRING, respectively. Results RNA was sequenced from 28 samples (6 preOA, 11 OA, 11 sham). “Sham” and “preOA” were not different and were grouped. Three hundred ninety-seven genes were upregulated and 365 downregulated in OA synovium compared to unaffected. Gene ontology (GO) terms related to extracellular matrix (ECM) organization, angiogenesis, and cell signaling were overrepresented. There were 17 enriched pathways, involved in ECM turnover, protein metabolism, and growth factor signaling. Network analysis revealed clusters of differentially expressed genes involved in ECM organization, endothelial regulation, and cellular metabolism. Conclusions Enriched pathways and overrepresented GO terms reflected a state of high metabolic activity and tissue turnover in OA-affected tissue, suggesting that the synovium may retain the capacity to support healing and homeostasis in early disease. Limitations of this study include small sample size and capture of one point post-injury. Differentially expressed genes within key pathways may represent potential diagnostic markers or therapeutic targets for PTOA. Mechanistic validation of these findings is an important next step.
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Hattori T, Tsujii M, Uemura T, Sudo A. Arthroscopic resection of a loose body in the inextensible metacarpophalangeal joint of the middle finger complicated with osteoarthritis: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20943773. [PMID: 32742657 PMCID: PMC7375710 DOI: 10.1177/2050313x20943773] [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] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/25/2020] [Indexed: 11/11/2022] Open
Abstract
Arthroscopic surgery is a standard technique for removal of loose bodies in large joints. By contrast, there were a few reports of arthroscopic surgery for loose bodies in small joints. We herein report a case of a 70-year-old woman with an inextensible metacarpophalangeal joint in the right middle finger due to an intra-articular loose body that developed after osteoarthritis. Surgery proceeded under vertical traction using traction tower. Two portals were developed at dorsal aspect on the metacarpophalangeal joints. The loose body was removed under arthroscopy with a small incision of both skin and sagittal band, thereby resolving clinical symptoms, including pain and limitations to metacarpophalangeal joint motion.
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Affiliation(s)
- Tetsuya Hattori
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, Tsu City, Japan
| | - Masaya Tsujii
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, Tsu City, Japan
| | - Takeshi Uemura
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, Tsu City, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, Tsu City, Japan
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Ahn KS, Choi IC, Kang CH, Park JW. Ultrasound diagnosis and follow-up of a locked thumb metacarpophalangeal joint caused by radial sesamoid entrapment: a case report. BMC Musculoskelet Disord 2020; 21:509. [PMID: 32736548 PMCID: PMC7395378 DOI: 10.1186/s12891-020-03541-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/27/2020] [Indexed: 11/28/2022] Open
Abstract
Background A locked thumb metacarpophalangeal joint is a rare condition that presents as restricted joint motions with mild hyperextension deformity, usually after a relatively minor hyperextension injury. Owing to the limitations of radiographs, computed tomography is a useful diagnostic imaging modality for assessing sesamoid displacement. However, despite its convenience, ultrasound findings of the locked thumb have rarely been reported. Here, we report a case of a locked thumb metacarpophalangeal joint diagnosed and followed-up using ultrasound. Case presentation A 15-year-old boy with a locked thumb metacarpophalangeal joint presented to our hospital. On physical examination, the 1st metacarpophalangeal joint was found to be hyperextended, and active and passive flexions were not possible. While radiographs were inconclusive, ultrasound revealed radial sesamoid entrapment at the 1st metacarpophalangeal joint causing locking. After closed manual reduction, metacarpophalangeal motions recovered. Success of the reduction was also confirmable by ultrasound. Conclusions Ultrasound can be a feasible modality to diagnose a locked thumb metacarpophalangeal joint and immediately judge the success or failure of the reduction.
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Affiliation(s)
- Kyung-Sik Ahn
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - In Cheul Choi
- Division of Hand Surgery & Reconstructive Microsurgery, Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
| | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jong Woong Park
- Division of Hand Surgery & Reconstructive Microsurgery, Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
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Xie LJ, Yang S, Wang YQ, Ye HP. [Dynamic orthosis with Shujinxi (, SJX) external granule for the treatment of collateral ligament contracture of metacarpophalangeal joint]. Zhongguo Gu Shang 2020; 33:219-23. [PMID: 32233247 DOI: 10.12200/j.issn.1003-0034.2020.03.006] [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] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore clinical efficacy of hand power device and Shujinxi (, SJX) external granule in treating collateral ligament contracture of metacarpophalangeal joint. METHODS Fifty patients with collateral ligament contracture of metacarpophalangeal joint from June 2017 to January 2019 were divided into experimental and control group, 25 patients in each group. In experimental group, there were 17 males and 8 females aged from 19 to 63 years old with an average of (40.53±9.42) years old; 36 affected fingers; the courses of disease ranged from 23 to 82 days with an average of (52.37± 11.20) days; treated with hand power device and SJX external granule. In control group, there were 15 males and 10 females aged from 21 to 58 years old with an average of (42.11±8.36) years old; 32 affected fingers; the courses of diseases ranged from 18 to 71 days with an average of (48.24±12.50) days; treated with loose training of metacarpophalangeal joints. Symptoms of pain of affected finger, flexion and extension function were observed between two groups, VAS score was used to evaluate relieve degree of pain, grip size was used to evaluate recovery of grip, total active motion was applied to assess recovery of metacarpophalangeal joints, the second operation and occurrence of complications between two groups were compared. RESULTS All patients were followed up about 8 weeks. VAS score, total active motion of metacarpophalangeal joints and grip of affected finger before and after treatment in experimental group were (4.22±1.09) point vs (1.98±1.01) point ,(17.40±6.31) ° vs (70.95±7.68) ° ,(4.83±3.09) kg vs (23.17±10.54) kg respectively, while in control group were (4.66±0.95) point vs (2.84± 1.06) point ,(16.25±5.66) ° vs (59.14±10.61) ° ,(5.06±4.05) kg vs (16.25±9.66) kg; there were statistical difference between two groups before and after treatment, and these items in experimental group after treatment were higher than that of control group (P<0.05) . There were no complicationsoccurred betweentwo groups. Onepatientinexperimentalgroup and 8 patients in controlgroupneededto bethesecondoperation, andhadsignificancedifference (P<0.05) . CONCLUSION Handpowerdevice and SJXexternalgranulecouldobviouslyrelievesymptomsof pain of affected finger, improve recovery of grip strength, increase total active motion, and has good safety. It is an effective method for treating for the treatment of collateral ligament contracture of metacarpophalangeal joint.
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Affiliation(s)
- Li-Juan Xie
- Department of Reparative and Reconstructive Surgery, Foshan Hospital of TCM, Foshan 528000, Guangdong, China
| | - Song Yang
- Department of Reparative and Reconstructive Surgery, Foshan Hospital of TCM, Foshan 528000, Guangdong, China
| | - Ying-Qiong Wang
- Department of Reparative and Reconstructive Surgery, Foshan Hospital of TCM, Foshan 528000, Guangdong, China
| | - Hui-Ping Ye
- Department of Reparative and Reconstructive Surgery, Foshan Hospital of TCM, Foshan 528000, Guangdong, China
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Ikumi A, Tanaka T, Matsuura Y, Kuniyoshi K, Suzuki T, Yamazaki M. Pin Insertion to the Interosseous Hood Minimize the Finger Motion Restriction for the Proximal Phalangeal Percutaneous Fixation: A Cadaveric Study. J Hand Surg Asian Pac Vol 2020; 25:177-183. [PMID: 32312196 DOI: 10.1142/s2424835520500204] [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
Background: The purpose of this study was to identify the optimal pin insertion point to minimize finger motion restriction for proximal phalangeal fixation in cadaver models. Methods: We used 16 fingers from three fresh-frozen cadavers (age, 82-86 years). Each finger was dissected at the level of the carpometacarpal joint and fixated to a custom-built range of motion (ROM)-measuring apparatus after skin removal. The pin was inserted into the bone through four gliding soft tissues: the interosseous hood, dorsal capsule, lateral band, and sagittal band. Then, each tendon was pulled by a prescribed weight in three finger positions (flexion, extension, and intrinsic plus position). Changes in the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) angles were measured before and after pinning. We compared the differences between the insertion points using the Tukey-Kramer post hoc test. Results: Placement of pins into the sagittal band significantly restricted MCP joint flexion, while placement into the dorsal capsule and lateral band significantly restricted PIP joint flexion. Only placement into the interosseous hood showed no significant difference in joint angles between the three finger positions compared to pre-pin insertion. There were no significant effects on MCP, PIP, and DIP joint extension. Conclusions: The ROM of the MCP joint was obstructed due to pinning in most areas of insertion. However, pin insertion to the interosseous hood did not obstruct the finger flexion ROM compared to that of other gliding soft tissues; therefore, we believe that the interosseous hood may be a suitable pin insertion point for proximal phalangeal fixation.
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Affiliation(s)
- Akira Ikumi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toshikazu Tanaka
- Department of Orthopedic Surgery, Kikkoman General Hospital, Chiba, Japan
| | - Yusuke Matsuura
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuki Kuniyoshi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takane Suzuki
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Hara A, Yokoyama M, Ichihara S, Maruyama Y. Treatment of an intraarticular comminuted fracture of the base of the proximal phalanx in a ring finger using the Ichi-Fixator external fixator system: A case report. Int J Surg Case Rep 2020; 68:12-17. [PMID: 32109766 PMCID: PMC7044468 DOI: 10.1016/j.ijscr.2020.02.020] [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] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Comminuted fractures involving the articular surface of the base of the proximal phalanx are relatively rare. We treated a patient with this type of fracture by open reduction and internal fixation with a locked-wire-type external fixator (Ichi-Fixator System). PRESENTATION OF CASE A 45-year-old man was injured because his ring finger was kicked during a Futsal game. Radiographs and computed tomography revealed a comminuted intraarticular fracture of the proximal phalanx of this ring finger. We treated the fracture with open reduction and K-wires and external fixation. We removed the K-wire and external fixator 5 weeks postoperatively and initiated range of motion exercises. Five months postoperatively, his finger motion was fully recovered without restriction. DISCUSSION Comminuted intraarticular fractures of the base of the proximal phalanx are usually treated with plating. Complications such as interference with excursion of the central slip and lateral bands, extensor tendon rupture, and plate prominence have been reported in these fractures. In our patient, the Ichi-Fixator System was useful as a distraction apparatus for metacarpophalangeal joint fixation. CONCLUSION A comminuted intra-articular fracture of the base of the proximal phalanx was treated successfully using the Ichi-Fixator system.
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Affiliation(s)
- Akira Hara
- Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan; Department of Orthopedic Surgery, Tanaka Neurosurgical Hospital, Tokyo, Japan.
| | - Minoru Yokoyama
- Department of Orthopedic Surgery, Tanaka Neurosurgical Hospital, Tokyo, Japan
| | - Satoshi Ichihara
- Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Yuichiro Maruyama
- Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
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Takahashi R, Ohmichi Y, Hatayama N, Hirai S, Naito M, Nakano T. Anatomical relationship between the sagittal band and extensor tendon of the thumb: a focus on variations of the extensor pollicis brevis tendon insertion. Anat Sci Int 2020; 95:356-362. [PMID: 32036559 DOI: 10.1007/s12565-020-00528-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 08/22/2019] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
The sagittal band of the finger is an aponeurosis-like structure surrounding the metacarpophalangeal joint. Sagittal band rupture causes extensor tendon dislocation from the dorsal side of the metacarpophalangeal joint. The thumb has two extensor tendons: extensor pollicis longus and extensor pollicis brevis tendons. Multiple studies have reported variations of extensor pollicis brevis tendon insertion. However, it remains unclear how the thumb sagittal band envelopes the extensor pollicis longus and extensor pollicis brevis tendons. This study investigated the anatomical relationship between the sagittal band and the two extensor tendons of the thumb. One hundred hands (47 right, 53 left) from 54 cadavers were examined to assess the detailed structure of the thumb sagittal band and extensor pollicis longus and extensor pollicis brevis tendons. We found that the thumb sagittal band enveloped both the tendons either separately (type I) or collectively (type II). Thirty-four cases (34.0%) were type I and 66 cases (66.0%) were type II. The extensor pollicis longus and extensor pollicis brevis tendons enveloped in the type I thumb sagittal band were inserted on different sites, respectively, whereas those tendons enveloped in the type II thumb sagittal band were inserted on the same sites. This study demonstrated that differences in the type of thumb sagittal band are closely associated with variations in extensor pollicis brevis tendon insertion. We predicted that these differences contribute to the sliding distance between the extensor pollicis brevis and extensor pollicis longus tendons and affect the pathophysiology of extensor tendon dislocation.
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Affiliation(s)
- Ryo Takahashi
- Department of Anatomy, School of Medicine, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan
- Department of Judo Therapy, Chuwa Professional Training College of Medical Care, Aichi, Japan
| | - Yusuke Ohmichi
- Department of Anatomy, School of Medicine, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan.
| | - Naoyuki Hatayama
- Department of Anatomy, School of Medicine, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan
| | - Shuichi Hirai
- Department of Anatomy, School of Medicine, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan
| | - Munekazu Naito
- Department of Anatomy, School of Medicine, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan
| | - Takashi Nakano
- Department of Anatomy, School of Medicine, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan
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Pugliese BR, Carballo CT, Connolly KM, Mazan MR, Kirker-Head CA. Effect of Fatigue on Equine Metacarpophalangeal Joint Kinematics-A Single Horse Pilot Study. J Equine Vet Sci 2019; 86:102849. [PMID: 32067670 DOI: 10.1016/j.jevs.2019.102849] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/30/2019] [Accepted: 11/07/2019] [Indexed: 11/15/2022]
Abstract
The objective was to validate a scientific method for characterizing equine metacarpophalangeal joint (MCPJ) motion in the nonfatigued and fatigued states using a single horse at trot, slow canter, and fast canter. One healthy Thoroughbred gelding exercised on a treadmill to exhaustion (fatigued state) (heart rate >190 BPM and blood lactate >10 mmol/L) while bilateral MCPJ angular data were acquired using electrogoniometry. Blood lactate and heart rate reflected transition from nonfatigued to fatigued states with increasing exercise duration and treadmill speed. Electrogoniometry consistently demonstrated: increase in mean MCPJ maximum extension angle with onset of fatigue; altered extension and flexion angular velocities with onset of fatigue; and increasing stride duration and decreasing stride frequency with onset of fatigue. The method allowed a preliminary but comprehensive characterization of the dynamic relationship between MCPJ kinematics and fatigue, prompting the need for multisubject studies that may enhance our ability to moderate exercise-related distal limb injury in equine athletes.
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Affiliation(s)
- Brenna R Pugliese
- Orthopaedic Research Laboratory, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA
| | - Cristina T Carballo
- Orthopaedic Research Laboratory, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA
| | - Kevin M Connolly
- Orthopaedic Research Laboratory, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA
| | - Melissa R Mazan
- Orthopaedic Research Laboratory, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA
| | - Carl A Kirker-Head
- Orthopaedic Research Laboratory, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA.
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Yao L, Li C, Li J. [Research progress in artificial metacarpophalangeal joint and interphalangeal joint prostheses]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019; 33:1326-1330. [PMID: 31544447 DOI: 10.7507/1002-1892.201902015] [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] [Indexed: 11/03/2022]
Abstract
Objective To summarize the research progress in artificial metacarpophalangeal joint and interphalangeal joint prostheses. Methods The research literature on artificial metacarpophalangeal joint and interphalangeal joint prostheses at home and abroad was reviewed and summarized from anatomy, prosthesis design, and material development. Results The artificial joint replacement can correct deformity, relieve pain, and improve function immediately. In the past 50 years, many researches have focused on the design and material of prostheses and surgical technique of joint replacement. There are three types of prostheses, including hinged limit-type-prosthesis, semi-limit-type-prosthesis, and non-limit-type-prosthesis. The prostheses have their own advantages and disadvantages, the long-term effectiveness of joint replacement is not ideal. Conclusion The metacarpophalangeal joint and interphalangeal joint prostheses with more anatomical structure and biocompatible materials are needed.
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Affiliation(s)
- Ling Yao
- Department of Orthopedics, 920 Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650100, P.R.China;Department of Graduates, Kunming Medical University, Kunming Yunnan, 650500, P.R.China
| | - Chuan Li
- Department of Orthopedics, 920 Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650100, P.R.China
| | - Jun Li
- Department of Orthopedics, 920 Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650100,
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Roh YH, Hong SW, Gong HS, Baek GH. Prognostic Factors for Nonsurgically Treated Sagittal Band Injuries of the Metacarpophalangeal Joint. J Hand Surg Am 2019; 44:897.e1-897.e5. [PMID: 30660398 DOI: 10.1016/j.jhsa.2018.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Received: 04/10/2018] [Revised: 10/01/2018] [Accepted: 11/16/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to evaluate the factors that influence the prognosis for patients with sagittal band injuries who were treated nonsurgically. METHODS A total of 94 patients who had been diagnosed with traumatic sagittal band injury and initially treated with 7 weeks of metacarpophalangeal (MCP) joint extension orthosis wear (5 weeks of full-time followed by 2 weeks of part-time use) were studied. The response to treatment, including finger range of motion (ROM), extensor tendon instability, grip strength, and functional outcome measured as Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score were assessed at 24-week follow-up. The factors that were assessed for their influence on the outcomes were age, sex, occupation, hand dominance, type of injury, injury severity, time to treatment, and the duration of orthosis wear. Potential predictor variables in bivariate analyses were entered into multivariable analyses to determine prognostic indicators of the outcomes. RESULTS After 24 weeks' follow-up, 67 patients (71%) achieved resolution of symptomatic tendon translocation with 83% of grip strength and 90% of ROM compared with the unaffected hand. The final mean QuickDASH scores was 15. Twenty-seven patients (29%) had persistently symptomatic tendon subluxation, and of those, 18 (19%) underwent surgical repair. There were significantly more manual laborers in the failure group than in the success group. Subjects in the treatment failure group were older, had longer symptom durations, and were more likely to have grade III injuries than were those in the success group. Multivariable analysis revealed that manual labor, longer symptom duration, and grade III injury were associated with a higher likelihood of treatment failure. CONCLUSIONS An MCP extension orthosis for sagittal band injury (5 weeks of full-time followed by 2 weeks of part-time use) led to mostly satisfactory results with 71% of patients achieving resolution of symptomatic tendon translocation, but manual labor, longer symptom duration, and grade III injury were associated with a higher likelihood of treatment failure. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, South Korea.
| | - Seok Woo Hong
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
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Tohyama M, Iida K, Konishi S. Iatrogenic displacement of the metacarpal head of the index finger while attempting closed reduction of a complex dorsal metacarpophalangeal joint dislocation. Trauma Case Rep 2019; 23:100243. [PMID: 31517016 PMCID: PMC6727105 DOI: 10.1016/j.tcr.2019.100243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2019] [Indexed: 11/28/2022] Open
Abstract
We describe the case of an 84-year-old woman with a dorsal dislocation of the metacarpophalangeal (MCP) joint of the left index finger. Closed reduction was performed at an orthopaedic clinic which led to an iatrogenic complete displacement of the second metacarpal head to the volar side. Because reduction was impossible, surgery was performed. The metacarpal head was reduced and fixed with two headless intramedullary screws. Careless attempting a closed reduction of the complex dorsal MCP joint dislocation might be contraindicated in elderly patients with bone fragility.
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Affiliation(s)
- Masahiko Tohyama
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan.,Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Ken Iida
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Sadahiko Konishi
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
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