Low-cost procedure for deformity correction in rheumatoid hands.

BACKGROUND: Surgical correction of ulnar drift of metacarpo-phalangeal joint (MPJ) due to Rheumatoid arthritis (RA) is conventionally done by silicon joint arthroplasty which is expensive and may be associated with many complications. We report the outcome of low-cost autologous interpositional arthroplasty. MATERIAL AND METHODS: Five patients (8 hands, 32 arthroplasties) underwent correction of ulnar drift of MPJ by dorsal capsule interpositional arthroplasty. Results were assessed according to the degree of recovery of movement at the MPJ and correction of ulnar drift. Functional improvement was graded as excellent, good and fair. Pain alleviation was assessed by visual analogue score (VAS) score. RESULTS: Excellent results were seen in 3 patients (5 hands, 20 arthroplasties), good in 1 patient (2 hands, 8 arthroplasties) and fair in 1 patient (1 hand, 4 arthroplasties). VAS score for pain decreased from mean preoperative 8.2/10 to 1/10. On average follow up of 1.4 years there was good hand function, no recurrence of deformities and patients were pain free. CONCLUSION: Interpositional arthroplasty for MPJ using dorsal capsule for correction of post RA ulnar drift is a low-cost option which improves the hand function and cosmesis. Additionally, it avoids all the complications related with the use of silicon joints.

[Splints in occupational therapy of the hand in an Austrian central hospital--current status]. / Die ergotherapeutische Schienenversorgung der Hand in einem österreichischen Zentralkrankenhaus--eine Bestandsaufnahme.

Ergotherapeutic splinting is essential in the treatment of diseases, injuries and innate deformities of the hand. However due to its high material and staff costs, a definitely diagnosed indication is a prequisite for prescription. A retrospective study was performed using the Krankenhausinformationssystem (KIS) to establish the total number of hand splints prescribed by the Department of Physical Medicine and Rehabilitation of the General Hospital of Vienna from 1/1992 until 8/1998, as well as referring doctors/departments and diagnoses leading to referral were recorded and descriptively evaluated. The total number of patients was 1972. 1236 (63%) of the cases were referred by surgical departments/branches, 410 (20%) by internal departments, 151 (8%) by the neurological department and 175 (9%) by other departments. The diagnosis leading to referral were rheumatoid arthropathies (542 = 26%), peripheral nerve lesions (458 = 22%), tendon lesions (201 = 10%), Dupuytren' contractures after surgery (184 = 8%), degenerative joint diseases (82 = 4%), conditions after fractures (55 = 2.5%), patients after amputations (50 = 2.3%), disorders of the central nervous system (53 = 2.5%), focus removals (40 = 2%) and tendovagintis (35 = 1.7%). The remaining 19% were referred due to surgical repositionings, soft tissue injuries, local infections and various other diagnoses. The majority of ergotherapeutic splintings was prescribed due to forms of rheumatic or rheumatoid diseases, peripheral nerve lesions as well as hand surgery. In this study documenting the clinical practice of a medical center was primarily aimed at providing the basis for further discussion of both factual and economic aspects of future developments in splinting.