RESUMEN
PURPOSE: Though the previous studies had described various surgical techniques for the treatment of mallet finger injuries, consensus on which technique was the most effective and appropriate surgical methods had not yet reached. This review aimed to systematically compare the effectiveness and safety of the treatment for mallet finger injuries via Kirschner wire fixation versus suture anchor technique to recommend an optimum option. METHODS: All literatures published until December 31, 2019 compared Kirschner wire fixation versus suture anchor technique to treat mallet finger were acquired through a comprehensive search in multiple databases. A meta-analysis was performed by the Cochrane Collaboration's RevMan 5.3 software. RESULTS: A total of 8 trials with 362 cases consisted of 4 randomized controlled trials and 4 prospective studies. The results suggested that the groups treated with kirschner wire fixation experienced more significant advantage in less complications than suture anchor groups (Pâ <â.05). On the other hand, no significant differences were found in terms of the total active range motion of the distal interphalangeal joint, the average distal interphalangeal joint extensor lag, Visual Analogue Scale scores, recurrence, as well as functional assessment at the final follow-up (Pâ>â.05, respectively) between the two surgical procedures. CONCLUSIONS: No obvious superiority were shown for the effectiveness between the two surgical interventions based on the above results. But in view of the less economic spending and complications, Kirschner wire fixation should be a better alternative relative to the suture anchor technique for inevitable surgical treatment of mallet finger lesions. However, a prudent attitude is still necessary to choose the two operative managements before a large sample and high-quality randomized controlled trials had been performed.
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Hilos Ortopédicos , Traumatismos de los Dedos/cirugía , Fijación Interna de Fracturas/instrumentación , Deformidades Adquiridas de la Mano/cirugía , Anclas para Sutura , Adulto , Femenino , Traumatismos de los Dedos/fisiopatología , Articulaciones de los Dedos/fisiopatología , Articulaciones de los Dedos/cirugía , Deformidades Adquiridas de la Mano/fisiopatología , Humanos , Masculino , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
INTRODUCTION: Soft-tissue mallet finger occurs due to loss of terminal extensor tendon secondary to rupture of distal phalanx. Although using noninvasive splints for 6-8 weeks is the gold standard for conservative treatment of closed soft-tissue mallet injuries, patient compliance is an important factor impacting on patient outcomes. In this study, we used a single Kirschner Wire (K-W) to fix the distal interphalangeal (DIP) joint in extension in those patients failed to comply with routine splinting. MATERIALS AND METHODS: In this prospective study, 190 patients with Doyle type 1 closed soft-tissue mallet finger deformity were included in four groups between 2011 and 2015. These groups were determined according to treatment modalities. Patients in the first group were treated with a finger splint (n = 109). Patients in the second group first received a finger splint and then K-W was applied due to lack of adequate compliance (n = 23). Patients in the third group were treated with K-W only (n = 47), and the fourth group did not accept surgical treatment nor conservative treatment (n = 11). After 20 weeks of follow up, we evaluated the results with functional measurements according to Crawford criteria and patient satisfaction. Additionally, the mid-term outcome was assessed with a follow-up at 2 years. RESULTS: At 20th week postoperatively, average DIP extension lag was 6 degrees (0-30) for the first group, 6.1 degrees (0-30) for the second group, 3.8 degrees (0-25) for the third group, and 17.3 degrees (7-30) for the fourth group. Total patient satisfaction was 85%, which was considered excellent or good. Swan neck deformity was observed in 11% of patients. Osteomyelitis and KW related complications were not observed. There were no statistically significant differences between short-term and mid-term results. CONCLUSION: Internal fixation via K-W may be a suitable treatment option compared to splint therapy for management of closed soft-tissue mallet finger in noncompliant patients. Using this treatment approach, the success rate for patients could satisfactorily be improved.
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Hilos Ortopédicos , Traumatismos de los Dedos/terapia , Deformidades Adquiridas de la Mano/terapia , Cooperación del Paciente , Complicaciones Posoperatorias/prevención & control , Traumatismos de los Dedos/fisiopatología , Falanges de los Dedos de la Mano/fisiopatología , Deformidades Adquiridas de la Mano/fisiopatología , Humanos , Estudios ProspectivosRESUMEN
OBJECTIVE: Wrist deformity in older people is common following treatment for a wrist fracture, particularly after non-surgical treatment. A cohort of older wrist fracture patients were surveyed by telephone regarding perceived deformity, bother with deformity and patient-reported wrist function. The objectives were to: (1) determine whether older patients with wrist fractures perceived a deformity of their wrist and if they were bothered by it; (2) test if there were associations between deformity and treatment-type and between deformity and function; (3) test for associations between bother and treatment-type and between bother and function; (4) measure the test-retest reliability of the 'bother' question. RESULTS: Of 98 eligible patients who were invited to participate, 41 responded. Out of 41, 14 (34%) believed they had a deformity and 4 (10%) reported that they were bothered by the appearance of their wrist. Deformity was associated with non-surgical treatment (RR = 3.85, p = 0.006) but was not significantly associated with functional outcomes (p = 0.15). All those who were bothered belonged to the non-surgical treatment group. Bother was significantly associated with poorer functional outcomes (p = 0.006) and this association was clinically significant (MD = 35 points). The deformity and bother questions were found to have excellent test-retest reliability; κ = 1.00 and κ = 0.92, respectively.
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Envejecimiento , Fracturas Óseas , Deformidades Adquiridas de la Mano , Deformidades Adquiridas de la Articulación , Traumatismos de la Muñeca , Muñeca , Anciano , Anciano de 80 o más Años , Envejecimiento/patología , Femenino , Fracturas Óseas/patología , Fracturas Óseas/fisiopatología , Fracturas Óseas/terapia , Deformidades Adquiridas de la Mano/patología , Deformidades Adquiridas de la Mano/fisiopatología , Humanos , Deformidades Adquiridas de la Articulación/patología , Deformidades Adquiridas de la Articulación/fisiopatología , Masculino , Muñeca/patología , Muñeca/fisiopatología , Traumatismos de la Muñeca/patología , Traumatismos de la Muñeca/fisiopatologíaRESUMEN
LEARNING OBJECTIVES: After reviewing this article, the participant should be able to: Start early protected movement at 3 to 5 days after surgery with relative motion extension splinting for zone 5 extensor tendon lacerations over the hand. Allow patients to resume regular activities much sooner than the conventional 3 to 4 weeks of splinting after extensor tendon repair. Improve the rehabilitation of boutonniere deformities with relative motion splinting. SUMMARY: This article focuses on surgery and rehabilitation of extensor tendon injuries from the proximal interphalangeal joint (boutonniere) to the wrist. Relative motion flexion and extension splinting and wide awake, local anesthesia, no tourniquet surgery have revolutionized the management of these lesions, with early protected movement, sooner return to regular activities, and improved rehabilitation. This article explains and illustrates these new advances in extensor tendon management.
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Articulaciones de los Dedos/cirugía , Deformidades Adquiridas de la Mano/cirugía , Procedimientos de Cirugía Plástica/tendencias , Cuidados Posoperatorios/tendencias , Traumatismos de los Tendones/cirugía , Articulaciones de los Dedos/fisiopatología , Deformidades Adquiridas de la Mano/etiología , Deformidades Adquiridas de la Mano/fisiopatología , Deformidades Adquiridas de la Mano/rehabilitación , Humanos , Cuidados Posoperatorios/instrumentación , Cuidados Posoperatorios/métodos , Rango del Movimiento Articular , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos de Cirugía Plástica/métodos , Recuperación de la Función , Traumatismos de los Tendones/complicaciones , Traumatismos de los Tendones/fisiopatología , Traumatismos de los Tendones/rehabilitación , Factores de Tiempo , Resultado del TratamientoRESUMEN
Abstract Background and objectives: Leprosy remains a leading cause of peripheral neuropathy and disability in the world. Primary objective of the study was to determine the incidence of deformities present at a time of diagnosis and new deformities that patients develop over follow up period. Material and methods: An open, retrospective cohort study was performed at a tertiary medical center in western India. Recruitment phase of the study was of 2 years (2009-2010) followed by observation/follow up phase of 7 years till 31st December 2017. New patients with leprosy and released from treatment cases who presented with deformity as defined by WHO disability grade (1998) and subsequently developing new deformities during the follow up period of up to 7 years were included in the study. Results: The study included 200 leprosy patients. Of the total 254 deformities, 168 (66.14%) deformities were noticed at the moment of diagnosis, 20 (7.87%) deformities occurred during the follow up phase. Of all patients, 21.25% had Grade 1 deformity and 6.31% had Grade 2 or more severe deformity. Deformities of hand were most common in 44.48%, followed by feet 39.76%, and face 15.74% respectively. Limitation of study: Mode of inclusion of patient was self-reporting during follow up phase so there is possible under reporting of the disabilities. Conclusion: New deformities continue to develop in certain forms of leprosy even after release from treatment. Long-term & regular follow up of patients who have been released from treatment is required.
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Humanos , Masculino , Femenino , Evaluación de la Discapacidad , Lepra/fisiopatología , Lepra/patología , Nervios Periféricos/fisiopatología , Factores de Tiempo , Índice de Severidad de la Enfermedad , Deformidades Adquiridas del Pie/fisiopatología , Deformidades Adquiridas del Pie/patología , Deformidades Adquiridas de la Mano/fisiopatología , Deformidades Adquiridas de la Mano/patología , Registros Médicos , Estudios Transversales , Estudios Retrospectivos , Estudios de Seguimiento , Progresión de la Enfermedad , Cara/anomalías , IndiaRESUMEN
BACKGROUND AND OBJECTIVES: Leprosy remains a leading cause of peripheral neuropathy and disability in the world. Primary objective of the study was to determine the incidence of deformities present at a time of diagnosis and new deformities that patients develop over follow up period. MATERIAL AND METHODS: An open, retrospective cohort study was performed at a tertiary medical center in western India. Recruitment phase of the study was of 2 years (2009-2010) followed by observation/follow up phase of 7 years till 31st December 2017. New patients with leprosy and released from treatment cases who presented with deformity as defined by WHO disability grade (1998) and subsequently developing new deformities during the follow up period of up to 7 years were included in the study. RESULTS: The study included 200 leprosy patients. Of the total 254 deformities, 168 (66.14%) deformities were noticed at the moment of diagnosis, 20 (7.87%) deformities occurred during the follow up phase. Of all patients, 21.25% had Grade 1 deformity and 6.31% had Grade 2 or more severe deformity. Deformities of hand were most common in 44.48%, followed by feet 39.76%, and face 15.74% respectively. LIMITATION OF STUDY: Mode of inclusion of patient was self-reporting during follow up phase so there is possible under reporting of the disabilities. CONCLUSION: New deformities continue to develop in certain forms of leprosy even after release from treatment. Long-term & regular follow up of patients who have been released from treatment is required.
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Evaluación de la Discapacidad , Lepra/patología , Lepra/fisiopatología , Estudios Transversales , Progresión de la Enfermedad , Cara/anomalías , Femenino , Estudios de Seguimiento , Deformidades Adquiridas del Pie/patología , Deformidades Adquiridas del Pie/fisiopatología , Deformidades Adquiridas de la Mano/patología , Deformidades Adquiridas de la Mano/fisiopatología , Humanos , India , Masculino , Registros Médicos , Nervios Periféricos/fisiopatología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
Currently, research based on the technology and applications of 3D printing is being actively pursued. 3D printing technology, also called additive manufacturing, is widely and increasingly used in the medical field. This study produced custom casts for the treatment of mallet finger using plaster of Paris, which was traditionally used in clinical practice, and 3D printing technology, and evaluated their advantages and disadvantages for patients by conducting a wearability assessment. Mallet finger casts produced using plaster of Paris, when incorrectly made, can result in skin necrosis and other problems for patients. These problems can be mitigated, however, by creating casts using 3D printing technology. Additionally, plaster casts or ready-made alternatives can be inconvenient with respect to rapid treatment of patients. In contrast, 3D-printed casts appear to provide patients with appropriate treatment and increase their satisfaction because they are small in size, custom-made for each patient, and can be quickly made and immediately applied in clinical practice.
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Traumatismos de los Dedos/terapia , Deformidades Adquiridas de la Mano/terapia , Impresión Tridimensional , Férulas (Fijadores) , Sulfato de Calcio/uso terapéutico , Traumatismos de los Dedos/fisiopatología , Dedos/fisiopatología , Deformidades Adquiridas de la Mano/fisiopatología , Humanos , Satisfacción del PacienteRESUMEN
BACKGROUND: The aim of the current biomechanical study was to investigate a newly developed surgical technique for mallet fingers. The new method is based on the Ishiguro method which requires a K-wire through the distal interphalangeal joint for temporary fixation. The new technique avoids the joint trans fixation using a specially designed finger nail holder. This method was compared to the established Ishiguro's technique. METHODS: For biomechanical testing, 32 paired, fresh-frozen human fingers (Digit II-V) of 4 donors (ages 60 to 71â¯years) were used. The paired fingers were assigned to either the new method or Ishiguro's technique. The biomechanical testing consisted of a cyclic cantilever bending (2000â¯cycles, 1-7N) followed by a load to failure test. The groups were evaluated for plastic deformation, stiffness, change in stiffness during cyclic loading, subluxation and failure load by analysing force-deflect data and fluoroscopic images. FINDINGS: The nail fixation group showed significantly higher failure loads and stiffness than the trans fixation group. The values of plastic deformation were significantly lower in the nail fixation group. No differences were found in the change of stiffness. No subluxation was found in both groups. INTERPRETATION: In the current biomechanical study, nail fixation performed at least as good as Ishiguro's trans fixation technique. The results and ease of implementation indicate that the newly developed nail fixation technique might be a useful treatment method in daily clinical practice without the need of temporary joint trans-fixation avoiding possible associated problems. To establish this method, clinical trials will be necessary.
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Hilos Ortopédicos , Fijación Interna de Fracturas/métodos , Deformidades Adquiridas de la Mano/fisiopatología , Luxaciones Articulares , Uñas , Rango del Movimiento Articular , Anciano , Fenómenos Biomecánicos , Cartílago/patología , Femenino , Articulaciones de los Dedos , Dedos , Fluoroscopía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: Claw finger deformity occurs during attempted finger extension in patients whose intrinsic finger muscles are weakened or paralyzed by neural impairments. The deformity is generally not acutely present after intrinsic muscle palsy. The delayed onset, with severity progressing over time, suggests soft tissue changes that affect the passive biomechanics of the hand exacerbate and advance the deformity. Clinical interventions may be more effective if such secondary biomechanical changes are effectively addressed. Using a computational model, we simulated these altered soft tissue biomechanical properties to quantify their effects on coordinated finger extension. METHODS: To evaluate the effects of maladaptive changes in soft tissue biomechanical properties on the development and progression of the claw finger deformity after intrinsic muscle palsy, we completed 45 biomechanical simulations of cyclic index finger flexion and extension, varying the muscle excitation level, clinically relevant biomechanical factors, and wrist position. We evaluated to what extent (1) increased joint laxity, (2) decreased mechanical advantage of the extensors about the proximal interphalangeal joint, and (3) shortening of the flexor muscles contributed to the development of claw finger deformity in an intrinsic-minus hand model. RESULTS: Of the mechanisms studied, shortening (or contracture) of the extrinsic finger flexors was the factor most associated with the development of claw finger deformity in simulation. CONCLUSIONS: These simulations suggest that adaptive shortening of the extrinsic finger flexors is required for the development of claw finger deformity. Increased joint laxity and decreased extensor mechanical advantage only contributed to the severity of the deformity in simulations when shortening of the flexor muscles was present. CLINICAL RELEVANCE: In both the acute and chronic stages of intrinsic finger paralysis, maintaining extrinsic finger flexor length should be an area of focus in rehabilitation to prevent formation of the claw finger deformity and achieve optimal outcomes after surgical interventions.
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Simulación por Computador , Contractura/fisiopatología , Deformidades Adquiridas de la Mano/fisiopatología , Parálisis/fisiopatología , Fenómenos Biomecánicos , HumanosRESUMEN
There are various surgical solutions for arthrosis of the proximal interphalangeal (PIP) joint: arthrodesis or denervation. Clinodactyly that is major and the index fingers are traditional contraindications for PIP arthroplasty prostheses. The recurrence of clinodactyly with ligament imbalance and mechanical complications are known complications. The purpose of our study was to evaluate the objective and subjective clinical results and radiological complications of Tactys® prostheses on the PIP joint of the index fingers or with clinodactyly of more than 5° in the other fingers. Two surgeons have implanted 35 total gliding modular Tactys® prostheses in 29 women and 3 men since 2010. The indications for surgery were arthrotic and painful PIP joints. Average pre-op clinodactyly was 7.03° (5-30°) with ulnar deviation (29 cases). Eleven index fingers presented with average clinodactyly of 14.2° (10-20°). The digits operated on were as follows: 13 index fingers, 14 middle fingers, 5 ring fingers and 3 little fingers. Arthrosis was primitive in 23 cases, post-traumatic in 6 cases and rheumatoid in 6 cases. The average age of patients undergoing surgery was 63.7 years (40-85). Objective (mobility, strength, index finger exclusion, scores, clinodactyly) and subjective (patient satisfaction, pain) functional results were collected by a neutral and independent observer, as were radiological complications. With an average follow-up of 2.6 years (1-6.3), the range of motion in all digits improved by 5.4° on average (55.5-60.8). The improvement in range of motion in the index fingers was 4.5° (57-61.5). Clinodactyly in all fingers was corrected by 1.36° (0-20). In the index fingers, average clinodactyly was 1.3° (0-10). The pinch strength in all PIP joints improved significantly from 2.3 kg (0.5-5) to 3.7 kg (1-8). On the PIP of the index fingers, the pinch strength had increased significantly from 2.5 kg (1-4) before surgery to 3.8 kg (1-7.5) post-op. Functional scores improved: PRWE (from 55.36 to 26.7/100), Quick DASH (from 54.6 to 30.5/100). Patient satisfaction was excellent in 15 cases, good in 8 cases, average in 10 cases, poor in 2 cases. The average VAS Pain Score improved from 5.6 to 1.45. We found 3 major complications requiring surgery: 2 stiffening and 1 mechanical loosening with secondary arthrodesis. Five patients presented with non-troublesome, reducible swan neck deformity and one algodystrophy. A gliding, fixed Tactys® prosthesis allowed us to restore ligament balance and to optimally rebalance the periarticular structures. The improvement in range of motion and the correction of clinodactyly was maintained over time. Total arthroplasty of the PIP with a Tactys® is no longer a formal contraindication for the index fingers and in cases of clinodactyly of more than 5°.
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Artroplastia para la Sustitución de Dedos/instrumentación , Articulaciones de los Dedos/cirugía , Deformidades Adquiridas de la Mano/cirugía , Prótesis Articulares , Osteoartritis/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Articulaciones de los Dedos/fisiopatología , Deformidades Adquiridas de la Mano/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis/fisiopatología , Satisfacción del Paciente/estadística & datos numéricos , Diseño de Prótesis , Rango del Movimiento Articular , Escala Visual AnalógicaRESUMEN
OBJECTIVES: To establish a new assessment tool for ulnar drift (UD) in rheumatoid arthritis (RA). METHODS: We established an observational cohort of 67 patients (134 rheumatoid hands) beginning in 2004. Fifty-two patients (100 hands) had follow-up in 2009 and 37 patients (63 hands) completed follow-up in 2015. UD was evaluated with the Fearnley classification and our scoring method, which assesses four parameters of the metacarpophalangeal joint. Cluster analysis using UD parameters divided hands into groups. Changes in UD over time, correlation of the Fearnley stage and cluster with a functional assessment, and reliability of the parameters were analyzed. RESULTS: UD increased and worsened over time according to the trend test. A dendrogram indicated five clusters would be appropriate. Both the Fearnley classification and cluster were associated with function; however, our method related to function more linearly (R-squared: 0.42). We found one type of hand in which bone destruction precedes the joint dislocation and one type in which joint dislocation progresses with little deviation during UD progression. CONCLUSION: Our UD evaluation appeared to be simple and related to function. Additionally, it enables dividing UD hands into five stages. Thus, our assessment should be beneficial compared to the Fearnley classification in considering treatments of UD.
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Artritis Reumatoide/complicaciones , Deformidades Adquiridas de la Mano , Luxaciones Articulares , Articulación Metacarpofalángica , Adulto , Anciano , Análisis por Conglomerados , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Deformidades Adquiridas de la Mano/diagnóstico , Deformidades Adquiridas de la Mano/etiología , Deformidades Adquiridas de la Mano/fisiopatología , Humanos , Japón , Luxaciones Articulares/diagnóstico , Luxaciones Articulares/etiología , Luxaciones Articulares/fisiopatología , Masculino , Articulación Metacarpofalángica/patología , Articulación Metacarpofalángica/fisiopatología , Persona de Mediana Edad , Gravedad del Paciente , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Injury to the central nervous system can create upper extremity deformities and dysfunction, typically caused by a cerebrovascular accident, traumatic brain injury, anoxic brain injury, or spinal cord injury. Regardless of the etiology, disruption of inhibitory upper motor neuron (UMN) pathways can lead to a constellation of symptoms such as muscle weakness, decreased motor control, hyperexcitable tendon reflexes, muscle spasticity, and agonist-antagonist cocontraction that characterizes a condition known as UMN syndrome. The magnitude of neurorecovery varies among patients who have sustained brain injuries and can be classified as having a functional or nonfunctional upper extremity based on the presence or absence of volitional motor control at a specific joint, respectively. Many surgical procedures can be employed to optimize function, decrease pain, improve hygiene, and enhance cosmesis in patients with UMN syndrome.
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Enfermedad de la Neurona Motora/cirugía , Extremidad Superior/cirugía , Contractura/fisiopatología , Contractura/prevención & control , Electromiografía , Deformidades Adquiridas de la Mano/fisiopatología , Deformidades Adquiridas de la Mano/cirugía , Humanos , Enfermedad de la Neurona Motora/fisiopatología , Espasticidad Muscular/fisiopatología , Espasticidad Muscular/cirugía , Bloqueo Nervioso , Examen Neurológico , Procedimientos Ortopédicos , Extremidad Superior/fisiopatologíaRESUMEN
BACKGROUND: Limited Joint Mobility (LJM) is a dreaded complication of Diabetes Mellitus (DM). During the last half century, LJM has been studied in patients of different age because it has been considered useful for the monitoring of a patient's condition and for the prevention of vascular disease and diabetic foot. OBJECTIVES: The main aims of this review are to describe the relationship between DM and joint mobility as well as its prevalence and assessment. We have also investigated the role of LJM in the development of diabetic foot ulcers. METHODOLOGY: An in-depth literature search was conducted to identify studies that examined the prevalence and characteristics of LJM in patients with DM of different types, age, durations and chronic complications. RESULTS: Many factors (therapy improvements, population characteristics and different evaluation methods) concur to hinder an exact assessment of the prevalence of LJM. However, it has been confirmed that LJM is widespread among patients with DM and may affect more than two-thirds of them in addition to being a major risk factor for foot ulcer. Its role in the monitoring of a patient's condition is also important for the definition of risk thresholds such as in patients with diabetic foot. The efficacy of exercise therapy for the treatment of LJM, also in patients at risk of foot ulcer, has not been discussed. CONCLUSION: Difficulties encountered in the definition of the prevalence of LJM may hinder its study and the establishment of preventive interventions. However, LJM plays a key role in the monitoring of patients, especially those at risk for ulcer.
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Complicaciones de la Diabetes/epidemiología , Pie Diabético/epidemiología , Deformidades Adquiridas de la Mano/epidemiología , Articulaciones de la Mano/fisiopatología , Inestabilidad de la Articulación/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Complicaciones de la Diabetes/historia , Complicaciones de la Diabetes/fisiopatología , Complicaciones de la Diabetes/terapia , Pie Diabético/historia , Pie Diabético/fisiopatología , Pie Diabético/prevención & control , Femenino , Deformidades Adquiridas de la Mano/historia , Deformidades Adquiridas de la Mano/fisiopatología , Deformidades Adquiridas de la Mano/prevención & control , Estado de Salud , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Lactante , Inestabilidad de la Articulación/historia , Inestabilidad de la Articulación/fisiopatología , Inestabilidad de la Articulación/prevención & control , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Rango del Movimiento Articular , Factores de Riesgo , Adulto JovenRESUMEN
AIM: In China, hand surgeons treat fewer rheumatoid arthritis (RA) patients compared to other countries. We investigated whether physician and surgeon knowledge, attitudes and practices regarding RA hand deformities reflect current evidence and may contribute to the low utilization of surgery. METHOD: We surveyed hand surgeons and rheumatologists at three tertiary hospitals in Beijing, China. Questionnaires were developed from literature and expert review to assess their knowledge, attitudes and practice patterns related to rheumatoid hand surgery. RESULTS: Thirty-five hand surgeons and 59 rheumatologists completed the survey. Roughly one-third felt that the rheumatologists and hand surgeons agree on how to manage RA hand deformities. One-fifth of rheumatologists and 29% of hand surgeons believed that drug therapy can correct hand deformities, which contradicts current evidence. Likewise, 30% and 14%, respectively, recommended surgery for early-stage hand sequelae that do not meet current indications for surgery. Over 80% of surgeons and rheumatologists had no exposure to the other specialty during training and felt their training on the treatment of rheumatoid hand deformities was inadequate. CONCLUSION: Although we found similar interspeciality disagreement in China as is seen in the United States, there appears to be less interaction through training and consultations. Our results also indicate potential deficits in training and unawareness of evidence and indications for rheumatoid hand surgery. These findings help to explain why surgery for rheumatoid hand deformities is rare in China; doctors have fewer opportunities to collaborate across specialties and may not be able to select appropriate candidates for surgery.
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Artritis Reumatoide/cirugía , Actitud del Personal de Salud , Deformidades Adquiridas de la Mano/cirugía , Articulaciones de la Mano/cirugía , Conocimientos, Actitudes y Práctica en Salud , Procedimientos Ortopédicos , Cirujanos Ortopédicos/psicología , Reumatólogos/psicología , Adulto , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/fisiopatología , Beijing , Femenino , Deformidades Adquiridas de la Mano/diagnóstico , Deformidades Adquiridas de la Mano/fisiopatología , Articulaciones de la Mano/fisiopatología , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Pautas de la Práctica en MedicinaRESUMEN
INTRODUCTION: In hemiplegic patients with a spastic clenched fist deformity, one of the goals of surgery is to address the hygiene, nursing and appearance problems. Transfer of the flexor digitorum superficialis (FDS) to the flexor digitorum profundus (FDP), initially described by Braun and colleagues, opens the non-functional hand in these patients. The primary objective of our study was to confirm the effectiveness of this technique for correcting these deformities. The secondary objectives were to demonstrate potential functional gains and to identify potential complications. MATERIAL AND METHODS: A Braun procedure was performed in 26 patients (9 women, 17 men, ranging in age from 36 to 79 years). The overall appearance of the hand was graded using the Keenan classification system. Complications related to the surgery were documented. The hand's function was evaluated with the House score. RESULTS: The average follow-up was 47 months. Preoperatively, all patients had a class V hand: severe clenched-fist deformity with zero pulp-to-palm distance. Postoperatively, 10 patients had a type I hand (open hand, with less than 20° spontaneous extension deficit of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints) and 12 patients had a type II hand (20° to 40° spontaneous extension deficit of the MCP and PIP joints). The mean House score for all patients went from 0 to 0.88, and seven patients had functional improvements. Four patients had a forearm supination posture, 10 had intrinsic deformity with spontaneous MCP flexion and 6 had a swan-neck deformity. CONCLUSION: Superficialis-to-profundus tendon transfer (STP) provides satisfactory outcomes in terms of hand opening, with some patients also experiencing improved hand function. However, the complications cannot be ignored. LEVEL OF EVIDENCE: IV-retrospective or historical series.
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Deformidades Adquiridas de la Mano/fisiopatología , Deformidades Adquiridas de la Mano/cirugía , Espasticidad Muscular/cirugía , Transferencia Tendinosa/métodos , Adulto , Anciano , Lesiones Encefálicas/complicaciones , Femenino , Articulaciones de los Dedos/fisiopatología , Deformidades Adquiridas de la Mano/etiología , Hemiplejía/etiología , Humanos , Masculino , Articulación Metacarpofalángica/fisiopatología , Persona de Mediana Edad , Espasticidad Muscular/etiología , Rango del Movimiento Articular , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Transferencia Tendinosa/efectos adversos , Tendones/cirugía , Resultado del TratamientoRESUMEN
Velazquez showed to know the entity of thumb osteoarthritis by finely describing it in one of his paintings. The concepts of anatomical damage, loss of strenght, and functional impairment are transmitted to the observer.
Asunto(s)
Deformidades Adquiridas de la Mano/historia , Medicina en las Artes/historia , Osteoartritis/historia , Pulgar , Deformidades Adquiridas de la Mano/patología , Deformidades Adquiridas de la Mano/fisiopatología , Historia del Siglo XV , Historia del Siglo XVII , Historia del Siglo XVIII , Historia del Siglo XX , Humanos , Osteoartritis/patología , Osteoartritis/fisiopatología , Pinturas/historia , España , Pulgar/patología , Pulgar/fisiopatologíaRESUMEN
Descriptions of multiple extensor slips and accessory extensor tendons of the hand are extensively published in the contemporary literature. Despite their varied anatomy, accessory tendons seldom have a functional implication for the patient. We report a case detailing a previously undescribed accessory extensor tendon of the hand, which resulted unusually in an aberration in the mechanics of a single digit. This was explored and corrected surgically, resulting in an excellent outcome for the patient.
Asunto(s)
Deformidades Adquiridas de la Mano/fisiopatología , Articulación Metacarpofalángica/cirugía , Procedimientos Ortopédicos/métodos , Rango del Movimiento Articular/fisiología , Tendones/anomalías , Deformidades Adquiridas de la Mano/cirugía , Humanos , Masculino , Articulación Metacarpofalángica/fisiopatología , Persona de Mediana EdadRESUMEN
Background/Aim: Dupuytren's disease is a progressive disease of the palmar and digital fascial structures, with functional limitations. There are no clear recommendations about the optimal time of surgical repair, concerning the hand impairment. The aim of our study was to investigate the relation between finger's contracture degree and success of surgical treatment of the Dupuytren's disease. Methods: This prospective analysis included 60 patients operated on due to Dupuytren's contracture. According to preoperative contracture degree of proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joint, patients were divided into three groups: the group 1: < 15°, the group 2: 15−30° and the group 3: > 30°. All the patients underwent operation of partial palmar fasciectomy. Postoperative improvement was expressed with contracture reduction INDEX. Results: There were 60 patients with 85 fingers affected. The groups 1, 2 and 3 had 22 (37%), 37 (62%) and 26 (43%) fingers with MCP contracture and 32 (37.4%), 24 (28.2%) and 29 (34.1%) fingers with PIP contracture, respectively. Postoperative contractures of MCP joint in these groups were 0, 0.135° and 5°, and of PIP joint 0, 2.08 ° and 16.89°, respectively. After six months all MCP contractures resolved, while PIP joint contracture in the group 3 remained 13.62°. The reduction INDEX was 98.85%, 97.62% and 75.52% in the groups 1, 2 and 3, respectively. There was a statistically significant difference in the INDEX value between the groups (p = 0.0001). Conclusion: The degree of PIP joint contracture is related to the outcome of surgical treatment of Dupuytren's disease. Optimal results are achieved when contracture degree is between 15° and 30°. Surgical treatment of MCP joint contracture is successful regardless of the preoperative joint contracture degree.