Osseointegrated Finger Prostheses Using a Tripod Titanium Mini-Plate.

BACKGROUND: Digital amputation is a common upper extremity injury and can cause significant impairment in hand function, as well as psychosocial stigma. Currently, the gold standard for the reconstruction of such injuries involves autologous reconstruction. However, when this or other autologous options are not available, prosthetic reconstruction can provide a functionally and aesthetically viable alternative. This study describes a novel technique, known as a tripod titanium mini-plate, for osseointegrated digit prostheses, and reviews the outcomes in a set of consecutive patients. METHODS: A retrospective review of patients who underwent 2-stage prosthetic reconstruction of digit amputations was performed. Demographic information, occupation, mechanism of injury, number of amputated fingers, and level of amputation were reviewed. Functional and aesthetic outcomes were assessed using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale and a visual analog scale (VAS) score, respectively. In addition, complications during the postoperative period were recorded. RESULTS: Seven patients were included in this study. Their average age was 29 years. Five patients had single-digit amputations and 2 patients had multiple-digit amputations. Functional and aesthetic outcomes were assessed using the Q-DASH score (average, 10.4) and VAS score (average, 9.1), respectively. One episode of mild cellulitis was seen at 24 months of follow-up. However, it was treated successfully with oral antibiotics. No other complications were reported. CONCLUSIONS: When autologous reconstruction is not suitable for digit reconstruction, prosthetic osseointegrated reconstruction can provide good aesthetic and functional results. However, larger series with longer-term follow-up are required in order to rule out the possibility of other complications.

Sonographic assessment of suture artifact obscuring visualization of the digital nerve.

INTRODUCTION: The purpose of this study was to grade the severity of sonographic artifact produced by four suture materials and to determine whether these artifacts affect visualization of a digital nerve. METHODS: A needle was placed into a pig foot to mimic a normal volar digital nerve. Incisions superficial to the needle were closed with different suture types, specifically nylon (N), chromic (C), vicryl (V), and prolene (P). Sonographic images were obtained using a high-frequency transducer. Twenty radiology residents and attending physicians graded the severity of artifact and nerve obscuration. Two image types were shown: one suture type per image and a composite image of each suture type, adjacent to one another. RESULTS: Severity of nerve obscuration was as follows: composite image: P = N = V > C; individual images: P > N > V > C. Severity of artifact was: composite image: V = N > P > C; individual image: P > N > V > C. CONCLUSION: Although all sutures produced artifact, only C produced mild artifact, which did not significantly obscure visualization of the nerve model.

Sonographic assessment of volar digital nerve injury in the context of penetrating trauma.

OBJECTIVE: The purpose of this article was to report our experience using ultrasound to assess digital nerve integrity after penetrating hand trauma with sensory deficit. Ultrasound was performed in the long axis on 22 digital nerves in 11 patients using a 12-14-MHz linear array hockey stick transducer. CONCLUSION: Of 22 volar digital nerves evaluated by sonography, six were transected. All imaging findings were confirmed surgically. High-frequency ultrasound permits accurate imaging of intact and transected volar digital nerves.