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1.
Plast Reconstr Surg ; 145(3): 723-733, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097314

RESUMO

BACKGROUND: The wide-awake approach enables surgeons to perform optimal tensioning of a transferred tendon intraoperatively. The authors hypothesized that the extensor indicis proprius-to-extensor pollicis longus tendon transfer using the wide-awake approach would yield better results than conventional surgery. METHODS: A retrospective analysis was performed of the prospectively collected data of 29 consecutive patients who underwent extensor indicis proprius-to-extensor pollicis longus tendon transfer. Patients were treated with the wide-awake approach (group A, n = 11) and conventional surgery under general anesthesia (group B, n = 18). The groups were compared retrospectively for thumb interphalangeal and metacarpophalangeal joint motion, grip and pinch strength, specific extensor indicis proprius-to-extensor pollicis longus evaluation method (SEEM), and Disabilities of the Arm, Shoulder and Hand questionnaire score at 6 weeks and 2, 4, 6, and 12 months postoperatively. RESULTS: Group A showed significantly better interphalangeal joint flexion and total arc of motion at 6 weeks and 2, 4, and 6 months, and significantly better metacarpophalangeal joint flexion and total arc of motion at all time points. Interphalangeal and metacarpophalangeal joint extension showed no difference at all time points. Group A showed significantly better specific extensor indicis proprius-to-extensor pollicis longus evaluation method scores at 2 and 4 months, and Disabilities of the Arm, Shoulder and Hand questionnaire scores at 4, 6, and 12 months. Grip and pinch strength showed no difference at all time points. The complication rate and duration until return to work were not different between groups. CONCLUSION: Compared with the conventional approach, the wide-awake approach showed significantly better results in the thumb's range of motion and functional outcomes, especially in the early postoperative periods. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Traumatismos dos Dedos/cirurgia , Cuidados Intraoperatórios/métodos , Ruptura/cirurgia , Traumatismos dos Tendões/cirurgia , Transferência Tendinosa/métodos , Vigília , Adulto , Idoso , Anestesia Geral , Anestesia Local , Doença Crônica/terapia , Feminino , Articulações dos Dedos/cirurgia , Seguimentos , Humanos , Masculino , Articulação Metacarpofalângica/cirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento Articular , Estudos Retrospectivos , Transferência Tendinosa/efeitos adversos , Polegar , Resultado do Tratamento
2.
Plast Reconstr Surg ; 145(3): 617e-628e, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097332

RESUMO

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.


Assuntos
Articulações dos Dedos/cirurgia , Deformidades Adquiridas da Mão/cirurgia , Cuidados Pós-Operatórios/tendências , Procedimentos Cirúrgicos Reconstrutivos/tendências , Traumatismos dos Tendões/cirurgia , Articulações dos Dedos/fisiopatologia , Deformidades Adquiridas da Mão/etiologia , Deformidades Adquiridas da Mão/fisiopatologia , Deformidades Adquiridas da Mão/reabilitação , Humanos , Cuidados Pós-Operatórios/instrumentação , Cuidados Pós-Operatórios/métodos , Amplitude de Movimento Articular , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Traumatismos dos Tendões/complicações , Traumatismos dos Tendões/fisiopatologia , Traumatismos dos Tendões/reabilitação , Fatores de Tempo , Resultado do Tratamento
3.
Plast Reconstr Surg ; 145(2): 445-455, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985638

RESUMO

BACKGROUND: Posttraumatic proximal interphalangeal (PIP) joint contractures of the digits are common and are associated with impaired hand function. However, relapse is common after surgical release of PIP joint contractures. This article presents a novel treatment strategy with a PIP joint adipofascial flap to resurface the joint after release, and compares patients with similar joint contracture release who did and did not undergo resurfacing with a PIP joint adipofascial flap. METHODS: From January of 2010 to January of 2018, 10 patients received single-digit PIP joint flexion contracture release and PIP joint adipofascial flap resurfacing; 20 patients received a stepwise release as a control group. Thirty joints were compared, and the degree of extension lag improvement over time was measured during an average follow-up period of 292.4 days. RESULTS: Greater extension lag improvement was observed in the PIP joint adipofascial flap group compared with the control group (37.0 ± 19.2 degrees versus 21.0 ± 19.5 degrees; p =0.055). The ratio of improvement was also significantly higher in the flap group (0.79 ± 0.26 versus 0.49 ± 0.46; p =0.049). Flap resurfacing appeared to have a beneficial effect on improvements in extension lag (p =0.042), whereas a higher number of secondary operations, associated fractures, and maximum visual analogue scale score 1 week postoperatively were negatively associated with extension lag in univariate analysis (p < 0.05). Generalized estimating modeling showed that flap resurfacing had a significantly positive effect on extensor lag improvement with time (ß = 2.235; p =0.04). CONCLUSIONS: PIP joint adipofascial flap resurfacing following PIP joint contracture release may improve and maintain extensor lag. Recovery of joint motion may also be quicker compared with conventional release alone. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Contratura/cirurgia , Articulações dos Dedos/cirurgia , Tecido Adiposo/transplante , Adolescente , Adulto , Idoso , Criança , Contratura/reabilitação , Terapia por Exercício/métodos , Feminino , Articulações dos Dedos/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
Arch Orthop Trauma Surg ; 140(1): 139-144, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31691006

RESUMO

INTRODUCTION: Finger proximal interphalangeal joint (PIP) reconstruction after the destruction of parts of the joint remains challenging. Surgical techniques include implant arthroplasty, arthrodesis, free vascularized joint transfer, and non-vascularized bone and joint transfer. This study analyzes our experience after non-vascularized transfer in terms of range of motion, postoperative rehabilitation, and patient satisfaction. MATERIALS AND METHODS: Between 2009 and 2014, ten patients underwent non-vascularized partial joint transfer for PIP joint reconstruction. One of them was lost to follow-up. Included patients had osteochondral partial joint transplants of 25-50% of the toes (n = 4) and the hand (n = 5). Range of motion (ROM), grip-, and pinch-strength were measured at the last follow-up control and compared to the healthy side. Patients were asked to score the pain at rest/ on load on a visual scale (VAS: 0 = no pain; 10 = excruciating pain). Satisfaction self-assessment was evaluated by asking the patients to grade their postoperative result as excellent, very good, good or poor. RESULTS: Mean follow-up period was 4.0 years (range 1.2-7.9 years). Mean PIP joint flexion was 93 ± 26° at the last follow-up control. Mean grip- and pinch-strength of the operated side at the last control were, respectively, 43 ± 18 kg and 8 ± 5 kg, close to the healthy side values (45 ± 15 kg and 9 ± 4 kg). Mean pain at rest/on load measured on a visual scale was, respectively, 0.3 ± 1 and 1.8 ± 2. Eight patients (89%) rated their operation as excellent, and one as poor. CONCLUSION: In this study, non-vascularized partial joint transfer provides a mobile and stable PIP joint 4 years after reconstruction. The surgical technique presented herein is complex depending on additional injuries but results in great patient satisfaction.


Assuntos
Articulações dos Dedos/cirurgia , Articulações/transplante , Traumatismos dos Dedos/cirurgia , Humanos , Satisfação do Paciente , Força de Pinça , Amplitude de Movimento Articular , Articulação do Dedo do Pé/cirurgia
5.
Arch Orthop Trauma Surg ; 140(1): 43-50, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31486856

RESUMO

INTRODUCTION: Several methods treating proximal interphalangeal joint (PIP) fracture dislocations have been established providing early joint mobilization. The aim of this study was to evaluate the clinical and radiological outcome of unstable fracture dislocations of the PIP treated with a parabolic dynamic external fixator consisting of two Kirschner (K)-wires. MATERIALS AND METHODS: Twenty-one patients who sustained a pilonoidal fracture of the PIP joint and were treated with a dynamic external fixator were evaluated retrospectively. The active range of motion, pain level, DASH score, Buck Gramcko Score, and the patient's satisfaction and acceptance were assessed. X-ray images were evaluated for bone healing, joint alignment, and signs of osteoarthritis. RESULTS: Mean PIP joint range of motion was 76°. Patients showed very mild discomfort (mean 0.7), high patient satisfaction (mean 1.9), and a moderate acceptance (mean 2.7). The mean DASH score was 11.6 and the Buck Gramcko score 13. All patients showed bone healing. One patient suffered from a recurrent dislocation, and another a subluxation of the PIP joint while wearing the fixator. Both joints could be corrected by modifying the fixator under image intensifier. Twenty patients (95%) showed a concentric and stable aligned joint. Three patients showed an osteoarthritis stage 0, five stage 1, nine stage 2, three stage 3, and one stage 4 according to the Kellgran-Lawrence Score. CONCLUSION: The use of a parabolic dynamic external fixator constructed from two K-wires restores joint alignment and stability in unstable pilonoidal PIP joint disclocation fractures. It allows immediate PIP joint mobilization to avoid adhesions. Modifications of the radius of the parabolic construct within cases of postoperative malalignment, without anesthesia, can restore joint axis and malalignment. This fixator is a cost-effective alternative, showing a good clinical outcome.


Assuntos
Traumatismos dos Dedos , Articulações dos Dedos , Fratura-Luxação , Fixação de Fratura , Fios Ortopédicos , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/cirurgia , Fratura-Luxação/diagnóstico por imagem , Fratura-Luxação/cirurgia , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Humanos , Estudos Retrospectivos
6.
Acta Chir Orthop Traumatol Cech ; 86(5): 358-361, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748112

RESUMO

PURPOSE OF THE STUDY Arthrodesis of interphalangeal joints of the hand is a method used to treat conditions associated with joint destruction, instability and pain. Our study aims to evaluate the outcomes of the treatment of sequelae of septic arthritis of interphalangeal joints by arthrodesis with external fixation. This topic is hardly covered in literature. Moreover, it compares the outcomes of application of this method in diabetic patients and non-diabetic population. MATERIAL AND METHODS Arthrodesis by means of Stellbrink external fixator was performed in 17 patients who had suffered septic arthritis of interphalangeal joints of the hand. The following parameters were followed in patients in our group: age, sex, etiology of disease, smoking, diabetes, affected fingers and joints of the hand, side, microbial culture finding, wound healing, postoperative ATB therapy and its duration, radiographic signs of the union of arthrodesis and potential complications. RESULTS The group included 8 men and 9 women. The mean age was 66.2 years. 5 patients in the group were diabetic. In 16 patients the wound healed per primam, in 1 case per secundam. The average duration of postoperative ATB therapy was 4.3 weeks. The X-ray showed the union of fused articular surfaces at 6.9 weeks on average. Complications occurred in 3 patients, namely 1 case of secondary wound healing, 1 case of nail bed damage and 1 case of flexor tenosynovitis of the operated finger. The arthrodesis was successfully healed in all the patients and a no difference was detected between diabetic and nondiabetic patients. DISCUSSION When arthrodesis of interphalangeal joints of the hand is performed using an external fixator, the metal material is introduced outside the area of inflammation, or the field potentially at risk of infection, therefore this method is predetermined for surgeries in the terrain changed by inflammation or potentially at risk of inflammation. Compared to the other methods such as arthrodesis by inserting K-wires intramedullary, there is no risk of migration of the metal material and the associated soft tissue irritation. CONCLUSIONS Our study confirms the safety and efficiency of arthrodesis of interphalangeal joints of the hand by means of an external fixator in treating the sequelae of septic arthritis. The union of arthrodesis with no complications was observed even in all the diabetic patients. Ranking among the main advantages of this method are the easy care for the surgical wound, achievement of easy and firm fixation with the possibility to apply an external fixator outside the area of the original infection. Key words:arthrodesis, external fixator, septic arthritis, interphalangeal joint.


Assuntos
Artrite Infecciosa/cirurgia , Artrodese/instrumentação , Articulações dos Dedos/cirurgia , Idoso , Artrite Infecciosa/complicações , Artrodese/métodos , Fios Ortopédicos , Complicações do Diabetes/complicações , Fixadores Externos , Feminino , Humanos , Masculino , Resultado do Tratamento
7.
Tech Hand Up Extrem Surg ; 23(4): 176-181, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31738739

RESUMO

Digital external fixation is often used for the management of complex injuries involving the proximal interphalangeal joint, including pilon fractures of the middle phalanx base and unstable fracture-dislocations. Several dynamic "homemade" constructs have been described which utilize only K-wires and rubber bands and allow early range of motion within the construct. Although these constructs are inexpensive and their application is fairly straightforward, their designs pose a few potential problems when the construct is stressed during rehabilitation efforts. These designs utilize a blocking K-wire which relies on pin-to-pin contact to maintain reduction and creates unnecessary friction that can impede motion and result in pin loosening in bone. Furthermore, rubber band rupture can occur and destabilizes the construct. Here we present a novel technique which utilizes only K-wires and K-wire caps, provides adequate joint distraction and stabilization throughout the arc of motion, and avoids the aforementioned pitfalls of existing designs.


Assuntos
Fixadores Externos , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/cirurgia , Adulto , Fios Ortopédicos , Traumatismos dos Dedos/diagnóstico por imagem , Articulações dos Dedos/diagnóstico por imagem , Fluoroscopia , Humanos , Masculino
8.
J Hand Surg Asian Pac Vol ; 24(3): 270-275, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31438789

RESUMO

Background: Long-standing trigger finger can lead to proximal interphalangeal (PIP) joint flexion contracture. In the present study, we present the clinical outcome of percutaneous release with finger splinting for trigger finger with PIP joint flexion contracture prospectively. Methods: We compared outcomes in patients with trigger fingers combined with proximal interphalangeal joint flexion contracture treated by percutaneous release therapy regimen alone (group I) or percutaneous trigger finger release combined with finger splint (group II) during January 2011 and May 2016 with 6 months follow up. Results: Sixty-five patients were randomly allocated to group I (35 patients) or group II (30 patients). Symptoms of locking sensation and pain over the A1 pulley were improved in all patients. The patients in group II showed significantly greater improvements in the flexion contracture angles of proximal interphalangeal joint at post-operative 3 months later (group I, 9.4° ± 4.1°; group II, 27.8° ± 4.6°) and at 6 months later (group I, 15.1° ± 5.2°; group II, 35.7° ± 5.3°) relative to group I. In group II, 25 fingers achieved near full extension (< 10° contracture) after 6 months. Conclusions: Percutaneous release combined with finger splint is regarded as a useful therapy to speed recovery of trigger finger with proximal interphalangeal joint flexion contracture.


Assuntos
Contratura/terapia , Articulações dos Dedos/cirurgia , Contenções , Dedo em Gatilho/terapia , Contratura/fisiopatologia , Feminino , Articulações dos Dedos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Exercícios de Alongamento Muscular , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Dedo em Gatilho/fisiopatologia
9.
J Hand Surg Asian Pac Vol ; 24(3): 342-346, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31438800

RESUMO

Background: Multi-fragmental intra-articular middle phalanx base fractures mostly occur in young adults during sports or work-related activities. If left untreated properly proximal interphalangeal joint (PIPJ) instability and pain persists, thus impairing the hand's function and the patient's quality of life. Joint surface reconstruction with hamate osteochondral graft can be used for multi-fragmental middle phalanx base reconstruction. Methods: A retrospective study was conducted. The technique was used for 17 patients. Follow-up was performed at least 6 months after the surgery. Patients were asked to fulfil multiple surveys: Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE) and Modern Activity Subjective Survey 2007 (MASS07). Objective measurements included strength of the power and pinch grip, range of motions (ROM) in both proximal interphalangeal and distal interphalangeal (DIPJ) joints. All measurements were taken on both hands, on operated and contralateral fingers. Results: Out of 17 patients 5 were females and 12 males, mean age 40 (ranged 22-65 years) Eleven patients agreed to participate in the follow-up. All patients were right-handed, 8 patients had injured their right hand. The injuries' aetiologies were sports (n = 3), fighting (n = 2) and work-related (n = 4). Six patients were treated with immobilisation before the surgery, which was performed on average 45 days after the injury (ranged 1-184 days). Two patients developed arthrosis post-operatively and received synthetic joints. Mean DASH score was 6.9, PRWE score was 5.2 and mean MASS07 score was 6.8. Patients achieved on average 90% of power grip and 100% of pinch grip with their injured hand compared to their healthy hand. Average ROM in PIPJ was 82.2° and in DIPJ 68.9°. No patients experienced joint instability or chronic pain. Conclusions: Hemi-hamate arthroplasty provides satisfactory results in patients with both acute and chronic dislocated intra-articular middle phalanx base fractures.


Assuntos
Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/cirurgia , Hemiartroplastia , Fraturas Intra-Articulares/cirurgia , Luxações Articulares/cirurgia , Adulto , Idoso , Feminino , Hamato/transplante , Força da Mão , Humanos , Luxações Articulares/etiologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Hand Surg Rehabil ; 38(5): 307-311, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31382028

RESUMO

Arthrodesis of the proximal interphalangeal joint is a proven technique for treating of a range of pathological conditions, including osteoarthritis. There are multiple surgical procedures. A biomechanical study was conducted to compare the stability of a compression wire to intraosseous wiring for the arthrodesis. Seventeen formalin-fixed human fingers were randomly assigned into two groups and the bone mineral density was determined. Arthrodesis in 20° flexion was performed using an oblique compression wire (n=8) or intraosseous wiring (n=9). The stability of the arthrodesis was tested by applying a tensile bending force until failure. The mean force needed to fail the compression wire arthrodesis and intraosseous wire arthrodesis was not significantly different (76.2N, SD 31N and 63.0N, SD 28N). There was no correlation between bone density and force to failure. The compression wire was within the approximate range achieved by intraosseous wiring in withstanding substantial force before failure. From a biomechanical point of view, a compression wire is feasible for PIP arthrodesis.


Assuntos
Artrodese/instrumentação , Artrodese/métodos , Fios Ortopédicos , Articulações dos Dedos/cirurgia , Humanos , Distribuição Aleatória , Estresse Mecânico , Resistência à Tração
11.
Orthop Clin North Am ; 50(4): 489-496, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466664

RESUMO

The distal interphalangeal (DIP) joints are subjected to the highest joint forces in the hand, and at least 60% of individuals older than age 60 years have DIP joint arthritis. Debridement of degenerative distal interphalangeal joints with mild to moderate disease can provide satisfactory outcomes; however, those joints with more severe angular and rotation changes are reliably treated with fusions. Regardless of the fixation method, DIP fusions have high success rates, are well tolerated, and are extremely durable.


Assuntos
Articulações dos Dedos/cirurgia , Osteoartrite/cirurgia , Polegar/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artrodese , Humanos , Pessoa de Meia-Idade , Osteoartrite/epidemiologia , Resultado do Tratamento , Adulto Jovem
12.
Acta Orthop Belg ; 85(2): 240-246, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31315016

RESUMO

Bony mallet finger injuries comprise 30% of all mallet injuries. Operative treatment of bony mallet fingers injuries still remains controversial. The aim of this study was to describe the k-wire extension blocking technique and the functional results using the PRWHE questionnaire. A single center retrospective observational cohort of 36 patients was defined between January 2010 and December 2015. Inclusion criteria for this study were acute fractures with 1) persistent displacement of more than 3 mm in extension splint, 2) palmar subluxation of the distal phalanx or 3) fracture fragments consisting of more than one third of the joint surface. According to the PRWHE questionnaire, excellent results were observed with a mean follow up period of 32 months of all patients. Two patients developed a clinically relevant superficial wound infection and one patient developed a nail deformity. In conclusion, the k-wire extension blocking technique is safe and results in excellent mid-term functional outcome.


Assuntos
Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/cirurgia , Fraturas Ósseas/cirurgia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica/fisiologia , Adolescente , Adulto , Fios Ortopédicos , Criança , Feminino , Fixação Interna de Fraturas , Consolidação da Fratura/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
BMC Musculoskelet Disord ; 20(1): 323, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288790

RESUMO

BACKGROUND: Recurrent severe Dupuytren contracture of the small finger's proximal interphalangeal (PIP) joint is a difficult problem. Further surgery carries high risk of complications and poor outcome. Patients are often offered finger amputation. We have devised a novel surgical procedure consisting of middle phalanx monoblock resection and ligament reconstruction to create a new functioning interphalangeal joint. METHODS: Two patients requesting small-finger amputation because of severe PIP joint contracture after multiple treatments for Dupuytren contracture were offered and accepted this new procedure. Through a dorsal incision the extensor tendon is incised longitudinally exposing the middle phalanx and interphalangeal joints. The collateral ligaments of both interphalangeal joints are detached from the middle phalanx. The middle phalanx is dissected from soft tissues (including the flexor digitorum superficialis tendon) and removed. The distal phalanx is brought proximally and the ends of the collateral ligaments are sutured with non-absorbable sutures with the joint held in full extension and congruency. The two patients were evaluated at 18 months and 15 months after surgery, respectively. RESULTS: Both patients regained good finger posture with almost full extension and had normal sensation and no pain. Active flexion in the new interphalangeal joint was 60 degrees and 35 degrees, respectively. Both patients had full metacarpophalangeal joint flexion and extension, normal 2-point discrimination in the small finger and higher grip strength in the treated than the contralateral hand. Radiographs showed a congruent new interphalangeal joint. Both patients were very satisfied with the outcome. CONCLUSIONS: In patients with Dupuytren disease and severe PIP joint contracture after multiple treatments, this novel procedure consisting of middle-phalanx excision and ligament reconstruction creating a new functioning interphalangeal joint has good short-term outcomes and is a favorable alternative to finger amputation. Longer follow-up will show whether these results are durable.


Assuntos
Contratura de Dupuytren/cirurgia , Tratamentos com Preservação do Órgão/métodos , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Idoso , Ligamentos Colaterais/cirurgia , Contratura de Dupuytren/diagnóstico , Articulações dos Dedos/cirurgia , Falanges dos Dedos da Mão/cirurgia , Dedos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Recidiva , Índice de Gravidade de Doença , Resultado do Tratamento
14.
J Orthop Surg Res ; 14(1): 212, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299978

RESUMO

BACKGROUND: The aims of this study were to propose a novel implant design for the proximal interphalangeal joint (PIPJ) of the hand using a rolling contact joint (RCJ) mechanism and to derive an optimal implant design based on human PIPJ kinematics. METHODS: In total, 10 participants with normal PIPJs were enrolled in this study. True lateral finger radiographs were obtained in 10° increments from 0º (full extension) to 120° flexion of PIPJ. Radiographs were used to determine the average center of rotation, which formed the basis of a mathematical expression of the PIPJ kinematics. The variations in extensor tendon excursions in relation to the range of motion of PIPJ were determined using results from previous cadaveric studies. As the next step, a PIPJ implant design using an RCJ mechanism that was most consistent with the mathematically expressed PIPJ kinematics and tendon excursions was determined using a constrained optimization algorithm. RESULTS: The final proposed PIPJ implant had a relatively constant center of rotation over the entire PIPJ range of motion among the participants. In addition, the extensor tendon excursions of the proposed implant as applied to the phalangeal bones were similar to those of the human tendon. The proposed PIPJ implant achieved an acceptable position of the RCJ surface on the proximal and middle phalanges, which was derived from the constrained optimization algorithm. CONCLUSIONS: A novel PIPJ implant design using an RCJ mechanism demonstrated acceptable outcomes in terms of PIPJ human kinematics and tendon excursions.


Assuntos
Articulações dos Dedos/cirurgia , Prótese Articular/tendências , Desenho de Prótese/métodos , Desenho de Prótese/tendências , Fraturas do Rádio/cirurgia , Adulto , Feminino , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Adulto Jovem
15.
J Am Acad Orthop Surg ; 27(12): 444-450, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31170098

RESUMO

INTRODUCTION: This investigation compares the outcomes of proximal interphalangeal (PIP) arthroplasty in patients older than and younger than 60 years. METHODS: Overall, 299 consecutive, primary PIP arthroplasties were performed over a 14-year period, including 126 arthroplasties performed in patients younger than 60 years. In younger patients group, a higher rate of posttraumatic and inflammatory arthritis was observed. RESULTS: In patients younger than 60 years, 32 (25%) revision surgeries occurred. Risk of revision surgery was associated with younger age. The 10-year implant survival rate was 72% for the patients younger than 60 years versus 86% for those older than 60 years. Silicone implants decreased the risk of revision surgery, although it was increased in posttraumatic arthritis. The most common complication in young patients was dislocation (n = 21). At a mean follow-up of 6.4 years, pain levels had significantly improved in patients younger than 60 years, and PIP range of motion and pinch strength were maintained. However, older patients had improved PIP motion compared with younger patients. CONCLUSIONS: Younger age leads higher revision rates after PIP arthroplasty, particularly in the posttraumatic setting. LEVEL OF EVIDENCE: Therapeutic, level III.


Assuntos
Artroplastia de Substituição de Dedo , Articulações dos Dedos/cirurgia , Falanges dos Dedos da Mão/cirurgia , Adulto , Fatores Etários , Artrite/epidemiologia , Artrite/etiologia , Feminino , Traumatismos dos Dedos/complicações , Traumatismos dos Dedos/cirurgia , Humanos , Prótese Articular , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Amplitude de Movimento Articular , Reoperação/estatística & dados numéricos , Risco , Fatores de Tempo , Resultado do Tratamento
16.
Anticancer Res ; 39(6): 2951-2955, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177134

RESUMO

Primary synovial chondromatosis is a benign condition and consists of cartilaginous metaplasia of the synovium, which leads to the production of intra-articular and periarticular osteocartilaginous bodies. The entity usually involves the synovium of large joints (knee, hip, elbow, and shoulder). It has also been reported in the hand, especially involving interphalangeal or metacarpal joints of digits. The most common symptoms are pain, swelling, loss of range of motion and muscle atrophy. Because of its low prevalence and non-specific symptoms, synovial chondromatosis can present a diagnostic challenge for the hand surgeon and may lead to a delay in treatment. To date, only three cases involving distal interphalangeal joint have been reported. This article describes a rare case of primary articular synovial chondromatosis in the distal interphalangeal joint of a 65-year-old female, giving a deep insight into this pathology, and reviews the literature.


Assuntos
Condromatose Sinovial/diagnóstico , Condromatose Sinovial/cirurgia , Articulações dos Dedos/cirurgia , Idoso , Condromatose Sinovial/patologia , Feminino , Articulações dos Dedos/patologia , Humanos , Doenças Raras
17.
Clin Orthop Surg ; 11(2): 220-225, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31156775

RESUMO

Background: Fracture-dislocation of the proximal interphalangeal (PIP) joint of the finger is challenging due to the high risk of stiffness. The purpose of this study is to evaluate the clinical and radiological results of a modified transosseous wiring technique for the management of chronic fracture-dislocations of the PIP joint. Methods: Ten patients (nine men and one woman; mean age, 38.3 years; range, 21 to 69 years) with neglected fracture-dislocation of the PIP joint were included. The mean duration from injury to operation was 14.7 weeks (range, 3 to 66 weeks). The dorsolateral approach and extension block pinning were used to reduce dislocation. After thorough debridement of the scar tissues in the dorsal dead space and the fracture site, the reduction was maintained with transosseous wiring. Radiologic evaluations of bone union and arthritic changes and clinical evaluations (range of motion of the PIP joint and Disabilities of the Arm, Shoulder and Hand [DASH] score) were performed. The mean follow-up period was 12.9 months (range, 12 to 19 months). Results: All patients demonstrated evidence of radiographic healing within a mean healing time of 6 weeks (range, 4 to 10 weeks); however, one had a widened gap and one had an early arthritic change. The mean range of motion in the PIP joint was 81° (range, 50° to 105°). The mean DASH score was 21.6 (range, 7.5 to 35.8). Conclusions: For chronic fracture-dislocation of the PIP joint, transosseous wiring with direct curettage and optimal bone purchase can provide satisfying outcome.


Assuntos
Fios Ortopédicos , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/cirurgia , Fratura-Luxação/cirurgia , Fixação Intramedular de Fraturas/métodos , Adulto , Idoso , Desbridamento , Avaliação da Deficiência , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Articulações dos Dedos/diagnóstico por imagem , Fratura-Luxação/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Tempo para o Tratamento
18.
J Hand Surg Asian Pac Vol ; 24(2): 195-201, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31035871

RESUMO

Background: Chronic, post-traumatic, avulsion of the proximal interphalangeal (PIP) joint volar plate represents a disabling lesion. The purpose of this report is to describe a flexor digitorum superficialis (FDS) tenodesis using a mini-bone anchor inserted into the proximal phalanx, and its clinical outcome. Methods: 15 patients with chronic post-traumatic hyperextension instability of the PIP joint were treated surgically. From the first post-operative day patients were invited to start an early gradual joint active motion, wearing an extension block splint. Forty days after surgery, clinical evaluations were carried out, including: joint stability, pain and range of motion (ROM). The use of a circumferential splint was recommended for two further months, avoiding strenuous manual activities. The range of motion, time lost at work and the functional results were recorded six months after surgery. Results: At last follow up, 7 of the 13 reviewed patients presented an excellent functional recovery, with complete resolution of pain and stability with attainment of ROM comparable to the contralateral finger. The others 6 patients obtained good results, with remission of the functional impairment and pain, with either residual hyperextension or flexion contracture. There was one case of recurrence consecutively to a premature traumatic work-related activity. Conclusions: The FDS tenodesis via a bone anchor, combined with early active PIP joint protected motion, was shown in this study to be effective and reliable.


Assuntos
Articulações dos Dedos/cirurgia , Placa Palmar/cirurgia , Âncoras de Sutura , Tenodese/instrumentação , Adulto , Idoso , Feminino , Falanges dos Dedos da Mão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Placa Palmar/lesões , Modalidades de Fisioterapia , Cuidados Pós-Operatórios , Amplitude de Movimento Articular , Tenodese/métodos , Adulto Jovem
19.
Arch Orthop Trauma Surg ; 139(7): 1025-1031, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31093754

RESUMO

Osteitis of the fingers is a serious infection that needs early diagnosis and appropriate surgical debridement and antibiotic treatment of the infected bone. If the effects of treatments are insufficient, long-term antibiotic treatment and repeated operations could be required. In worst cases, some patients may have to undergo amputation. Recently, the usefulness of the Masquelet technique in extensive traumatic bone defects has been reported. We herein describe two cases of immunocompromised patients with purulent osteitis involving joint destruction of the finger treated by two-stage arthrodesis using the Masquelet technique. They obtained good infection control and better function of the finger than before the operation. Moreover, there was no recurrence of the infection. The Masquelet technique could be an alternative technique for osteitis with high risk of amputation.


Assuntos
Antibacterianos/administração & dosagem , Artrodese , Desbridamento/métodos , Articulações dos Dedos , Falanges dos Dedos da Mão , Osteomielite , Idoso , Artrodese/instrumentação , Artrodese/métodos , Feminino , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/cirurgia , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/cirurgia , Humanos , Hospedeiro Imunocomprometido , Imagem por Ressonância Magnética/métodos , Masculino , Osteomielite/diagnóstico , Osteomielite/etiologia , Osteomielite/fisiopatologia , Osteomielite/cirurgia , Recuperação de Função Fisiológica , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
20.
Clin Plast Surg ; 46(3): 339-345, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31103078

RESUMO

"Stiff finger," defined as a finger with decreased range of motion in one or more joints, is commonly found after hand injury and is classified into flexion or extension deformities. Pathogenesis is due to dysfunction in one or more of the following anatomic components: (1) osseous and articular; (2) capsuloligamentous; (3) musculotendinous units; (4) soft tissue and fascia. Evaluation and treatment are based on accurate identification and correction of pathologic structures. The mainstay of treatment is directed hand therapy with exercises and splinting to mobilize stiff joints. Operative interventions are offered after gains from therapy have been exhausted.


Assuntos
Traumatismos dos Dedos/terapia , Articulações dos Dedos/fisiopatologia , Dedos/cirurgia , Articulação Metacarpofalângica/fisiopatologia , Procedimentos Ortopédicos/métodos , Contenções , Algoritmos , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/anatomia & histologia , Articulações dos Dedos/cirurgia , Humanos , Articulação Metacarpofalângica/anatomia & histologia , Articulação Metacarpofalângica/cirurgia , Amplitude de Movimento Articular
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