Small joint arthrodesis in hand reconstruction.
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Arthritis, Rheumatoid↗
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"Pepper-pot" arthrodesis of the small joints of the hand: our experience in 68 cases.
Sixty-eight small joint arthrodeses were performed in the hand using a new technique. Following removal of the articular cartilage, multiple drill holes are made through the subchondral bone, connecting the medullary canal with the joint space. The final joint position is maintained with an intraosseous wire loop and a Kirschner wire. Union was achieved at a mean of 7 weeks and our results are comparable with those of other series. This technique is easy to perform but is contraindicated if there is extreme joint destruction. Its main advantages are that the position of the fusion can be adjusted as bone-to-bone congruency is maintained through an arc of flexion and the overall length and shape of the digit is preserved.
Adolescent↗
Synoviorthesis with erbium-169: a double-blind controlled comparison of erbium-169 with corticosteroid.
Intra-articular injections of erbium--169 citrate and methylprednisolone acetate in hand joints were compared in a randomly selected double-blind trial. The patients included 21 with rheumatoid arthritis and 3 with psoriatic arthritis, and the design was an intrapatient comparison. No difference between joints treated with the radioisotope or steroid was observed in the year following injection.
Arthritis↗
Musculo-tendinous and joint elastic characteristics during elbow flexion in children.
OBJECTIVE: The aim of the present research was to determine joint stiffness and musculo-tendinous stiffness in children. BACKGROUND: No reliable data was available on differences in such parameters when comparing children and adults. METHODS: Sinusoidal perturbations and quick-released movements were applied to the right elbow during flexion to determine joint stiffness and musculo-tendinous stiffness, respectively. For normalization purposes, stiffness indexes were calculated as the slope of the relationship between stiffness and torque. RESULTS: Main results were that musculo-tendinous stiffness indexes obtained in children were similar to adult data deduced from the literature. On the other hand, joint stiffness indexes obtained in children were in the range 0.9-3.8 rad(-1) and were lower than those reported in the literature for adults (between 4 and 8.5 rad(-1)). CONCLUSION: Since normalized musculo-tendinous stiffness is similar in children and in adults, it can be hypothesized that, during growth, increase in ability to produce force parallels elastic tissue development. RELEVANCE: Stiffness parameters could be used, in the context of other functional tests, to characterize changes in muscle properties in neuromuscular disorders when elastic tissues are supposed to be altered.
Adolescent↗
Arthrodesis of small joint of the hand: a rapid and effective technique.
Seventy-six patients underwent 103 arthrodeses of digital joints of the hand to treat deformity, pain, or instability. Each fusion was done by means of a surgical technique that allowed for proper positioning with minimal shortening. No bone graft was used. Only one joint failed to fuse. Bony union was present in 10 weeks or less in 86% of the digits. External immobilization was not used in one third of the joints, primarily low-demand patients with rheumatoid arthritis. There were two superficial pin tract infections that healed after pin removal and a course of oral antibiotics. This surgical technique proved to be technically simple and allowed for easily adjusted positioning of each joint without multiple osteotomies or excess shortening.
Arthrodesis↗
[Reconstructive surgery of malunited joint fractures of the hand].
Malunion of fractures, joint fractures and pseudoarthroses leads to therapy-resistant pain during function and loading, especially in the wrist, with a risk of early arthrosis. In spite of the extraordinary adaptability of the hand, malunion in the axis and rotation can lead, for example, to cross-finger malfunction. Because of the relatively thin layer of soft tissue, secondary operations to correct the axis, rotation and the length of the phalanx are possible. Each reoperation on the hand diminishes the blood flow, and the anatomical structures change with cicatrices. Thus, the risk of damaging blood vessels or nerves is increased. Operative correction of the position, arthroplasties, joint prostheses, arthrodeses, arthrolyses and denervation are all part of the operative repertoire. It is necessary to repair the joint surface as well as the capsule-ligament structures. Furthermore, we also express our opinion regarding the indications and contraindications of secondary operations. We discuss the risks and complications during operations and especially stress the aspect of having enough patient information. Finally, we describe the operative techniques in special cases. The necessity for reconstructive secondary operations is increasing as more and more replantations are being done and hand lesions in polytraumatized patients are being neglected. To date, not enough attention has been given to these problems in the scientific literature.
Arthrodesis↗
[Morphology of the human rib perichondrium from the aspect of arthroplasty of the small joints of the hand].
The human rib perichondrium is a suitable material for reconstruction interventions on small joints of the hand. Optical and electron microscopy analysis of the human rib perichondrium has shown some features different from the similar perichondrium in rabbits. In its superficial layers there are apart from the vascularity also myelinized nerve fibres, fat-cells and heparinocytes. In the medium layer and in the inner layer of the perichondrium there are cells which by their characteristics correspond to fibrocytes. Among them are collagen fibrillae coated with materials which can be fixed by the ruthenium red. The inner layer cannot be exactly distinguished from the cartilage of the rib.
Arthroplasty↗
Growth disturbances in the hands following thermal injuries in children. 1. Flame burns.
Five children developed growth disturbances following severe burns of their hands. Joint abnormalities, amputations, and periosteal reaction were seen on radiographs, and all had premature epiphyseal fusion in several phalanges or metacarpals, a finding rarely described previously.
Burns↗
Development rate of mutilans fingers in patients with rheumatic disease.
OBJECTIVE: To describe arthritis mutilans (AM) deformity during the progression of rheumatic disease. METHODS: The development of mutilans-like hand deformities in 2 patients with juvenile chronic arthritis (JCA) and in 2 patients with adult onset rheumatoid arthritis (RA) are presented. The hands of these patients were evaluated at least at two time points during the course of disease using two different scoring methods based on differently summed Larsen grades of the hand joints. RESULTS: Two patients (one with JCA and one with RA) showed AM changes after a disease period of less than 10 years and 2 not until after 30 years. The patients with adult onset disease were young at the onset of joint disease. Early wrist fusions were performed on both patients showing a slow development rate. CONCLUSIONS: The development rate of AM is very variable, even in patients with the same diagnoses. Wrist fusion prevents shortening of the carpus and may decrease the development rate of AM.
Adult↗
[Degenerative-dystrophic diseases of the locomotor system in metallurgists].
AIM: To evaluate prevalence of osteoarthrosis (OA) in metallurgists in conditions of high tension of the locomotor system and exposure to industrial pollutants depending on the age, sex and duration of service. MATERIAL AND METHODS: Epidemiological survey covered 713 workers (284 females and 429 males) of the Orsko-Khalilovsky Metallurgical Company. OA detection was made basing on screening questionnaire N 1, record N 2 and OA diagnostic criteria designed and tested in the RAMS Rheumatism Institute. RESULTS: Prevalence of OA among workers of the metallurgic company reached 71.6%. 83.5 and 63.8% females and males had degenerative changes in the joints and spine, respectively. This rate got higher with age and duration of service. Combination of OA with osteochondrosis (OC) was registered in 61.7%, isolated OC and OA--in 25.0 and 13.3%, respectively. OC developed most frequently in the lumbar, cervical-lumbar, cervical-thoracic spine while OA was found in the knee, shoulder and hand joints. CONCLUSION: Workers engaged in metallurgic industry work in conditions of high static-dynamic tension of the osteomuscular system and exposure to industrial chemical and physical hazards. The above risk factors contribute to high OA incidence. With age and longer exposure, both men and women fall ill with OA more frequently and have combined lesions of the spine and peripheral joints: 64.5 and 59.1% for women and men, respectively.
Adolescent↗
[A method of administration of drugs into the small joints of the hand and foot].
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Ankle Joint↗
Subjective symptoms in temporomandibular joint osteoarthrosis.
Questionnaires about subjective symptoms were sent by post to 120 patients referred to the clinic for mandibular dysfunction. A group of 20 patients with crepitation of the temporomandibular joint (TMJ) and a group of 19 patients with palpatory tenderness of the TMJ were compared with a reference group of 29 patients for any difference in local subjective symptoms, frequency of headache and symptoms in other joints. The patients with TMJ crepitation, which were considered to have TMJ osteoarthrosis, were older and reported a higher frequency of grating sound from the TMJ than the patients in the reference group. The patients with palpatory tenderness of the TMJ reported a higher frequency of toothgrinding, more severe symptoms of mandibular dysfunction and a higher frequency of symptoms in the hand joints. No correlation was found between subjective symptoms of mandibular dysfunction and those of other joints. The results of the study indicate that patients with TMJ osteoarthrosis do not differ from other patients with mandibular dysfunction with respect to subjective symptoms and that subjective symptoms of mandibular dysfunction in general develop independently of those in other joints.
Adolescent↗
Analysis of risk factors for neuropathic foot ulceration in diabetes mellitus.
Diabetes mellitus affects about one in 25 Australians. Neuropathic foot ulceration is a frequent complication in persons with diabetes. This study evaluates the importance of different risk factors for the development of this condition. The role of nonenzymatic glycosylation and pressure beneath the sole of the foot in the pathogenesis of neuropathic foot ulcers was investigated. Twenty-seven subjects with diabetes with a recent history of neuropathic foot ulceration were matched by age and sex with a group of 50 control subjects without neuropathy or history of foot ulceration. The degree of nonenzymatic glycosylation was assessed by analyzing the average level of glycosylated hemoglobin in the 3 years prior to the development of the foot ulcer and a goniometer assessment of peripheral joint (hand and ankle) flexibility. Dynamic pressure of the plantar aspect of the foot was recorded using a Musgrave Footprint System pedobarograph during a normal gait cycle. There was no significant difference in age, sex, body mass index, and duration or type of diabetes between the ulcer and control groups. The pressure of the plantar aspect of the foot was significantly elevated (p < 0.01). Ankle joint flexibility was reduced (p < 0.01) in cases with neuropathic foot ulceration compared with the control group. There was a trend toward elevation of glycosylated hemoglobin (HbA1c fraction) or HbA1c in the ulcer group (p = 0.06). The results suggested that nonenzymatic glycosylation occurs at a more significant level in patients with diabetes with a history of neuropathic foot ulceration.
Aged↗
[Feasibility and limitations of reconstructive interventions in rheumatoid arthritis and Bekhterew's disease].
Among the reconstructive interventions in rheumatoid arthritis preponderate the arthroplasties, among them again the resection arthroplasties in contrast to the alloarthroplasties. The resection arthroplasties are most frequently performed on the forefoot and on the hand joint and the cubital joint. The artificial joint substitute is possible nearly on every joint. As to the hip joint the problems are already satisfactorily solved, not yet, however, on the knee joint. In Bechterew's disease the indication to the alloarthroplasty is to be rendered depending less on pain than on function. In severe kyphoses the columnotomy is to be taken into consideration.
Arthritis, Rheumatoid↗
New radiographic grading scales for osteoarthritis of the hand. Reliability for determining prevalence and progression.
We developed and evaluated scales for grading the prevalence and progression of the individual radiographic features of osteoarthritis (OA) of the hand. Four equally time-spaced hand radiographs from 50 participants in the Baltimore Longitudinal Study of Aging, who were followed for at least 20 years, were read separately and "blindly" by 4 experienced, trained readers. Eleven hand joints were individually assessed for the presence of osteophytes, joint space narrowing, subchondral cysts, subchondral sclerosis, lateral deformity, and cortical collapse, and were also graded using the Kellgren/Lawrence scale, a global estimate of OA. The intraclass correlation coefficient was used to determine cross-sectional inter- and intrareader reliability. Interreader agreement on OA progression was evaluated using life-table analysis. Each of the grading scales for the individual radiographic features of OA of the hand, except for cysts, were cross-sectionally reliable between readers. Each reader was able to reproduce his original scores almost perfectly when grading the radiographs a second time. Using these scales, the different readers agreed on all the features of longitudinal progression of OA of the hand, except cysts. We believe that this method for grading hand radiographs for OA has proved to be reliable for both cross-sectional and longitudinal studies.
Adult↗
Rheumatoid deformities of the proximal interphalangeal joints of the hand.
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Arthritis, Rheumatoid↗
Quantitative analysis of finger motion coordination in hand manipulative and gestic acts.
This article reports an experimental study that aimed to quantitatively analyze motion coordination patterns across digits 2-5 (index to little finger), and examine the kinematic synergies during manipulative and gestic acts. Twenty-eight subjects (14 males and 14 females) performed two types of tasks, both right-handed: (1) cylinder-grasping that involved concurrent voluntary flexion of digits 2-5, and (2) voluntary flexion of individual fingers from digit 2 to 5 (i.e., one at a time). A five-camera opto-electronic motion capture system measured trajectories of 21 miniature reflective markers strategically placed on the dorsal surface landmarks of the hand. Joint angular profiles for 12 involved flexion-extension degrees of freedom (DOF's) were derived from the measured coordinates of surface markers. Principal components analysis (PCA) was used to examine the temporal covariation between joint angles. A mathematical modeling procedure, based on hyperbolic tangent functions, characterized the sigmoidal shaped angular profiles with four kinematically meaningful parameters. The PCA results showed that for all the movement trials (n = 280), two principal components accounted for at least 98% of the variance. The angular profiles (n = 2464) were accurately characterized, with the mean (+/-SD) coefficient of determination (R2) and root-mean-square-error (RMSE) being 0.95 (+/-0.12) and 1.03 degrees (+/-0.82 degrees ), respectively. The resulting parameters which quantified both the spatial and temporal aspects of angular profiles revealed stereotypical patterns including a predominant (87% of all trials) proximal-to-distal flexion sequence and characteristic interdependence--involuntary joint flexion induced by the voluntarily flexed joint. The principal components' weights and the kinematic parameters also exhibited qualitatively similar variation patterns. Motor control interpretations and new insights regarding the underlying synergistic mechanisms, particularly in relation to previous findings on force synergies, are discussed.
Biomechanical Phenomena↗
[The characteristics of the course of inflammatory joint diseases in the inhabitants of an agricultural region].
The course of the main chronic inflammatory diseases of the joints was analyzed with special reference to the rural region of Georgia. 30 patients with rheumatoid arthritis (RA), 13 with ankylosing spondylarthritis, and 6 with reactive arthritis are registered and followed up by the rheumatologist. It is shown that the population of the region in question is characterized by a later onset of RA, a high percentage of the seronegative variety of the disease with involvement of the hand joints, and ankylosing of the carpal joints. The males demonstrate a low activity of the process. Since RA ran a benign course, the patients were only treated with nonsteroidal anti-inflammatory agents. The RA patients preserved work fitness for a long time. Ankylosing spondylarthritis was marked by the primary injury to the spine associated with the development of ankylosis and calcification of the ligamentous apparatus without a well-defined spinal deformity. Large-scale examination of the population of the region has shown the necessity of such measures for they permit identification of new cases of the disease to carry out early adequate treatment and specialized employment of the patients.
Adult↗