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At least 343 records · Page 19Linked to original sources
PubMed2000

[Complete superficial replacement of the middle finger joint--long-term outcome and surgical technique].

Pain, weakness, malalignment and limited range of motion (ROM) at the PIP joint following arthrosis (degenerative or post-traumatic) or rheumatoid arthritis frequently require surgical treatment. PIP joint fusion or implantation of a prosthetic device are options. The purpose of this study was to report our long-term results with a surface replacement PIP arthroplasty (SR PIP arthroplasty) and the description of our operative technique. 82 prostheses were done in 60 patients between 1980 and 1999. All patients were reexamined, the average follow up was 64 months (12 to 260 months); average age was 57 years. 48 patients were operated on the right hand, 12 on the left hand. 44 patients were female, 16 were male. All patients complained of pain preoperatively. Patients were divided into three groups: A degenerative arthrosis, B posttraumatic arthrosis and C inflammatory arthritis. Active range of motion of all fingers of the operated hand, grip-strength, pain relief, joint stability or deformity and comprehensive radiographic assessment were studied. The subjective impressions of the patients were measured in four grades: very satisfied--satisfied--dissatisfied--very dissatisfied. Finally the investigators divided the overall results in: good--fair--poor. The average flexion arc was 31 degrees (maximum 15 degrees hyperextension to 95 degrees flexion) preoperatively and 47 degrees (maximum 14 degrees hyperextension to 90 degrees flexion) postoperatively. Over 70% of the patients had complete pain relief. In 12 fingers secondary procedures were necessary, usually related to soft tissue deformity and extensor tendon function. No arthrodesis was performed as a following operation. In 40 fingers a good result was achieved (49%), 25 had a fair (30%) and 17 (21%) a poor result. Our results of resurfacing PIP arthroplasty are encouraging and provide equal and usually improved motion in comparison with other joints. With experience and refinements of the operative technique our confidence in surface replacement arthroplasty has increased. For this reason we prefer this procedure for posttraumatic or degenerative arthrosis as against PIP joint fusion or silastic implants.

Aged↗
PubMed1994

[Are "Busch fracture", "avulsion fracture of the extensor tendon" or "fracture of the dorsal terminal finger joint" synonyms? Anatomic studies of the insertion of the extensor aponeurosis and significance in hand surgery].

With the help of thick transparent cross-sections of fingers, it has been shown that fibers of the extensor aponeurosis insert distal to the avulsed fragment of the distal phalanx. The consequence for hand surgery is not to expose the fragment through a dorsal incision but through a mid-lateral one. In this way, the distant parts of the aponeurosis distal to the fracture remain intact and there is no break in the continuation of the dorsal extensior plate.

Adult↗
PubMed2005

Doppler ultrasound findings in healthy wrists and finger joints before and after use of two different contrast agents.

OBJECTIVE: To examine the effect of contrast agents on Doppler ultrasound findings in the synovial membrane in the wrist and fingers of healthy volunteers. MATERIALS AND METHODS: Eleven healthy subjects were included in the study (5 women and 6 men, mean age 38 years, range (20-60)). They had no clinical signs of inflammatory or degenerative joint diseases. A total of 66 joints were examined-6 joints for each subject: wrist and metacarpophalangeal (MCP) joints 1-5-before contrast injection and after Levovist and SonoVue injection with a 30 minute interval. RESULTS: Colour Doppler activity was detected in 10/55 (18%) MCP joints before contrast injection and in 29/55 (53%) and 28/55 (51%) joints after Levovist (p<0.0001) and SonoVue injection (p = 0.0001), respectively. A significant increase in Doppler activity in the radial (p<0.05) and ulnar (p = 0.01) parts of the wrist joint was detected only after SonoVue injections. With spectral Doppler no difference was found in the resistive index (RI) in the vessels measured before as compared with those only detected after contrast injection. CONCLUSION: The number of joints with colour Doppler activity in healthy volunteers was increased by the use of contrast agents. No changes in RI were detected. The value of contrast agents remains to be demonstrated in inflammatory diagnostics.

Adult↗
PubMed1993

[Functional treatment of basal joint fractures of three-joint fingers].

Phalangeal fractures have up to now always been treated using a conservative static form of splint. Open reduction and stabilisation is preferred in the case of injuries with severe displacement, shortening, open fractures and joint involvement. In this study, we have shown the results of 86 proximal phalangeal fractures that were treated with "dynamic splinting". In the "intrinsic plus" position a dorsopalmar plaster splint is affixed in combination with a Bedford double finger stall, splinting the injured finger securely to its neighbour. Clinical and X-ray results were evaluated. Oblique, rotational and transverse fractures can be reduced and treated showing good results with dynamic splinting. Bending fractures cannot always be treated with this method. Especially basal fractures with dorsal comminution can be problematic. Comminuted fractures can only be treated with dynamic splinting if they have been primarily adequately reduced. Intraarticular condylar fractures have to be treated surgically. Our results have also shown that the fingers still are freely mobile even when the bone has not healed in an anatomical position.

Adolescent↗
PubMed1989

[Late results after surgical and conservative treatment of capsule ligament injuries of the finger joints].

Late results following operative and conservative treatment of 215 ligamentous injuries with injured metacarpophalangeal and interphalangeal joints are presented. These 215 cases represent 77,4% of all hand injuries which were treated in the years 1976 to 1981 at the Traumatological Department of Essen University. Mobility, stability, and function were used to evaluate and compare the late results. A modification of the scheme of Buck-Gramcko et al. for the evaluation of finger's mobility after flexor tendon injuries was employed. 75% of late results were judged to be "good to very good", 16,5% "satisfactory", and 8,5% "poor". The most important influences on the late results were found to be the time between injury and treatment and the patient's age. Further factors were open injuries and the destruction of large parts of the palmar plate. The late results in cases after surgery were much better than those after conservative treatment. Only injuries without total rupture of the palmar plate or collateral ligaments - which were in nearly all cases treated conservatively - reached good or very good late results in over 90%. A better evaluation of the bony injuries could be achieved by special X-ray technique such as magnification views of the involved joints. If the duration of immobilisation is shortened a better restoration of full joint mobility is ensured without disturbing joint stability.

Adolescent↗
PubMed1987

[Microbore wires in osseous tendon ruptures of the distal finger joint].

Osteosynthesis with crossed Kirschner-wires is a common method for fracture stabilization. With wires of 0.8, 0.6, 0.5 and 0.4 mm thickness, small avulsion fractures of tendons in the digits are reduced and fixed anatomically. In cases of ideal closed reduction, percutaneous insertion of the wires is possible.

Arthrodesis↗
PubMed1984

[Replantation at the distal finger joint. Indication, technic, result, failure, case reports, alternatives].

In cases of digital replantation distal to the DIP-joint the sequence of steps in the operation procedure has to be changed, compared with replantation in more proximally situated amputations: the arterial microanastomosis has to be carried out before skeletal fixation. In a few case reports the success of this method but also the failure and an alternative method (double neurovascular VY-plasty) are described.

Accidents, Occupational↗
PubMed1987

Hyperextension injuries of the PIP finger joint. Comparison of early motion and immobilization.

In a prospective study of traumatic lesions of the volar fibrocartilage of the PIP joint, 56 patients were randomized to treatment by immobilization for 3 weeks and 56 patients, to purely analgetic treatment without immobilization. Seventy-eight patients were reexamined 6 months later and 77 patients, in a follow-up study 2-3 years after the injury. No difference was found between the two groups with respect to subjective complaints or objective signs.

Adolescent↗
PubMed2002

[Sensitivity and significance of nuclear magnetic tomography findings of finger joints in rheumatoid arthritis].

Evaluation of the sensitivity and value of magnetic resonance imaging (MRI) findings and miniarthroscopic investigations (mini-/needle-arthroscopy = MA) of metacarpophalangeal (MCP) joints in patients with rheumatoid arthritis (RA). 30 patients with RA (21 female, 9 male), disease duration 2 months to 22 years and mean disease activity score (DAS) of 3.90 (range: 2.00-7.67) were examined by MRI of the hand (MCP region) and following MA of the MCP-II joints. MRI parameters for arthritis (synovial enhancement, synovial extension, cortical alterations, joint gap width) and corresponding macroscopic items (synovial extension, synovial hyperemia and vascularity, cortical alterations) by MA, scored semiquantitatively for synovitis (graduated from 0-III degree), were correlated. Additionally, normal radiographs of the hands were performed and compared with MRI findings concerning the detection of bony lesions. Evaluation of the 30 MRI and MA examination revealed highly significant correlations (p < 0.0001) for the parameters of synovial extension (MRI/MA), cortical alterations (MRI/MA) and synovial enhancement (MRI) compared to synovial hyperemia and vascularity (MA). We found significant correlations for parameters of activity and chronicity of RA pathology as assessed by MRI and MA. The detection rate of cortical lesions by MRI was two and a half times higher than by X-ray. MRI findings of MCP-II joints compared to those of MCP III-V showed that the MCP-II joint was more strongly involved.

Adult↗
PubMed1991

The Nicolle finger joint prosthesis: a reappraisal.

The Nicolle prosthesis was used to replace 101 metacarpophalangeal joints in patients with rheumatoid arthritis over a ten-year period. Mean active flexion achieved was 30 degrees. Mean ulnar deviation was 27 degrees. 4% of joints had to be removed after a mean interval of 42 months, for infection. None of the implants had fractured.

Arthritis, Rheumatoid↗
PubMed2005

[The WEKO finger joint prosthesis].

The WEKO prosthesis was developed between 1989 and 1993 in order to restore stability and function of destroyed metacarpophalangeal joints in rheumatoid arthritis. The prosthesis is a hinged one and is fixed to the bone cementlessly by special osseointegrated sleeves in which the stem of the implant is fastened by a cone. Forty-eight patients with 74 prosthesis have been operated on in 1993. In a follow-up study in 2003, 43 of them (89.5 %) with 65 prostheses (87.8 %) could be re-examined clinically and radiographically. In seven patients (16.2 %) implant arthroplasty failed comprising loosening of the prosthesis within their sleeves, loosening of the sleeves in the bone and implant breakage. Twelve implants (16.2 %) had to be removed. The range of motion at follow-up was 0/10/70 degrees in comparison to 0/0/90 degrees postoperatively. Patients satisfaction over the first three to four years was higher than later due to deterioration of the rheumatoid disease. Thus, classical handscores to assess the outcome could not be applied. A second generation of the WEKO prosthesis was developed to improve rotational stability and osseointegration paying attention to reports concerning failures which were seen also by other authors. The stem of the implant was changed to a cylindrical one with star shaped cross-section which allows some pistoning in order to reduce the stressload of the sleeves.

Arthritis, Rheumatoid↗
PubMed1998

[Functional neuroanatomy of the radial nerve in the region of the long wrist and finger joint extensors and the supinator groove].

Basing on electrophysiological data measured by us we studied the course of the radial nerve or its motoric branches with regard to anatomically conditioned bony contractions and their possible significance for pain experienced at the radial epicondyle of humerus, the pain being known under several synonymous designations. To differentiate between the various pathomechanisms discussed in the literature, we performed longitudinal and transversal dissections on a total of 40 cadaveric arms. We found as constant variations to the topographic anatomy published in the standard literature a regularly extended and (in relation to the other muscles we examined) exposed course of the nerve branch proceeding towards the m. extensor carpi radialis brevis. As the only long wrist extensor muscle this is innervated in most cases from the superficial end branch of the radial nerve. The origin of the muscle projected regularly over the common aponeurosis of the extensor tendon and delimitated in most of the preparations the distal end of the tunnel of the deep radial nerve. Since the deep radial branch and the muscular branches parallel to that branch cross this part of the tendon at an obtuse angle we believe that the repeatedly discussed possibility of a dynamic nerve compression without structural influences is the triggering mechanism for the observed nerve damage.

Cadaver↗