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At least 451 records · Page 25Linked to original sources
PubMed1986

Lesser digital arthrodesis.

Arthrodesis at the proximal interphalangeal joint is a surgical procedure useful when dealing with semireducible or nonreducible contractures of the lesser digits. When arthrodesis of the proximal interphalangeal joint is performed, there is conversion of the retrograde dorsal buckling force of the long extensor tendon to a plantargrade straightening force of the flexor tendon. This occurs as a result of the rigid strut created at the arthrodesis site. If metatarsal equinus is present, arthrodesis can help reduce this deformity and eliminate plantar pressure contributing to submetatarsal tyloma. An arthroplasty procedure does not resist deforming forces and is more useful in correcting painful deformities where flexibility is desired postoperatively. It is therefore important, even in "simple" digital surgery, to understand the etiology of the pathology and identify and structure the goals of the surgery. The end-to-end arthrodesis offers the advantage of being easy to perform, relatively free of complication, and able to maintain the length of the digit. A fixation device, such as a Kirschner wire or monofilament wire, may be needed to maintain the correction. Its inherent complications have been described. It can be relatively unstable. The peg in hole arthrodesis offers the advantage of better stability which does not necessarily require internal fixation. There is also rapid bone healing due to the side-to-side configuration of the arthrodesis site. The procedure is more complicated and time consuming to perform than an end-to-end procedure. There is more shortening in the peg in hole. Taking these factors into account, the surgeon should choose the procedure which best meets the preoperative criteria and expected postoperative results.

Arthrodesis↗
PubMedDate not supplied

Preventing loss of the great toe with the hallux interphalangeal joint arthroplasty.

Chronic ulcerations of the hallux may result in amputation if infection becomes uncontrolled. Salvage of the hallux often requires surgical intervention when conservative measures fail. Many authors have described various procedures to prevent recurrent ulceration and the potential for loss of the great toe. The authors have reviewed their experience with the hallux interphalangeal joint arthroplasty for chronic neuropathic ulcers of the great toe. Between August 1988 and July 1991, the authors performed 46 hallux interphalangeal joint arthroplasties on 40 patients (22 males, 18 females). Of the 40 original patients, one patient was lost to follow-up in the immediate postoperative period, leaving 45 procedures on 39 patients. Thirty-six feet were noted to heal both the procedure and ulceration uneventfully (80%). There were five minor complications (11%). Four cases were deemed failures (9%). Overall, 41 feet (91%) healed and had no evidence of recurrence in the follow-up period. Follow-up was an average of 23.6 months (range 4-44 months). The hallux interphalangeal joint arthroplasty has been a valuable procedure for chronic ulcerations of the hallux. By allowing these ulcers to heal, loss of the great toe has been avoided. Function and structure of the foot has been maintained.

Adult↗
PubMed2006

Methodology for determining the sensitivity of swing leg toe clearance and leg length to swing leg joint angles during gait.

During the swing phase of gait, the effective length of the leg-distance from the hip joint center to the toe-must be made shorter than the distance from the hip to the floor to avoid toe-stubbing or tripping while walking. Critical toe clearance occurs approximately halfway through swing phase when the distance between the toe and the floor reaches a local minimum. Analytical techniques derived in this study were used to evaluate: (1) the sensitivity of toe clearance to the swing leg hip, knee, and ankle joint angles; and (2) the sensitivity of the hip-toe distance to the swing leg knee and ankle joint angles. The toe clearance, hip-toe distance, toe clearance sensitivity (TCS), and hip-toe distance sensitivity (HTDS) were calculated for each frame of data during the swing phase of 10 able-bodied subjects. A minimum toe clearance of 1.9+/-0.5cm occurred at about 51% of the swing phase during able-bodied gait. At that particular time, the toe clearance was found to be most sensitive to the angle of the ankle (17.1cm/rad), then the hip (9.5cm/rad), and lastly the knee (2.5cm/rad). The hip-toe distance was found to be about twice as sensitive to the angle of the ankle (-15.3cm/rad) than to that of the knee (-7.6cm/rad) at the time of critical toe clearance. The methodology developed here and the baseline information calculated for able-bodied subjects could be used to evaluate the effects that different gait pathologies have on swing-phase toe clearance and hip-toe distance.

Adult↗
PubMed1993

Composite finger metacarpophalangeal joint reconstruction in combined second and third free toe-to-hand transfers.

Composite metacarpophalangeal joint reconstruction using the toe proximal phalanx and the metacarpal head, with a capsular repair, is an option during free toe transfer procedures for absent fingers. Eleven composite metacarpophalangeal finger joint reconstructions were performed in four patients concurrent with combined second and third toe-to-hand transfer. The average follow-up period was 5 years. Postoperative assessment included range of motion, stability, radiographic changes, and pain. The average range of motion was 52 degrees, average ulnar stress deviation was 14 degrees. No patients complained of pain. Composite metacarpophalangeal joint reconstruction should be considered in free toe-to-hand procedures when metacarpal head articular cartilage is preserved.

Adolescent↗
PubMed1978

B-cells of the synovial membrane. II. Differentiation during development of the synovial cavity in the mouse.

Study of pre- and postnatal development of the metatarsophalangeal joint of the mouse shows that the synovial cavity (SC) forms before any differentiation of the synovial mesenchyme. The primitive cleft results from degradation of a thin vascular mesenchymal layer in direct contact with the chondrogenic layers. Differentiation of the synovial membrane coincides with clarification of the SC (3rd to 6th day of postnatal life). When dilatation of the SC occurs (6th to 8th day), the two intimal cells types (A- and B-cells) are well identified. The B-cells already show typical features at day 6; their content of typical dense secretory vesicles is comparable to that of the adult B-cells at day 13. The specific secretory function of B-cells could be correlated with the particular structure of the intimal interstitial tissue and could account for the origin of some protein(s) of the synovial fluid.

Animals↗
PubMed2003

Concomitant plantar tarsometatarsal (Lisfranc) and metatarsophalangeal joint dislocations.

We report an unusual case of concomitant plantar tarsometatarsal (Lisfranc) and 1st and 2nd metatarsophalangeal (MTP) joint dislocations and fracture of the neck of the third metatarsal bone which has never been reported before. The plantar dislocation of the Lisfranc joint was treated by open reduction and fixation with K-wires; the dislocations of the MTP joints and neck fracture of the third metatarsal bone were treated by closed reduction and percutaneous fixation with K-wires and immobilized with a plaster cast. At the 5 year follow-up examination, our patient had no complaints, but the radiograph showed degenerative changes of the Lisfranc and the 1st MTP joint.

Adult↗
PubMed2006

Engraftment of cutaneous fibroblasts within synovial membrane in a nonhuman primate: short-term results.

OBJECTIVES: Gene therapy using cells as vectors to achieve secretion of therapeutic proteins may hold promise in the treatment of chronic diseases. Cell-based gene therapy with xenogeneic cells secreting antiinflammatory cytokines (IL-4, IL-13, or IL-1 receptor type II) has been found effective in mice with collagen-induced arthritis (CIA), a model for human rheumatoid arthritis. Autologous cells engineered to produce antiinflammatory cytokines were also effective in the mouse CIA model. In all these experiments, the cells were grafted into the subcutaneous tissue of the back, resulting in systemic treatment. To evaluate the feasibility of cell-based gene therapy confined to the joints, we performed intraarticular injections of autologous cells in a rhesus monkey with CIA, a model more similar to human RA. METHODS: We prepared ex vivo cultures of skin fibroblasts from the animal then transfected the cells with a plasmid carrying the lacZ gene. We injected these marker cells into metacarpophalangeal, metatarsophalangeal, and interphalangeal joints. RESULTS: Kinetic evaluation of synovial tissue X-gal labeling, which reflected reported gene expression by skin fibroblasts present within the synovium, showed significant labeling by transfected cells up to 6 days after intraarticular injection. Xenogeneic fibroblasts (Chinese hamster ovary cells) injected intraarticularly were also detected within synovial specimens; however, labeling intensity was less marked than with autologous cells. Our findings establish the feasibility of skin fibroblast grafting into the synovium. CONCLUSION: This preliminary study opens the door to studies of heterotopic autologous transfected cells for the treatment of CIA in monkeys by direct gene transfer within joints.

Animals↗
PubMed1984

Reconstruction of metacarpophalangeal joint by free vascularized autogenous metatarsophalangeal joint transplant.

Six cases of autotransplantation of free vascularized second metatarsophalangeal joint to reconstruct damaged metacarpophalangeal (MP) joints are reported. Anatomical studies in cadaver and clinical cases involving the origin, course, and importance of preserving the articular branch of the metatarsal artery are described. Follow-up of cases from six months to 21/2 years postoperative reveal recovery of thumb function, stability of the transplanted joint, and no obvious degenerative changes.

Adult↗
PubMed1979

Radiography in joint reconstruction with perichondrial grafts.

The radiographic findings in 13 joints successfully reconstructed with free perichondrial grafts from the rib are reported. Radiography was performed during a period of 13 to 40 months postoperatively. Definite cortical demarcation occurred after 8 to 11 months and had increased 11 to 16 months following surgery. In 3 cases the final examination of 2 metacarpophalangeal joints and one proximal interphalangeal joint was completed with arthrography which demonstrated that the articular surfaces appeared even although the cortical bone contours were somewhat irregular. The extent of the joint spaces largely resembled that in healthy controls.

Adult↗
PubMed1982

Conservative management of the hypersensitive foot in rheumatoid arthritis.

Treatment of the painful foot in rheumatoid arthritis requires an understanding of the abnormal mechanics and progressive disease process. The clinical problems are manifested in the forefoot (MP joints and toes) and in the longitudinal arch and subtalar joint. The evaluation includes a thorough history and physical, and the use of various tools to indicate and quantitate abnormal weightbearing, problems in circulation and sensation. Nonsurgical treatment includes appropriate drugs, and devices and shoes which reduce shear, redistribute weightbearing, support unstable joints, and accommodate irregular shapes and surfaces. Certain infections and neurovascular problems require early surgical solutions.

Arthritis, Rheumatoid↗