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At least 667 records · Page 37Linked to original sources
PubMed1986

[Percutaneous management of intra-articular fractures of the interphalangeal joints of the fingers].

Open reduction of intra-articular fractures of the proximal interphalangeal joints of the fingers requires extensive exposure of the bone. This often leads to disturbance of the delicate mechanics of the joint. The results are, therefore, sometimes not as good as expected. The authors describe a new method of treatment, using the image intensifier with magnification. The fragments are reduced by means of a golf-club shaped instrument, which is inserted into the medullary cavity through a small skin incision and a drill hole in the bone. After reduction, the position is held by a framework of percutaneously introduced thin Kirschner-wires.

Adult↗
PubMed1987

Degenerative diseases of the metacarpophalangeal joints.

Degenerative arthritis of the finger metacarpophalangeal joints is uncommon and, when seen, a specific etiology should be sought. MP joint arthritis in the absence of a history of trauma may signal an underlying systemic disease. The clinical and radiographic findings may be subtle. Once degenerative changes occur, the usual treatment is arthroplasty using a flexible silicone rubber (Swanson) finger joint implant that should provide a relatively stable and painless joint with a functional range of motion. Degenerative arthritis of the thumb MP joint is more common following injuries that damage the ligaments on the ulnar or radial side of the MP joint and which result in lateral instability of the joint. Arthritis of the MP joint also may occur following infection or direct joint injury. Secondary MP arthritis may result from thumb CMC joint disease and must be attended to at the time CMC joint reconstruction is performed. Degenerative disease of the thumb sesamoid bones must be considered in patients with persistent MP joint pain after either trauma or MP joint fusion.

Acromegaly↗
PubMed1983

Simultaneous closed dislocation of both interphalangeal joints in one finger.

A rare case of simultaneous dislocation of both interphalangeal joints in one finger in a table-tennis player is presented. The second dislocation took place when the first dislocated joint became the fixed part of the finger as it hit a wall. Treatment was, first, hyperextension to unlock the base of the phalanx, then traction along the phalanx: its base was then pushed into contact with the head of the proximal phalanx. Splinting was applied with the joint in slight flexion.

Adult↗
PubMed2003

Restoration of thumb sensibility with the innervated first dorsal metacarpal artery island flap.

PURPOSE: This study investigated the quality of sensibility from innervated first dorsal metacarpal artery (FDMCA) island flaps in younger and older patients and evaluated the donor site morbidity at the index finger. METHODS: Twenty-five patients with an innervated FDMCA island flap to restore sensibility of the thumb were divided into groups according to age (>50 or <50 years). Sensory recovery and cortical reorientation were tested with Semmes-Weinstein monofilaments, a calibrated 2-point discrimination tester, and needle prick testing. Donor site morbidity was evaluated for range of motion, aesthetic appearance, pain, and problems with injuries. RESULTS: The mean age of the patients was 48.3 years and the mean follow-up period was 3 years. The 14 patients older than 50 years had a static 2-point discrimination (s2-PD) of 10.9 mm compared with 10.8 mm of the 11 patients younger than 50 years. The average loss of s2-PD of the flap compared with the donor area averaged 2.7 mm in all patients. Complete cortical reorientation occurred in 7 patients older than 50 years and in 5 patients younger than 50 years. Total loss of range of motion of all donor finger joints was 14 degrees (4.4%) compared with the contralateral index finger. Twenty-two patients were satisfied with the result. CONCLUSIONS: There were no age-related differences in the surgical results of the innervated FDMCA island flap and the donor site morbidity was negligible.

Adult↗
PubMed1990

[Rheumatologic complications and amyloidosis in dialysis patients].

Articular complications seem to be very common in patients under chronic dialysis, where they currently constitute the main limitation to the long-term functional prognosis. Carpal tunnel syndrome is often bilateral and severe; after 8 to 10 years of haemodialysis, it is usually associated with local deposits of amyloid substance. Treatment must be undertaken early and it is surgical. Arthropathies due to microcrystalline deposits take various forms, the most frequent being acute periarticular attacks related to apatite crystals. Septic arthritis is a frequent complication, dangerous in such patients, and which must be considered in every case of acute or subacute arthritis. Chronic arthropathies affect more than one half of the patients who have been under dialysis for more than 10 years. The most common are arthralgias of the shoulders often associated with pain in other joints, restricted joint movements and synovial thickening notably in the wrists, small finger joints and knees; radiology shows subchondral cavities betraying the presence of the cervical spine, are fairly frequent in patients under long-term haemodialysis. The pathogenesis of these complications is not yet fully understood, and several factors may be involved. Anatomically, carpal tunnel syndrome and chronic arthropathies are associated with articular deposits of a very special amylose consisting of beta-2 microglobulins.

Amyloidosis↗
PubMedDate not supplied

Simultaneous dorsal dislocation of both interphalangeal joints in a finger.

This paper has described three cases of simultaneous dorsal dislocation of both interphalangeal joints of a finger. Although two of three patients had minimal limitation of the active range of motion of the PIP and DIP joint, none had complaints of functional disability in their finger.

Adolescent↗
PubMed2003

Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis.

OBJECTIVE: To evaluate the interobserver agreement of ultrasonographic assessment of finger and toe joints in patients with rheumatoid arthritis (RA) by 2 investigators with different medical backgrounds. METHODS: Ultrasonography and clinical examination were performed on 150 small joints of 30 patients with active RA. A General Electric LOGIQ 500 ultrasound unit with a 7-13-MHz linear array transducer was used. In each patient, 5 preselected small joints (second and third metacarpophalangeal, second proximal interphalangeal, first and second metatarsophalangeal) were examined independently on the same day by 2 ultrasound investigators (an experienced musculoskeletal radiologist and a rheumatologist with limited ultrasound training). Joint effusion, synovial thickening, bone erosions, and power Doppler signal were evaluated in accordance with an introduced 4-grade semiquantitative scoring system, on which the investigators had reached consensus prior to the study. RESULTS: Exact agreement between the 2 observers was seen in 91% of the examinations with regard to bone erosions, in 86% with regard to synovitis, in 79% with regard to joint effusions, and in 87% with regard to power Doppler signal assessments. Corresponding intraclass correlation coefficient values were 0.78, 0.81, 0.61, and 0.72, respectively, while unweighted kappa values were 0.68, 0.63, 0.48, and 0.55, respectively. Ultrasonography showed signs of inflammation in 94 joints, while clinical assessment revealed tenderness and/or swelling in 64 joints. CONCLUSION: An experienced radiologist and a rheumatologist with limited ultrasound training achieved high interobserver agreement rates for the identification of synovitis and bone erosions, using an introduced semiquantitative scoring system for ultrasonography of finger and toe joints in RA. Signs of inflammation were more frequently detected with ultrasound than with clinical examination. Ultrasonography may improve the assessment of RA patients by radiologists and rheumatologists.

Adult↗
PubMed1992

Distal joint injuries of the thumb and fingers.

The DIP joints of fingers and the interphalangeal joints of thumbs provide important stability and contribute to the flexion and extension arc of the digit. A variety of injuries can affect these joints, involving their ligaments, bones, and tendons. Instituting proper and effective treatment is predicated on making an accurate diagnosis of the injury and understanding the function of each anatomic structure.

Acute Disease↗
PubMed1986

Irreducible compound dorsal dislocations of the proximal interphalangeal joint of the finger.

Three cases of compound irreducible dorsal dislocation of the proximal interphalangeal joint of the finger are reported. The probable mechanism is discussed. The findings warrant the description "volar capsular boutonnière" as the condyles of the proximal phalanx buttonhole, through the volar structures. Open reduction combined with debridement, is the treatment for such compound irreducible dorsal dislocations. Dislocation of the proximal interphalangeal joints of the fingers are common and can usually be reduced by simple traction. Occasionally reduction by closed methods is unsuccessful because of interposition of volar or dorsal soft tissue structures (Lamb 1981). This study reports three cases of compound dorsal dislocation of the proximal interphalangeal joint with volar soft tissue interposition. Such lesions are sparsely mentioned in text books on fractures and hand injuries and hitherto only a few cases have been published (Lamb 1981, Bunnell 1956).

Adolescent↗
PubMed1995

Destructive arthropathy of the hands in chronic hemodialysis patients. A report of seven cases with pathological documentation.

Destructive arthropathy of the hands is common in chronic hemodialysis patients. The clinical and histological features in seven cases are reported. There were five females and two males aged 45 to 78 years. Hemodialysis duration at the time of surgery was 48 to 228 months (mean 92 months). Four patients had arthrodesis, two had insertion of silastic implants and one had a diagnostic surgical biopsy. The site of the surgical procedure was a distal interphalangeal joint in three patients, a proximal interphalangeal joint in one, a trapeziometacarpal joint in two, and both a proximal and a distal interphalangeal joints in one. All seven patients had severe destructive arthropathy responsible for pain and instability. Roentgenograms showed joint space obliteration and subchondral erosions or lysis, without osteophytosis. Several finger joints were involved in six of the seven patients. Histologic studies of the synovial membrane (n = 7) and subchondral bone (n = 4) found no amyloid even in the three patients with clinical or roentgenographic evidence of amyloidosis at other sites. Electron microscopy studies were done in two patients and failed to disclose crystals or amyloid. Our findings demonstrate that destructive arthropathy of the hands in hemodialysis patients is not a manifestation of dialysis-related amyloidosis. The pathophysiology of the condition remains poorly understood.

Aged↗
PubMed1997

Aesthetic life-like finger and hand prostheses: prosthetic prescription and factors influencing choices.

This paper reviews the authors' experience with fitting life-like finger and hand prosthesis. The methodology and technical considerations in producing these prostheses, the prosthetic prescription according to the level of amputation and the challenges faced with each level are discussed. In cases where the amputation is sufficiently distal, a thimble prosthesis has been used. This is compared to fitting a full-length finger prosthesis. Besides allowing free range of motion of the proximal finger joints which would otherwise be covered and restricted with fitting a finger prosthesis, a thimble prosthesis minimises skin coverage for optimal sensibility and is easier to don and doff. In cases of amputations where a digital fitting is precluded, a partial or a total hand is prescribed. A comparison between fitting a finger, a partial hand prosthesis and a total hand prosthesis is also discussed. Cases of a digital, transcarpal and a more proximal transmetacarpal amputations are relatively easy to fit with a prosthesis. An incomplete transmetacarpal amputation where much of the breadth of the hand is preserved presents a difficult challenge as it necessitates fitting with a partial hand prosthesis. Besides the need to cover a large area of the intact skin and the associated problems with reduced sensibility and stump perspiration, a partial hand prosthesis is difficult to don and doff.

Fingers↗
PubMed1979

Flexible implant arthroplasty of the proximal interphalangeal joint of the fingers.

The use of an intramedullary stemmed flexible (silicone) hinge in reconstruction of the proximal interphalangeal joint has allowed us to obtain more predictable, durable, and reproducible results. The indications, surgical technique, and postoperative rehabilitation of this technique vary with each type of deformity presented and must be carefully followed. Adequate reconstruction of the extensor mechanism and the collateral ligament system, and appropriate postoperative rehabilitation are essential to obtain good balance of the digit, with functional mobility and stability of the reconstructed proximal interphalangeal joint.

Finger Joint↗
PubMed1997

Avulsion fracture of the metacarpophalangeal joint of the finger.

Six patients with avulsion fractures of the metacarpophalangeal joints of the fingers are reported. Operation was performed in all cases. Judging from the operative findings, the radiological assessment of fragment shape is helpful in treatment. Surgery is recommended when the fragment is triangular or rectangular in shape because the fracture involves the articular surface. Conservative treatment is effective if the fragment is round because the articular surface of the joint is not involved in this type of fracture. The avulsed fragment often overlaps the metacarpal head and a collateral ligament injury is likely to be misdiagnosed. It is important to suspect this injury and assess the shape of the whole fragment for a good functional result.

Adolescent↗