Opponensplasty--a rare complication and its prevention.
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Adult↗
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[Results of a multicenter study of chondroitin sulfate (Condrosulf) use in arthroses of the finger, knee and hip joints].
61 patients, suffering from osteoarthritis of the hip, knee and/or finger joints, were included into this open, multicenter, phase IV trial. Patients were treated with chondroitinsulfate (CS) at the recommended dose for 3 months. Concomitant NSAID-therapy, which was necessary for disease control at the beginning of the observation period could be reduced by 72% throughout the 3 months of CS-therapy. The decrease of pain was revealed to be statistically significant; serious side effects were not to be observed during the study. At the beginning of the observation period patients suffered from overall severe pain, and therefore the decrease of pain down to a level, which could not have been achieved by NSAID therapy alone to a greater extent, is of special interest. The results of this trial represent the first office based Austrian data on CS-therapy. In conclusion it could be demonstrated that a significant reduction of the daily NSAID consumption was possible by concomitant CS-therapy, without the risk of deterioration of the patients' symptoms. The 97% compliance does not give evidence for drop-out bias. Moreover, the results of this trial are comparable to other international double-blind, in part placebo-controlled studies, concerning CS-therapy, indicating beneficial results in the treatment of osteoarthritis.
Administration, Oral↗
[2-stage plastic repair of the flexor tendons of the fingers: the indications and technic].
Based on their experiences with treatment of 58 patients with consequences of severe traumas of the hand the authors analyze and substantiate indications for using the method of the two-stages tendoplasty of finger flexors. The technique of implantation of polychlorvinyl rods is described in detail. Relatively high frequency of additional procedures on different anatomical structures of the hand is noted. Special attention is given to intra- and postoperative prophylactics of infectious complications. It was found that time of the second operation should be determined not only by the time of formation of the smooth wall capsule around the implant but also by the degree of liquidation of finger joints contractures.
Finger Injuries↗
[Diagnosis and therapy of injuries of the lamina fibrocartilaginea of the hand (palmar plate)].
Authors studied a frequent injury of the finger joints. The anatomy, the mechanism of the injuries, the diagnostic possibilities of the lamina fibrocartilaginea ("palmar plate") and of the palmar ligaments of the joints are described. In the diagnosis a special significance is attached to the stressed and tangential X-ray pictures. They take the part of the conservative treatment of the injury. In cases of dislocations, that cannot be reduced, of open "palmar plate" injuries and of major hyperextension and dislocations of the broken bone scale, operative treatment is thought necessary. In the treatment of the injuries of the "palmar plate" of the PIP joint they use the so called rein method, that keeps the palmar cartilaginous joint capsule, torn at the injury, on its original place, it enables however the active joint movements, the gymnastics and hinders this way the development of the joint contracture.
Adolescent↗
[Swanson silastic implant arthroplasty in pathology of the metatarsophalangeal joint of the great toe].
Fifty-one disorders of the metatarsophalangeal joint of the Great Toe have been treated by implantation of a Swanson silastic prosthesis. A finger-joint device was used in 29 cases and a Great Toe device in 22 cases. The pathological lesions were degenerative arthrosis, rheumatoid arthritis or failure of preceding procedures. The mean follow-up was 3 years. In more than 2 cases out of 3 pain was abolished. Joint movement was only slightly improved but there was a better range of dorsiflexion and an improved gait. The axis of the Great Toe was generally satisfactory and pre-existing deformity was corrected in 3 cases out of 4. These results are satisfactory in the short term and were better with the Great Toe device. Osteophytic reaction may be the cause of long-term failures.
Arthroplasty↗
Results of treatment of chronic dorsal fracture-dislocations of the proximal interphalangeal joints of the fingers.
We reviewed 20 cases of chronic dorsal fracture-dislocation of the proximal interphalangeal joint, with a mean follow-up period of 74 months. In patients without comminuted palmar fragments, open reduction and internal fixation or osteotomy of the malunited fragment provided good results. In treating patients with damaged articular cartilage or with comminuted palmar fragments by palmar plate arthroplasty, poor results were obtained because of secondary osteoarthritic changes.
Adolescent↗
Gout in the elderly, a separate entity?
To evaluate whether the clinical pattern of gout differed between elderly women and men a retrospective study was performed in all women (22) and men (18) in our rheumatological clinics who developed gout after the age of 60. The diagnosis was made after a mean of 2.6 years of joint complaints in women and after 1.2 years in men. In about half the patients complaints started in more than one joint, often including the big toe. In five women, but none of the men, complaints started in the fingers. No correlation was found between gout and the presence of tophi or Heberden's nodes in the finger joints. The mean uric acid level was higher in women (0.61 mmol/l) than in men (0.53 mmol/l), and almost all the women (95%) used diuretics and only 56% of the men did so.
Age Factors↗
Arthroscopy of the proximal interphalangeal joints of the finger.
Cadaveric studies were carried out to evaluate the technique, portals and possible indications for arthroscopy of the proximal interphalangeal joints of the finger. We suggest horizontal placement of the hand instead of using a traction tower, as it is important to be able to flex the joint freely. The recommended arthroscopic portals are either between the central slip and the lateral bands of the extensor mechanism or between the lateral band and the collateral ligament. A blunt technique of introduction is used to avoid iatrogenic cartilage damage and possible digital nerve injury.
Adult↗
Metacarpophalangeal joint arthroplasty in rheumatoid arthritis: results of Swanson implants and digital joint operative arthroplasty.
We discuss 69 metacarpophalangeal (MP) implant arthroplasties performed in 30 patients with rheumatoid arthritis. The follow-up averaged 5 years. We studied 19 finger joint prostheses by Condamine, digital joint operative arthroplasty (stabilized version; DJOA) and 50 flexible silicone Swanson implants. We used a new comprehensive scoring system to evaluate the MP alloarthroplasties. Such a scoring system incorporates clinical and radiological data. The outcome following MP joint replacement with DJOA was never evaluated as 'good'; in 11 joints the result was 'fair', and in 8 joints, 'poor'. As regards MP arthroplasty with Swanson implants, the results were evaluated as 'good' in 40 joints, as 'fair' in 10 joints, and in none as 'poor'. In our series, DJOA did not provide stability in arthritic MP joints. In all joints replaced with DJOA, dislocation of the articulating surfaces and signs of loosening were present. We regard three factors as being the main causes contributing to the poor outcome of DJOA when used as MP replacements. Firstly, the proximal prosthetic component is poorly matched to the anatomical shape of the metacarpal bone (conisation of the bone). Secondly, adequate coaptation cannot be achieved with this prosthetic design, even in the presence of extensive soft-tissue reconstruction. Thirdly, the use of polyethylene in MP joint replacements is questionable. In contrast, the silicone Swanson implants in our series provided superior results when used as MP implants in the rheumatoid hand.
Adult↗
Arthropathy and cutaneous calcinosis in hemodialysis oxalosis.
Recently, calcium oxalate crystals have been identified in the synovial fluid of patients with arthritis and end-stage renal failure. We describe 4 patients who, during the course of long-term hemodialysis, developed calcium oxalate crystal deposits in the synovium and skin. Clinical manifestations included podagra, tenosynovitis, olecranon bursitis, and acute and chronic synovitis of the large joints that were associated with chondrocalcinosis or subchondral bone erosions. Diffuse involvement of the hand, with chondrocalcinosis of the finger joints, miliary calcified deposits in the skin, and artery calcifications, was observed in 3 patients. The fourth patient had erosive arthropathy. Oxalosis secondary to end-stage renal failure in patients treated with long-term hemodialysis can present with articular manifestations that resemble those of gout, pseudogout, and apatite deposition disease. Other characteristic features of the synovitis associated with oxalosis secondary to end-stage renal disease were: predominant involvement of the hand, mild inflammatory changes in the synovial fluid and synovium, and poor response to administration of nonsteroidal antiinflammatory agents.
Calcinosis↗
[Development of rheumatoid arthritis orthopedics in German-speaking countries].
In the realization that the cause of and thus an appropriate curative systemic therapy for rheumatoid arthritis did not and does not exist, surgical treatment of this usually destructive disease emerged as a major field in orthopedics in collaboration with internists specialized in rheumatology. The establishment of working groups within the scientific society initiated by the German Association for Orthopedics and Traumatology (DGOT) in 1971 to improve efficiency was a decisive factor for the further development in the German-speaking countries. A significant role was played by the fact that the Swiss N. Gschwend from Zurich was entrusted with the formation of the working group. This ensured that other German-speaking colleagues in Austria as well as Scandinavia also had the opportunity to add their input and influence rheumatoid orthopedics to a large extent. The DGOT also supported the creation of the ARO, which was founded as an independent association within the DGOT in 1992. The growth of rheumatoid orthopedics received considerable impetus from the fact that it was recognized in 1981 as the only subspecialty of orthopedics granted equal footing, as was the case for rheumatology in internal medicine. At the start of the 1970s, interest was focused on synovectomy for joint preservation, also with regard to its techniques and the possibility for preventive indications. Influenced by the experience gained from the development of endoprosthetic replacements, arthrodeses for rheumatic patients, e.g., in the region of the shoulder and knee joints, were almost completely ignored. The special field of reconstructive surgery on the hand and wrist employing implantation of finger joints and limited arthrodeses yielded impressive subjective and partially functional improvement for the patients. New impulses in the surgical treatment of foot deformities with joint-saving techniques for toe joints and endoprosthetic reconstruction of the ankle have brought about new trends in rheumatoid orthopedics in the past 10 years. Operative stabilization of cervical instabilities represents a special aspect in the development of rheumatoid orthopedics. Both the differential indication and the surgical technique have changed. The development of magnet resonance tomography and new implants for the cervical spine has played a significant role. Rheumatoid arthritis surgery has shown preference to integrating physical measures including in particular ergotherapy and special hand therapy into local surgical interventions. Functional treatment measures, care of braces and aids, and training in joint protection have become a firm part of the therapeutic concept. It is significant that in the German-speaking countries a treatment plan focused solely on the joints has thus far not gained general acceptance as is the case in Anglo-American countries. Preference is given to working as a team with subspecialties for upper and lower extremities and the spinal column. This guarantees that the priorities of the patients who usually present with multiple joint alterations can be dealt with by one group.
Arthritis, Rheumatoid↗
Elective free vascularized double transfer of toe joint from second toe to proximal interphalangeal joint of index finger: a case report.
Alternatives to the treatment of major injuries to the proximal interphalangeal (PIP) joint include fusion, implant arthroplasty, perichondrial grafting, single autogenous free vascularized transfer, and double autogenous free vascularized transfer. A patient presented a gunshot wound to the index finger with loss of skin and extensor tendon and PIP joint disruption. The finger was reconstructed with a composite free flap of skin and extensor tendon and PIP and distal interphalangeal joints of the second toe. A follow-up of 10 months is presented, which demonstrates PIP joint motion and finger function.
Adult↗
[Subcutaneous profundus tendon rupture--reconstruction or primary arthrodesis].
Subcutaneous rupture of the flexor tendon is not as rare as described. Between 1972-1982 14 patients with ruptured flexor tendons were treated at the accident hospital in Linz. The average age was 34.8 years. In most of the cases we use primary arthrodesis with the Harrison-Nicolle-Peg, because the external fixation is very short and the method gives secure ankylosis or arthrodesis of the distal finger joint.
Adult↗
A crossover clinical trial of piroxicam, indomethacin and ibuprofen in rheumatoid arthritis.
A single-blind, crossover trial was carried out in 24 patients with definite or classical rheumatoid arthritis to compare the effectiveness and tolerability of piroxicam (20 mg once daily) with that of indomethacin (25 mg 3-times daily), ibuprofen (400 mg 3-times daily) and placebo. Each drug was given in random order for a period of 1 week. Pain, joint tenderness and morning stiffness decreased and grip strength increased with piroxicam compared to placebo; no statistically significant difference could be found between piroxicam and the two other active agents. A reduction in joint circumference could not be demonstrated with piroxicam or ibuprofen but most patients did not have reducible swelling in their finger joints. Piroxicam was just as effective as the other two drugs overall, but fewer side-effects were noted with piroxicam.
Adult↗
Simultaneous Bennett's fracture and metacarpophalangeal dislocation of the same thumb in a soccer player.
Double dislocations of finger joints are rare. An unusual case of a simultaneous Bennett's fracture/dislocation ofthe carpometacarpal joint and a dorsal dislocation of the metacarpophalangeal joint of the same thumb, and the management of this injury are reported. The patient had an excellent functional result.
Adult↗
Fingers, hands or patients? The concept of independent observations.
In hand surgery trials, it is often possible to take several measurements from the same patient, because many disorders here affect bilateral or multiple structures, such as the hand itself, the finger joints or the tendons. Most conventional statistical analyses that take place on the level of hands, digit rays or joints rather than patients violate the assumption that observations should be independent. Furthermore, ignoring the multiplicity of data inflates sample size and thus may lead to spurious significance. This article describes three options to deal with such problems. First, the analysis can simply be restricted to only one measurement per patient. Second, a self-controlled design may be advantageous for conditions that usually have a bilateral pattern. Third, complex statistical modelling (involving generalized estimating equations) can be used to analyse all available measurements with adjustment for data dependency.
Controlled Clinical Trials as Topic↗
Double dislocation of both interphalangeal joints in the finger. Case report and literature review.
The authors report a case of traumatic dislocation of both interphalangeal joints of the ring finger in a 29-year-old male patient, an injury sustained while playing soccer football. Reduction was achieved by closed manipulation, followed by splinting in the "intrinsic plus" position. The joints were stable but had not yet fully recovered their mobility at six months follow-up. The authors survey the literature reports on this rare injury.
Adult↗
High-resolution multipinhole single-photon-emission computed tomography in experimental and human arthritis.
OBJECTIVE: To image inflammatory arthritic lesions in experimental arthritis and in patients with arthritis, using a newly developed high-resolution multipinhole single-photon-emission computed tomography (MPH-SPECT) technique. METHODS: Six interleukin-1 receptor antagonist-deficient mice with arthritis of the front and back paws and 2 control BALB/c mice were imaged with MPH-SPECT and scored macroscopically for arthritis. SPECT imaging was performed with a conventional gamma camera upgraded with a pyramidal lead collimator affixed with MPH apertures. All images were reconstructed, and uptake in the paws was quantified in counts/weight and injected activity. To transfer the imaging technique to humans we examined the clinically dominant hand of 6 individuals (3 with established rheumatoid arthritis [RA], 1 with early RA, 1 with osteoarthritis, and 1 healthy control). RESULTS: MPH-SPECT images were high-resolution 3-dimensional tomographic images, which allowed exact localization and quantifiable observation of increased bone metabolism. MPH-SPECT counts of inflamed joints in mice correlated with macroscopic scoring and histologic joint analysis postmortem. In humans, MPH-SPECT images depicted a detailed visualization of tracer accumulation in bony structures of hand and finger joints, and were also capable of imaging increased bone metabolism that had appeared normal with other imaging modalities, e.g., magnetic resonance imaging. CONCLUSION: The MPH-SPECT technique represents a new diagnostic tool in the detection of bone pathology in small-animal arthritis research. Compared with macroscopic scoring, this new method provides a more objective and higher-precision quantifiable measurement of bone reaction, allowing visualization of inflammatory processes of the whole skeleton in vivo. These results suggest that MPH-SPECT may be useful as a diagnostic instrument for monitoring experimental arthritis, with further potential for use in human studies of RA.
Aged↗