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PubMed1993

Stability and constraint of the proximal interphalangeal joint.

The kinematics of the intact proximal interphalangeal joint of 12 fresh cadaver index fingers were measured by means of an electromagnetic tracking system. The specimens were then randomly divided into two groups for ligament sectioning in two different sequences and for testing under lateral stress. Lateral stress of the intact proximal interphalangeal joints produced an average of 5 degrees of adduction and 9 degrees of supination motion throughout the arc of flexion/extension. Maximum lateral angulation was 15 degrees under 1 kg of force (30 N cm) applied at the distal end of the middle phalanx. Joint angulation increased to 20 degrees after total sectioning of the collateral ligament. Joint laxity was greatly reduced in full extension, in full flexion, and when the muscles were loaded. The proximal interphalangeal joint remained stable when one half of the collateral ligament was left intact. The results indicate that lateral stability of the proximal interphalangeal joint is provided primarily by the collateral ligament. When the lateral stress test is normal in proximal interphalangeal joint extension, an additional test in 20 to 30 degrees of flexion should be considered to avoid a false-negative result. Angulation greater than 20 degrees is abnormal and indicates a loss of collateral ligament integrity.

Electromagnetic Phenomena↗
PubMed1978

Digital contracture deformity after implantation of a silicone prosthesis: light and electron microscopic study.

Following the implantation of a silicone tendon prosthesis for reconstruction of a deep flexor tendon, an extensive, dense, contractile fibrosis developed rapidly. The resulting flexion deformity ultimately necessitated an amputation. The amputated specimen was examined by light and electron microscopy. A great many myofibroblasts were seen in the new tendon sheath, which, because of their contractile properties, probably caused the deformity.

Contracture↗
PubMed1995

[Results of flexor tendon repair using the Tsuge technic. Apropos of a series of 95 fingers].

The authors review a series of 76 patients with 95 fingers involved, 66.6% of them occurring in zone II. The core stitch was performed according to the Tsuge technique (type II) combined with a peritendinous running suture. Results based on TAM were excellent or good in 60%, fair in 22%, and poor in 18%. Influencing factors were associated lesions, mainly vascular and lesions in zone II. Rupture occurred in 5% and adhesion in 22% of cases. Providing similar results to those of other techniques published in the current literature, the Tsuge techniques is preferred because it is simpler and faster to perform.

Adolescent↗
PubMed1976

Evaluation of the two-stage flexor-tendon reconstruction in severely damaged digits.

From July 1971 to July 1974, the two-stage tendon-grafting procedure of Hunter and Salisbury was performed in thirty-two severely damaged digits in twenty-five patients. Of these digits, twenty-three fingers and five thumbs could be evaluated for gain in total active flexion (expressed as per cent of preoperative passive flexion) and for gain in total active motion (expressed as per cent of total preoperative passive motion) after follow-ups ranging from six to fifty months. The results for total active flexion were 60.9 per cent good, 21.7 per cent fair, and 17.4 per cent poor, and for total active motion 21.7 per cent good, 56.5 per cent fair, and 21.7 per cent poor. Complications were frequent after both stages and included infection, migration of the rod, and adhesions within the proximal end of the newly formed sheath. Flexion contractures were a significant problem.

Adolescent↗
PubMedDate not supplied

Current practice patterns of flexor tendon rehabilitation.

The rehabilitation of persons with repaired lacerations of their finger flexor tendons requires a precise therapeutic approach. But optimal therapy is often difficult to ascertain, given the plethora of postoperative regimens published in the scientific literature. The purpose of the survey was to describe current and historical practice patterns of therapists rehabilitating intrasynovial flexor tendon repairs. Key elements were identified as surgical suture, protocol, initiation of therapy, frequency of therapy visits, initiation of active motion, discharge protective splint, initiation of resistance, proximal interphalangeal joint flexion contracture, outcomes, rupture, and general attitudes. One hundred and ninety-one therapists completed the survey. Findings suggest that Kleinert-type and Duran-type regimens are widespread. Active finger flexion is initiated at a mean of 18.6 days postoperatively. Nearly 30% of respondents utilize early active finger flexion exercise within the first postoperative week. Current practice patterns regarding the timing of the initiation of key elements vary from those reported in the literature.

Contracture↗
PubMed2003

Evaluation of a high dose to a finger from a 60Co accident.

Electron spin resonance and fluorescence in situ hybridization were used to evaluate the dose to the finger of a worker who accidentally touched a radiotherapy 60Co therapy source in November 1995. In September 1999, the middle finger was amputated. We estimated the dose to the bone of the finger to be 6.4 +/- 0.5 Gy using the electron spin resonance additive dose method and a corrected dose of about 20 +/- 3 Gy could be inferred by translocation analysis in peripheral lymphocytes using the fluorescence in situ hybridization method. This retrospective dosimetry was performed for the victim 4 y after the accident, but the compatibility of the results obtained by physical and biological methods reinforce their validity, although in the case of partial-body exposure the biological method has limitations and demonstrates the need to find appropriate correction factors.

Adult↗
PubMed2003

The usefulness of quantitative ultrasound at the hand phalanges in the detection of the different types of nontraumatic fractures.

The aim of this retrospective study was to determine whether quantitative ultrasound (QUS) at the hand phalanges has the ability to discriminate between individuals without and with different types of nontraumatic fractures. All women (n = 2466) (age range 38-88 years) not affected by metabolic diseases or under treatment with drugs known to interfere with bone metabolism were divided into controls without fractures (n = 1883) and women with nontraumatic previous fractures (n = 583). Fractures were the result of minimal trauma involving a fall from a standing height or less during normal daily activity. Fractured group was divided into subgroups on the basis of the types of fractures: hip, spine, wrist or other fractures. Skeletal status was assessed using the DBM Sonic 1200 (IGEA, Carpi, Italy) which measures the amplitude-dependent speed of sound, Ad-SoS (m/s) in the distal metaphyses of the proximal phalanges of the second through fifth finger of the dominant hand. Women with hip, spine, wrist or other fractures had significantly lower Ad-SoS values than controls (1814 +/- 60 m/s, 1829 +/- 57 m/s, 1870 +/- 64 m/s, 1893 +/- 66 m/s, respectively, vs. 1943 +/- 73 m/s, p < 0.001). Ad-SoS revealed the following areas under the ROC curve: 0.91 +/- 0.027 for hip fracture, 0.89 +/- 0.019 for spine fracture, 0.77 +/- 0.012 for wrist fracture and 0.70 +/- 0.023 for other fractures. By multiple logistic regression analysis, the probability of having fracture, estimated as odds ratio for each 1 SD reduction in Ad-SoS, was: 3.49 (95% CI, 1.57-7.75) for hip, 3.25 (95% CI, 1.94-5.45) for spine, 2.24 (95% CI, 1.86-2.70) for wrist and 1.81 (95% CI, 1.36-2.40) for other fractures. The present study demonstrates the ability of phalangeal QUS to discriminate between subjects with and without different types of nontraumatic fractures. Phalangeal QUS revealed the best sensitivity and specificity in discriminating hip- and spine-fractured patients from controls.

Accidental Falls↗
PubMed2005

Donor site morbidity in cross-finger flaps.

As relevant literature is scarce, this study was undertaken to assess the donor site morbidity of cross-finger flaps. It included 23 patients who had undergone reconstruction of a finger defect with a cross-finger flap. Any additional trauma to the donor finger was an exclusion criterion. Split thickness skin grafts were employed for donor site closure in 13 cases, full thickness skin grafts were used in 10 cases. Follow-up time averaged 83 months. Active and passive total range of motion of the donor finger and maximal pinch grip strength in kilopascals were measured. Both parameters were compared to the corresponding finger of the other hand. The donor site scar was evaluated for instability and pain in the donor finger was determined subjectively with a visual analogue scale. Cold intolerance and the cosmetic appearance of the donor site were also assessed. Active total range of motion of the donor fingers averaged 156 degrees . Average active total range of motion of the contralateral control fingers was 173.6 degrees . There was a significant difference between the donor fingers and the control fingers (p = 0.03) but not between split thickness and full thickness grafted donor sites (p = 0.91). Grip strength was significantly impaired in the donor fingers (p = 0.03), but there was no significant difference between split thickness and full thickness grafted donor sites. Subjective cosmetic evaluation by the patients revealed significantly better results for full thickness grafted donor sites. Donor finger pain averaged 2.4 with a range of 0-8. Five of the 13 patients with split thickness grafted donor sites and two of the 10 patients with full thickness grafted donor sites mentioned cold intolerance. In conclusion, the cross-finger flap is a secure and valuable option. There is, however, significant donor site morbidity. Our results suggest that alternative solutions should also be considered and if a cross-finger flap is employed, donor sites should be closed with full thickness grafts.

Adolescent↗
PubMed2004

A simple fixation method for unstable bony mallet finger.

Closed treatment has provided good results in uncomplicated cases of mallet finger; however, surgical fixation is recommended when there is involvement of more than one third of the base of the distal phalanx. Various techniques have been described for this purpose. The goal of this report is to present a simple method of K-wire fixation and show our results with this procedure.

Bone Wires↗
PubMed2001

[Surgical treatment for boutonniere deformity of the fingers. Retrospective study of 47 patients].

Disruption or laceration of the central slip of the extensor tendon at the proximal interphalangeal (PIP) joint with volar displacement of the lateral bands can result in the so-called boutonniere deformity which includes loss of extension at the PIP joint and compensatory hyperextension of the distal interphalangeal (DIP) joint. Many procedures has been described in the literature and no standard treatment can be recommended. The authors reports a series of 47 cases of posttraumatic boutonniere deformity. The mean follow-up was five years. Majority of patients were males (38 males). The mean age was 41 years-old (17-82 y.o.). The etiology was in 23 cases a missed subcutaneous disruption of the central slip of the extensor tendon and in 24 cases an inappropriate treatment of laceration of the extensor apparatus at the dorsal aspect of the PIP joint. The involved digit was in seven cases the index finger, in 14 cases the long finger, in 14 cases the ring finger and in 12 cases the little finger. It is essential to distinguish the supple boutonniere deformity without or after physical therapy (34 cases) and the stiff boutonniere deformity even after a hand physical therapy program (13 cases). Results were assessed on pain and active range of motion of the PIP joint as well as the range of motion of the DIP joint. Supple boutonniere deformities, except one treated by an isolated distal tenotomy of the extensor tendon (1/34), was treated by a procedure of reconstruction of the extensor apparatus including resection-suture of the central slip and redorsalisation of the lateral bands when there was a DIP hyperextension with a moderate flexion deformity of the PIP joint, and (33/34) with 90% of excellent and good results. Poor results (4/33) were due in two cases to the absence of physical therapy, in one case to septic osteoarthritis and in one to secondary rupture of the suture. For the 13 stiff boutonniere deformities, when the PIP flexion deformity was moderate, a distal tenotomy performed to correct the DIP hyperextension was satisfactory in three cases with a useful result (20 degrees-70 degrees). For destroyed PIP joint (osteoarthritis), two silicone spacers were implanted with also a satisfactory result (30 degrees-70 degrees). In the eight remaining cases, a teno-arthrolysis was performed combined with a reconstruction of the extensor apparatus as described. Six poor results were obtained with arthritic PIP joints (which should have required initially silicone implants), and two fair results (30 degrees-60 degrees) with non-destroyed PIP joints. Supple boutonniere deformity must always be treated by initial physical therapy. Surgical procedure with reconstruction of the extensor apparatus is satisfactory if the PIP joint is normal. When there is PIP osteoarthritis, it may be beneficial to perform a two-stage technique with tenoarthrolysis followed hand therapy and a secondary reconstruction of the extensor apparatus as these last procedure give satisfactory results on a supple boutonniere deformity.

Adolescent↗
PubMed1994

A comparison of post-operative mobilization of flexor tendon repairs with "passive flexion-active extension" and "controlled active motion" techniques.

We report a comparative study of the outcome of flexor tendon repairs mobilized by either a "passive flexion-active extension" or a "controlled active motion" regimen. We show that the controlled active motion regimen conferred significant benefits on the final range of motion and extensor lag. The rupture rate was raised with "controlled active motion" but this was not greater than levels reported by other authors using "passive flexion-active extension" regimens.

Finger Injuries↗
PubMed1983

Fixed post-traumatic flexion-contractures of digits. Review of thirty-three cases.

A fixed post-traumatic flexion contracture of a finger is usually secondary to multiple previous operations. We have observed that a former flexor tendon laceration is not constant and is missing in 18% of our cases. The flexor tendons are, nevertheless, always involved in the contracture. A volar skin contracture was present in all cases, but only in half of them was noted a retraction of the volar components of the PIP joint. This articular involvement has no statistical correlation with the time elapsed from the onset of the contracture. We have reviewed 33 cases of post-traumatic flexions contractures of the digits all secondary to volar trauma. In every case there was at least a flexor tendon adhesion and skin contracture. They have all been submitted to both objective and statistical analysis. Results have been evaluated by comparison between the normal functional range of motion for each digit and the actual post-operative active range of motion. On the basis of our study we conclude that the age of the patient is an important prognostic factor. We obtained 75% satisfactory results in patients younger than 27 years, but only 22% in the older group. Good results are more easily obtained in radial (65%) than ulnar digits (31%). While the authors rated 39% of the results bad, half of the patients in this group were satisfied with the result. A volar PIP joint release has been necessary in half of the cases with no significant secondary joint stiffness. A skin flap is necessary to cover the cutaneous defect secondary to the release. There is no statistically significant advantage to cross finger flaps. Therefore we feel that local flaps are indicated except in the cases where local scar tissues would not make it, feasible. The prognosis is independent of the number of previous operations and of associated nerve lesions. Therefore amputation is not the only solution for a multi-operated finger fixed in flexion.

Adolescent↗
PubMed1955

Injuries of the fingers and hands; a review of cases from the standpoint of compensation.

Review of records in cases of injury to the hand that come before the California Industrial Accident Commission indicate that:1. Primary closure at a suitable level in finger amputations is often preferable to plastic repair.2. Complications incident to plastic repair in minor injuries frequently increase disability and cost to employer.3. Tendon injury resulting from strain is a frequently overlooked cause of disability.

Accidents, Occupational↗
PubMed1998

Anomalous digital nerve loop: a case report.

In this case, a digital nerve loop was observed during the dissection of the digital nerves to the third web space; the common digital artery was passing through this loop. This rare case is presented and its importance is discussed.

Adult↗