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At least 865 records · Page 48Linked to original sources
PubMed1993

Index transposition after resection of the long finger ray.

Ten patients underwent index-to-long-finger ray transposition for repair after resection of the long finger ray. Care was taken to preserve the second web space and prevent painful neuromas. Rigid internal fixation was achieved with a T plate, and mobilization was started immediately. There were no nonunions. Postoperative motion was equal to preoperative motion in acute cases and equal or better in chronic cases. Mean grip strength was 0.65, and pinch strength was 0.78 compared with the uninjured hand. There were no painful neuromas, hypersensitive scars, or deterioration of monofilament or two-point sensibility. The breadth and appearance of the first and second web spaces were equal bilaterally. Digit alignment and rotation were normal. The six patients receiving worker's compensation returned to work in between 3 and 24 weeks, and the other patients returned in between 11 days and 12 weeks.

Acute Disease↗
PubMed1994

Arthrodesis of the proximal interphalangeal joint of the finger: comparison of the use of the Herbert screw with other fixation methods.

We report a retrospective review of 224 proximal interphalangeal joint arthrodeses in the digits using Herbert screws (37), Kirschner wires (100), tension band wiring (69), plates (11), and other miscellaneous techniques (7) for fixation. Average time to clinical union was 7 weeks and time to radiographic union was 10 weeks. Nonunion occurred in 31 cases (24 digits). The primary nonunion rate was highest in psoriatic arthritis, intermediate in rheumatoid arthritis, lower in acute trauma and post-traumatic reconstruction, and nonexistent in osteoarthritis. The primary nonunion rate was highest using Kirschner wires, intermediate using tension band wires, and lowest using Herbert screws. All Kirschner wires, six tension band wires and one Herbert screw were removed after fusion. The Herbert screw provides secure fixation, is easy to insert, and affords a rapid and reliable arthrodesis at the proximal interphalangeal joint.

Arthrodesis↗
PubMed1994

Free and island vascularized joint transfer for proximal interphalangeal reconstruction: a series of 27 cases.

Twenty-seven vascularized joints were transferred in 26 patients for proximal interphalangeal joint reconstruction: 7 heterodigital island, 7 homodigital island (distal to proximal interphalangeal), 2 free heterodigital, and 11 free second toe proximal interphalangeal. With a mean follow-up period of 37 months, mean active range of motion of heterodigital island joint was 56 degrees (mean extensor lag, 21 degrees), excepting one failure ending with an arthrodesis. Four complications occurred in the homodigital island joint series: one sepsis, one nail dystrophy, one failed distal arthrodesis, and one bone abutment in flexion. Excluding the sepsis, mean active final range of motion was 52 degrees after a mean follow-up period of 18 months. The two free heterodigital joints had 80 degrees and 65 degrees of motion. The worst results occurred in the free second toe proximal interphalangeal joints transferred, with a mean active range of motion of 33 degrees (mean extension lag 39 degrees). The main advantages of these techniques are a compound tissue transfer, rapid bone healing, good lateral stability, growth potential, and long-term cartilage preservation.

Adult↗
PubMed1990

Epinephrine-induced vasospasm reversed by phentolamine digital block.

A case of profound digital vasoconstriction caused by the accidental injection of epinephrine from a commercial bee sting kit is reported. One hour later the patient had a cold, painful, blanched finger. A digital block using a 2-mg dose of phentolamine mixed with 2% lidocaine was performed. Thirty minutes after treatment, the finger was pink and warm. The patient reported a marked decrease in pain. Reexamination 12 hours later showed only mild tenderness at the fingertip. No tissue necrosis occurred. One month after injection, there were no apparent sequelae. Although the use of alpha-adrenergic blocking agents by regional infiltration to treat accidental infusion or extravasation of epinephrine has been suggested, no reports of this technique are found in the emergency medicine literature. The mechanism of digital vasoconstriction and the action of phentolamine are discussed.

Accidents↗
PubMed1995

Removal of a hardened steel ring from an extremely swollen finger.

For several years various authors have discussed the removal of rings from swollen fingers. Removal normally has involved cutting the ring, but nondestructive methods of removal using string frequently have been recommended as well. A case is reported of a patient who presented with a hardened roller bearing on an extremely swollen index finger, which defied all attempts at removal by previously successful methods. A new yet simple method was developed that eliminated the edema and permitted the removal of the hardened ring. The entire finger distal to the ring was wrapped with a tight, elastic band that reduced the edema and freed the ring. Evaluation of the progress of the edema reversal was permitted by using a blood pressure cuff as a tourniquet. The blood pressure cuff, which was used while the elastic band was removed, prevented the refill of the tissue while the finger was examined. Four sessions of compression lasting approximately 10 to 15 minutes each with the elastic band were necessary to eliminate the edema and release the ring. The ring was finally removed utilizing a short piece of string to ease it over a small laceration.

Adult↗
PubMed2004

Primary use of the index finger for reconstruction of amputated thumbs.

Seven cases of primary reconstruction of traumatic amputation of the thumb using the index finger are reported. In six cases, the reconstruction was done using an injured index finger, while in one case where the amputation of the thumb was through the carpometacarpal joint, an intact index finger was primarily pollicised. This reduces cost of treatment, hospitalisation period and allows earlier rehabilitation without a period of a 'no thumb experience'. We have followed all the patients for a minimum period of 2 years and all of them have excellent functional results. We believe that pollicisation of a normal index finger, if thumb amputation is through the carpometacarpal joint or an injured index finger at the time of initial management of a severely traumatised hand with thumb amputation is an excellent technique for thumb reconstruction.

Accidents, Occupational↗
PubMed2006

Microvascular soft tissue reconstruction of the digits.

INTRODUCTION: Composite tissue loss to digits following trauma may require flap coverage. Local reconstruction techniques are popular but can result in a functional limitation at the donor site. Small free flaps though complex, may provide a superior alternative. METHOD: We retrospectively reviewed the case-notes of all patients who had a small free flap to a digit following trauma. The time period was 4 years (2000-2004). Sixteen patients with 18 digital free flaps were identified. These comprised of 10 venous flow-through flaps, one lateral arm flap, one great toe to thumb pulp transfer, three first web space flaps from the foot, one medial plantar flap and two free posterior interosseous flaps. All 16 patients were invited for clinical review at an out-patients clinic. Ten patients (11 flaps) attended follow-up. Standardised assessment of outcome in terms of scar quality at both the recipient and donor sites, sensibility, range of motion and function of the hand was completed. RESULTS: Overall the average follow-up period was 14 months, with 16 out of 18 flaps surviving. Of the patients that attended for clinical review, the majority recovered excellent function of the hand (quick-DASH--av. 5.7) with satisfactory aesthetics, minimal pain or limitations in range of motion. The flaps were all soft and durable. Ten flaps recovered protective but not discriminative sensation (only one flap was innervated). The three patients whose donor site was the first-web space of the foot developed significant hypertrophic scarring. CONCLUSION: Small free flaps provide an acceptable method of reconstructing digital defects. Venous flow-through flaps provided the best overall results in this series. The donor site for first-web space flaps is probably unacceptable.

Adolescent↗
PubMed2006

Fractures of the phalanges and interphalangeal joints in children.

Phalangeal fractures in children are common, and conservative treatment leads frequently to a good functional outcome. Articular or displaced fractures require early re-cognition and special attention, including surgery. In children, remodeling occurs primarily in the sagittal plane, and rotational deformities are often unacceptable.

Casts, Surgical↗