[Replantation of small fragments of the distal phalanx of the fingers].
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Adolescent↗
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Functional brace in the treatment of diaphyseal fractures of the proximal phalanges of the last four fingers.
The authors describe a system of functional brace for the treatment of displaced fractures of the proximal phalanx of the fingers. Using four digit syndactylization this technique allows simultaneous stabilisation of the fracture and early active mobilization of the proximal interphalangeal joint, where stiffness is known as the principal impairment after such fractures. Among 14 cases treated by this method, fracture healing has been obtained in all cases with only one significant malunion. No severe stiffness has been observed and active motion at the PIP joint has been in a useful sector of 25 degrees and 75 degrees at least in all cases.
Adult↗
Simple arthrolysis for flexor rigidity of the proximal interphalangeal joint.
The authors report 19 cases of simple arthrolysis of the proximal interphalangeal joint for flexion rigidity. Their cases were limited to isolated lesions of the joint without any flexor or extensor tendon involvement. The technique is described, and the importance of postoperative physical therapy is stressed. The results in these cases, in contrast with those in complicated cases of rigidity, are very satisfactory. The etiology is primarily sprains and dislocations of the proximal interphalangeal articulation, immobilized for too long a time in flexion (in the so-called "functional position").
Combined Modality Therapy↗
Retrospective survey of seventeen toe transfers relation between surgical techniques and functional results.
The functional results of 17 toe transfers (15 second toes, 1 great toe and 1 monobloc second and third toes) are presented: arteries: 16 revascularisations achieved successfully out of 17. Veins: only one re-exploration had to be performed and it was successful. Osteosynthesis: performed in 10 cases with plate and screws, in 5 cases with a single K-wire and in 1 case with a double K-wire. No osteosynthesis was necessary in one case. Uneventful bone healing was always achieved. Tendons: the amplitude of movement at the interphalangeal joints (PIP & DIP) in post-traumatic cases is sufficient to ensure the desired function. In cases of congenital anomaly, however, the mobility of the transferred toe is almost nonexistent and function relies on the mobility of the recipient stump. Nerves: either discriminative or protective sensation was always obtained. Skin: in all cases adequate skin cover was obtained without resorting to a flap. Sequellae at the foot: there are virtually none when the second toe is removed. Various gait impediments occur, however, particularly on uneven surfaces, when the great toe or the monobloc second and third toes are removed.
Bone Plates↗
Homodigital neurovascular island flaps in hand surgery. A study of sixty cases.
The homodigital island flap is a useful technique in problem cases such as distal amputation of the pulp, atrophic or insensative pulp on the index finger or thumb and painful neuromas. In a series of 60 operations preformed by one surgeon with the SOS Main in Strasbourg, we describe the indications for, and results of, several different techniques: unipedical flaps either advanced or "exchanged" and bipedical flaps either advanced or retreated.
Adolescent↗
[Autoplastic foot-to-hand joint transplantations].
Our surgical experience in the field of total and partial foot-to-hand joint transplants has evolved over the past 9 years (1973). In the case of serious traumatic injury of finger joints of the hand, we don't suggest any surgical solution other than that of arthrodesis or arthroplasty of the damaged joint. In our experience joint transplantation is a reconstructive operation of the whole functionality of the injured finger. This operation partially restores the active function of the finger involved and gives both the patient and the surgeon the possibility of an alternative to arthrodesis, arthroplasty or painful instability of the destroyed joint, thus avoiding their characteristic disabilities. The transplantation guarantees a true stability of the joint and in the majority of cases the disappearance of pain. The technique described are the result of our experience in treating our clinical cases which consist of 20 patients treated, over more than 9 years at the Division of Hand Surgery of Traumatologic and Orthopaedic Center of Turin. The total number of transposed joints is 22, 16 of which are hemiarticular grafts. The operations have concerned 8 M.P. and 14 PIP joints of the fingers.
Adult↗
[Palliative operations for correction of claw fingers].
Palliative treatment of palsy of intrinsic muscles of the four fingers classically aims at suppressing claw. But functional restoration is mainly ensured in setting up again the volar flexion, the stage preparing prehension. Three hundred and thirty seven hands have been operated. Each one of the utilized interventions has advantages and drawbacks that have to be known in order to select the best adapted technics, the more or less important stiffness of fingers being the most important criteria. Finally a simple choice is easy and possible, particularly for inexperienced surgeons in the treatment of those paralysis (that become rarer and rarer in the West on account of the success of nervous sutures facing a large number of leprotic hands to operate in endemic countries); it is the metacarpophalangeal stabilization test: the active interphalangeal extension obtained after passive manual stabilization, of metacarpophalangeal joint indicates the degree of proximal interphalangeal residual stiffness, and the indications come in function of these various types of stiffness. Loose PIP joint: residual flexion from 0 degree to 20 degrees: MP capsular shortening, H shaped, and flexor pulley advancement; "Lasso" operation: a single slip of FDS by finger or one FDS for two fingers; Bunnell-Litter's operation: one FDS for 4 fingers; Giraudeau's operation: FCR + fascia lata; Brand's operation: 1st (ECRL) or 2nd (ECRB) + tendon graft; Palande's operation: ECRB + many tailed fascia lata graft fixed at the muscle tendon junction. Stiff PIP Joint: residual flexions from 20 degrees to 60 degrees: modified Bunnell's operation: one FDS for 2 fingers, the FDS of the third used to restaure the opposition; "lasso" operation: one FDS for each finger, or for two fingers. Very stiff PIP joint: residual flexion superior to 90 degrees: proximal interphalangeal joint arthrodesis.
Finger Injuries↗
[Loss of digital tissues and carpal canal syndrome. Apropos of 3 cases].
We have observed three cases of carpal tunnel syndrome (CTS) complicated by cutaneous ulcerations and acroosteolysis. Although our first patient had a mild case of CTS, he had a concomitant amphetamine addition. This led to a mania for gnawing away at the digits in the territory of the median nerve. Our other two patients had severe cases of CTS. One suffered from diabetes and the other from primary amyloidosis. Surgical decompression of the median nerve was carried out in these two cases and led to rapid healing of the cutaneous lesions. The latter patients suffered from the entity known in the french literature as carpal tunnel "ulcero-mutilating" (ulcero-osteolytic CTS). This paper discusses possible mechanisms for its pathogenesis. In one of our cases, for example, we were struck by the role played by the patient's behavioral habits whether it be conscious or subconscious in the self-perpetration of the cutaneous and osseous lesions.
Amyloidosis↗
Mallet fractures.
Contrary to our observations, reports in the literature maintain that only a third of mallet finger deformities are caused by intra-articular fractures of the posterior margin of the distal phalanx. As functional impairment sometimes remains after treatment, there is still much discussion as to the relative merits of conservative and surgical management of this lesion. This article presents 21 cases of mallet finger deformities with fracture of the distal phalanx, of which 17 received surgical treatment. The operative technique is described, followed by a discussion of the results.
Adolescent↗
[Blocked metacarpophalangeal joint: etiologic factors and treatment].
The metacarpo-phalangeal is a crucial joint and its stiffness deeply affects hand function. A series of 15 post-traumatic cases resulting in a complete and irreversible block of the joint is presented. Indication for joint release are given and the surgical technique is described. Different approaches are utilized in relationship to associated lesions. Post-operative treatment and percentages of improvement in joint excursion for each digit are reported. All working patients resumed the previous job even in presence of a limited articular gain. Best results where confined uncomplicated post-traumatic cases with crushing of surrounding soft tissues.
Adolescent↗
[Is it necessary to continue to reimplant all or part of the terminal phalanx of the finger? Apropos of a homogenous series of 38 cases (35 patients)].
The authors present their experience with the very distal reimplantations: an homogenous series of 38 cases is presented. G. Foucher at SOS Mains Strasbourg showed this technique to the authors in 1980. The authors present their technique, which is adapted with the level of distal amputation, then their postoperatively attitude is presented in detail, particularly for "the bleeding maintained" and for the iterative surgery when necessary. Then the failures are precised. Finally functional results are studied: mobility is often good, sensibility is precised with the Weber test, cold pain is frequent, stop of work average is two months. Finally unsatisfactory nail and distal tip are precised.
Amputation, Traumatic↗
Osteotomy of the metacarpals and phalanges stabilized by AO plates and screws.
Although digital or metacarpal nonunion with resultant functional disability of the hand is encountered often enough that corrective osteotomy becomes a consideration, many surgeons are reluctant to attempt osteotomy in the hand. This reluctance is reflected in the sparse number of cases reported in the literature. Since the effectiveness of AO plates and screw fixation for acute phalangeal and metacarpal fractures is well established, it seems logical to perform osteotomies in phalanges or metacarpals and stabilize them in the same fashion. We have reviewed 36 such osteotomies from the files of the AO Documentation Center. The osteotomies were done through either phalanges or metacarpals to correct angulation and/or rotary malunion, and yielded twenty-three very good, eight good and five poor results, or an overall satisfactory result rate of 86%. All osteotomy sites healed and the poor results reflect persistent deformity or limited adjacent joint motion. Thus, it appears that previously expressed pessimism regarding potential non-union or joint stiffness following phalangeal or metacarpal osteotomy is not warranted in angular and/or rotational osteotomy in the hand can yield satisfactory results in a very high percentage of patients.
Adolescent↗
[Value of Swanson implants in complex traumatic lesions of the proximal interphalangeal joint].
The authors report the results of 30 Swanson implants, inserted immediately, or secondarily in complex trauma of the proximal interphalangeal joint of long fingers in 24 patients (19 men, 5 women). All patients were reviewed by the same examiner with a mean follow-up of 7 years (range: 17 months-17.2 years). All implants were inserted secondarily after the accident, except in 7 cases in which the local conditions led the operator to insert the implant immediately. At review, 20 implants were still in place, 6 patients had requested amputation, and arthrodesis had been performed in 4 cases. The mean range of movement was -13,4 degrees to 37 degrees, i.e. a mean amplitude of 23.6 degrees. The lateral stability of the operated finger was considered to be satisfactory in 50% of cases, and the patient was satisfied with the operation in 65% of cases. The authors consider that useful mobility of the proximal interphalangeal joint should be preserved whenever possible. The Swanson implant is currently a useful alternative to amputation or arthrodesis, especially as it does not compromise these procedures if they are required subsequently.
Adult↗
Double armed reinsertion suture (DARS) of the profundus flexor tendon with immediate active mobilization of the finger. 63 cases.
Between 1982 and 1994, the authors performed 63 flexor digitorum profundus tendon reinsertions according to the "lost-suture" DARS method (double armed reinsertion suture). This technique consists of 2 Bunnell sutures fixed to the lateral and anterior parts of the cut surface of the tendon. Nylon suture material is passed through a transverse hole made in the base of the distal phalanx. Active flexion without resistance is commenced postoperatively. A similar limit to extension is only applied in the case of an associated lesion if the neurovascular pedicle. Forty tendons were reviewed for this study (patients between the ages of 7 and 75 years, 35 males for 5 females). The lesion involved the thumb in 13 cases and long fingers in 27 cases. According to the authors' criteria, the results were scored as excellent 20% (8 cases); good 70% (28 cases); poor 10% (10 cases). The "lost-suture" DARS technique is a simple method which allows immediate active mobilization of the finger and appears to guarantee satisfactory functional results with no risk of tendon rupture.
Adolescent↗
Treatment of recurrent digital scar contracture in paediatric patients by proximal phalangeal island flap.
Despite adequate medical treatment, digital palmar burn scar contractures can still occur in children. Surgical treatment basically consists of scar release and skin grafting or Z-plasty. However, recurrence of deformity can occur, especially in children. Ten children with recurrent digital contractures were operated. The palmar scars were released and the defects covered by proximal phalangeal island flap. All flaps survived completely and no recurrence was observed, even 5 years after surgery. These promising results encouraged us to propose proximal phalangeal island flap as first choice in the treatment of recurrent digital scar contractures in paediatric patients.
Burns↗
Irreducible dorsal dislocation of the interphalangeal joint of the thumb due to the palmar plate. A case report.
Dorsal dislocation of the thumb interphalangeal joint is rare. Only very few cases of irreducible dislocation has been reported at this joint. The authors report a case of compound irreducible dislocation due to the palmar plate interposition. The sesamoid, the flexor pollicis longus have been reported to block reduction of the dorsal dislocation of the thumb interphalangeal joint doctors on casualities should not insist if reduction is not easily obtained, the patient should then be guide towards a surgical team for surgical treatment.
Adult↗
Understanding the perionychium.
The fingernail and toenail are unique to primates. The anatomy and physiology of the nail must be understood for nail care to be effective. The most common cause of deformity of the nail bed is trauma, which requires careful suturing and postoperative care if the desired results are to be achieved. Congenital anomalies, tumors, and infection can also cause nail deformities and can frequently be corrected or improved surgically.
Carcinoma, Squamous Cell↗
A flexion contracture splint for the distal interphalangeal joint: distal interphalangeal joint flexion contracture splinting.
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Contracture↗