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At least 1,045 records · Page 58Linked to original sources
PubMed2000

[Plastination histologic investigations on the inserting pars terminalis aponeurosis dorsalis of three-sectioned fingers].

With the help of thick transparent cross-sections of fingers, manufactured by plastination histology, it has been shown that fibres of the extensor aponeurosis insert not only the way described in current textbook on the basis phalangis distalis and on the capsule of the distal interphalangeal joint. Our studies prove that parts of the dorsal extension plate insert dorsally to the nail matrix and others run over the edge of the basis phalangis to the proximal part of the diaphysis where they intermingle with the periost of the phalanx.

Dissection↗
PubMed2001

[Tension force in dynamic splints made of neoprene].

Dynamic splints are the most difficult ortheses to make. Unrestricted finger joint mobility is usually prevented by the size of their components. Ortheses made out of neoprene material have the advantage of being pliable and at the same time can be constructed as dynamic splints. Neoprene material elasticity allows conforming it into a tube that can be fitted over a finger, spreading uniform pressure. A traction slip can be cemented to the neoprene finger tube. With neoprene splints, lever arms are more efficient. Their tubular design applies and spreads traction and countertraction forces in all directions. Neoprene material's elasticity contributes in reducing edema formation as well as distributes forces applied to the finger over a large area. The risk of excessive pressure is the only drawback of an elastic tubular design, it may cause pain and tissue ischemia. A meticulous tailoring prevents this potential risk.

Biomechanical Phenomena↗
PubMed2001

Effect of local cold provocation on systolic blood pressure and skin blood flow in the finger.

Demonstration of increased vascular cold reactivity in patients with Raynaud's syndrome is difficult. For medico-legal reasons, it is important to get objective measures of vasospasm in these patients. Evaluation of the degree of vasospasm also provides prognostic information which is useful for patient management. In this study, we compare two methods of arterial circulation measurement. The laser Doppler scanning is a new method, which uses the recently developed laser Doppler perfusion imaging (LDPI) instrument. The aim of the present study was to compare the effect on finger skin blood flow measured with LDPI with changes in finger systolic blood pressure during local cold provocation. The effect of such provocation, skin blood flow and systolic blood pressure, were studied in 15 healthy controls. Six patients with known traumatic vasospastic disease (TVD) were also tested with both methods. Finger skin blood flow was measured with LDPI on the distal phalanx of the index finger of the left hand, every minutes during 6 min of local heating at 40 degrees C followed by local cooling for 3 min at 15 degrees C and then for 3 min at 10 degrees C. Finger systolic blood pressure was measured with strain-gauge method before and after local cooling to 10 degrees C with a cuff perfused with water of desired temperature. The test was performed in the same finger within a week of the laser Doppler scanning. Local finger cooling to 15 degrees C and 10 degrees C caused a significant decrease in blood flow, most marked at 10 degrees C. There was, however, no correlation between the decrease in blood flow and blood pressure. In the TVD-patients decreases in skin blood flow were similar compared with the healthy controls. In contrast, the changes in systolic blood pressure, were outside normal range (systolic quotient <0.65) in five of the six patients (83%), and also in 11 of the 15 healthy controls (73%). In conclusion, there is no correlation between the decrease in finger skin blood flow and systolic blood pressure during local cold provocation. For diagnosis of traumatic vasospastic disease (TVD), local cold-induced changes in finger systolic blood pressure seems superior to changes in skin blood flow, but the ideal clinical method for demonstrating increased cold-induced vasospasm is, however, still lacking.

Adult↗
PubMedDate not supplied

Knuckle pads: does knuckle cracking play an etiologic role?

Very little has been published on knuckle pads and the cosmetic and psychological effects they can have. In children, most knuckle pads are considered to be idiopathic; however, familial cases as well as those caused by trauma have been described. We report a 14-year-old African American girl with a 3-year history of slowly enlarging hyperkeratotic nodules over multiple finger joints and on the lateral aspects of several fingers. These lesions were initially confined to the patient's left hand but subsequently involved the right hand. The patient and her mother denied any unusual hobbies or sports in which the patient's fingers might be traumatized. The patient, however, was noted to crack her knuckles during her clinic visit. To the mother's surprise, the patient admitted to doing this quite frequently on a daily basis. A diagnosis of knuckle pads was made and confirmed histologically. To our knowledge, this is the first reported case of knuckle pads with cracking of the knuckles as the possible etiology.

Adolescent↗
PubMed1999

Arterial anatomy and clinical application of the dorsoulnar flap of the thumb.

After injection of stained latex at the brachial artery, the arterial supply of the dorsal aspect of the thumb was studied by light microscopy in 25 cadavers. An artery, located on the dorsoulnar side and connecting the head of the first metacarpal with the dorsal arcade of the proximal nail fold, was found in all dissections. We report the results of the anatomic study and the clinical applications of a dorsoulnar skin flap that can be raised on its artery with a distal pedicle. Clinical experience is based on 32 flaps. In 25 cases this flap was used for distal skin loss coverage (palmar or dorsal) of the thumb as an island flap. In 7 cases it was used for reconstruction of the finger pulp (5 index and 2 middle fingers) in the form of a cross-finger flap.

Cadaver↗
PubMed1999

Early protected motion after extensor tendon repair.

Thirty hands with 50 extensor tendon lacerations, excluding mallet finger injuries, were examined. They were treated with surgical repair followed by immediate motion which included a dynamic splinting and tendon mobilization program. The average follow-up period was 7 months (range, 8 weeks to 2 years). Forty-five of the 50 tendons regained full range of motion (average total active motion, 262 degrees) within an average time of 9 weeks; the remaining 5 tendons had extension lags of < or = 10 degrees. All patients regained at least 93% of their predicted normal strength within 9 to 12 weeks and returned to their previous level of activity in an average of 10 weeks. These results, which include complex lacerations, are an improvement from previously published data. This is probably due to the addition of a tendon mobilization program to dynamic splinting following extensor tendon repair.

Adolescent↗
PubMed1999

Proximal interphalangeal joint silicone arthroplasty for posttraumatic arthritis.

The long-term results of 16 silicone implant arthroplasties following severe destruction of the proximal interphalangeal joint and surrounding soft tissue in 14 patients were evaluated. Two implants were revised (1 arthrodesis and 1 amputation) and are not included in the results. On a visual analog scale of 0 to 100, the subjective evaluation relating to the quality of function and the ability to perform activities of daily living scored 73 on average (range, 0-100; median, 75). The range of active motion compared with the opposite side ranged from 0% to 100% (average, 47%; median, 56%). The lateral deviation, either radial or ulnar, averaged 4 degrees (range, 0 degrees to 9 degrees; median, 4 degrees). Rotational deformity, either radial or ulnar, averaged 8 (range, 0 degrees to 32 degrees; median, 4 degrees). Pinch strength of the operated finger on average was 75% of the opposite nonoperated finger (range, 14% to 164%; median, 70%). Possible statistical correlation between objective and subjective results was evaluated. Subjectively, most patients were satisfied because they were pain free. Objectively, notable rotational deformity, alignment deviation, and loss of pinch strength and range of motion were observed, but these did not correlate well with the subjective assessment. Silicone implant arthroplasty for posttraumatic arthrosis should be used for those cases in which associated adhesions may be corrected by simple tenolysis, allowing for active range of motion shortly following arthroplasty. Even in these cases, the objective results of silicone arthroplasty may not be as good as its subjective outcome.

Adolescent↗
PubMed1999

Portable mini-fluoroscopy improves operative efficiency in hand surgery.

A paired case cohort study was performed using retrospective review of operative times for defined hand surgical procedures in an attempt to quantify efficiency with and without the use of portable fluoroscopy. Patients included in the study underwent 1 of 4 defined surgical procedures controlled to ensure similar operative technique (total wrist fusion, in situ 4-corner fusion, closed reduction/internal fixation using K-wires of phalangeal shaft fractures, and metacarpophalangeal or interphalangeal joint fusions using K-wires). One group used intraoperative standard film radiographs and the other used portable mini-fluoroscopy to examine hardware placement. Both groups were paired by operative procedure to eliminate procedure bias on overall operating time. Analysis demonstrated a 38% reduction in total operative time in the group using portable mini-fluoroscopy compared with standard intraoperative radiographs.

Arthrodesis↗
PubMed2000

Microvascular skin response to local cooling and body tilt early after digital replantation.

To elucidate the alteration in cutaneous microvascular reactivity early after replantation (14-21 days), laser Doppler (LD) flow changes evoked by direct and indirect local cooling and head-up body tilt were studied in the replanted digits (n = 10) and compared with those evoked in the healthy contralateral digits of the same patients (n = 10). During the first 3 minutes of direct cooling of the injured hand, LD flow increased significantly compared with the LD flow before cooling, which confirms that moderate vasodilation is the dominant component of the response to local cooling in skin microcirculation in the early period after replantation. During body tilt, LD flow in the healthy contralateral digit decreased significantly in only the first minute, while LD flow in the replanted digit started to decrease in the second minute after tilting; the decrease was significant from the third to the sixth minute. These results are consistent with the hypothesis that increased human skin alpha-adrenergic receptor sensitivity may be present as early as 2 to 3 weeks after replantation.

Adolescent↗
PubMed2000

Experience with the pedicled latissimus dorsi flap for finger reconstruction.

The pedicled latissimus dorsi flap was used for the reconstruction of finger function in 12 patients with severely disabled hands. The fascial origin of the muscle was sutured directly to finger flexors in 6 patients, and to extensors in the other 6 patients in the forearm without severing the neurovascular pedicle. Voluntary contraction of the muscle was obtained in all patients. Useful tendon gliding was achieved in 6 patients, thereby providing total active motion of fingers of >100 degrees. In the remaining 6 patients, however, several problems such as stiff finger joints prevented appropriate tendon gliding, resulting in total active motion of <60 degrees. When these problems are overcome, the pedicled latissimus dorsi muscle can yield satisfactory excursion for extrinsic tendons of the fingers. In contrast to free muscle transplantation, early and predictable recovery of function can be obtained using this particular technique without any risk of denervation of the muscle.

Adolescent↗
PubMed2000

Osseointegrated finger prosthesis: An alternative method for finger reconstruction.

Three patients had traumatic amputation of the index and middle fingers at the base of the proximal phalanx. A 2-stage reconstruction procedure with osseointegrated titanium implants was performed in each patient to fix a finger prosthesis to the proximal phalanx. The first stage included implantation of the titanium fixture into the medullary canal of the proximal phalanx. After a 3-month rest period to allow the fixture to firmly osseointegrate with the proximal phalanx, a skin-penetrating abutment was placed on top of the fixture, to which the prosthesis was firmly attached. The follow-up period ranged from 16 to 24 months. There were minimal skin problems. Some tactile sensibility, better motor function, and good cosmetic results were achieved. (J Hand Surg 2000; 25A:86-92.

Adolescent↗