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At least 1,063 records · Page 59Linked to original sources
PubMed2001

The palmar pocket method: an adjunct to the management of zone I and II fingertip amputations.

In 1979 Brent reported a new replantation method, without vascular anastomosis, that used a subcutaneous pocket. Brent chose the contralateral chest wall as a pocket site, but in other clinical reports, the abdominal wall was used. For both sites there were complications such as stiffness in the wrist, elbow, and shoulder joints and anxiety about pulling out the pocketed finger. To overcome these problems, we chose the ipsilateral palm and named this method the palmar pocket method. We used this method in 16 cases in which a digit other than the thumb had been amputated between the tip and lunula. In 13 cases the method was completely successful, and in 3 cases there was a small area of tip necrosis. The palmar pocket method is a simple and reliable operation for fingertip reattachment and more comfortable for patients than pocketing in the chest wall or abdominal wall.

Amputation, Traumatic↗
PubMed2001

The adipofascial turnover flap for coverage of the exposed distal interphalangeal joint of the fingers and interphalangeal joint of the thumb.

The adipofascial turnover flap was used to cover exposed distal interphalangeal joints of 8 fingers and interphalangeal joints of 4 thumbs. The flap was raised from the dorsum of the injured digit with a base located at the edge of the defect. The flap has a random type of vascularity and was designed with a base-to-length ratio of 1:1.5 to 1:2. All flaps survived completely. Various other types of flaps that have been used to reconstruct dorsal digital skin defects were reviewed and compared with the adipofascial turnover flap.

Accidents, Occupational↗
PubMed2001

Fingertip replantation using a single volar arteriovenous anastomosis and drainage with a transverse tip incision.

Four cases of fingertip replantation using a single volar arteriovenous anastomosis and drainage with a transverse tip incision are reported. Because of lack of suitable arteries for anastomosis in the amputated finger, in each case a volar radial vein was anastomosed to the proximal digital artery and external drainage was performed through a transverse tip incision. In 3 cases the replanted fingertip survived completely; partial necrosis occurred in 1 case. Because veins are more superficial and larger than arteries, they are more available for anastomosis. The results indicate that this method is a useful alternative in fingertip replantation.

Adult↗
PubMed2002

Historical perspective of finger joint motion: the hand-me-downs of our predecessors. The Richard J. Smith Memorial Lecture.

Understanding the mechanics of human dexterity requires an appreciation of the kinetic chains that comprise the hand and the intricate interplay of muscles and ligaments that control its movements. Some of the salient contributions to this field are described from a personal point of view in the hope that this perspective will stimulate further understanding of this unique human tool.

Finger Injuries↗
PubMed2003

Treatment of chronic, traumatic hyperextension deformities of the proximal interphalangeal joint with flexor digitorum superficialis tenodesis.

PURPOSE: To our knowledge, there are no reports in the literature regarding treatment of chronic, posttraumatic proximal interphalangeal (PIP) joint hyperextension deformities with flexor digitorum superficialis tenodesis. The purpose of this study was to describe the surgical treatment and results of flexor digitorum superficialis tenodesis for the treatment of chronic, posttraumatic PIP joint hyperextension deformities. METHODS: Twelve patients were reviewed retrospectively and re-examined at a mean follow-up period of 35 months (range, 6-108 mo). Evaluation included completion of a Disabilities of the Arm, Shoulder, and Hand questionnaire and range of motion (ROM) measurements. RESULTS: There were 5 excellent, 5 good, and 2 fair results. Five patients had a residual flexion contracture at the PIP joint of 5 degrees to 15 degrees, although this did not create any functional impairment as determined by responses to the Disabilities of the Arm, Shoulder, and Hand questionnaire at follow-up evaluation. The 2 patients with fair results had postoperative PIP flexion contractures of 30 degrees and 60 degrees. All 12 patients returned to their previous occupations and recreational activities. CONCLUSIONS: Flexor digitorum superficialis tenodesis is an effective method with predictable results for the treatment of chronic, traumatic hyperextension deformities of the PIP joint.

Adult↗
PubMed2003

Long-term results of free vascularized second toe joint transfers to finger proximal interphalangeal joints.

PURPOSE: To review the long-term clinical results of free vascularized second toe joint transfers for severely damaged finger proximal interphalangeal (PIP) joints. METHODS: Eleven joints in ten patients (1 woman, 9 men) were reviewed between 10 and 22 years after surgery. The average patient age at the time of the surgery was 32 years. Patients were evaluated at a mean follow-up time of 15 years; evaluation included range of motion of the transferred PIP joints and the remaining healthy second toe PIP joints, grip strength, finger and toe pain, finger function, gait disturbance, patient satisfaction, and x-ray changes. RESULTS: The mean active range of motion was 47 degrees that lacks 41 degrees extension and flexes to 88 degrees. The mean grip strength was more than 80% that of the nonaffected hand, and no finger pain or gait disturbances were reported. All patients had some extension lag and flexion contractures but most were satisfied with the clinical and functional results of surgery. In all joints, the joint spaces were preserved, although 1 patient had arthritis and 3 had osteophytes. CONCLUSIONS: It is important to prevent extension lag and flexion contracture to get better results from free vascularized second toe joint transfers. The transferred toe PIP joint is durable.

Adult↗
PubMed2000

Reconstruction of pulp defect using a free finger-pulp flap from an excised extra digit.

We present a case of a post-traumatic finger-pulp reconstruction in which we used a free finger-pulp flap elevated from the excised extra digit in a patient with coincidental polydactyly of the thumb that had not been previously corrected. It resulted in satisfactory reconstruction of the defect with a well-padded, sensitive fingertip (static two-point discrimination of 3 mm) and excellent cosmetic appearance with the simultaneous correction of the polydactyly.

Adult↗
PubMed1999

Arthroplasty of the proximal interphalangeal joint using the Sutter implant for traumatic joint destruction.

We report the functional results in a series of 21 Sutter arthroplasties for post-traumatic arthritis with an average follow-up of more than 2 years. The dorsal approach was used in every case. Pain was always present preoperatively and mobility was reduced to an average range of motion of 15 degrees. Postoperatively, pain was absent in 18 cases. The average active range of motion was 55 degrees. There were two fractures of implants. Although the follow-up is limited, the Sutter arthroplasty has given results that are similar to, or better than, those reported for other techniques.

Adolescent↗
PubMed2000

Survival factors in digital replantation: significance of postoperative anaemia.

Two hundred and fifty-two consecutive digital replantations and revascularizations in 201 patients were retrospectively reviewed to determine factors influencing survival. Children under 9 years of age, women, complete amputations, blood transfusions and secondary thrombectomy were poor prognostic factors. In addition, low haemoglobin and haematocrit levels during the postoperative period were associated with a higher failure rate. Inappropriate use of anticoagulants and excessive postoperative anaemia should be avoided following replantation.

Adult↗
PubMed2001

Metacarpal and phalangeal lengthening by callus distraction.

Twelve metacarpals and two phalanges in 14 patients (nine males and five females) were lengthened between August 1992 and March 1999 by the callus distraction technique using a small external fixator (Orthofix). The indications were traumatic amputation (10 cases), aplasia (three cases) and hypoplasia owing to premature epiphyseal closure of the metacarpal (one case). All patients were reviewed with a median follow-up time of 39 (range, 9-88) months. The median age of the patients was 15 (range, 4-39) years. The median lengthening was 21 (range, 13-34) mm which was a median of 82% (range, 38-162) of the original bone length. The median times for callus distraction and consolidation were 4.5 and 7.5 weeks respectively. All except one patient tolerated the procedure well and were satisfied with the results. Functional improvement was seen in 13 out of 14 patients, but non-union was observed in one patient.

Adolescent↗
PubMed2001

Transthecal digital block at the proximal phalanx.

This study assessed the efficacy of a modified transthecal digital block. Three-hundred-and-sixty consecutive digits were anaesthetised with this technique for the treatment of fractures, infections and foreign bodies. Complete palmar and dorsal anaesthesia was achieved in 357 of the 360 digits (99%), including 52 of 53 thumbs (98%). The technique was extremely easy to perform and no complications occurred.

Finger Injuries↗
PubMed2001

Type 5 avulsion of the insertion of the flexor digitorum profundus tendon.

Four cases of avulsion of the insertion of the flexor digitorum profundus tendon with an osseous fragment are presented. In each case, there was another significant fracture of the distal phalanx. The current classification system for flexor profundus avulsions is reviewed and an extended classification is offered which considers such avulsions.

Adult↗
PubMed2002

Condylar advancement osteotomy for correcting condylar malunion of the finger.

Unicondylar fractures of proximal and middle phalanges of the finger can unite with intra-articular malunion, which may result in joint pain, stiffness and deformity. There is currently no satisfactory technique of corrective osteotomy for these fractures. Extra-articular osteotomies often do not give good results and existing techniques of intra-articular osteotomy through the healed fracture site are technically difficult due to the small bone fragment, difficulty achieving stable fixation and the risk of avascular necrosis. We propose a different method of intra-articular correction with a longitudinal osteotomy and advancement of the malunited condyle. The "condylar advancement osteotomy" can overcome problems encountered with the other techniques. Excellent results were obtained in six patients.

Adolescent↗
PubMed2002

Modified "on-top-plasty" technique for restoring length to amputation stumps.

Five patients were successfully treated with a modified "on-top-plasty" technique, in which a finger stump is lengthened by transfer of an adjacent amputation stump with a reverse blood flow fingerstump. This technique can be performed in the acute phase or as a secondary procedure. A conventional on-top-plasty can be performed by transfer of a partially amputated index or ring finger to the "top" of the proximal phalanx of an amputated middle finger. Alternatively, the transferred part may be used in an intercalated fashion to reconstruct the middle phalanx, using a prosthesis to reconstruct the proximal interphalangeal joint. The results, complications and disadvantages of the technique are reported. We propose this procedure for the reconstruction of the middle ring finger when a free microneurovascular toe-to-hand transfer is contraindicated or refused by the patient.

Adult↗
PubMed1999

[Dorsal intra-articular end-phalangeal fractures].

In a retrospective clinical study, thirty-six patients with a dorsal intraarticular fracture of the DIP-joint were examined. The fracture can be classified according to the size of the dorsal fragment as a mallet finger or as an intraarticular fracture with the tendency for dislocation. Subcutaneous tendon ruptures with a small dorsal fragment respond well to conservative treatment. Intraarticular fractures should be treated surgically. Anatomical reduction and joint stability are the treatment aims. In 21 patients, tension band wiring was performed, in eight cases percutaneous treatment with the "Hakendraht" was carried out.

Bone Wires↗
PubMed2001

[Is mini-screw osteosynthesis a suitable procedure in surgical treatment of intra-articular distal phalanx fractures?].

In a retrospective clinical study, the results of operative treatment of intraarticular fractures of the distal phalanx were studied. From February 1992 to December 1998, 75 patients were treated operatively, 47 were examined. 14 patients were treated with Lengemann wire and temporary transfixation of the DIP joint, 25 patients were treated with screw fixation and in eight patients another procedure (wire suture, Kirschner wire, "Hakendraht", combination of screw and wire) was used. All patients had little or no pain. All patients had no or only little limitation in activities of daily living. Two patients after screw fixation had serious limitations. Four patients after Lengemann wire fixation had an extension lag in the DIP joint of up to 10 degrees, four patients between 11 and 20 degrees and one patient 25 degrees. 19 patients after screw fixation had an extension lag of the DIP joint of up to 10 degrees, five patients between 11 and 20 degrees and one patient of 25 degrees. Arthrosis of the DIP joint was seen in five patients after Lengemann wire fixation and in two patients after screw fixation. Screw fixation in the treatment of intraarticular fractures of the distal phalanx is a good, but demanding procedure with the potential for exact reconstruction of the joint surface, since implant removal is not necessary.

Bone Screws↗