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The radiological features of the psoriatic arthritis, already known in the literature, are reviewed by the authors. On the basis of their own record (33 patients), they underline 3 peculiar features of the disease: thickening of the soft tissue involving the whole finger, three joints involvements of the same finger, association of subchondral proliferation and periostitis.
Fourteen children with electrical burns involving 33 fingers were followed for a period of more than 8 years. Primary treatment was conservative in 17 fingers, of which 11 required surgery at a later date. Adequate function was restored in 12 fingers after completion of this treatment and persisted for 8 years and more. In 5 fingers substantial joint deformities developed. For 16 fingers surgery was required as primary treatment. Bone involvement was present in 10 of these. Secondary surgery proved to be necessary in 2 fingers, on one aseptic necrosis necessitated replacement by a bone graft. All of the 16 fingers showed good function in the period under review. There was no radiological evidence of deformities, but growth was substantially slower than normal. Apparently coverage of exposed bone with well vascularized tissue improved local blood flow so that damage other than that originally produced by the electrical burns was prevented.
The author presents a review of the current ideas of the function of the oblique retinacular ligament, first introduced by Landsmeer. It was suggested that the oblique ligament plays an important role in synchronizing the movements of the two distal phalanges and that it initiates extension of the maximally flexed distal phalanx. The author raises some objections to these ideas, referring partly to experiments performed by Harris and partly to some experiments reported in the present paper. These experiments disclosed that extension of the maximally flexed distal phalanges was actively initiated by motor forces. The author proposes another function of the oblique retinacular ligament, i.e. as a restraining and thus stabilizing force of the flexed terminal phalanx when the fingertip is used for pressure while the proximal interphalangeal joint is forced into full extension.
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Dysplasia epiphysealis hemimelica (DEH) or Trevor's disease is a rare developmental disorder of asymmetric epiphyseal cartilage overgrowth accompanied by an accessory, epiphyseal ossification center. No published reports exist of metacarpal or phalangeal DEH. We report a case of bilateral DEH of the index finger: right-sided distal index metacarpal and left-sided index proximal phalanx. Both were surgically corrected with excision of the accessory ossification center; a transepiphyseal cartilaginous wedge was excised, and the articular surface was maintained. Follow-up shows maintenance of alignment without recurrence at 12 and 18 months after operation.
This paper reviews the use of the Swanson finger prosthesis, concentrating on clinical results from the metacarpophalangeal (MCP) joint and modes of prosthetic "failure". While "failure" is generally associated with fracture, it is recognised that fracture does not always necessitate replacement of the Swanson prosthesis. Fracture tends to occur at the junction of the distal stem and hinge of the prosthesis. Initial improvements in ulnar deviation and range of motion (ROM) tend to be gradually reduced over the duration of implantation, and there is little evidence to suggest any long-term improvement in hand strength. Bone erosion and silicone synovitis have been seen but at a much lesser incidence than in other joints implanted with silicone spacers. An evaluation of retrieved Swanson prostheses, tied in with patient history and hand measurements might provide additional information to improve the design of the Swanson prosthesis itself and of other finger prostheses.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Studies of human joint lubrication mechanisms have led to the conclusion that under normal healthy conditions they are fluid film lubricated. The main features responsible for allowing this mechanism to operate are the dynamic nature of the loading and the compliance of the bearing surfaces (articular cartilage). In contrast, artificial joints, being made of much more rigid materials, have been demonstrated to be lubricated by a mixed regime, where some load is carried by the fluid film and some by solid to solid contact. Since some surface contact takes place then wear remains a problem and friction is much higher than in human joints. The use of compliant surface bearings for artificial joints has been explored and shown to be of great advantage, reproducing the effects of natural joints. However, elastomeric materials are known to degrade in aqueous solutions so this aspect has been examined to ensure a reasonable life in the human body. Joints of the lower limb--hip, knee, and ankle--have similar load and motion patterns and behave in a similar way in terms of lubrication. Joints of the hand are not in any way similar in their behaviour and so a typical upper limb joint, the finger, has been studied to see if improvements can be made to the design of replacement artificial joints. Novel suggestions like plastic on plastic joints have been shown to be an alternative which is worthy of further consideration.
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Synovial cysts of the pulp of the little finger in three elderly patients were shown by arthrography to arise from leakage of synovial fluid from the wrist joint into the ulnar bursa and thence into the flexor synovial sheath in the digit. Distant as well as local sources of the contents of synovial cysts should be considered when the local anatomy permits communication between a degenerate joint and an adjacent tendon sheath.