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At least 1,567 records · Page 87Linked to original sources
PubMed1990

Osteoarthritis of the proximal interphalangeal joint of the hand: arthroplasty or fusion?

Forty-three procedures on the proximal interphalangeal joint in 24 patients are retrospectively reviewed. A diagnosis of erosive osteoarthritis accounted for 83% of the joints that had operation. Flexible silicone interposition, cemented Biomeric arthroplasty, or arthrodesis were done based on the individual functional needs of each patient and involved digit. All cemented Biomeric devices, preferentially implanted in the radial digits for optimal lateral stability, failed through the elastomer hinge at an average of 2.25 years after operation. Arthrodesis of the proximal interphalangeal joint in the radial digits provided greatest improvement in lateral pinch strength. Flexible silicone interposition arthroplasty in the ulnar digits provided an average flexion arc of 56 degrees with satisfactory pain relief. Although none required revision, radiographically evident bone resorption adjacent to the silicone implant was progressive over time; 35% of implants followed-up longer than 2 years demonstrated periarticular erosion and 20% followed-up beyond 4 years had extensive endosteal resorption along the intramedullary prosthetic stems. Surgical treatment of the osteoarthritic proximal interphalangeal joint remains an unsolved problem.

Adult↗
PubMed1998

Use of a multiplanar distracter for the correction of a proximal interphalangeal joint contracture.

Proximal interphalangeal (PIP) joint contractures are common complications in hand injuries and conditions such as Dupuytren's contracture. Conventional treatment such as splinting and serial casting may result in inadequate improvement. Operative release of the contracture may be complicated by neurovascular overstretch with injury to the digital nerves or vascular compromise. Gradual distraction of the contracted joint may prevent this neurovascular injury. The multiplanar distracter was designed for three-dimensional distraction of the mandible. Distraction may be obtained in the X, Y, or Z planes. With this device, the angular relationship between two planes may be altered. A 22-year-old male with a PIP joint contraction following replantation failed conventional treatment for release. With the use of a multiplanar distracter, the flexion contraction was reduced from 95 degrees to a more functional 30 degrees using gradual angular distraction. The angle between the proximal and middle phalanges were gradually changed using the ability of the distracter to change the angular relationship in the X-Y plane. At 3 and 6 months postdistraction, the patient has maintained his 30-degree flexion angle. The multiplanar distracter is a simple technique that may be useful for the treatment of PIP joint contractures that fail conventional therapy.

Adult↗
PubMedDate not supplied

Distal interphalangeal joint implant arthroplasty in a musician.

Degenerative joint disease commonly affects the distal interphalangeal (DIP) joints, causing articular destruction and marginal bone formation. Treatment for pain relief and function is most often done through arthrodesis. The case of a 70-year-old concert violinist with left index finger DIP joint osteoarthritis is presented. Arthritis in the involved joint caused pain and deformity and interfered with the patient's ability to play music. Trial arthrodesis with K-wires proved impossible because of the patient's need for continued mobility. Swanson hinge implant arthroplasty was performed on the affected DIP joint. The patient eventually achieved an excellent result and was able to return to playing the violin professionally. Treatment and therapy guidelines are presented.

Aged↗
PubMed2006

Septic arthritis of the small joints of the hand.

Twenty-five patients with sepsis of 26 hand joints were treated by urgent debridement, antibiotics and early hand therapy. We reviewed 15 patients (16 joints) in a clinic and three patients by postal questionnaire after a mean follow-up of 54 (range 10-94) months. Of the 26 involved joints, 14 had restricted motion at discharge. Stiffness increased with increase in delay between onset and treatment. At final review, one joint with painful degenerative changes had been fused. Seven patients had regained full movements. The remaining six had some stiffness but, nevertheless, had undergone significant improvement in the ranges of movement. There were two cases with radiological joint degeneration in this group of six patients. Three patients had mild, intermittent pain. No patient had significant disability. While there is significant loss of motion after this joint pathology in the early recovery period, overall motion and function appears to improve over the longer term.

Activities of Daily Living↗
PubMed1997

Enchondroma of the distal phalanx of the hand.

We saw five patients who had enchondroma of the distal phalanx, a relatively uncommon site for that lesion. Three patients had pain secondary to a pathological fracture and were managed with curettage and bone-grafting through a palmar longitudinal incision. The other two patients had severe deformities of the fingertip and nail. One was managed with disarticulation of the distal interphalangeal joint and the other, with curettage and grafting through a dorsal approach followed by reconstruction of the nail matrix. We believe that the palmar incision in the pulp of the finger has few, if any, complications.

Adult↗
PubMed1985

Flexible implant arthroplasty in the proximal interphalangeal joint of the hand.

Between 1966 and 1981, 812 proximal interphalangeal joints were reconstructed by the senior author using the flexible silicone rubber implant resection arthroplasty method. Within this series, a group of 182 patients with 424 proximal interphalangeal joint implants were available for a detailed clinical and roentgenographic review. Increased motion in a more functional arc with good pain relief and a favorable bone response pattern were noted in most cases after surgery. Complications were rare and included implant dislocation or fracture, recurrence of deformity, and infection. The highest complication rate was noted in implant reconstructions performed to correct rheumatoid swan-neck deformities.

Adult↗
PubMed1981

Chronic boutonniere deformity--an anatomic reconstruction.

Restoration of motion and appearance of the chronic boutonniere deformity is often accomplished by splinting. If the deformity persists following appropriate splinting, and if a full passive range of motion of the proximal interphalangeal joint is present, surgery may be recommended. Thirteen patients had surgical reconstruction over a 10-year period, with satisfactory improvement in all but one. This operation involves release of the transverse retinacular ligaments and reconstruction of the damaged central slip by using the local joint capsule and synovium attached to the base of the proximal phalanx.

Adult↗
PubMed1998

Long-term results of surgical treatment for macrodactyly of the hand.

A retrospective review was performed for 23 patients who were surgically treated for macrodactyly of the hand between 1964 and 1995. Treatment regimens varied among the patients, and more than two operative procedures were performed in 65 percent of the patients. At final follow-up, the average length of the affected digits was 102 percent of that of the normal contralateral side. The average circumference of the digits was 121 and 124 percent at the proximal interphalangeal and distal interphalangeal joints, respectively. The average range of motion was 65, 57, and 37 degrees at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints, respectively. Although it is difficult to compare treatment regimens, epiphysiodesis/epiphysectomy was quite effective in the prevention of longitudinal overgrowth of the digits, but resection of the hypertrophic nerves was unsuccessful in preventing finger overgrowth.

Female↗
PubMed1973

A case of active chronic hepatitis with painless erosive arthritis.

True arthritis is very much less common than arthralgia in patients suffering from active chronic hepatitis and only scanty information is available about the joint changes in this disease. We report here the case of a young woman with active chronic hepatitis complicated by a painless, erosive small joint arthropathy.

Adult↗
PubMed1998

Destruction and arthroplasties of the metatarsophalangeal joints in seropositive rheumatoid arthritis. A 20-year follow-up study.

Destruction and arthroplasties of the metatarsophalangeal (MTP)joints and interphalangeal (IP) joint of the big toe were evaluated in 103 seropositive rheumatoid arthritis (RA) patients in a prospective follow-up study at onset and at 1, 3, 8, 15, and 20 years from entry. A total of 83 patients attended the 15-year follow-up and 68 attended the 20-year follow-up. Data on the forefoot synovectomies and reconstructions performed were obtained from patient documents and radiographs. The radiographs were assigned by the Larsen method; in the end point analysis the last or preoperative radiograph was used. Erosions of Larsen grade > or =2 were present in 6%/ of the investigated 1236 joints at onset and after 20 years in 62%, respectively. At the end point, 24% of the joints were severely damaged (Larsen grade 4-5). The MTP I and IP joints showed the lowest grade of destruction during follow-up, and MTP V the worst destruction. Synovectomies were performed in 24 MTP joints; a total of 75% of these joints were later resected. MTP II-V head resections were performed in 21% and the Keller procedure in 12% of the MTP I joints. Erosive changes occur early in the MTP joints, and their grade of destruction is high; therefore they should be included in radiographic criteria and scores. MTP synovectomies are insufficient treatments for RA without concomitant immunosuppression of the disease.

Adolescent↗
PubMed1991

Tendon transfers in patients with cervical spinal cord injury.

Between 1983 and 1988, 32 patients with cervical spinal cord injuries underwent 124 upper limb tendon transfers during 85 procedures. Of the numerous surgical procedures that have been recommended for treatment of this condition, my experience indicates that the most successful are posterior deltoid-to-triceps transfer, restoration of finger flexion, and restoration of thumb opposition. Longitudinal incisions prove to be quite cosmetic.

Activities of Daily Living↗
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↗
PubMed1997

Extensor indicis proprius to extensor pollicis longus transfer: results and complications.

In a detailed analysis of hand, thumb and index function after extensor indicis proprius transfer for extensor pollicis longus rupture in 13 patients, we found 12 excellent or good results despite mobility restriction in most of them. The extension lag in the metacarpophalangeal and interphalangeal joint of the thumb and the metacarpophalangeal joint of the index was respectively 17 degrees, 8.5 degrees, and 25 degrees. Extension force of the index was reduced to 65%. Grip force and dexterity reached 90% and 115% of the contralateral side.

Adult↗