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At least 1,603 records · Page 89Linked to original sources
PubMed2005

The potential of tissue engineering in orthopedics.

This article presents models of human phalanges and small joints developed by tissue engineering. Biodegradable polymer scaffolds support growth of osteoblasts, chondrocytes, and tenocytes after implantation of the models in athymic mice. The cell-polymer constructs are vascularized by the host mice, form new bone, cartilage, and tendon with characteristic gene expression and protein synthesis and secretion, and maintain the shape of human phalanges with joints. The study demonstrates critical progress in the design and fabrication of bone, cartilage, and tendon by tissue engineering and the potential of this field for human clinical orthopedic applications.

Animals↗
PubMed2005

Anatomy of the collateral ligaments of the proximal interphalangeal joint.

PURPOSE: To study and clarify the anatomy of the proper collateral ligaments and accessory collateral ligaments of the proximal interphalangeal joint. METHODS: The collateral ligaments of 8 proximal interphalangeal joints were dissected under an operating microscope to gain an appreciation of their fiber direction and the anatomy of their origin and insertion. Two undissected joints were studied histologically. RESULTS: The proper collateral ligament was found to arise widely from dorsal and proximal to and from the fovea on the side of the head of the proximal phalanx and insert for some distance on most of the side of the base of the middle phalanx. The ligament is stout and its fibers are oriented parallel to the middle phalanx in all positions of the joint. The accessory collateral ligament was found to be a less substantial structure lying between the proper collateral ligament and the volar plate. CONCLUSIONS: The anatomy shown by this study is quite different from that shown in most of the anatomic and hand surgery literature, particularly in line drawings.

Cadaver↗
PubMed1997

Staged flexor tendon reconstruction using pedicled tendon graft from the flexor digitorum superficialis.

The use of pedicled flexor digitorum superficialis tendon as a tendon graft in the second stage of flexor tendon reconstruction has the advantage of employing local intrasynovial tendon graft and allowing early active range of motion. This method of staged flexor tendon reconstruction was used in 47 patients between 1983 and 1993. Thirty-three patients were evaluated 1 year or longer after the second stage of surgery. The follow-up period averaged 3.7 years. Sixty-four percent of the injuries were in zone II, and 30% were Boyes grade V in severity. Good to excellent results were achieved in 64% of patients. Three patients needed graft tenolysis. Postoperative persistent flexion contractures ranging from 8 degrees to 55 degrees of the proximal interphalangeal or distal interphalangeal joints or both were present in 88% of patients. Several factors that influenced the final outcome were identified: age over 25 years, zone II injuries of Boyes grade V, and the lack of a regular postoperative rehabilitation program were associated with relatively less successful final results.

Adolescent↗
PubMed1993

Rate of recovery after flexor tendon repair in zone II. A prospective longitudinal study of 145 digits.

A series of 145 digits were treated with three controlled motion programmes after flexor tendon repair in zone II. Active interphalangeal joint motion was measured four, six and 12 weeks; six months and one year after operation. Although there were differences in the final results among the groups, the rate of recovery from the end of the controlled motion period (four weeks after operation), was not significantly different in the three treatment groups. Overall, a mean of 37% of the final distal interphalangeal joint range of motion and 9% of the final proximal interphalangeal joint range of motion was recovered between three months and one year postoperatively. In only 10 of 27 digits with a poor result (combined interphalangeal joint range of motion less than 90 degrees) at three months, was the result still poor at one year; 10 regained another 40 degrees or more, and eight another 50 degrees or more. The results indicate that it is worth waiting six or 12 months before considering tenolysis.

Adult↗
PubMed1993

Gap formation after flexor tendon repair in zone II. Results with a new controlled motion programme.

Intratendinous metal markers were used to study gap formation in 36 flexor digitorum profundus repairs during and after early controlled motion with a programme combining dynamic traction and passive flexion to all four digits. The mean gap 3 weeks after operation was 2.5 mm. The mean final gap was 2.6 mm. The results of linear regression analysis showed that gap formation within the observed range from 0 to 8.5 mm did not negatively affect tendon excursions or clinical results in terms of active interphalangeal joint range of motion. These findings are in accordance with the results of a previous study of gap formation in patients treated with a modified traditional Kleinert traction programme. Together the two studies confirm that controlled motion is effective in restricting the adhesions associated with gap formation during postoperative immobilisation.

Adolescent↗
PubMed1985

Reconstruction of the thumb by a free pedal neurovascular flap and composite phalanx-joint-tendon homograft: a preliminary report.

A one-stage procedure for reconstructing the thumb was used in 10 patients, using previously frozen bone-joint-tendon composite allograft and a neurovascular free skin flap from the foot. Levels of injury ranged from the greater multiangular bone to the middle of the first phalanx. Postoperative bony absorption and joint degeneration were minimized, and no cases of tissue rejection were encountered. Further advantages of the procedure are that subsequent nerve regeneration and cutaneous sensibility are improved, and that there are better functional and aesthetic results, compared to other techniques. Using this procedure, donor site dysfunction is also minimal.

Amputation, Traumatic↗
PubMed1997

Skin replacement in Dupuytren's disease.

We have reviewed 90 rays in 67 patients who had undergone radical digital dermofasciectomy. Follow-up was from 24 to 100 months. Problems with skin grafts, moving two-point discrimination and active range of joint movement were noted. The recurrence rate in this series was 8%, a very much better figure for disease control than has been reported for standard approaches for Dupuytren's disease. Radical digital dermofasciectomy is strongly recommended for all cases of recurrent Dupuytren's disease requiring reoperation and as a primary procedure when there is significant skin involvement.

Dupuytren Contracture↗