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At least 19 recordsLinked to original sources
PubMed1990

Free vascularised toe joint transfer for reconstruction of the metacarpo-phalangeal joint.

Two single and two double free vascularised joint transfers from the foot to hand have been undertaken in four patients over a period of four years. All were to replace metacarpo-phalangeal joints in young patients in whom the use of prosthetic devices was considered unsuitable. All the transfers were successfully completed, but one failed late in the second post-operative week due to sepsis. The results of the remaining three transfers compare favourably with prosthetic arthroplasty and continue to improve. Donor site morbidity in the foot has been minimal and is reviewed.

Adolescent↗
PubMed1988

[Experimental and clinical studies on free toe-joint transplantation to replace a finger joint by microvascular technic].

Major vascular pattern of the toe joints was investigated with template and transparent specimens in ten lower limbs of five Japanese monkeys and seven adult human amputated lower limbs. This led to the conclusion that the metatarsal artery should be used for toe MP joint grafts, while the unilateral proper digital artery is suitable for toe PIP joint grafts, together with concomitant or dorsal cutaneous vein. Twelve PIP and nine MP joints, a total of twenty-one experimentally grafted monkey toe joints with the above described vascular pedicles were radiologically and functionally in excellent condition after twelve months, whereas twenty-seven experimentally grafted monkey toe joints without vascular pedicles fell into cartilage degeneration after six months. Based on the results obtained from these experimental studies, nine human finger joints, consisting of two CM, four MP and three PIP joints, were replaced with either toe MP or PIP joints. One and half years on average after the grafting, the grafted toe joints were radiologically and functionally normal with growth of the open epiphysis.

Adolescent↗
PubMed1990

Free vascularized toe-joint transfer in hand reconstruction: a series of 25 patients.

Twenty-eight vascularized toe-joint transfers performed on 25 patients were reviewed. A number of different techniques were used: proximal interphalangeal joint or metacarpophalangeal joint reconstruction, one-stage double joint transfer, and interphalangeal thumb or trapezometacarpal joint replacement. Using these types of vascularized joint transfer allows one-stage composite transfer (including skin, bone, and extensor tendon) and provides rapid bone healing, potential growth in the young, good long-term cartilage preservation, normal lateral stability in pinch, and limited but useful range of motion (mainly at the proximal interphalangeal level).

Adolescent↗
PubMed1991

Vascularized single toe joint transfer to the hand.

We report a retrospective review of our series of thirty-one single joints harvested from the toe in twenty-six patients and transferred to the metacarpophalangeal or proximal interphalangeal joint of the finger. Twenty-six transfers were done in traumatic cases and five in congenital. Follow-up averaged 22.6 months. Average range of motion was from 17.1 degrees to 44.3 degrees, with an arc of 27.2 degrees. The congenital group had an average motion ranging from 14.4 degrees to 27.2 degrees and an arc of 12.8 degrees. The traumatic group's motion was from 17.6 degrees to 47.6 degrees and an arc of 30.0 degrees. Complication rates were significant, with fifty percent of the patients experiencing one or more complications. Although vascularized joint transfer is a demanding procedure, it provides a reasonable alternative to arthrodesis and with further refinement in technique may become a reliable treatment option.

Adolescent↗
PubMed1992

[Livedo racemosa, skin necrosis at the basal toe joint].

An 81 year old male patient treated by sulfonylurea and diet was known to have type II diabetes for three years. Because of pulmonary embolism phenprocoumon had been administered for four months. Painful livedo racemosa developed acutely on both lateral sides of the feet and the left knee. A necrosis of the skin over the base of the left small toe developed within a few days. On the basis of the clinical picture cholesterol-embolism was diagnosed. Since anticoagulation is known to promote cholesterol-embolism it was discontinued. Prostaglandin E1 infusions into both legs were administered. Within 3 months the cutaneous lesions healed completely.

Aged↗
PubMed1976

Degenerative disease in the temporomandibular, metatarsophalangeal and sternoclavicular joints. An autopsy study.

The right temporomandibular, sternoclavicular and first metatarsophalangeal joints were removed post mortem from 39 subjects. The surfaces of the various parts of the joints were examined and evaluated according to a grading system. Repeated evaluation of the joints showed a good reproducibility of the grading system. Of the 33 temporomandibular joints, 12 showed deviations in shape. Degenerative disease was uncommon and seen in only 3 joints. The total "score for degeneration" showed only a weak correlation with age (r = 0.28, rs = 0.08). Degenerative disease was common in the 35 sternoclavicular joints. All joints except 7 showed degenerative changes. A moderate correlation was found between age and the score for degeneration (r = 0.58). Of the 39 metatarsophalangeal joints only 5 were allotted no points of degeneration. A moderate correlation was found between age and score for degeneration (r = 0.61). No significant differences of degeneration were found between sexes. The coefficient of correlation between the score for degenerative disease of the temporomandibular joint and the degeneration score for the sternoclavicular joint and the toe-joint were r = 0.22 (rs = 0.16) and r = 0.46 (rs = 0.44), respectively. The significant association of degenerative disease found between the toe-joint and the sternoclavicular joint (r = 0.54, rs = 0.54) was reduced (to r = 0.29) when age-dependence was excluded. The degenerative changes described in this material are probably mostly due to local factors.

Adolescent↗
PubMed1985

Reconstructive foot surgery.

In rheumatoid arthritis (RA) we find a high rate of foot involvements, especially in progressive cases when we see patients submitted for hospital treatment. In about 50% of these patients the ankle joints are involved (25), in juvenile RA even in two thirds of all cases. More than half of all progressive cases show also joint affections of the forefoot. Mainly the metatarsophalangeal joints are involved, especially the first MTP joint. We also can find a high involvement rate of the interphalangeal joint of the big toe. In RA the peripheral toe joints II-V are less frequently involved. Changes in these joints are very much likely to be caused by other inflammatory rheumatic diseases. Even more often than in the ankle joints we can find changes in the tarsal joints, as well as in the tarsometatarsal joints. As we know, in RA the incidence of surgery does not refer to the affection rate. The indication for surgery depends mainly on the amount of functional disability, pain, and the efficacy of conservative treatment. The need of these therapies can differ very much in various countries. E.g. in the Rheumatism Foundation Hospital, Heinola more than one third of all operations were foot surgery, whereas in our clinic, organised in a very similar way to Heinola, we have "only" 20%. Apart from tenosynovectomies and synovectomies at the ankle joint, the operations are nearly exclusively of reconstructive character.

Ankle Joint↗
PubMed1992

Great toe metatarsophalangeal joint arthrodesis: a user-friendly technique.

Thirty-four feet (23 patients) were treated with a metatarsophalangeal (MP) joint fusion of the hallux using five threaded 0.062-in K wires for fixation. Operations were done for the following diagnoses: rheumatoid arthritis (26 procedures), hallux rigidus (1), salvage of previous bunionectomies (3), hallux valgus with absent toe, bilateral fusion (2), severe hallux valgus with chronic MP joint synovitis (1), and congenital hallux varus (1). The ages ranged from 17 to 73 years, with an average of 55 years. Follow-up was available on 31 of the fusions by questionnaire and telephone contact, with an average follow-up of 24 months and a minimum of 1 year. The successful arthrodesis rate was 97%. In 9% of the procedures (three cases), the patients were dissatisfied: This was due to pain under the first metatarsal head in two cases and to impingement between the first and second toes in a third case. In 91% of the fusions (29 of 32 patient responses), the patients stated that they would have the surgery if they had to choose again. Patients indicated "complete satisfaction" in 15 fusions and "satisfaction with reservations" in 14. Patients felt that their ability to wear desired shoes was improved in 48% of the procedures, was unchanged by the fusions in 26%, and was worse than before the operation in 26%. Based on this study and review of the literature, a recommendation is made for fusing the rheumatoid hallux with 25 degrees to 30 degrees of valgus and 10 degrees of extension. In general, selection of toe position for fusion is based on reducing stress on the hallux interphalangeal joint and accommodating the position of the second toe. The multiple pin fixation technique gives a high incidence of fusion, it is easy to perform, and it is adaptable to the varying requirements for toe position.

Adolescent↗
PubMed1992

Vascularized toe-to-finger joint transplantation. 11 patients followed for 4 years.

Since 1983, we have transplanted 11 free vascularized joints in 8 men and 3 women, mean age 32 years. The causes of joint involvement were trauma in 9 cases and infection in 2. One MP and 10 PIP joints of the second toe were transplanted to 3 MP and 8 PIP joints of the fingers. After a mean postoperative follow-up period of 4 years, the mean postoperative range of motion was 31 degrees compared with 16 degrees preoperatively. Radiographs showed destruction of 4 PIP joints, probably caused by vascular failure in 2 joints and infection in 2. In spite of no evidence of arthrosis, some of the joints had gradually undergone a loss of extension. Although there are some problems that should be overcome, we advocate a free vascularized toe-joint transplantation for severe finger-joint destruction without extensive surrounding soft-tissue damage.

Adolescent↗
PubMed1992

Free vascularized joint transfers in acute complex hand injuries: case reports.

The loss of function of the metacarpophalangeal joint is a significant disability. Simultaneous reconstruction of the soft tissue, extensor mechanism, joint, and flexor tendon in a complex hand injury is difficult and challenging. Free vascularized autogenous toe joint transplantation is a useful technique that provides not only joint replacement but also the soft tissue, extensor mechanism, and flexor tendon in more severe complex hand injuries. Two patients underwent immediate, free vascularized metatarsophalangeal joint transfer of the second toe to replace the long and ring finger metacarpophalangeal joint in acute complex hand injuries. The follow-up results at 16 months and 8 months postoperatively are presented.

Acute Disease↗
PubMed1977

[Arthritis in thalassemia minor].

Seven cases with the syndrome of thalassemia minor and pauciarticular, non-erosive, seronegative arthritis are described. Other known causes of seronegative arthritis had been excluded. There was a predilection for middlesized joints such as ankles, wrists and elbows. Usually the synovitis was asymmetrical from onset, with one to eight joints affected. Finger or toe joint were usually spared. Extraarticular synovitis such as tenosynovitis or bursitis were not observed, nor were nodules, signs of vasculitis or visceral involvement. The course of this arthritis showed chronicity and mild, persistent, non-erosive synovitis without joint effusions. X-ray revealed juxtaarticular osteoporosis of the affected joints, characterized by a diminution of the number of trabeculae (hypertrophic atrophy) combined with broadening of the singular trabeculae; this picture is typical of hemoglobinopathies. - Computed tomography showed a probable slight deficit of bone mineralization. Laboratory investigations including ESR, routine immunological tests, blood chemistry, and HLA-tissue typing were all normal. - The combination of this peculiar arthropathy with thalassemia minor would appear to be worthy of note and requires a further search among the forms of arthritis of unknown origin.

Adult↗
PubMed1985

Immediate free vascularized joint transfer from second toe to index finger proximal interphalangeal joint: a case report.

The results of treatment of severe injuries to the proximal interphalangeal joint are unsatisfactory. The methods of joint reconstruction are discussed, including fusion, implant arthroplasty, perichondrial grafting and vascularized joint transfer. A patient is presented with a severe crush injury to the dorsum of the index finger with loss of skin and extensor tendon and proximal interphalangeal joint disruption. Immediate reconstruction of the finger is described using a composite free flap of skin, extensor tendon and proximal interphalangeal joint from the second toe. Follow-up at two years is described, demonstrating proximal interphalangeal motion and finger function.

Adult↗
PubMed1978

The gout patient in general practice.

A study of the clinical profile of gout-diagnosed patients was undertaken within general practice in Great Britain. At the time of the first attack of acute gouty arthritis, the mean age was 52.3 years and 15.6% of the total 1077 patients were female. Males had an earlier clinical onset than females and the average frequency of attacks of acute gouty arthritis was 0.91 per patient year. Ten per cent of the cases were believed to be secondary gout, with diuretic therapy the most frequent cause. The sample showed a highly significant association between gout and the higher social classes, a family history among blood relatives in 23% of cases, tophi were noted in 4.6% of cases where sought and 38.2% of cases were 10% or more overweight and significantly heavier than a non-gouty population. The great toe joint was most frequently involved, both in the first episode and in all acute episodes combined. The most frequently occurring associated chronic condition was hypertension which was present in 27.8% of cases. Renal stones occurred in 6.1% and renal impairment in 2.2%. Only 20.4% of the patients were referred to hospital, with the younger being referred more frequently than the older. Those with joint involvement other than the great toe had a greater chance of being referred, as did those who also had angina pectoris, myocardial infarction and hypertension. Allopurinol appeared to be the drug of choice for long-term control therapy and phenylbutazone for the acute attack.

Adolescent↗
PubMed1992

[Biomechanics of the joints of the large toe. Shape and movement of the first tarsometatarsal joint and of the medial cuneonavicular joint].

90% of the first (hallucal) tarsometatarsal joints are screw-shaped; the axis is directed upwards to the front touching the lateral edge of the joint. Thus the plantar flexion is inevitably accompanied by an adduction and a pronation, and vice versa a dorsiflexion is consequently accompanied by an abduction and a supination, when the articular surfaces exactly slide along each other. 10% of these joints, however, are ellipsoid-shaped; in this case the distal articular surface of the medial cuneiform bone has the form of an ovoid head, and a strong ligament situated next to the lateral edge of the joint effects the same kind of motion described above. The medial cuneonavicular joint is always ellipsoid-shaped, the head of which is made up by the medial facet of the distal articular surface of the navicular bone. Each of the two joints mentioned has a considerable range of mobility.

Biomechanical Phenomena↗