Arthroscopy of the proximal interphalangeal joints of the finger

Cadaveric studies were carried out to evaluate the technique, portals and possible indications for arthroscopy of the proximal interphalangeal joints of the finger. We suggest horizontal placement of the hand instead of using a traction tower, as it is important to be able to flex the joint freely. The recommended arthroscopic portals are either between the central slip and the lateral bands of the extensor mechanism or between the lateral band and the collateral ligament. A blunt technique of introduction is used to avoid iatrogenic cartilage damage and possible digital nerve injury.     

第2足趾近侧趾间关节移植重建指间关节

目的报道第2足趾近侧趾间关节复合组织移植重建近侧指间关节的临床疗效。方法我科于2001年9月～2004年1月,根据近指间关节的损伤情况,设计应用第2足趾近侧趾间关节符合组织移植重建近侧指间关节。结果临床应用15例获得了满意的疗效,术后经6～28个月的随访,全部成活,无关节疼痛,患者对手指外形与功能恢复满意,多次经X光片复查未见关节退形性变的征象。结论该方法是重建手部小关节损伤较理想的方法,值得推广应用。     

足第二趾近侧趾间关节移植再造拇手指关节

目的 报道游离足第二趾近侧趾间关节移植再造拇手指关节临床疗效.方法 对手指关节损伤49例54指,采用吻合血管的足第二趾近侧趾间关节移植修复,其中再造掌指关节21指、近侧指间关节28指、远侧指间关节5指.全关节移植38指,半关节移植16指,术后观察其临床疗效.结果 移植关节49例54指全部成活.术后伤口均一期愈合.随访5～19个月,所有病例移植骨关节均愈合,临床愈合时间为4～8周,骨性愈合时间6～12周,移植关节均未出现退行性变,未出现骨不连及再骨折的现象.移植近侧指间关节屈曲活动度为35°～90°(平均65°);移植掌指关节者屈曲活动度为30°～75°(平均45°);移植远侧指间关节屈曲活动度为25°～65°(平均35°).参照关节活动度TAM/TAF评定标准评定,属优者23指,良者25指,可者5指,差者3指,优良率84%.近侧指间关节移植者效果最佳,其次是掌指关节,远侧指间关节移植者最差.结论 采用游离足第二趾近侧趾间关节移植修复拇手指关节缺损,功能恢复满意,可以较好的改善关节的功能.     

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.     

Osteoarthritis of the distal interphalangeal joint

Osteoarthritis occurs with the highest prevalence in the distal interphalangeal joint of the hand and has been divided into an erosive and a nonerosive form. The pathogenesis of the early stages of osteoarthritis is poorly understood, but considerable emphasis has been placed on the role of cartilage and subchondral bone as well as soft tissue structures such as collateral ligaments and tendons. Radiographic evaluation represents the most standardized method to quantify disease progression, with different systems having been developed for defining and grading radiographic features. This current concepts article examines the recent knowledge base regarding the etiology, pathogenesis, and evaluation of osteoarthritis of the distal interphalangeal joint.     

Dislocation of both interphalangeal joints of one finger

A rare type of dislocation involving both interphalangeal joints of one finger is described. The mechanism of injury is discussed, and the importance of immobilizing the finger in the correct position is stressed.     

Chondrocyte clusters adjacent to sites of cartilage degeneration have characteristics of progenitor cells

The purpose of this study was to investigate the site‐specific characteristics and roles of chondrocyte clusters in human knee osteoarthritis. Cartilage explants were obtained from 45 knees undergoing total knee replacement surgery. The explants were taken from 4 locations in the knee: the medial femoral condyle, the medial posterior femoral condyle (MPC), the lateral femoral condyle, and the lateral posterior femoral condyle (LPC). Cartilage degeneration, cell density, and cell arrangement were compared histologically. A live/dead cell viability assay and immunohistochemical analyses using antibodies against STRO‐1, FGF2, and Ki‐67 were performed. Cell proliferation and cartilaginous nodule production in MPC and LPC explants in monolayer culture were compared. Finally, MPC cartilage explants were cultured to observe histological changes. The cell density of the MPC explants was higher than that of the LPC because of clustering. MPC explants contained more live cells than the LPC did, and the expression of IHC markers in MPC explants was higher than that in LPC. Chondrocytes from MPC proliferated faster and produced more nodules in monolayer culture than those from the LPC and MPC explants were repaired during organ culture. In conclusion, chondrocyte clusters adjacent to severe cartilage degeneration have specific characteristics, with progenitor and proliferative potential. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:548–555, 2015.     

Impact of simulated proximal interphalangeal arthrodeses of all fingers on hand function

PURPOSE: To evaluate the impact of simulated proximal interphalangeal (PIP) arthrodeses on hand performance and to assess the resulting compensatory metacarpophalangeal (MCP) joint motions in healthy subjects. METHODS: Fifteen healthy subjects were tested under 2 conditions: (1) with unrestricted distal interphalangeal, PIP, and MCP joints and (2) with the PIP joint fixed at 40 degrees of flexion in all 4 fingers of 1 hand and unrestricted MCP and distal interphalangeal joints. Subjects performed the Jebsen hand function test and 13 activities of daily living. Perceived difficulty in performing tasks was assessed with a study-specific questionnaire. The motion of each finger was monitored using a motion analysis system. RESULTS: The average time to complete the Jebsen test did not increase significantly with simulated PIP arthrodesis, nor did subjects perceive the tasks to be more difficult. Activities of daily living tasks requiring power grasp did not show significant increases in MCP flexion or abduction. Precision handling tasks requiring greater PIP joint flexion did show increased MCP flexion and were associated with greater perceived difficulty. CONCLUSIONS: Our study showed a minimal overall impact from simulated arthrodeses of all 4 fingers at the PIP joints in 40 degrees of flexion when measured by selected lower-demand activities of daily living in healthy subjects. Precision handling tasks that normally use higher degrees of PIP joint flexion, however, were perceived to be more difficult to perform and required greater compensatory motion at the MCP joints. This study does not address directly the impairment that patients with generalized hand arthritis may experience after PIP joint arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic, Level I.     

Simultaneous dorsal dislocation of the interphalangeal joints in ring finger with proximal interphalangeal joint dislocation of the middle finger: case report and review of the literature.

A 30-year-old amateur goalkeeper sustained simultaneous dislocation of the proximal and distal interphalangeal joints of the ring finger and of the proximal interphalangeal joint of the middle finger following a hyperextension injury. This was reduced under a local anaesthetic. Neighbour finger strapping and early mobilisation achieved an excellent functional outcome when reviewed at eight weeks after the initial injury.     

Capsulectomy of the metacarpophalangeal and proximal interphalangeal joints.

From July 1975, through March, 1978, 105 metacarpophalangeal joint capsulectomies in 37 patients, 47 dorsal proximal interphalangeal (PIP) capsulectomies in 26 patients, and 65 volar PIP capsulectomies in 41 patients were performed. The procedures were done after conservative methods had failed, and the results were tabulated in each area by diagnostic category. In the major group in which stiffness resulted from fracture and crushing injuries, average gains of 13 degrees to 18 degrees of active motion were achieved, with a change in arc of motion, while nerve paralysis patients did substantially better. The study should clarify expectations from the procedure; functional gains may still be significant.     

近指间关节关节镜手术的应用解剖学研究

目的 研究人体近指间关节的解剖结构特点,探索关节镜的手术入路和术中牵引力,为近指间关节关节镜手术的开展提供解剖学基础.方法 对5具国人新鲜尸体示、中、环、小指共40个近指间关节及10个拇指指间关节标本进行解剖学研究,找出合适的关节镜人路和术中牵引力.利用2个废弃指进行临床手术模拟实验研究.结果 选择近指间关节的桡背侧或尺背侧作为关节镜的入路,以3.0 kg的牵引力最为合适.在手术模拟实验中,成功置入1.9 mm的关节镜并清晰地观察到关节内各个结构.结论 近指间关节关节镜手术用于明确关节内病变的诊断和辅助治疗是可行的.     

Swanson design finger joint implant utilized in the proximal interphalangeal joints of the foot: a preliminary study

The purpose of this paper is to present preliminary findings regarding the use of the Silastic finger joint implant H.P. (Swanson design) in resection arthroplastic procedures of the proximal interphalangeal joint of the second and/or third toes. This paper reports on 42 cases which have beer, performed and in which significantly satisfactory results have been achieved.     

Surface replacement arthroplasty of the proximal interphalangeal joint

The first proximal interphalangeal joint (PIPJ) replacements were hinged devices with single-axis motion. Newer implant arthroplasties of the PIPJ have anatomically designed proximal phalangeal and middle phalangeal components. A need to create balanced forces across the joint was the rationale for the semiconstrained PIPJ prosthesis, which uses an anatomic design. These low-profile implants limit bone excision while preserving the integrity of the collateral ligaments. Paramount in the success of this implant is maintaining the integrity of the insertion of the central slip as it inserts on the base of the middle phalanx. The proximal and middle phalanx should be broached such that the largest implant can be press-fit in place. Greater stability is gained with a collateral ligament-preserving implant. Patient selection should include those patients with sufficient soft-tissue integrity. In general, patients with inflammatory disorders, collateral ligament insufficiency, and acute or chronic PIPJ septic arthritis are poor candidates for PIPJ surface replacement arthroplasty.     

携带微型皮瓣的第二趾近趾间关节移植修复手指近指间关节缺损

目的 探讨采用携带微型皮瓣的游离第二趾近趾间关节移植修复手指近指间关节缺损的临床疗效.方法 对23例28指近指间关节缺损的患者,采用吻合血管的第二趾近趾间关节游离移植,其中全关节移植18指,半关节移植10指.结果 23例28指微型皮瓣全部存活,术后伤口均Ⅰ期愈合,无感染及骨髓炎发生.所有移植骨关节均愈合,临床愈合时间为4～8周,骨性愈合时间为6～10周;术后随访时间为5～16个月,平均9个月,移植关节均未出现退行性改变.1例2指半关节移植者术后移植关节向掌侧脱位,经手术再次矫形获得成功.移植近指间关节屈曲活动度为35°～90°,平均65°.参照关节活动度TAN/TAF评定标准评定:优10指,良14指,可2指,差2指;优良率为86%.结论 采用携带微型皮瓣的游离第二趾近趾间关节移植修复手指近指间关节缺损,功能恢复满意,关节活动可满足日常生活的需要,能很好地改善关节的功能.     

Replacement of proximal interphalangeal joints with new ceramic arthroplasty: A prospective series of 20 proximal interphalangeal joint replacements

A prospective consecutive series of 20 proximal interphalangeal (PIP) joints replaced with a new ceramic unconstrained prosthesis (MOJE) included 13 patients with osteoarthrosis, five with rheumatoid arthritis, and one each with post-traumatic infection and traumatic arthrosis. All patients were assessed preoperatively and postoperatively at one year by an independent physiotherapist and an occupational therapist who evaluated grip strength, range of motion, activities of daily living (ADL) and occupational scores (COPM Canadian Occupational Performance Measure). The mean range of motion of the PIP joint improved from 43° to 60° (p=0.001), and the mean grip strength from 169–199 N (p=0.002). The patients’ self-perception of occupational performance, assessed by the COPM, improved significantly from 3.6–6.6 (p<0.001) for satisfaction, and 3.8–6.3 (p<0.001) for performance. The MOJE PIP joint replacement provides significant pain relief, improved strength and range of motion, and short-term satisfaction. Further long-term studies are therefore advocated.     

Simultaneous dislocation of the both interphalangeal joints in the middle finger

Simultaneous dorsal dislocation of both interphalangeal joints in one finger is an uncommon injury. This injury usually occurs on the ulnar side of the hand involving ring and little fingers. We report a case of simultaneous dislocation of both interphalangeal joints in the middle finger with small avulsion fractures. Closed reduction and splinting in ‘intrinsic plus position’ provided a good result with full range of motion by 8 weeks after the initial injury.     

Chronic recurrent dislocation of the proximal interphalangeal joint of the finger

Two cases of chronic recurrent dislocation of the proximal interphalangeal joint were seen after dislocation without an accompanying fracture. Reconstructive procedures prevented recurrent dislocation in both cases.