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1.
A 63-year-old woman was unable to actively flex the interphalangeal joint of her right thumb after a hyperextension injury. Surgical exploration revealed an avulsion of the distal insertion of the palmar plate, allowing the bulk of the plate to block the joint during attempted active flexion. Resection of the palmar plate restored active flexion and caused no joint instability. We do not believe this lesion, which resulted in this disability, has been previously described.  相似文献   

2.
Sixty-four digits amputated at or distal to the distal interphalangeal joint were reimplanted in 57 patients with the use of microsurgical techniques. Five patients were children under 3 years of age. The percentage of survival was 96.9%. Before the operation, the surgical anatomy of the amputated digits was studied and particular attention was focused on the microvasculature. Equal emphasis was given to the reinnervation and revascularization of the amputated digits.  相似文献   

3.
Avulsion fractures of the thumb metacarpophalangeal joint require adequate treatment to prevent instability or articular incongruity. Open reduction and internal fixation may be difficult because of the small fracture fragment size. Nine patients underwent acute open reduction and tension wire fixation of displaced or rotated avulsion fractures. Follow-up examination was at approximately 26 months. All fractures healed in anatomic alignment without instability or articular incongruity. Pain, stiffness, and loss of pinch, were subjectively rated as none in six patients and mild in three. The injured thumb demonstrated firm stability in extension and 30° flexion in all patients. Metacarpophalangeal and interphalangeal motion averaged 77% and 97% of the opposite hand respectively. Planar and palmar abduction averaged 96%. Pinch strength in apposition averaged 97% and in opposition 99% of the uninvolved hand. Grip strength was 96% of the contralateral extremity.  相似文献   

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Shin EK  Osterman AL 《Hand Clinics》2008,24(3):239-250
Degenerative joint disease affecting the thumb metacarpophalangeal and interphalangeal joints is a debilitating condition, which can significantly restrict activities of daily living. Conservative measures to address symptoms include oral anti-inflammatory medications, activity modification and splinting, and intraarticular corticosteroid injections. Surgical interventions include arthroscopic synovectomy, arthroplasty, and finally arthrodesis of the affected articulations. Although short-term results from synovectomy and arthroplasty seem promising, long-term data are not yet available. Arthrodesis of the metacarpophalangeal and interphalangeal joints yields a stable yet functional thumb with reliably good pain relief.  相似文献   

6.
Prosthetic rehabilitation of any defect or abnormality of any part of the body must be as indiscernible as possible from the surrounding natural tissues in terms of cosmesis as well as function. Surgical procedures are more likely to meet the requirements of absolute function but the patients' involvement and willingness to undergo extensive and costly procedures like micro-surgical grafting and implants may preclude these procedures. This paper presents an alternative method of prosthetic rehabilitation of an amputated thumb with a heat cured silicone material.  相似文献   

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We report a method of resurfacing the degloved thumb from the base of the thumb up to the interphalangeal joint level using two neurovascular island flaps from the adjacent sides of the long and the ring fingers, nourished by the third common neurovascular pedicle. This twin flap was used successfully in seven patients. The reconstruction gave adequate static two-point discrimination of 10mm at 6 weeks without complaints of neuroma pain, painful scars or cold intolerance.  相似文献   

9.
We investigated the long-term functional results of ray resection (14 cases) and amputation (nine cases) for ring avulsion injuries of ring finger which could not be replanted or underwent failed replantation. The mean follow-up was 37 (range, 24-63) months in the ray resection group and 32 (range, 24-40) months in the amputation group. Grip strength, key pinch strength, chuck pinch strength, hand circumference and palmar volume were decreased in the ray resection group but only grip strength and pulp pinch strength were significantly decreased in the amputation group. These results suggest that ray resection should be avoided in patients with occupations that need strong key and chuck pinch functions.  相似文献   

10.
In a prospective study six patients with dorsal fracture subluxation of the IP joint of the thumb or the DIP joint of the finger were treated conservatively using an extension block splint. The fracture size varied from 22% to 47% of the articular surface of the volar base of the terminal phalanx. Good or excellent results were reported in all cases except for one, which was fair. Only one case in the study complained of any pain, and this was minimal. Conservative treatment using extension block splintage for this injury is as good as a surgical approach.  相似文献   

11.
目的 探讨采用背侧阻挡支具固定治疗近指间关节掌侧撕脱骨折的疗效.方法 2007年8月至2010年4月,对10例近指间关节EatonⅡ型和较稳定的Ⅲ型损伤患者,采用背侧阻挡支具治疗.从受伤到接受治疗时间为2~14d,平均8d.背侧阻挡支具限制近指间关节背伸,鼓励屈曲活动,4~6周后去除支具,全面进行功能练习.结果 10例均获得随访,随访时间为3~6个月,平均4.5个月,近指间关节主动活动范围平均92°(87°~96°),与对侧健指关节活动范围相当.手功能评定采用Incavo评定法,临床结果全部为优.所有患者对治疗过程及效果满意.结论 背侧阻挡支具治疗近指间关节EatonⅡ型和较稳定的Ⅲ型损伤,可获得满意的疗效.方法简单、廉价而并发症少,是治疗此类损伤的首选方式.  相似文献   

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The adipofascial turnover flap was used to cover exposed distal interphalangeal joints of 8 fingers and interphalangeal joints of 4 thumbs. The flap was raised from the dorsum of the injured digit with a base located at the edge of the defect. The flap has a random type of vascularity and was designed with a base-to-length ratio of 1:1.5 to 1:2. All flaps survived completely. Various other types of flaps that have been used to reconstruct dorsal digital skin defects were reviewed and compared with the adipofascial turnover flap.  相似文献   

15.
Dorsal dislocation of the interphalangeal (IP) joint of the thumb is a rare injury, and closed dislocation without fracture is especially unusual. We present here two cases of closed dislocation of the thumb which were reduced by manipulation.  相似文献   

16.
Hyperextension injuries of the proximal interphalangeal joint have traditionally been immobilized in flexion. This may lead to a proximal interphalangeal flexion contracture of the joint. In an effort to prevent flexion contracture and to simultaneously avoid hyperextension laxity, we have immobilized these injuries in zero degrees of extension for 7 to 10 days. Immobilization is followed by buddy taping and active range of motion until 3 weeks after injury. Protective buddy taping is used until the 6-week point. We report our results using this treatment for only palmar plate avulsion fractures. We did not include proximal interphalangeal joint injuries associated with dorsal dislocation or major collateral ligament injury. Twenty-two of 45 patients were available for follow-up evaluation. Length of follow-up averaged 30 months (range, 6 to 36 months). A high percentage of patients had good or excellent results. In no patient did hyperextension laxity develop and in only one was there a flexion contracture. On the basis of these results, we recommend this treatment protocol for hyperextension injuries of the palmar plate of the proximal interphalangeal joint associated with small avulsion fractures.  相似文献   

17.
An unusual case of an irreducible anterior fracture dislocation of the proximal interphalangeal joint in a child with open epiphyses is described. Bilateral intraarticular avulsion fractures at the proximal attachment of the collateral ligaments were present, and the phalangeal head was locked through a tear in the central slip.  相似文献   

18.
A dislocation of the interphalangeal joint of a thumb was treated without problems. The simultaneous dislocation of the lunate was not diagnosed or treated until the plaster cast was removed. Even in cases with an obvious lesion like a finger joint dislocation it is necessary to investigate all other fingers and the wrist to exclude other lesions and to avoid delay in treatment.  相似文献   

19.
Kentaro Watanabe 《Hand surgery》2005,10(2-3):209-211
Five cases with an avulsion fracture of the thumb metacarpophalangeal joint treated by a simple method of internal fixation are described. This method is designed as a form of modified tension band wiring using the combination of a single Kirschner wire and a pull-out wire, and is technically easy.  相似文献   

20.
We report the replantation of an amputated thumb using a venous skin flap, harvested from the volar surface of the forearm, to make up the soft tissue defect, and to restore the vascular continuity to the thumb.  相似文献   

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