Silicone interpositional arthroplasty of the distal interphalangeal joint

Twenty-three female patients had silicone interpositional arthroplasty of the distal interphalangeal joint in 38 digits. The operative indications were pain and deformity of the distal interphalangeal joint. The underlying diagnosis was osteoarthritis in all but one patient who had rheumatoid arthritis. The average age at the time of operation was 58.3 years. The implants have been in place for a mean period of 72.2 months (range, 12.6 to 123.1 months). At follow-up, extension lag averaged 12.7 degrees and the range of motion of the distal interphalangeal joint had a mean value of 33.2 degrees. Compared with arthrodesis, silicone interpositional arthroplasty offers the advantage of retained motion while preserving stability.     

Localized Sudeck's dystrophy and distal interphalangeal osteoarthritis of a finger: anatomicoradiologic study

After an injury to the right ring finger, a 44-year-old woman experienced pain in the distal interphalangeal joint. A subcutaneous mucoid cyst was noted near the joint. The x-ray films revealed no fracture but a narrowing of the joint space and a well-defined radiolucent area in the ulnar condyle of the middle phalanx. The biopsy specimen of this area excluded infection or tumor and revealed active osteogenic remodelling. These elements permitted a diagnosis of distal interphalangeal osteoarthritis that was associated with highly localized Sudeck's dystrophy (also called " parcellar algodystrophy"). This unusual case suggests the possibility that this dystrophy might be favored by an "osteoarthritic terrain" and might also play a role in the evolution of the osteoarthritis.     

Distal symphalangism: symbrachydactylism arising in a family with distal symphalangism.

A recent survey of congenital hand anomalies has revealed that symphalangism of the distal interphalangeal joint is more frequent than had previously been reported. To date, however, only 3 familial pedigrees have been documented in the literature. The family reported in this article had 9 individuals spanning 4 generations affected with symphalangism of the distal interphalangeal joint. In all cases, this was associated with ankylosis of the distal interphalangeal joint of the second through fifth toes. One child in the family also had brachyphalangism bilaterally as well as a bifid distal phalanx of the thumb. The world's literature does not seem to include a similar case. As with previous cases of fusion of the distal interphalangeal joint, there was little functional disability resulting from this anomaly and we do not recommend operative procedures to restore motion.     

Dorsal Dislocation of the Distal Interphalangeal Joint and Volar Dislocation of the Metacarpophalangeal Joint in the Same Finger: A Case Report

Double dislocations of the finger interphalangeal and/or metacarpophalangeal joints are a rare entity. Sixty-four cases of distal and proximal interphalangeal joint double dislocations have been previously reported. Five cases of metacarpophalangeal and interphalangeal double dislocations of the thumb have also been reported. Only one case has been reported in the English literature regarding simultaneous dislocations of the distal interphalangeal and metacarpophalangeal joints in the nonthumb digit. The directions of the dislocation were the same; both were dorsal. We report, to our knowledge, the first ever case of a double dislocation a non-thumb digit in opposing directions—volar at the metacarpophalangeal joint and dorsal at the distal interphalangeal joint.     

Distal interphalangeal joint silicone interpositional arthroplasty: surgical technique and functional outcome

Distal interphalangeal joint arthroplasty is effective in alleviating the pain of degenerative arthritis while preserving motion and stability. This procedure was undertaken as an alternative to arthrodesis for 17 women with osteoarthritis and 1 woman with rheumatoid arthritis. Silicone interpositional arthroplasty was performed in 31 digits of patients whose mean age was 58.3 years. The patients were evaluated at an average of 72.2 months (range, 12.6 to 123.1 months) after surgery. All patients reported that their primary preoperative symptom of pain was effectively eliminated by the procedure. At reevaluation, the active range of motion of the distal interphalangeal joint averaged 32.2 degrees and extension lag averaged 12.7 degrees . Lateral stability of the distal joint was present in all but one middle finger implant. Two implants were removed at 3 months postoperatively for wound problems and one at 31 months because of prothesis fracture.     

Distinguishing erosive osteoarthritis and calcium pyrophosphate deposition disease

Erosive osteoarthritis is a term utilized to describe a specific inflammatory condition of the interphalangeal and first carpal metacarpal joints of the hands. The term has become a part of medical philosophical semantics and paradigms, but the issue is actually more complicated. Even the term osteoarthritis (non-erosive) has been controversial, with some suggesting osteoarthrosis to be more appropriate in view of the perspective that it is a non-inflammatory process undeserving of the “itis” suffix. The term “erosion” has also been a source of confusion in osteoarthritis, as it has been used to describe cartilage, not bone lesions. Inflammation in individuals with osteoarthritis actually appears to be related to complicating phenomena, such as calcium pyrophosphate and hydroxyapatite crystal deposition producing arthritis. Erosive osteoarthritis is the contentious term. It is used to describe a specific form of joint damage to specific joints. The damage has been termed erosions and the distribution of the damage is to the interphalangeal joints of the hand and first carpal metacarpal joint. Inflammation is recognized by joint redness and warmth, while X-rays reveal alteration of the articular surfaces, producing a smudged appearance. This ill-defined, joint damage has a crumbling appearance and is quite distinct from the sharply defined erosions of rheumatoid arthritis and spondyloarthropathy. The appearance is identical to those found with calcium pyrophosphate deposition disease, both in character and their unique responsiveness to hydroxychloroquine treatment. Low doses of the latter often resolve symptoms within weeks, in contrast to higher doses and the months required for response in other forms of inflammatory arthritis. Reconsidering erosive osteoarthritis as a form of calcium pyrophosphate deposition disease guides physicians to more effective therapeutic intervention.     

Instructional Course Lecture. Arthrodesis of the interphalangeal joints with headless compression screws

Interphalangeal arthrodesis is a reliable method of pain relief for arthritic proximal and distal interphalangeal joints in the fingers. Indications include osteoarthritis, acute trauma, chronic reconstruction for trauma, rheumatoid and other inflammatory arthritides, and at the distal interphalangeal joint, chronic mallet finger deformity and unreconstructible flexor tendon defects. Solid arthrodesis imparts stability to the digital skeleton. Headless compression screws can be reproducibly inserted and are a good method to provide fixation adequate to accomplish interphalangeal arthrodesis. Surgical technique involves a dorsal incision and preparing the skeleton for good bony apposition. Exact technique for screw insertion depends on the specific screw used. Union rates range from 85% to 100% in published studies, with time to union of 7 to 10 weeks.     

Clinical and radiologic features of primary osteoarthritis of the hand

An appreciation of the salient clinical and radiologic presentations of osteoarthritis, as well as associated tenosynovial problems (stenosing tenosynovitis and carpal tunnel syndrome), is necessary for effective diagnosis. The treatment of osteoarthritis is predicated upon an understanding of the anatomy and pathomechanics of the disease process. Relevant features of the anatomy of the joints of the hand have been reviewed. The correlation of pathologic abnormalities with their radiologic findings has been presented. The degenerative joint disease termed osteoarthritis affects primarily cartilagenous and osseous tissues, while synovial changes are less pronounced. The characteristics of osteoarthritis of the interphalangeal, carpometacarpal joint of the thumb, and metacarpophalangeal joints of the hand have been reviewed.     

Complex fracture-dislocation of the proximal interphalangeal joint of the hand. Results of a modified pins and rubbers traction system

We reviewed 13 patients with a complex fracture-dislocation of the proximal interphalangeal joint of a finger and one patient with a complex fracture-dislocation of the interphalangeal joint of thumb. We had treated these injuries using a pins and rubbers traction system which had been modified to avoid friction of the pins against the bone during mobilisation of the joint in order to minimise the risk of osteolysis. A Michigan hand outcome questionnaire was used for subjective assessment. The active range of movement (AROM) of the proximal and distal interphalangeal joints and the grip strength were used for objective assessment. The mean follow-up was 34 months (12 to 49). The mean normalised Michigan hand outcome score was 84. The mean AROM of the proximal interphalangeal joint was 85 degrees and that of the distal interphalangeal joint 48 degrees. The mean grip strength was 92% of the uninvolved hand. Twelve patients have returned to their original occupations. There has been no radiological osteolysis or clinical osteomyelitis. This modified traction system has given acceptable results with a low rate of complications. It is light, cheap, effective and easy to apply.     

Surgical treatment of degenerative osteoarthritis of the fingers

Degenerative osteoarthritis of the long fingers is rare and surgical management is often necessary if there is joint pain, however this indication should not only be based on radiographic imaging. The specific anatomical problems of the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are described. The surgical approach for each joint is described as well as functional management, in particular that of the extensor apparatus. Mobility should always be preserved for the MCP, arthroplasties are recommended for the PIP except for the index, and arthrodesis for the DIP. The different and most frequently used implants are described as well as the indications and expected results. The indications are discussed in relation to the limited results in the literature as well as the preferences of a panel of French hand surgeons.     

Flexor digitorum profundus tendon excursions during controlled motion after flexor tendon repair in zone II: a prospective clinical study.

Intratendinous metal markers were used to study flexor digitorum profundus tendon excursions during early controlled motion with dynamic flexion traction and to evaluate their significance for results after flexor tendon repair in zone II. The mean excursion was 1 mm along the middle phalanx and 5.6 mm along the proximal phalanx. This corresponded to a mean excursion per 10 degrees of controlled distal and proximal interphalangeal joint motion of 0.3 and 1.2 mm, respectively. Compared to active motion, controlled motion of the distal interphalangeal joint mobilized the tendon with an efficiency of 36% and controlled motion of the proximal interphalangeal joint mobilized the tendon with an efficiency of 90%. Controlled-motion excursions induced by the distal interphalangeal joint along the middle phalanx had little influence on subsequent active range of motion in the distal interphalangeal joint, whereas excursions along the proximal phalanx (for which the proximal interphalangeal joint was largely responsible) did have a significant influence on subsequent total active interphalangeal range of motion.     

Denervation of the proximal interphalangeal joint: a realistic and simple procedure

Pain relief in osteoarthritis of the proximal interphalangeal joint is a difficult problem. Joint denervation, a technique yielding good reproducible results in wrist and first carpometacarpal joint osteoarthritis, is, at the proximal interphalangeal joint level, a good alternative to implant arthroplasty or arthrodesis. The surgical technique is simple and may be performed under local anesthesia. Results are satisfactory with about 80% pain relief.     

选择性第二足趾关节移植的临床应用

目的　对手部关节缺损采用第二足趾选择性关节移植治疗,探讨不同术式的优缺点,提出康复训练及移植关节综合评定方法。　方法　自１９８７ 年开始临床应用吻合血管的跖趾全关节移植１０ 例、带关节囊近节趾骨基底部移植４ 例、趾间关节移植５ 例和趾间关节复合组织移植４ 例。术后早期系统康复训练。平均随访２５ 年,进行功能评定。　结果　优１０ 例,良７ 例,中４ 例,差２ 例。带关节囊近节趾骨基底部移植效果最佳;趾间关节移植效果次之;而跖趾全关节移植、趾间关节复合组织移植疗效较差。　结论　选择性第二足趾关节移植是治疗手部关节缺损的较好方法     

三角钢丝固定法在近指间关节周围断指再植中的应用

目的 评价在近指间关节周围断指再植时采用三角钢丝内固定法的临床疗效.方法　13例(19指)近指间关节周围的断指,其中中节基底13指,近节远端6指,断指再植时采用三角钢丝内固定法重建骨支架.结果　术后平均7周达骨愈合,近指间关节活动范围5°～84°.参照中华医学会手外科学会上肢部分功能试用标准进行评定,本组中优15指,良3指,差1指,优良率为94.7％.结论　在近指间关节周围断指再植时,采用三角钢丝法进行内固定,操作简便,有效固定的同时可允许早期开展关节功能训练,恢复良好的关节功能,临床效果满意.     

骨软骨移植治疗儿童远侧指间关节陈旧性骨折脱位

目的探讨儿童远侧指间关节陈旧性骨折脱位的治疗方法及疗效观察。方法采用游离骨软骨移植术治疗小儿伴有骨软骨缺损的远侧指间关节陈旧性骨折脱位9例9指。结果全部患者均获18个月～13年7个月的随访，优2例，良4例，可3例。结论骨软骨移植术既能有效的矫正畸形，又可保留一定的关节活动度，不失为一种较好的治疗方法。     

Mallet finger

Mallet finger involves loss of continuity of the extensor tendon over the distal interphalangeal joint. This common hand injury results in a flexion deformity of the distal finger joint and may lead to an imbalance between flexion and extension forces more proximally in the digit. Mallet injuries can be classified into four types, based on skin integrity and the presence or absence of bony involvement. Although various treatment protocols have been proposed, splinting of the distal interphalangeal joint for 6 to 8 weeks has yielded good results while minimizing morbidity in the majority of patients. Surgical management may be considered for acute and chronic mallet lesions in patients who have failed nonsurgical treatment, are unable to work with the splint in position, or have a fracture involving more than one third of the joint surface.     

Extensor tenotomy: a technique for correction of posttraumatic distal interphalangeal joint hyperextension deformity

Tenotomy of the dorsal apparatus over the middle phalanx was done in 13 digits for treatment of posttraumatic hyperextension of the distal interphalangeal joint associated with a boutonniere deformity. All but one patient was improved with distal interphalangeal joint flexion averaging 45 degrees at follow-up. Four digits had a 5 degree to 10 degree extensor lag. This procedure is simple and reliable and should be considered when increased distal interphalangeal joint flexion is desired.     

ARTHRODESIS OF THE DISTAL INTERPHALANGEAL JOINT USING A BIOABSORBABLE ROD AS AN INTRAMEDULLARY NAIL

There are several fixation techniques for arthrodesis of the distal interphalangeal joint. Since February 1999 we have used a bioabsorbable (poly-L-lactide, PLLA) rod as an intramedullary nail for arthrodesis of 15 distal interphalangeal joints and one interphalangeal joint of the thumb. The advantages include the absence of protruding hardware that would require removal, and technical simplicity. Preoperative diagnoses included degenerative arthritis in five patients, post-traumatic arthritis in 10 patients, and non-union after arthrodesis with crossed Kirschner wires in one patient. All patients were observed until there was clinical and radiographic evidence of fusion with the mean interval to fusion of 8 weeks (range 6-12). There were two cases of minor intermittent local swelling, which resolved. Fixation with a PLLA rod for arthrodesis of the distal interphalangeal joint is a simple and effective technique.     

Interphalangeal arthroscopy of the toes

Interphalangeal (IP) joint pathology of the toes has gained little attention of the orthopedic surgeon. However, similar intra-articular pathologies e.g. osteoarthritis, synovitis, chondral lesion, arthrofibrosis and instability can occur as in other joints. Moreover, many corrective procedures of toe deformity involved excisional arthroplasty or arthrodesis of the IP joint although it is not the site of primary pathology. Classically, the operations of the IP joint were performed in an open manner. We described the technique of interphalangeal arthroscopy and its application to treat various pathologies of the interphalangeal joint was discussed. Among the various indications for interphalangeal arthroscopy, arthroscopic ganglionectomy of recurrent IP ganglion is the single most important one.     

Arthrodesis of the distal interphalangeal joint using a bioabsorbable rod as an intramedullary nail.

There are several fixation techniques for arthrodesis of the distal interphalangeal joint. Since February 1999 we have used a bioabsorbable (poly-L-lactide, PLLA) rod as an intramedullary nail for arthrodesis of 15 distal interphalangeal joints and one interphalangeal joint of the thumb. The advantages include the absence of protruding hardware that would require removal, and technical simplicity. Preoperative diagnoses included degenerative arthritis in five patients, post-traumatic arthritis in 10 patients, and non-union after arthrodesis with crossed Kirschner wires in one patient. All patients were observed until there was clinical and radiographic evidence of fusion with the mean interval to fusion of 8 weeks (range 6-12). There were two cases of minor intermittent local swelling, which resolved. Fixation with a PLLA rod for arthrodesis of the distal interphalangeal joint is a simple and effective technique.