Biomechanical analysis of internal fixation techniques for proximal interphalangeal joint arthrodesis

Although numerous fixation techniques have been developed for performing small joint arthrodesis, no previous study of the biomechanical properties of these constructs has been published. The strength of specimens of arthrodesis of the proximal interphalangeal joint performed with cadaver material was determined for three-point anteroposterior bending, axial torsion, and lateral cantilever bending stress. Crossed Kirschner wires, intraosseous wiring, and figure of eight tension-band wiring were studied. Figure of eight tension-band wiring demonstrates superior strength in anteroposterior bending and torsion. For lateral bending stress, no significant difference exists among the techniques studied.     

Fiber-reinforced fixation implant for proximal interphalangeal joint arthrodesis shows implant bio-integration at 1-year follow-up

BackgroundA new bio-integrative fiber-reinforced implant (OSSIOfiber® Hammertoe Fixation Implant, OSSIO Ltd., Caesarea, Israel) was developed for proximal interphalangeal joint (PIPJ) correction-arthrodesis. The main purpose of this clinical study was to assess implant bio-integration at 1-year follow-up.MethodsTwenty-four patients, previously treated for a Hammertoe deformity using the bio-integrative, fiber-reinforced implant, were enrolled in this follow-up study. One-year follow-up included clinical examination, patient reported outcomes, radiographs, Magnetic Resonance Imaging (MRI) and bio-integration scoring.ResultsProximal interphalangeal joint (PIPJ) radiographic fusion rate was 92% (n = 22). MRI was analyzed for 24 (100%) patients. In 100% of patients (n = 24), the border between implant and surrounding tissue was scored as partially visible. There were no cyst formation or fluid accumulation findings. Mild bone edema was detected in 29% (n = 7) and is attributed to the chronic distribution of forces due to chronic abnormal gait and pasture. None of the edema findings were considered as adverse implant-related finding. The mean bio-integration score was 7.71 ± 0.46.ConclusionsThis study demonstrates safe bio-integration of the newly developed fiber-reinforced implant at 1-year follow-up without negative side effects.     

Fiber-reinforced fixation implant for proximal interphalangeal joint arthrodesis shows advanced implant bio-integration at 2-year follow-up

BackgroundA bio-integrative fiber-reinforced implant (OSSIOfiber® Hammertoe Fixation Implant, OSSIO Ltd., Caesarea, Israel) for proximal interphalangeal joint (PIPJ) correction-arthrodesis showed partial bio-integration at 1-year follow-up (1FU) in a previous study. The study was prolonged to assess the bio-integration at 2-year-follow-up (2FU).MethodsTwenty-four patients with proximal interphalangeal joint (PIPJ) correction-arthrodesis using the fiber-reinforced implant and analysed at 1FU, completed 2FU. Follow-up included clinical examination, patient reported outcomes, radiographs, MRI and bio-integration scoring. Results were compared between the 1FU and 2FU (paired t-test).ResultsRadiographs confirmed fusion in 96 % (n = 23) at 2FU (1FU, 92 % (n = 22)). Implant was no longer visible in 21 % (n = 5), partially visible in 33 % (n = 8), and fully visible in 46 % (n = 11)(1FU, fully visible 100 % (n = 24)). The border between implant and surrounding bone was scored not visible in 88 % (n = 21) and partially visible in 12 % (n = 3) (1FU, border partially visible 100 % (n = 24)). There were no cyst formation or fluid accumulation findings 1FU/2FU. Mild bone edema was detected in 4 % (n = 1) (1FU, 29 % (n = 7)). None of the edema findings were considered as adverse implant related. The mean bio-integration score was 9.71 ± 0.69 at 2FU (1FU, 7.71 ± 0.46). The parameters of border between implant and bone and bone edema further improved at the 2FU compared to the 1FU, total bio-integration score was also higher at 2FU than 1FU (each p < 0.05).ConclusionsThis study demonstrates 96 % PIPJ fusion rate and increased bio-integration from 1FU to 2FU, reaching advanced bio-integration of the fiber-reinforced implant at 2FU.     

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.     

Review of proximal interphalangeal joint excisional arthroplasty for the correction of second hammer toe deformity in 100 cases

BACKGROUND: The main bony procedures used in the treatment of second hammertoe are excisional arthroplasty and arthrodesis of the proximal interphalangeal (PIP) joint. While a number of studies have reported the outcomes after PIP joint arthrodesis, there are few reports of the outcome of excisional arthroplasty of the PIP joint for the correction of second hammertoes. The purpose of this study was to evaluate the long-term outcome of PIP joint excisional arthroplasty. METHODS: Seventy-five patients (100 toes) who had excisional arthroplasty of the PIP joint for the correction of second hammertoe were reviewed at an average followup of 44 months. All patients were seen in clinic and were physically examined to assess the alignment and function of each digit. The radiographs were evaluated preoperatively. The AOFAS clinical rating scale was used preoperatively and at final followup. Patients were asked to rate their satisfaction on a scale of 0 to 10 and were asked if they would be happy to have the surgery under similar circumstances again. RESULTS: The mean preoperative AOFAS clinical rating scale was 46. At final followup this increased to 94, showing an average improvement of 48 points (p < 0.0001). The mean satisfaction on a scale of 0 to 10 (with 0 equaling complete dissatisfaction and 10 complete satisfaction) was 9.3 (SD 1.3). One patient would not have been happy to undergo outpatient surgery again, because of a change in her social circumstances. CONCLUSION: In a group of 75 patients who had PIP joint arthroplasty for the correction of second hammertoe, high levels of satisfaction were achieved. No serious complications were encountered, and revision surgery was required in just two cases. Floating toe was the most common complication encountered, and although this did decrease the level of patient satisfaction in seven patients it was not a cause of footwear irritation or pain in any patient.     

Problematic bone fixation with pyrocarbon implants in proximal interphalangeal joint replacement: short-term results

Seventeen pyrocarbon PIP prostheses were implanted into 14 patients, followed prospectively and reviewed clinically. The patients were assessed after a mean follow-up of 20.5 months subjectively by a VAS pain scale and radiographically. Significant pain relief was noted in all patients from a mean of 7.6 pre-operatively to 1.3 at final follow-up. Migration of one, or both, components was observed radiographically in eight joints and radiolucent lines were evident in three more cases. The clinical results of the implants which had migrated were less favourable for range of motion and grip strength than the stable joints of this series, although, statistically, the results were not significant. The number of possibly unstable prostheses in this series raises the question as to whether pyrocarbon is suitable for uncemented pressfit fixation in combination with early functional rehabilitation.     

Elective free vascularized double transfer of toe joint from second toe to proximal interphalangeal joint of index finger: a case report

Alternatives to the treatment of major injuries to the proximal interphalangeal (PIP) joint include fusion, implant arthroplasty, perichondrial grafting, single autogenous free vascularized transfer, and double autogenous free vascularized transfer. A patient presented a gunshot wound to the index finger with loss of skin and extensor tendon and PIP joint disruption. The finger was reconstructed with a composite free flap of skin and extensor tendon and PIP and distal interphalangeal joints of the second toe. A follow-up of 10 months is presented, which demonstrates PIP joint motion and finger function.     

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.     

Management of a proximal interphalangeal joint fracture dislocation with a compass proximal interphalangeal joint hinge and therapy: a case report.

The purpose of this report is to describe the management of a chronic proximal interphalangeal (PIP) joint fracture dislocation in a 46-year-old computer programmer. Twenty days following injury, a right ring finger volar plate arthroplasty was performed, loose fracture fragments were excised, and a Compass PIP joint hinge was applied. The hinge was locked at 10 degrees to 15 degrees extension and held in this position for 8 days. On postoperative day 8, hand therapy was initiated. Many challenges were encountered. Insurance constraints required the patient to change therapists. The device frame cracked. The patient developed a PIP joint contracture with extensor lag. Despite these obstacles, the patient achieved a successful outcome, returning to normal pain-free use with grip strength at 87% of that of the uninvolved hand. At discharge, active range of motion was 12 degrees/100 degrees at the PIP joint and 0 degrees/40 degrees at the DIP joint. Passive extension was 0 degrees. At 6 months postoperatively, active range of motion was 0 degrees/105 degrees at the PIP joint and 0 degrees/60 degrees at the DIP joint. This case demonstrates the need for closely supervised postoperative therapy that includes good communication between providers, ongoing patient education, and close monitoring of range of motion.     

Boutonniere deformity of the second toe after planter dislocation of proximal interphalangeal joint: a case report

The boutonniere deformity is a well-known deformity in the fingers, however, its appearance on a lessor toe is extremely rare. In the present case, the deformity resulted from a rupture of the central slip of the extensor tendon and the shift of the lateral bands to the planter side after reduction of a traumatic planter dislocation of the PIP joint of the second toe. Surgical repair of the extensor mechanism brought good results.     

Biomechanical and functional testing of plate fixation devices for proximal phalangeal fractures.

Functional testing in fresh cadaver digits of a dorsally applied mini-H plate, a mini-straight plate, and a laterally applied mini-condylar plate demonstrated that all three significantly reduce (p less than 0.2) simulated active PIP joint flexion. The mini-condylar plate, however, provided the least reduction of any of the three plates. Biomechanical testing of the same three plates on proximal phalanx after osteotomy in apex palmar and apex dorsal direction bending showed all three plates to provide rigidity less than the intact bone.     

Biomechanical testing of implant free wedge shaped bone block fixation for bone patellar tendon bone anterior cruciate ligament reconstruction in a bovine model

Background  

The use of an interference fit wedged bone plug to provide fixation in the tibial tunnel when using bone-patellar tendon-bone autograft for anterior cruciate ligament reconstruction offers many theoretic advantages including the potential to offer a more economical and biological alternative to screw fixation. This technique has not been subjected to biomechanical testing. We hypothesised that a wedged bone plug fixation technique provides equivalent tensile load to failure as titanium interference screw fixation.     

A vascularised bone graft from the medial femoral condyle for recurrent failed arthrodesis of the distal interphalangeal joint.

A vascularised bone graft from the medial femoral condyle was used to correct a recurrent failed arthrodesis of the index finger distal interphalangeal joint. The flap was based upon the articular branch of the descending genicular artery. Union was confirmed 3 months after surgery.     

Intra-articular loop wire fixation allows joint preservation and early motion in replantation around the proximal interphalangeal joint.

Restoration of motion is an important component of success in digital replantation. This is achieved only with rigid bony fixation that allows early post-operative mobilisation. In addition, the technique used should be simple and avoid excessive soft tissue stripping. These aims are difficult to achieve in amputations near the base of the proximal phalanx with existing bone fixation techniques. We describe a modification of the perpendicular loop wiring technique, where one wire loop is intra-articular, which satisfies the above criteria, and describe its application and results in two clinical cases.     

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 degrees to 60 degrees (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.     

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.