Simultaneous subluxation of the metacarpophalangeal joints of all four fingers: a case report

Simultaneous subluxation of the metacarpophalangeal joints of all four fingers is rare, and we have found no cases in the literature. A 45-year-old construction worker fell and dislocated the metacarpophalangeal joints of all the fingers of his left hand. Closed reduction by manipulation was successfully accomplished, and the patient returned to work within 5 months of his accident. He had a full range of motion 1 year later.     

Surgical treatment of hand disorders in Farber's disease: a case report

Farber's disease is a rare autosomal recessive disorder caused by a deficiency of acid ceramidase activity whose symptoms include hoarseness, subcutaneous nodules, and painful swollen and contracted joints. This case report focuses on hand abnormalities and surgical treatment of hand disorders in Farber's disease. A 9-year-old girl had occasional painful locking of the metacarpophalangeal joints of the middle fingers and severe tenderness of the dorsal aspect of the wrists. Resection of several nodules within the metacarpophalangeal joint and of a nodule that was firmly attached to the extensor pollicis longus tendon beneath the extensor retinaculum relieved pain and enabled the patient to perform daily activities.     

Opera-glass hand in rheumatoid arthritis.

Characteristic deformities occur in the fingers, thumb, and wrist in the opera-glass hand in rheumatoid arthritis. Shortening and instability are the result of bone resorption and dislocation and can be severely disabling. Early spontaneous fusion of the proximal interphalangeal joint preserves digital length. Functional improvement can be obtained in the fingers by interphalangeal joint arthrodesis and metacarpophalangeal prosthetic arthroplasty and in the thumb with metacarpophalangeal and/or interphalangeal arthrodesis. With interphalangeal arthrodesis, interposition grafts often are required in order to restore length and secure fusion. "Prophylactic" arthrodesis of interphalangeal joints should be considered when resorption seems imminent.     

The mechanism of the intrinsic-minus finger: a biomechanical study

To demonstrate in the cadaver model that the sequence of extension of the flexed metacarpophalangeal and proximal interphalangeal joints of the intrinsic-minus finger can be explained on the basis of moment ratios about these joints, the engineering concept of free body analysis was applied. Intrinsic-minus fingers, i.e., fingers of a cadaver in which all forces exerted by the intrinsic muscles were removed, were observed to hyperextend maximally at the metacarpophalangeal joint before extension of the proximal interphalangeal joint began. Mathematical calculation of moments provides an explanation of this sequence. This study confirmed that, when an equilibrium of forces at the hyperextended metacarpophalangeal joint is reached, the proximal interphalangeal joint is incompletely extended. These forces include: (1) the proximal pull of the extensor tendon; (2) the distal loading of the extensor tendon by the flexor tendons; (3) the force preventing spanning of the laminae.     

Open dorsal metacarpophalangeal dislocations of the index, long, and ring fingers

An open dorsal dislocation of the metacarpophalangeal joints of the index, long, and ring fingers was treated satisfactorily by early reduction.     

Clawhand deformity presumed secondary to Parkinson's disease

A clawhand deformity presumed to be secondary to Parkinson's disease is described. No such association was found previously recorded in the literature. The marked limitation in hand function was improved by lengthening the extensor tendons, a 4-tail superficialis transfer to the intrinsic muscles, and capsulotomy of the metacarpophalangeal joints of the index and long fingers.     

Reconstruction of a hand, amputated at the metacarpophalangeal level, by means of combined second and third toes from each foot: a case report

Reconstruction of all four fingers that were amputated at the metacarpophalangeal (MP) joints of the right hand of a 17-year-old male patient was performed by simultaneous transfer of the combined second and third toes from each foot at the level of the metatarsophalangeal joint. Fifteen-month follow-up showed acceptable cosmesis with satisfactory functional results. The patient had no foot discomfort, even after prolonged walking and running.     

Short-term efficacy and safety of collagenase injection for Dupuytren's contracture: Therapy protocol for successful outcomes in a clinical setting

PurposeTo assess the short-term efficacy and safety of collagenase injection for Dupuytren's contracture and of our post-injection therapy protocol alternative the instruction of phase III studies at clinical setting.MethodsThe retrospective study included 23 fingers of 21 hands of 18 patients for primary metacarpophalangeal (MP) joints and 11 fingers of 10 hands of 10 patients for primary proximal interphalangeal (PIP) joints with Dupuytren's contracture who were treated with 0.58 mg collagenase Clostridium histolyticum (CCH) injections at our hospital consecutively from September 2015 to October 2017. The mean age of the patients was 73.0 years (range, 57–88) for primary MP joints and 70.7 years (61–81) for primary PIP joints. Following standard CCH injection and manipulation on the next day, certified hand surgeons evaluated and treated each patient based on a defined 4-week therapy protocol that consisted of performing finger exercises during the day and wearing static extension splint at night for all cases, and of wearing Capener dynamic splint intervention to address severely contracted PIP joints. We measured the degree of contracture at baseline, immediately, 4 weeks, and 12 weeks after the last manipulation.ResultsMore improvement of contracture was seen in the MP joints than in the PIP joints. For the five fingers severely contracted and treated with Capener splint intervention, the mean passive PIP joint contracture was 62.0° at baseline, 21.0° immediately, further improved to 6.0° by 4 weeks, and maintained 8.0° by 12 weeks after the last manipulation. The adverse events were mild-to-moderate local reactions in the injected hand.ConclusionsThe clinical efficacy and safety of CCH were confirmed in a clinical setting similar to phase III studies. The improvement of 4-week-intervention was maintained at 12 weeks after the last manipulation. Severely contracted PIP joints could benefit from Capener splint intervention.     

腹部皮瓣瓦合足背皮瓣修复手部严重皮肤脱套伤

目的报道利用腹部带蒂皮瓣瓦合足背游离皮瓣移植修复手部严重脱套伤的手术方法及，临床疗效。方法2003年2月～2010年6月．收治手部严重脱套伤患者9例。彻底清创后2—5指末节或中节中部平面以远指骨截除，创面先采用腹部带蒂皮瓣包埋手部创面，3～4周后行腹部皮瓣断蒂，并用腹部皮瓣覆盖手（指）背侧创面，游离足背皮瓣修复手（指）掌侧创面，足背供区行游离植皮术。皮瓣成活后3个月、6个月分别行手指分指术。结果术后9例手掌、手背皮瓣均顺利成活，伤口均一期愈合，足部供区植皮区及腹部供区伤口一期愈合。随访以最后一次分指术后开始计算，时间为6～48个月．平均15个月。手掌、手背皮瓣无臃肿。2—5指掌指关节活动为0°-80°，指间关节僵直于伸直位，2—5指可完成与拇指的对指、对捏等功能。手（指）背皮瓣感觉恢复为S1-S2，手（指）掌皮瓣感觉恢复为S2～S3＋。足背供区及腹部无明显瘢痕挛缩，行走无明显影响。结论利用腹部带蒂皮瓣瓦合足背游离皮瓣移植修复手部严重脱套伤，可以修复手部创面，重建手部分功能，是一种较好的治疗方法。     

A complex reimplantation of digits: a case report.

In multiple finger amputations, microsurgical reconstruction should concentrate on the thumb, index, and middle fingers. The patient in the case report presented in this paper initially sustained an amputation of all of the digits on the left hand and an amputation of the right thumb. Both thumbs were amputated at the metacarpophalangeal joint. Initial replantation of the left thumb, index, and middle fingers and of the right thumb was carried out. The right thumb replantation failed and, after healing, the right great toe was transferred to the right hand. Subsequent to this, the patient developed useful function of all reconstructed digits. Twenty-one months after the first injury, both thumbs sustained new traumatic amputations 1.0 cm distal to the previous amputations. Both thumbs were replanted again successfully.     

Opened dorsal metacarpophalangeal dislocation of the four long fingers. Volar plates reinsertion with anchors

The authors describe the case of a 53 year-old right-handed patient, who fell from a scaffolding and sustained a dorsal metacarpophalangeal dislocation of the four long fingers of his left hand. Because of the major dorsal instability after reduction, a mini anchor was placed over each metacarpal neck, to help repair the volar plate. After active rehabilitation, the patient regained satisfying articular amplitudes and was able to get back to his job and his regular sports activities.     

Dorsal dislocation of the fourth and fifth carpometacarpal joints and simultaneous dislocation of the metacarpophalangeal joint of the small finger: a case report

A patient with dorsal dislocation of the fourth and fifth carpometacarpal (CMC) joints and dislocation of the metacarpophalangeal (MP) joint of the small finger was managed successfully by open reduction and transarticular fixation of the CMC joint dislocation and closed reduction of the MP joint dislocation. This rare combination of injuries has not been reported previously.     

Reconstruction of phalangeal articulations of the hand with vascularised phalangeal articulations of foot

SUMMARY: Since arthroplasty, prosthetic replacement and non-vascularised articulation autografting do not normally produce very satisfactory results for ankylosis of metacarpophalangeal and interphalangeal joints, the authors performed reconstruction of phalangeal articulations of the hand using vascularised phalangeal articulations of the foot in 11 patients with ankylosis of the metacarpophalangeal and interphalangeal joints of hand due by trauma. Procedures included reconstruction of 9 hand metacarpophalangeal joints with vascularised grafting of pedal metatarsophalangeal joints in six patients, reconstruction of the hand metacarpophalangeal joints with grafting of vascularised proximal interphalangeal joints of foot in two patients and reconstruction of the hand proximal interphalangeal joints with grafting of vascularised proximal interphalangeal joints of foot in three patients. Early functional exercise was encouraged in all cases post-operatively. Follow-up ranged from 3 to 10 years and revealed that 9 cases had normal appearance and length of recipient area, 1 had slightly clumsy dorsal skin in the hand and 1 had slight dorsal angulation of a metacarpal bone. Recovery of joint range of motion was satisfactory. Radiographic, gross and sensation examinations also showed good operative outcomes. The authors believe that vascularised pedal metatarsophalangeal joints, with a rich blood supply, can be grafted to effectively reconstruct the finger joints with good function. A low rate of degeneration results because pedal and hand metatarsophalangeal joints are similar in anatomy and physiological function.     

Open metacarpophalangeal dislocations: literature review and case report

BackgroundOpen dorsal metacarpophalangeal joint dislocations are rare. We report the case of a 62-year-old man who fell from a height of 10 m onto his left outstretched hand and presented to us with four open dorsal metacarpophalangeal joint dislocations. We review the literature and present our case to elucidate the best treatment protocol for open dorsal metacarpophalangeal joint dislocations.MethodsA systematic review was conducted using MEDLINE, Embase, and PubMed from 1946 to present. Publications were found using key terms and cross-referencing. Detail on patient demographic, presentation, mechanism of injury, injury management, and outcome were collected.ResultsA total of 102 articles of metacarpophalangeal joint dislocation (excluding thumb dislocations) were identified. Of these, only four were of open dorsal metacarpophalangeal joint dislocation involving the four long fingers. Open dislocation of the metacarpophalangeal joint in these studies showed no hand predominance, nor association with hand dominance.ConclusionOpen dorsal metacarpophalangeal joint dislocations of the four long fingers are unusual. Based on the available case reports and our experience, we suggest addressing this injury intraoperatively with minimal delay. Most cases will be associated with volar plate injury, and we encourage its repair with figure-of-eight stitches. Postoperatively, we suggest a dorsal blocking splint for 2 weeks followed by occupational therapy consisting of passive and active range of motion (ROM) exercises and adjunctive therapies to control edema and optimize scar tissue. Inadequate management of such injuries could be highly detrimental to hand function.

Electronic supplementary material

The online version of this article (doi:10.1007/s11552-014-9646-6) contains supplementary material, which is available to authorized users.     

Successful replantation of four fingers by a single common digital artery anastomosis

The replantation of 4 digits of 1 hand was attempted in a patient who had completely amputated his fingers at the level of the metacarpophalangeal joints. Anastomosis of the severed ends of the third common volar digital artery proved to be successful not only in re-establishing arterial circulation in the middle and ring fingers but also in the index and little fingers, as evidenced by survival of the digits and as evaluated by postoperative angiography. The reasons for this success are discussed in light of anatomic studies.     

Simultaneous Dislocation of the Metacarpophalangeal and Interphalangeal Joints of the Thumb

Combined dislocation of the metacarpophalangeal and uncommon. We know of only four previously reported cases. We report a new case characterised by dorsal dislocation of both joints. Because of entrapment of the volar plate, open reduction at the interphalangeal joint was necessary. The metacarpophalangeal dislocation was treated by closed reduction. After three weeks of immobilisation, physiotherapy resulted in a satisfactory outcome. Even if the diagnosis of dislocation of the interphalangeal joint is obvious it would be easy to overlook a simultaneous dislocation of the metacarpophalangeal joint with serious consequences. Whole hand examination remains an essential rule. interphalangeal joints of the thumb is     

Simultaneous dislocation of the metacarpophalangeal and interphalangeal joints of the thumb.

Combined dislocation of the metacarpophalangeal and interphalangeal joints of the thumb is uncommon. We know of only four previously reported cases. We report a new case characterised by dorsal dislocation of both joints. Because of entrapment of the volar plate, open reduction at the interphalangeal joint was necessary. The metacarpophalangeal dislocation was treated by closed reduction. After three weeks of immobilisation, physiotherapy resulted in a satisfactory outcome. Even if the diagnosis of dislocation of the interphalangeal joint is obvious it would be easy to overlook a simultaneous dislocation of the metacarpophalangeal joint with serious consequences. Whole hand examination remains an essential rule.     

带蚓状肌的游离足趾再造拇、手指

自１９７２年以来，在游离足趾再造拇、手指手术中，应用足趾蚓状肌与缺损拇、手指蚓状肌残端或关节囊进行缝合的方法共完成手术３００例，由于再造拇、手指的蚓状肌得到修复，既改善了其指间关节屈曲畸形，又防止了掌指关节的过伸。术后随访１－２２年，再造拇、手指的外形及功能均满意。     

The psychoflexed hand: New perspectives in diagnosis,classification and treatment

The psychoflexed hand is a rare clinical condition characterized by fixed finger contractures undetermined by organic etiology, often associated with a psychiatric pathology. We report a series of 20 patients (nine males and 11 females, mean aged 56.2 years). We have introduced a new classification of the various possible patterns of finger deformities: 1) Type 1: prevalent flexion contracture at the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the last two or three fingers; the thumb and the index are not affected; 2) type 2: prevalent flexion contracture at the PIP and distal interphalangeal (DIP) joints of the last two or three fingers; 3) type 3: flexion contracture of all the long fingers; 4) type 4: flexion contracture of all the fingers of the hand, including the thumb (clenched fist syndrome); 5) type 5: isolated flexus-adductus thumb (the long fingers are not affected); 6) type 6: flexion of digits associated with flexion contractures of other joints of the upper extremity. The treatment was conservative in 14 patients with recent deformities and surgical in six patients. Both forms of treatment were followed by a rigorous rehabilitation program, mostly based on home self-rehabilitation. The correction of the deformities was obtained in all cases and maintained over time.     

Double dislocation of the fifth metacarpal

A case of simultaneous dorsal dislocation of the metacarpophalangeal and carpometacarpal joints in the little finger is presented. The patient required an open reduction of the metacarpophalangeal joint, the carpometacarpal joint was reduced simultaneously. Thirty month post-operatively there was no subluxation of either joint.