Phalangeal fractures of the hand

Quantitative Measurement of Rotation in Phalangeal Fracture Malunion Using Computed Tomography Imaging-"Linkage Simulation"

Malunion of thumb and finger fractures causes problems in the cosmetic and functional aspects of the hand. Malunion of phalangeal fractures usually manifests as a combination of rotational deformities in the coronal, sagittal, and transverse planes, and corrective osteotomy is performed on the planes that cause these problems. Quantification of the deformity is essential for precise osteotomy and is difficult to perform in the transverse plane, even with radiography or computed tomography. Thus, we developed a technique called linkage simulation for the quantitative measurement of rotational deformities for surgical planning. In this procedure, finger extension and flexion can be simulated based on the predicted rotational axis of the joint, which is useful for determining the appropriate correction. Furthermore, by performing a reduction simulation in the software, it is possible to simulate the surgery and predict the postoperative results. This paper reports the details of this technique.

Innovative Approach to Unicondylar Proximal Phalangeal Fracture Fixation: Combining Antegrade Intramedullary Pinning With Flexion Proximal Interphalangeal Joint Transfixation

Various surgical techniques have been described for the fixation of displaced unicondylar fractures of the proximal phalanx, with K-wire and interfragmentary screws being the most commonly used. Although open reduction with joint exposure can provide direct visualization and allow for anatomic reduction, its potential drawbacks, such as joint stiffness and loss of range of motion, are of significant concern. We introduced a novel fixation technique for displaced unicondylar fractures of the proximal phalanx using antegrade intramedullary pinning and transfixation of the proximal interphalangeal joint, which is simple, effective, and does not require open reduction.

[Sports-related injuries of the thumb and fingers]

Finger and thumb injuries are common in established and trend sports. Imaging plays an important role in acute trauma care, further therapy planning, and ultimately for a rapid return to play. Sound knowledge of the complex anatomy of the fingers and thumb is indispensable for accurate diagnosis. This article presents the ligament anatomy of the metacarpophalangeal and interphalangeal joints of the finger and the thumb, the extensor and flexor tendon apparatus, and the diagnosis of typical sports injuries using x‑rays and magnetic resonance imaging. Furthermore, imaging findings of typical sports-associated injuries are illustrated.

[Postoperative imaging of the musculoskeletal system - hand]

BACKGROUND

Postoperative imaging is essential to document the surgical outcome of the musculoskeletal system of the hand.

OBJECTIVES

Common radiological findings in the postoperative musculoskeletal system of the hand are explained in the context of the preoperative findings.

MATERIALS AND METHODS

For important surgical procedures of the hand, classifications, surgical procedures, and complications are presented. Diagnostic criteria in postoperative radiography and computed tomography (CT) imaging are described for each indication group.

RESULTS

Clinical information and postoperative findings are systematically presented for fractures of the radius, scaphoid, metacarpal and phalanges, scapholunate dissociation, perilunate injuries and for procedures of arthrodesis and arthroplasty in the hand. Complications are pointed out.

DISCUSSION

Precise reporting in postoperative radiography and CT imaging of the hand is based on a well-defined order, a standardised examination technique and on synoptic evaluation of clinical and radiological criteria.

Comparison of surgical outcomes between single versus dual K-wire fixation for unstable distal phalanx fractures

Distal phalanx fractures are the most common injuries of the hand, and K-wire fixation is commonly performed for unstable fractures. However, there is no consensus regarding the number of K-wires to use in bone fixation. We aimed to compare the results between single and dual K-wire pinning. This retrospective study enrolled patients who underwent K-wire pinning for unstable distal phalanx fractures, including the shaft and tuft, from June 2016 through April 2020. We divided patients into two groups based on the number of K-wires used for bone fixation (single vs. dual). Clinical and radiographic data were measured and compared between the two groups. Additionally, multivariable logistic analysis was performed to identify the risk factors for nonunion. A total of 80 patients were enrolled. Among them, 27 were managed with a single K-wire and 53 with a dual K-wire. There was no significant difference in the union rate between the single and dual K-wire groups (77.7% vs. 84.9%, respectively), but time to union was significantly longer in the single K-wire group (11.3 vs. 8.4 weeks; p = .003). The presence of a bone gap after fixation was a risk factor for nonunion. Our study showed that the union rate was comparable between single and dual K-wire pinning in distal phalanx fractures. However, dual K-wire pinning shortened the union time.

Treatment of finger phalangeal fractures using the Ichi-Fixator system: A prospective study of 12 cases

External fixators are an effective treatment option for comminuted or unstable phalangeal fractures. We developed a new linked-wire type of external fixator (the Ichi-Fixator) for finger phalangeal fractures, which enables fine adjustment of the fixation under fluoroscopy guidance either in a static way or with distraction through small screws inside the fixator. This technique was designed to improve on the stability and rigidity of conventional percutaneous Kirchner wire fixation. We assessed the effectiveness of the fixator through 12 cases of open or percutaneous fixation in comminuted or unstable phalangeal fractures. All patients were examined for postoperative complications, functional recovery, pain on visual analog scale (VAS), and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score at the final follow-up visit. Patients could perform all routine activities with normal grip strength and a full range of hand motion without pain after treatment. This treatment, which reduces the postoperative discomfort and may allow an immediate return to work, will clearly boost patient satisfaction. Linked-wire type external fixation enhances the security of fixation, facilitates postoperative mobilization, and may allow an immediate return to work.

Sports Injury-Related Fingers and Thumb Deformity Due to Tendon or Ligament Rupture

Background:

Hand injuries are very common in sports, such as skiing and ball sports. One of the major reasons causing hand and finger deformity is due to ligament and tendon injury. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) can demonstrate the complex anatomy of the fingers and thumb, especially the tendons and ligaments, and provide the accurate diagnosis of clinically important fingers and thumbs deformity due to ligamentous and tendinous injuries during sport activities.

Methods:

Sixteen fresh un-embalmed cadaveric hands were harvested from eight cadavers. A total of 20 healthy volunteers' hands and 44 patients with fingers or thumb deformity due to sports-related injuries were included in this study. All subjects had MR examination with T1-weighted images and proton density-weighted imaging with fat suppression (PD FS) in axial, coronal, and sagittal plane, respectively. Subsequently, all 16 cadaveric hands were sliced into 2-mm thick slab with a band saw (six in coronal plane, six in sagittal plane, and four in axial plane). The correlation of anatomic sections and the MRI characteristics of tendons of fingers and the ulnar collateral ligament (UCL) at the metacarpal phalangeal joint (MCPJ) of thumb between 20 healthy volunteers and 44 patients (confirmed by surgery) were analyzed.

Results:

The normal ligaments and tendons in 16 cadaveric hands and 20 volunteers' hands showed uniform low-signal intensity on all the sequences of the MRI. Among 44 patients with tendinous and ligamentous injuries in the fingers or thumb, 12 cases with UCL injury at MCPJ of the thumb (Stener lesion = 8 and non-Stener lesion = 4), 6 cases with the central slip injury, 12 cases with terminal tendon injury, and 14 cases with flexor digitorum profundus injury. The ligaments and tendons disruption manifested as increased signal intensity and poor definition, discontinuity, and heterogeneous signal intensity of the involved ligaments and tendons.

Conclusions:

Sports injury-related fingers and thumb deformity are relatively common. MRI is an accurate method for evaluation of the anatomy and pathologic conditions of the fingers and thumb. It is a useful tool for accurate diagnosis of the sports-related ligaments and tendons injuries in hand.

Comparison Between Buddy Taping With a Short-Arm Splint and Operative Treatment for Phalangeal Neck Fractures in Children

BACKGROUND

Phalangeal neck fractures in children are difficult to treat conservatively because of the difficulty in maintaining reduction, obtaining satisfactory follow-up x-rays, and the limited remodeling potential. The purpose of this study was to present the results after using buddy taping with a short-arm splint for phalangeal neck fracture in children and to compare with operative treatment.

METHODS

Thirty-seven patients below 12 years old who had phalangeal neck fractures were included. Nineteen patients were underwent conservative treatment and 18 patients were underwent operative fixation with Kirschner wires. Clinical outcome and radiographs between groups were compared.

RESULTS

There were no significant differences between conservative group and operative group in the sagittal angulation, coronal angulation, and translation at immediately after reduction, at the 6-week, and final follow-up examination.

CONCLUSION

Buddy taping with a short-arm splint for treating phalangeal neck fractures had acceptable outcomes compared to that with surgical correction.

Quantitative 3-dimensional CT analyses of fractures of the middle phalanx base

BACKGROUND

Quantitative 3-dimensional computed tomography (3DCT) analyses can provide a more detailed understanding of fracture morphology. For fracture-dislocation of the proximal interphalangeal joint, the extent of fragmentation of the volar lip of the middle phalanx-a factor that might influence treatment-is not always apparent from radiographs. We hypothesized that there is no correlation between number of fracture fragments and the percentage of articular surface area involved in intra-articular fractures of the base of the middle phalanx using quantitative 3DCT analyses.

METHODS

We used 13 computed tomography scans with a slice thickness of 1.25 mm or less to create 3-dimensional models of 15 intra-articular fractures of the base of the middle phalanx in 13 patients. We resized 3-dimensional models of a non-fractured middle phalanx of the same hand to fit the fractured middle phalanx in order to approximate the size and shape of the fractured middle phalanx in its pre-injury state. We created a heatmap to demonstrate the location of the fractured articular surface.

RESULTS

With the number of scans available, we did not find a significant correlation between the percentage of articular surface area involved and the number of fracture fragments. The median percentage of articular surface area involved was 46 % (range, 21-90 %). The heatmap demonstrated that the radio-volar side of the articular surface seems to be more involved than the ulnar-volar side in intra-articular fractures of the base of the middle phalanx.

CONCLUSION

Quantitative 3DCT analysis of fracture fragments provides useful information that could facilitate surgery and analysis of complex fractures of the base of the middle phalanx.

LEVEL OF EVIDENCE

IV, Basic Science Study, Anatomic Study, Imaging.

Conservative treatment in Jersey finger: a case report

We report a case of a Type Vb flexor digitorum profundus tendon avulsion in a patient for whom surgery was contraindicated because of a high risk of stroke if anticoagulant treatment was to be stopped. After a 6-week conservative treatment and a 3-week self-physiotherapy programme, the patient achieved a nearly full active range of motion and an excellent functional result. A radiograph demonstrated a good fracture healing.

LEVEL OF EVIDENCE

V.