Management of posttraumatic finger contractures in adults

Self-Assisted Finger Stiffness Splint (SFSS)

Finger stiffness may arise from injuries, surgeries, or hand-related medical conditions, impacting hand function and overall well-being in daily life. Rehabilitation and hand therapy play a crucial role in restoring optimal range of motion, strength, and functionality. This article introduces the Self-Assisted Finger Stiffness Splint (SFSS), a dynamic splint designed for active finger movement applicable in post-trauma or postoperative rehabilitation. SFSS empowers patients to perform self-administered stretching exercises, expediting recovery and improving compliance. Its versatility extends to postoperative rehabilitation, covering cases like tenolysis of extensor tendons or rehabilitation after fracture healing. While particularly effective for proximal interphalangeal joint (PIPJ) and metacarpophalangeal joint (MCPJ) stiffness, SFSS remains valuable for managing isolated finger stiffness and proves beneficial in addressing multiple-digit stiffness.

Surgical Treatment for Patients with Post-traumatic Flexion Contracture of Proximal Interphalangeal Joint: Analysis of Various Affecting Factors

Background: A flexion contracture (FC) of the proximal interphalangeal (PIP) joint can have a profound negative influence on daily activity. The outcomes of surgical release of the PIP joint in literature are based on small sample size studies done several decades ago. The aim of this study is to report the outcomes of surgical treatment for post-traumatic FC of the PIP joint and to identify factors that affect these outcomes. Methods: This single institute retrospective study included patients from 2000 to 2020. We only included patients with post-traumatic FC of the PIP joint. We evaluated the demographic characteristics, cause of FC, surgical approaches and the various procedures conducted. We surveyed postoperative complications. During the study period, we asked about their current symptoms and evaluated their operative outcomes as excellent, good, fair or poor through the phone. Results: The average FC recovery angle was 37.3°. The small finger was the most affected, and the most common cause of FC was a tendon laceration. The volar plate complex release was the most frequently conducted procedure. The FC improvement was positively correlated to the degree of preoperative FC. The more severe preoperative flexion-extension arc was presented, the more FC recovery was achieved after operation. Patients who underwent multiple procedures had a higher degree of preoperative FC, and better correction was achieved with multiple procedures than with a single procedure. The most critical complication was recurrence. Conclusions: We were able to obtain average 37.3° of extension by surgical treatment. The more severe the FC presented before surgery, the greater the need for multiple procedures, however, this resulted in a significant increase in joint extension. Nevertheless, caution should be exercised regarding recurrence and could occur even with an experienced surgeon. Level of Evidence: Level IV (Therapeutic).

New frontiers of tendon augmentation technology in tissue engineering and regenerative medicine: a concise literature review

Tissue banking programs fail to meet the demand for human organs and tissues for transplantation into patients with congenital defects, injuries, chronic diseases, and end-stage organ failure. Tendons and ligaments are among the most frequently ruptured and/or worn-out body tissues owing to their frequent use, especially in athletes and the elderly population. Surgical repair has remained the mainstay management approach, regardless of scarring and adhesion formation during healing, which then compromises the gliding motion of the joint and reduces the quality of life for patients. Tissue engineering and regenerative medicine approaches, such as tendon augmentation, are promising as they may provide superior outcomes by inducing host-tissue ingrowth and tendon regeneration during degradation, thereby decreasing failure rates and morbidity. However, to date, tendon tissue engineering and regeneration research has been limited and lacks the much-needed human clinical evidence to translate most laboratory augmentation approaches to therapeutics. This narrative review summarizes the current treatment options for various tendon pathologies, future of tendon augmentation, cell therapy, gene therapy, 3D/4D bioprinting, scaffolding, and cell signals.

Prognostic factors for outcomes of surgical mobilisation in patients with posttraumatic limited range of motion of the proximal interphalangeal joint: a multivariate analysis

This study aimed to identify the prognostic factors for outcomes of surgical mobilisation in patients with posttraumatic limited range of motion (ROM) of the proximal interphalangeal (PIP) joint and determine which procedure actually improves the PIP joint ROM. A total of 71 fingers (57 patients: 49 men, 8 women; mean age, 41 years) with posttraumatic limited passive ROM of the PIP joint (<60°) who underwent surgical mobilisation were reviewed. Possible prognostic factors, including age, injury type, injured finger, injury in the adjacent finger, and procedure types, were assessed. We defined the PIP joint ROM improvement as the primary outcome in the linear regression analysis. To evaluate surgical efficacy, we classified the surgical treatment options into four categories (volar release, dorsal release, volar and dorsal release, and joint distraction with an external fixator) and compared their outcomes. The mean postoperative improvement in the PIP joint ROM was 12°. In the linear regression analysis, advanced age (estimate, -0.41; 95% confidence interval [CI], -0.76 to -0.06), open injury (estimate, -13.54; 95% CI -27.02 to -0.06), and skin defects (estimate, -23.22; 95% CI -34.83 to -11.61) were associated with worse outcomes; however, the volar approach was associated with favourable outcomes. Surgical mobilisation is strongly recommended when limited ROM of the PIP joint is caused by flexion site contracture. To improve the final outcome of fingers with complex injuries, a tailored treatment strategy is required to avoid dorsal release.

Controlled active exercise after open reduction and internal fixation of hand fractures

Background

Hand fractures can be treated using various operative or nonoperative methods. When an operative technique utilizing fixation is performed, early postoperative mobilization has been advocated. We implemented a protocol involving controlled active exercise in the early postoperative period and analyzed the outcomes.

Methods

Patients who were diagnosed with proximal phalangeal or metacarpal fractures of the second to fifth digits were included (n=37). Minimally invasive open reduction and internal fixation procedures were performed. At 3 weeks postoperatively, controlled active exercise was initiated, with stress applied against the direction of axial loading. The exercise involved pain-free active traction in three positions (supination, neutral, and pronation) between 3 and 5 weeks postoperatively. Postoperative radiographs and range of motion (ROM) in the interphalangeal and metacarpophalangeal joints were analyzed.

Results

Significant improvements in ROM were found between 6 and 12 weeks for both proximal phalangeal and metacarpal fractures (P<0.05). At 12 weeks, 26 patients achieved a total ROM of more than 230° in the affected finger. Postoperative radiographic images demonstrated union of the affected proximal phalangeal and metacarpal bones at a 20-week postoperative follow-up.

Conclusions

Minimally invasive open reduction and internal fixation minimized periosteal and peritendinous dissection in hand fractures. Controlled active exercise utilizing pain-free active traction in three different positions resulted in early functional exercise with an acceptable ROM.

[Capsular hydrodilatation versus kinesitherapy as initial treatment of finger capsulitis]

INTRODUCTION

To evaluate the effectiveness of early capsular ultrasound-guided hydrodilatation (HD) of the proximal interphalangeal or metacarpophalangeal joints in reducing joint stiffness and shortening kinesitherapy, as well as in improving hand functionality.

MATERIAL AND METHODS

We performed a one-year quasi-experimental pretest-posttest study with a control group in patients with proximal interphalangeal or metacarpophalangeal capsulitis in complex regional pain syndrome stages 2 or 3. Inclusion criteria consisted of age over 18 years, visual analogue scale<4 points and the absence of prior treatment. The control group received only kinesitherapy and the experimental group received capsular HD before kinesitherapy. There were 10 patients per group. The main measures were range of motion, active grip, Spanish validated Michigan Hand Outcomes Questionnaire and the number of kinesitherapy sessions required.

RESULTS

At baseline, the range of motion of the proximal proximal interphalangeal joint was 20° worse in the experimental group (P=.01). There were no statistically significant differences in the other baseline characteristics. Immediate gain in range of motion after HD was 61.71% (P=.024). No significant improvements were observed in functionality except in active grip after 2 weeks of HD (P=.02) and one month later compared with the control group (P=.014). The number of kinesitherapy sessions required was 19.6±10.42 (95% CI) in the HD group and 29.4±8.11 (95% CI) in the control group (P>.05).

CONCLUSIONS

Capsular HD could be considered as an initial treatment in finger joint stiffness because of the significant immediate improvement in range of motion. It is also an innovative technique in these joints with a short learning curve. The technique can be safely and effectively performed in a physiatry consulting room.