1
|
Papatolicas KA, Clingin JE, Nicks RJ. Dorsal blocking orthoses for proximal interphalangeal joint volar plate injuries: A retrospective cohort study investigating the impact of joint angle on patient outcomes. J Hand Ther 2024:S0894-1130(24)00053-X. [PMID: 39218759 DOI: 10.1016/j.jht.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 05/30/2024] [Accepted: 06/24/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Injuries to the proximal interphalangeal joint (PIPJ) of the fingers are commonly treated in hand therapy departments. Conservative management for PIPJ volar plate injuries typically involves a dorsal blocking orthosis and flexion exercises. Historically hand therapists have placed the PIPJ in varying degrees of flexion but the optimal angle is unknown. PURPOSE To compare the outcomes of two treatment groups who received dorsal blocking orthoses: Those who the orthosis was positioned in neutral compared to those in 25-30° of flexion. STUDY DESIGN Retrospective cohort study. METHOD Patients treated by the hand therapy service at a major metropolitan hospital network in Melbourne, Australia, for conservative management of a PIPJ volar plate injury over a three-year period were included in our study. Data regarding patient demographics, digits affected and injury type were collected. Outcomes included presence of a fixed flexion deformity (FFD), amount of hand therapy received and total active flexion at the PIPJ. RESULTS One hundred and eleven participants were included in our study. The mean age was 26 and 59 (53%) were males. Seventy two (64%) participants received a dorsal blocking orthosis positioned in neutral and 39 (35%) were positioned in 25-30° flexion at the PIPJ. Participants whose orthosis was positioned at 25-30° had an average of 24 more minutes in hand therapy (which equates to approximately one appointment) compared to those whose PIPJ was positioned in neutral (p=0.006, d=0.5). Eight percent less participants developed a FFD (p = 0.24) and 13% more participants achieved full flexion (p = 0.06) in the group who received a dorsal blocking orthosis in neutral, however these results were not statistically significant. CONCLUSION PIPJ volar plate injures treated in an orthosis positioned in neutral required fewer hand therapy appointments. There was no statistically significant difference between groups regarding development of a FFD or full flexion.
Collapse
Affiliation(s)
- Kelly A Papatolicas
- Maroondah Hospital, Eastern Health, Ringwood, Victoria, Australia; Box Hill Hospital, Eastern Health, Box Hill, Victoria, Australia
| | - Jessica E Clingin
- Maroondah Hospital, Eastern Health, Ringwood, Victoria, Australia; Box Hill Hospital, Eastern Health, Box Hill, Victoria, Australia.
| | - Rebecca J Nicks
- Maroondah Hospital, Eastern Health, Ringwood, Victoria, Australia; Box Hill Hospital, Eastern Health, Box Hill, Victoria, Australia
| |
Collapse
|
2
|
Kan JH, Barron OA, Bell BR. Congenital and Traumatic Conditions of the Pediatric Hand: Overview for the Radiologist. Semin Musculoskelet Radiol 2024; 28:424-436. [PMID: 39074725 DOI: 10.1055/s-0044-1779716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Alignment, longitudinal growth, and function of the musculoskeletal unit of the pediatric hand is complex due to the combination of open growth plates, ossification variations, and their relationship with finger tendinous and ligamentous attachments. This review presents the basics of normal development, acquired and congenital variations, and traumatic conditions of the pediatric hand from the perspective of the pediatric musculoskeletal radiologist and hand surgeon. This multimodality imaging article focuses on non-oncologic and non-rheumatologic conditions of the pediatric hand, inclusive of fingers, thumb, and metacarpal bones.
Collapse
Affiliation(s)
- J Herman Kan
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Olivia A Barron
- Department of Orthopaedics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Bryce R Bell
- Department of Orthopaedics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| |
Collapse
|
3
|
Godoy IRB, Yamada AF, Dilda G, Serfaty A, Skaf A, Cantarelli Rodrigues T. MRI findings of closed hand injuries in adolescent goalkeepers: a case-based review. Skeletal Radiol 2024; 53:1243-1254. [PMID: 38057436 DOI: 10.1007/s00256-023-04531-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023]
Abstract
Soccer-related injuries in youth goalkeepers are underrepresented in epidemiological studies, despite goalkeepers experiencing distinct types of upper limb injuries and training loads compared to outfield players. Digit injuries are particularly prevalent, with up to five times more upper extremity injuries reported in this position. Such injuries can lead to interphalangeal joint instability and an increased risk of reinjury. Mechanisms of injury include falls, axial loading of digits, and rotational force due to grasping activities. The proximal interphalangeal joint is the most frequently injured in sports, followed by the metacarpophalangeal joint of the thumb. Achieving precise diagnosis can be challenging due to the complex soft-tissue anatomy of the hand. Radiologists play a crucial role in accurate diagnosis through imaging studies, enabling timely treatment. This article focuses on closed traumatic finger and thumb injuries in adolescent goalkeepers, describing injury mechanisms and outlining relevant MRI features to facilitate proper clinical approaches for diagnosis based on imaging findings.
Collapse
Affiliation(s)
- Ivan Rodrigues Barros Godoy
- Department of Radiology, Hospital Do Coração (HCor), São Paulo, SP, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
- Department of Diagnostic Imaging, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - André Fukunishi Yamada
- Department of Radiology, Hospital Do Coração (HCor), São Paulo, SP, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
- Department of Diagnostic Imaging, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil
- Sociedade Esportiva Palmeiras, São Paulo, SP, Brazil
| | | | | | - Abdalla Skaf
- Department of Radiology, Hospital Do Coração (HCor), São Paulo, SP, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
| | - Tatiane Cantarelli Rodrigues
- Department of Radiology, Hospital Do Coração (HCor), São Paulo, SP, Brazil.
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil.
| |
Collapse
|
4
|
Nieves-Lopez B, Lacoste K, Garner HW, Aziz KT. Entrapment of the Volar Plate in the Retrocondylar Space of the Proximal Interphalangeal Joint Necessitating Open Reduction and Internal Fixation: A Case Report. J Orthop Case Rep 2024; 14:36-40. [PMID: 39035378 PMCID: PMC11258731 DOI: 10.13107/jocr.2024.v14.i07.4566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/06/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction Fracture-dislocations of the proximal interphalangeal joint (PIPJ) can have a significant impact on digital motion and hand function if inappropriately treated. While these injuries are commonly encountered, they can be quite challenging to manage. It is critical to ensure a concentric reduction and early motion when treating these injuries. Case Report A 17-year-old woman sustained a fracture-dislocation of the PIPJ of the left small finger. Despite a concentric closed reduction, she had pain and a mechanical block to PIPJ motion. Advanced imaging revealed volar plate entrapment in the retrocondylar space. She was treated with open reduction and direct volar plate repair. Postoperatively, the patient had an excellent outcome with no complications. Conclusion Our case highlights the importance of both performing an anesthetized examination and investigating the etiology of any limitations to motion even if there is an initial acceptable closed reduction.
Collapse
Affiliation(s)
- Benjamin Nieves-Lopez
- Department of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Ketrick Lacoste
- Department of Orthopedic Surgery, University of Florida, Jacksonville, Florida
| | - Hillary W Garner
- Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida
| | - Keith T Aziz
- Department of Orthopedic Surgery, Mayo Clinic Florida, Jacksonville, Florida
| |
Collapse
|
5
|
Phan R, Xie Y, Seth I, Atkinson CJ, Thomas D, Hunter-Smith DJ, Rozen WM, Cuomo R. Free hemi-hamate arthroplasty: A review of donor site outcomes. JPRAS Open 2024; 40:206-214. [PMID: 38633374 PMCID: PMC11021908 DOI: 10.1016/j.jpra.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/24/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction The use of the dorsal hamate as a free osteochondral bone graft or vascularized bone flap has become the mainstay for large, comminuted middle phalanx volar lip fractures. To date, few studies have been conducted in the assessment of donor site morbidity for the hemi-hamate graft or flap, and none have discussed modes of repair or reconstruction of this donor site. Methods A retrospective analysis of 14 hemi-hamate arthroplasty (HHA) procedures, including 6 vascularized and 8 non-vascularized grafts, from two surgeons was performed. Four hamate defect reconstruction techniques were utilized: no formal reconstruction, autologous bone grafting, gel foam, or synthetic bone substitute. The dorsal capsule was repaired with either extensor retinaculum grafting or by direct closure. Wrist range of motion, pain scores, and radiographic alignment were assessed. Results At 6 months follow-up, all patients achieved full, pain-free wrist motion compared to the uninjured side, with visual analog scale pain scores of 0. Serial radiographs showed maintained carpal alignment without instability or subluxation. No differences based on the hamate defect reconstruction method or capsular repair technique was demonstrated. Conclusion Safe return to pain free, unrestricted wrist function is achievable after HHA, regardless of hamate donor site management. Adequate dorsal capsular repair appears critical to prevent instability. Further study is needed to compare techniques, but choice may be guided by surgeon preference in the absence of clear evidence.
Collapse
Affiliation(s)
- Robert Phan
- Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - Yi Xie
- Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - Ishith Seth
- Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - Connor J. Atkinson
- Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - Damon Thomas
- Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - David J. Hunter-Smith
- Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - Warren M. Rozen
- Peninsula Health, Frankston Hospital, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - Roberto Cuomo
- Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| |
Collapse
|
6
|
Hunt TJ, Powlan FJ, Renfro KN, Polmear M, Macias RA, Dunn JC, Wells ME. Common Finger Injuries: Treatment Guidelines for Emergency and Primary Care Providers. Mil Med 2024; 189:988-994. [PMID: 36734106 DOI: 10.1093/milmed/usad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/10/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Finger and hand injuries are among the most common musculoskeletal conditions presenting to emergency departments and primary care providers. Many rural and community hospitals may not have immediate access to an orthopedic surgeon on-site. Furthermore, military treatment facilities, both within the continental United States and in austere deployment environments, face similar challenges. Therefore, knowing how to treat basic finger and hand injuries is paramount for patient care. MATERIALS AND METHODS The Armed Forces Health Surveillance Branch operates the Defense Medical Surveillance System, a database that serves as the central repository of medical surveillance data for the armed forces. The Defense Medical Surveillance System was queried for ICD-10 codes associated with finger injuries from 2015 to 2019 among active duty service members across the major branches of the military. RESULTS The most commonly reported finger injuries were open wounds to fingers without damage to nails, metacarpal fractures, phalanx fractures, and finger subluxation/dislocation. Emergency departments were the most commonly reported treatment facility type accounting for 35% of initial finger injuries, followed by 32.2% at orthopedic surgery clinics, 22.2% at family medicine clinics, and 10.8% at urgent care centers. CONCLUSIONS Finger injuries are common in the military setting and presenting directly to an orthopedic surgeon does not appear the norm. Fingertip injuries, fractures within the hand, and finger dislocations can often be managed without the need for a subspecialist. By following simple guidelines with attention to "red flags," primary care providers can manage most of these injuries with short-term follow-up with orthopedics.
Collapse
Affiliation(s)
- Tyler J Hunt
- Jack Hughston Memorial Hospital, Phenix City, AL 36867, USA
| | - Franklin J Powlan
- William Beaumont Army Medical Center, Fort Bliss, TX 79918, USA
- Texas Tech University Health Sciences Center of El Paso, El Paso, TX 79905, USA
| | - Kayleigh N Renfro
- William Beaumont Army Medical Center, Fort Bliss, TX 79918, USA
- Texas Tech University Health Sciences Center of El Paso, El Paso, TX 79905, USA
| | - Michael Polmear
- William Beaumont Army Medical Center, Fort Bliss, TX 79918, USA
- Texas Tech University Health Sciences Center of El Paso, El Paso, TX 79905, USA
| | - Reuben A Macias
- Blanchfield Army Community Hospital, Fort Campbell, KY 42223, USA
| | - John C Dunn
- William Beaumont Army Medical Center, Fort Bliss, TX 79918, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Matthew E Wells
- William Beaumont Army Medical Center, Fort Bliss, TX 79918, USA
- Texas Tech University Health Sciences Center of El Paso, El Paso, TX 79905, USA
| |
Collapse
|
7
|
Gottipati S, Satapathy D, Yalamanchili RK, Maley DK, Ifthekar S, Lakkireddy M. Neglected Dorsal Proximal Interphalangeal Joint Dislocation Treated by Volar Plate Arthroplasty: A Case Series. Cureus 2024; 16:e60077. [PMID: 38860079 PMCID: PMC11163305 DOI: 10.7759/cureus.60077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 06/12/2024] Open
Abstract
Chronic unreduced dislocations of the proximal interphalangeal joint are uncommon, and management principles for these injuries have not been defined. The dislocation can be volar or dorsal and closed reduction is rarely successful owing to soft tissue contractures. Treatment options in literature reviews for such rare injuries included open reduction of pip joint with volar plate arthroplasty, extension block pinning, hemi hamate arthroplasty, pip joint arthrodesis, Suzuki dynamic frame fixation, open reduction and repair of capsule and collateral ligaments with suture anchors. Few cases of amputation following treatment were even reported in literature emphasizing the role of meticulous soft tissue handling in such neglected cases of hand. We report six cases of neglected (more than three months old) dorsal dislocation of the PIP joint of the hand, treated with volar plate arthroplasty and extension block pinning. A functional range of motion with a stable joint can be achieved in such injuries with volar plate arthroplasty, as long as the articular cartilage is relatively preserved and bone loss is <30%.
Collapse
Affiliation(s)
- Sunil Gottipati
- Orthopaedics, Great Eastern Medical School and Hospital, Srikakulam, IND
| | - Deepankar Satapathy
- Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Bibinagar, IND
| | | | - Deepak Kumar Maley
- Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Bibinagar, IND
| | - Syed Ifthekar
- Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Bibinagar, IND
| | - Maheshwar Lakkireddy
- Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Bibinagar, IND
| |
Collapse
|
8
|
Rogers R, Luk L, Ross R, Cowling L, Wall B, Lawson-Smith M. Study of Hamate Fractures in a Single Tertiary Hands Unit: A Retrospective Cohort Study and Literature Review. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:344-348. [PMID: 38817751 PMCID: PMC11133886 DOI: 10.1016/j.jhsg.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/20/2024] [Indexed: 06/01/2024] Open
Abstract
Purpose The primary purpose of our study was to investigate hamate fractures at a single tertiary hand surgery unit in Western Australia, particularly comparing operative and nonsurgical outcomes. Methods Patients with hamate and/or hamate plus fifth carpometacarpal injury at our hand unit between 2019 and 2022 were identified. All patients had Quick Disability of the Arm, Shoulder and Hand (QuickDASH) patient-reported outcome measures recorded post treatment. Patients managed operatively and nonsurgically had a period of splinting with plaster of Paris and/or thermoplastic splint for a minimum of 2 weeks. All patients underwent hand therapy. Results Forty-eight patients with hamate and/or hamate plus fifth carpometacarpal injury were included in this study. Thirteen patients had Milch type 1 fractures, and 35 had Milch type 2 fractures. Six Milch type 1 fractures were managed operatively, and seven were managed nonsurgically. The average QuickDASH score for the operative group was 0.38. The average QuickDASH score for the nonsurgical group was 0.65. Sixteen Milch type 2 fractures were managed operatively, and 19 were managed nonsurgically. The average QuickDASH score for the operative group was 1.3. The average QuickDASH score for the nonsurgical group was 3.5. Conclusions For Milch type 2 fractures, patient-reported outcome measures were better for the operative group compared with the nonsurgical group. Type of study/level of evidence Therapeutic IV.
Collapse
Affiliation(s)
- Rebecca Rogers
- FHHS DOHS, FHHS DOOS, Notre Dame University, University of Western Australia, Fremantle, Western Australia
| | - Lincoln Luk
- FHHS DOHS, FHHS DOOS, Notre Dame University, University of Western Australia, Fremantle, Western Australia
| | - Rachel Ross
- FHHS DOHS, FHHS DOOS, Notre Dame University, University of Western Australia, Fremantle, Western Australia
| | - Laura Cowling
- FHHS DOHS, FHHS DOOS, Notre Dame University, University of Western Australia, Fremantle, Western Australia
| | - Benjamin Wall
- FHHS DOHS, FHHS DOOS, Notre Dame University, University of Western Australia, Fremantle, Western Australia
| | - Matthew Lawson-Smith
- FHHS DOHS, FHHS DOOS, Notre Dame University, University of Western Australia, Fremantle, Western Australia
| |
Collapse
|
9
|
Shenouda S, Means O, Fahrenkopf M. Irreducible Proximal Interphalangeal Joint Dislocation. EPLASTY 2024; 24:QA1. [PMID: 38501144 PMCID: PMC10948195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Samer Shenouda
- Michigan State University, College of Human Medicine, Grand Rapids, Michigan
| | - Olivia Means
- Integrated Plastic Surgery Residency, Corewell Health/Michigan State University, Grand Rapids, Michigan
| | | |
Collapse
|
10
|
Lama CJ, Jones MC, Dileso S, Weiss AP. The JAY (Joint Active Yoke) orthosis for a complex pip fracture-dislocation with failed volar plate repair: A case report. J Hand Ther 2023; 36:1020-1027. [PMID: 36914498 DOI: 10.1016/j.jht.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 08/16/2022] [Accepted: 09/13/2022] [Indexed: 03/16/2023]
Abstract
INTRODUCTION This case report details the postsurgical rehabilitation and outcome of a 57-year old neurosurgeon who underwent hemi-hamate arthroplasty and volar plate repair for a complex ring finger proximal interphalangeal (PIP) fracture-dislocation sustained after a fall while snowboarding. Following re-rupture and repair of his volar plate, the patient was fitted for a "yoke" relative motion flexor orthosis, termed a JAY (Joint Active Yoke) orthosis, in a manner reverse to that which is commonly used for extensor-related injuries. STUDY DESIGN/METHODS A 57 yo right hand-dominant male who suffered a complex PIP fracture-dislocation with failed volar plate repair undwent hemi-hamate arthroplasty and early active motion following using a custom-fabricated joint active yoke orthosis. PURPOSE OF THE STUDY The purpose of this study is to illustrate the benefits of this orthosis design in allowing for active controlled flexion of the repaired PIP joint with assist from the adjacent fingers, while also reducing joint torque and dorsal displacement forces. RESULTS A satisfactory active motion outcome was achieved with maintenance of PIP joint congruity allowing the patient to return to work as a neurosurgeon at 2-months post-operatively. DISCUSSION There is little published literature on the use of relative motion flexion orthoses following PIP injuries. Most current studies are isolated case reports on boutonniere deformity, flexor tendon repair, and closed reduction of PIP fractures. The following therapeutic intervention was considered an important contributor to a favorable functional outcome, as it minimized unwanted joint reaction forces in a complex PIP fracture-dislocation and unstable volar plate. CONCLUSION Future research with greater level of evidence is required to establish the various applications of relative motion flexion orthoses, as well as determine the appropriate time at which to place the patient in a relative motion orthosis following operative repair to prevent long-term stiffness and poor motion.
Collapse
Affiliation(s)
- Christopher J Lama
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University Providence, RI, USA.
| | - Matthew C Jones
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University Providence, RI, USA
| | - Sara Dileso
- Department of Hand Therapy, University Orthopedics, East Providence, RI, USA
| | - Arnold-Peter Weiss
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University Providence, RI, USA
| |
Collapse
|
11
|
Barrached M, Zari S, Lachkar A, Abdeljaouad N, Yacoubi H. Fracture-Dislocation Dorsal of the Proximal Interphalangeal Joint: A Case Report and Focus on Volar Plate Injuries. Cureus 2023; 15:e47663. [PMID: 38021719 PMCID: PMC10670557 DOI: 10.7759/cureus.47663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
The proximal interphalangeal (PIP) joint is the articulating joint between the proximal and middle phalanges of the fingers. A dorsal fracture-dislocation of the PIP joint of the fingers with volar plate injuries is an uncommon injury. Few cases have been published in the literature. In this article, we report the case of a subluxation fracture of the PIP joint in a 27-year-old male patient, without pathological history, a manual worker, right-handed, diagnosed 28 days after the injury. The treatment was surgical with open reduction and fixation of the fragment of the base of P2 with osteosutures. The functional results after three months were satisfactory with good sagittal and frontal joint stability and active flexion of the PIP joint at 95° and active extension at 0°. The control radiographs confirm the consolidation of the osteochondral fragment of the base of P2. The patient returned to his usual activities without pain.
Collapse
Affiliation(s)
- Mohammed Barrached
- Department of Traumatology and Orthopedic, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
| | - Saber Zari
- Department of Traumatology and Orthopedic, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
| | - Adnane Lachkar
- Department of Traumatology and Orthopedic, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
| | - Najib Abdeljaouad
- Department of Traumatology and Orthopedic, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
| | - Hicham Yacoubi
- Department of Traumatology and Orthopedic, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
| |
Collapse
|
12
|
Kolovich GP, Heifner JJ. Proximal interphalangeal joint dislocations and fracture-dislocations. J Hand Surg Eur Vol 2023; 48:27S-34S. [PMID: 37704028 DOI: 10.1177/17531934231183259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Although proximal interphalangeal joint dislocations are generally straightforward to treat, fracture-dislocations are among the most difficult hand injuries to manage. Fracture patterns range from simple to treat palmar plate avulsion fractures to complex, unstable pilon fractures of the base of the middle phalanx, where achieving adequate reduction and fixation can be extremely difficult. Moreover, these fractures may present sub-acutely or chronically, which greatly adds to the complexity of the case. It is therefore no surprise that clinical results vary and are often difficult to predict. We will discuss the clinical presentations, the various dislocation and fracture-dislocation patterns, treatment options and the complications of these injuries.
Collapse
|
13
|
Levy KH, Kurtzman JS, Horowitz EH, Dar QA, Hayes WT, Koehler SM. Proximal Interphalangeal Joint Congruity: A Biomechanical Study. Hand (N Y) 2023; 18:938-944. [PMID: 35156413 PMCID: PMC10470231 DOI: 10.1177/15589447211060419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surgical approaches to the proximal interphalangeal (PIP) joint often require disruption of soft tissue stabilizers. Additionally, PIP joint injuries frequently result in soft tissue disruption. This study evaluates the necessity of repairing soft tissue stabilizers by assessing their role in maintaining native joint congruity. METHODS Eight specimens were used to evaluate congruity at 0° and 30° flexion when loaded with 2 N of valgus force. This was performed in the native joint and after sequential sectioning of the surrounding ligaments in order: volar plate (VP), radial collateral ligament (CL), and ulnar CL. The skin flap was sutured with the ligaments unrepaired and the load was reapplied. Radiographs were taken after each load and used to measure the joint line convergence angle (JLCA). RESULTS Mean JLCA increased in both degrees of flexion after ligaments were sectioned but was only significantly different from the native joint after the VP was disrupted along with 1 CL. Joint congruity improved following repair of the skin flap in both degrees of flexion but was not significant. Joints were more congruent in 30° flexion for all subgroups, but none were significantly different compared to 0° flexion. CONCLUSIONS Disruption of the VP is insufficient to significantly alter PIP joint congruity. While sectioning of both the VP and CLs resulted in a statistically significant change in joint congruity, mean JLCA demonstrated changes of minor clinical significance. The osseous anatomy of the phalanges imparts inherent stability that maintains a congruent joint despite loss of the soft tissue stabilizers.
Collapse
|
14
|
Worgul CA, Stein AB. Extension-Block Pinning for Unstable Dorsal Proximal Interphalangeal Joint Fracture-Dislocations: A Simple, Percutaneous Technique With Reproducible Outcomes. Hand (N Y) 2023; 18:616-623. [PMID: 34991401 PMCID: PMC10233636 DOI: 10.1177/15589447211066352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Proximal interphalangeal (PIP) joint fracture-dislocations can be technically challenging injuries to treat, and no technique has proven to be superior nor lead to predictably good outcomes. We describe our experience of treating unstable dorsal fracture-dislocations of the PIP joint with extension-block pinning (EBP) at our institution over a 22-year period. METHODS In all, 23 patients with 24 unstable dorsal fracture-dislocations of the PIP joint treated with EBP between January 1998 and October 2020 were identified. All patients underwent closed reduction of the PIP joint and insertion of a Kirschner wire into the proximal phalanx, creating a mechanical block. Range of motion and joint congruity were assessed at final clinic follow-up. Long-term function was assessed via completion of a Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Spearman's correlation coefficient was utilized to assess if any association existed between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. RESULTS Mean range of motion at final follow-up was 83.3° and 22 of 24 PIP joints demonstrated a congruent reduction. In all, 15 of the 23 patients completed the QuickDASH questionnaire at a median long-term follow-up of 57.5 months (range: 3-157 months). Average QuickDASH score was 18.8, indicating minimal long-term disability. No statistically significant associations were found between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. CONCLUSIONS EBP offers a simple and innovative method to treat a complex injury of the PIP joint. It is technically straightforward and cheap, and produces excellent functional outcomes with minimal long-term disability.
Collapse
|
15
|
Kamble P, Prabhu RM, Mohanty S, Keny S. Hemi-hamate arthroplasty for the management of chronic proximal interphalangeal joint fracture dislocations: Analysis of 21 cases in Indian population and review of the literature. J Clin Orthop Trauma 2023; 37:102109. [PMID: 36743977 PMCID: PMC9894919 DOI: 10.1016/j.jcot.2023.102109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/02/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
Background Chronic fracture-dislocations involving the proximal interphalangeal (PIP) joint are challenging cases. We conducted this study to analyze the outcomes following hemi-hamate autograft reconstruction of such injuries and to compare our results with the existing literature. Methods A retrospective analysis of 21 patients with chronic dorsal PIP fracture-dislocations that were managed with hemi-hamate autograft reconstruction was done. The average articular surface involvement was 64%. The average duration between injury and surgery was 9.4 weeks (range, 6-16). Quick DASH (Disabilities of Shoulder and Hand) scores, VAS (Visual Analog Scale) scores, range of motion of the PIP joints, DIP (distal interphalangeal) joints, and MCP (metacarpophalangeal) joints were measured during serial follow-up visits. Results Union and graft incorporation was seen in all cases. The average Quick DASH score at four weeks post-surgery was 66 and it improved to eight at one year (p-value<0.05). The average VAS score at four weeks post-surgery was 7.66 and it improved to 2.09 at one year (p-value<0.05). The mean flexion of the MCP joint improved from 52.85° at the end of four weeks to 72.38° at one year (p-value<0.05). The average flexion at the PIP joint improved from 10.47° at the end of four weeks to 70.47° at one year (p-value<0.05). The average DIP flexion improved from 38.33° at the end of four weeks to 62.38° at one year (p-value<0.05). The average hand grip strength was 85% of the normal side. Conclusion Hemihamate autograft reconstruction is a suitable procedure for the management of chronic PIP joint fracture-dislocations, especially in cases with extensive involvement of the articular surface. Level of evidence III.
Collapse
Affiliation(s)
| | | | | | - Swapnil Keny
- Seth GS Medical College and KEM Hospital, Mumbai, India
| |
Collapse
|
16
|
Bond EC, Matenga M, B M MacLean S. Hamate vs. capitate grafting for proximal interphalangeal joint fracture-dislocation: an MRI-based study of 35 hands. J Hand Surg Eur Vol 2022; 47:755-760. [PMID: 35187984 DOI: 10.1177/17531934221081293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We examined the MRI scans of 35 adult hands to assess the feasibility of the hamate and the capitate as potential donor grafts in the management of comminuted intra-articular fractures at the base of the middle phalanges. Essentially neither the hamate nor the capitate were perfect anatomic matches in most digits, but the capitate had the advantage of having more uniform facets, and the capitate facet shapes were similar to those of the little finger. The measurement of angles in the coronal and sagittal plane showed that in some respects the differences between the potential graft and the base of the middle phalanges were smaller for the capitate than for the hamate. Moreover, the sagittal morphology of the capitate made it less prone to joint overstuffing than the hamate. We conclude that the capitate may be considered as a graft donor in selected cases, especially for the little finger.
Collapse
Affiliation(s)
- Elizabeth C Bond
- Orthopaedic Department, Tauranga Hospital, Tauranga, New Zealand
| | - Michaela Matenga
- Orthopaedic Department, Tauranga Hospital, Tauranga, New Zealand
| | | |
Collapse
|
17
|
Falk N, Pendergraph B, Meredith TJ, Le G, Hornsby H. Managing Fractures and Sprains. Prim Care 2022; 49:145-161. [DOI: 10.1016/j.pop.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe treatment options for phalangeal fractures. 2. Choose an appropriate fracture management plan that optimizes patient goals and range of motion. 3. Describe closed and open reduction techniques of commonly encountered phalangeal fracture patterns. SUMMARY Phalangeal fractures are the second most common upper extremity fracture. Although many can be treated with splinting, operative intervention may be required for unstable fracture patterns and those involving the articular surface. Failure to appropriately treat these fractures can result in finger stiffness, loss in range of motion, and functional deficits. The type of fixation method can range from percutaneous pinning to open reduction and internal fixation. This article presents a series of cases to illustrate the appropriate management of phalangeal fractures using an evidence-based approach.
Collapse
|
19
|
McDevitt J, Griffin M, Doyle D. Volar Plate Injuries of the Proximal Interphalangeal Joint. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
20
|
Management of Highly Comminuted Intra-articular Fracture Subluxations at the Proximal Interphalangeal Joint by Subchondral Buttress Fixation and Early Mobilization. Tech Hand Up Extrem Surg 2021; 25:258-263. [PMID: 34779423 DOI: 10.1097/bth.0000000000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article describes our technique of managing highly comminuted intra-articular fracture subluxations at the proximal interphalangeal joint by subchondral buttress fixation followed by early mobilization. This technique has proven to be reliable and all patients have been able to return to their preinjury level of activity.
Collapse
|
21
|
Mehta S, Jacob John JJ, Madhusudhan TR. Floating proximal interphalangeal joint (PIPJ) injury of the little finger in a child: A case report. Trauma Case Rep 2021; 33:100458. [PMID: 33869717 PMCID: PMC8044674 DOI: 10.1016/j.tcr.2021.100458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 11/10/2022] Open
Abstract
We present a floating PIPJ injury of the non-dominant hand little finger in a skeletally immature boy following a hyperextension injury while playing football. The injury was managed non-operatively with a successful outcome. This injury pattern can happen with trivial trauma in a child and could be easily missed. It is important to be aware of this pattern of injury and good functional outcomes are possible with non-operative treatment.
Collapse
Affiliation(s)
- Sonu Mehta
- Trauma & Orthopaedics, Glan Clwyd Hospital, Rhyl (Betsi Cadwaladr University Health Board), United Kingdom of Great Britain and Northern Ireland
| | - Jagan John Jacob John
- Trauma & Orthopaedics, Glan Clwyd Hospital, Rhyl (Betsi Cadwaladr University Health Board), United Kingdom of Great Britain and Northern Ireland
| | - Thayur R Madhusudhan
- Trauma & Orthopaedics, Glan Clwyd Hospital, Rhyl (Betsi Cadwaladr University Health Board), United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
22
|
Dynamic External Fixation for Interphalangeal Comminuted Fractures With Mallet Injury. EPLASTY 2021; 21:ic2. [PMID: 33747339 PMCID: PMC7941143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
23
|
Faccioli N, Santi E, Foti G, Mansueto G, Corain M. Cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of complex phalangeal fractures: economic simulation. Musculoskelet Surg 2020; 106:169-177. [PMID: 33211300 PMCID: PMC9130154 DOI: 10.1007/s12306-020-00687-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of this study was to evaluate the cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of the complex finger fractures with articular involvement. Methods We created a decision tree model simulating the diagnostic pathway of complex finger fractures, suggesting the use of CBCT as alternative to multi-slice computed tomography (MSCT), and we compared their clinical outcomes, costs, and cost-effectiveness for a hypothetical cohort of 10,000 patients. Measures of effectiveness are analysed by using quality-adjusted life years, incremental cost-effectiveness ratio, and net monetary benefit. Results Diagnosis of a complex finger fracture performed with CBCT costed 67.33€ per patient, yielded 9.08 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 29.94€ and a net monetary benefit of 9.07 € at 30,000€ threshold. Using MSCT for diagnosis costed 106.23 €, yielded 8.18 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 371.15 € and a net monetary benefit of 8.09 €. CBCT strategy dominated the MSCT strategy. The acceptability curve shows that there is 98% probability of CBCT being the optimal strategy at 30,000€ threshold (1 EUR equal to 1.11 USD; updated on 02/02/2020). Conclusion CBCT in complex finger fractures management is cost saving compared with MSCT and may be considered a valuable imaging tool in preoperative assessment, allowing early detection and appropriate treatment. It shortens the time to completion of diagnostic work-up, reduces the number of additional diagnostic procedures, improves quality of life, and may reduce costs in a societal perspective.
Collapse
Affiliation(s)
- N Faccioli
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Piazzale L.A.Scuro 10, 37134, Verona, Italy.
| | - E Santi
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Piazzale L.A.Scuro 10, 37134, Verona, Italy
| | - G Foti
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - G Mansueto
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Piazzale L.A.Scuro 10, 37134, Verona, Italy
| | - M Corain
- Hand Surgery Department, G.B. Rossi University Hospital, Piazzale L.A.Scuro 10, 37134, Verona, Italy
| |
Collapse
|
24
|
Abouelela A, Mubark I, Hassan M, Howells M, Ashwood N, Kitsis C. Mid-Term Outcomes of Unstable Complex Proximal Interphalangeal Joint Fracture Management Using the Ligamentotaxor® Device: A Case Series of 33 Cases. Cureus 2020; 12:e10519. [PMID: 33094060 PMCID: PMC7574824 DOI: 10.7759/cureus.10519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background and objective Fractures of the proximal interphalangeal joint (PIPJ) of the hand have always been difficult to treat, often leading to less than satisfactory outcomes. The use of dynamic external fixator devices to treat these fractures is well established and it is based on the philosophy of minimal soft tissue injury and early joint mobilization. There has been a wide variety in their designs, surgical technique, and reported outcomes. This study aimed to report the long-term outcome following the use of the Ligamentotaxor® device (Ligamentotaxor1, ArexTM, Palaiseau, France) in treating fractures of the PIPJ of the hand. Methods Between 2009 and 2018, 33 patients treated in our institution with Ligamentotaxor® for fractures of the PIPJ were followed up for a minimum period of 12 months. Radiographs and clinical records were reviewed for clinical and functional outcomes including finger range of motion (ROM), union, Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) score, and any complications. Results A total of 33 patients completed a minimum follow-up of 12 months (mean: 27.5 months). All fractures showed radiological union at a mean of 33 days. Surgery was performed within a mean of 8.9 days and surgical operating time averaged 23.7 minutes. Devices were removed at a mean of 33 days. At the end of the follow-up, the mean range of flexion was 66 degrees and the mean extension lag was six degrees. The mean QuickDASH score was 8.72. Of note, 85% of the patients experienced no limitations in their daily activities, while 35% reported pain on exertion. One patient had a pin tract infection. Four patients had cold intolerance and persistent swelling. Conclusion The results of the use of Ligamentotaxor® in this series are comparable to those of other dynamic external fixator devices reported in the literature. Thanks to its quick and easy surgical technique, the device provides an appealing option for the management of PIPJ fractures.
Collapse
Affiliation(s)
- Amr Abouelela
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Islam Mubark
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Mohammed Hassan
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Michael Howells
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Neil Ashwood
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Christos Kitsis
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| |
Collapse
|
25
|
Mabvuure NT, Pinto-Lopes R, Sierakowski A. Management of intraarticular proximal interphalangeal joint fracture-dislocations and pilon fractures with the Ligamentotaxor® device. Arch Orthop Trauma Surg 2020; 140:1133-1141. [PMID: 32448930 DOI: 10.1007/s00402-020-03482-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Fracture-dislocation and pilon injuries of the proximal interphalangeal joints (PIPJ) continue to pose significant management challenges. Stable fracture configurations can be treated with extension block splinting or pinning. Unstable fractures usually require open or closed reduction and fixation either directly/internally onto the fracture using Kirschner wires, cerclage wires, screws or miniplates or indirectly/externally by ligamentotaxis using external fixators which can be dynamic or static. Dynamic external fixators, such as Suzuki's pins and rubber traction system, S-Quattro and Hynes/Giddins frame, appear intuitive as they provide axial distraction, which reduces the fracture whilst obviating the need to open the fracture. They also allow immediate active movement whilst maintaining reduction. The Ligamentotaxor® (Arex, Pallaiseau Cedex, France) is a commercially-available dynamic external fixator which has been used at our institution since 2013. MATERIALS AND METHODS This retrospective study assessed the outcomes (interphalangeal joint active range of movement (AROM), QuickDASH score and complications) in 19 patients [mean age of 48.6 (SD 16.2)] whose proximal interphalangeal joint (PIPJ) fracture-dislocations and/or pilon fractures were treated with the Ligamentotaxor®. Injuries were classified according to Seno i.e. (1) volar lip fracture ± dorsal dislocation (2) dorsal lip fracture ± volar dislocation (3) pilon fracture. RESULTS There were fifteen (79%) pilon/Seno 3, three (16%) Seno 1 and one (5%) Seno 2 fractures. The mean PIPJ AROM was 70.6° (SD 4.48°) for all Seno classes and 70° (SD 5.6°) for the pilon subgroup. The QuickDASH score averaged to 2.65 (SD 0.88). There were two pin-site infections, three pin-site inflammations, one osteomyelitis and two complex regional pain syndrome diagnoses. One patient required arthroplasty after missing several appointments. CONCLUSIONS These results, considering the predominance of pilon fractures, compare favourably the published Ligamentotaxor® and other dynamic external fixator systems.
Collapse
Affiliation(s)
- Nigel Tapiwa Mabvuure
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, UK.
| | - Rui Pinto-Lopes
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, UK
| | - Adam Sierakowski
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, UK
| |
Collapse
|
26
|
Drain J, Mehta S, Goyal KS. An Analysis of Hamate Morphology Relevant to Hemi-Hamate Arthroplasty. J Hand Surg Am 2020; 45:657.e1-657.e6. [PMID: 31917048 DOI: 10.1016/j.jhsa.2019.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/06/2019] [Accepted: 11/13/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint can lead to joint incongruity from loss of the buttress function of the middle phalanx volar base. Hemi-hamate arthroplasty can reconstruct the volar articular surface of the middle phalangeal base where repair is not possible. We compared the anatomy of the hamate graft with the middle phalanx base. METHODS Forty unique skeletal specimens (40 hamates, 160 middle phalanges) were sampled. Anatomical features relevant to hemi-hamate reconstruction were measured, including the articular surface areas, the axial ridge angles, and the sagittal inclination angles of the hamate and the middle phalanx base specimens. Facets of the articular surfaces were classified as concave, convex, or flat. Calibrated measurements were made using digital photographs of the cadaveric specimens. Descriptive and univariate statistics were performed. RESULTS There was greater variability in the distal hamate than in the middle phalanx base. The ring finger facet of the distal hamate was concave in 39 of 40 specimens, whereas the little finger facet was convex in 31 of 40 specimens. The hamate axial ridge angle (66.0° ± 3.7°) was significantly different from the middle phalanx base (90.4° ± 0.4°). The hamate articular sagittal inclination (3.2° ± 4.1°) was significantly different from the middle phalanx base (51.2° ± 1.3°). The hamate articular surface area (1.96 cm2) was significantly greater than the middle phalanx base (mean index/middle/ring finger = 0.85 cm2 and mean little finger = 0.59 cm2). CONCLUSIONS The distal articular surface of the hamate is not anatomically identical to the middle phalanx base. The differences may still preclude anatomical reconstruction in the setting of a dorsal PIP fracture-dislocation, thereby affecting short- and long-term outcomes. CLINICAL RELEVANCE Knowledge of the anatomical differences between the distal hamate and the middle phalanx base may improve graft harvest and inset during reconstruction.
Collapse
Affiliation(s)
- Joseph Drain
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Saurabh Mehta
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kanu S Goyal
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
| |
Collapse
|
27
|
Najd Mazhar F, Jafari D, Taraz H, Mirzaei A. Treatment of dorsal fracture-dislocations of the proximal interphalangeal joint using the shotgun approach. J Hand Surg Eur Vol 2018; 43:499-505. [PMID: 29591322 DOI: 10.1177/1753193418766274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study assessed the outcome of open reduction and internal fixation of proximal interphalangeal joint fracture-dislocations through a shotgun approach, while keeping hemi-hamate arthroplasty as a back-up plan. After using the shotgun approach, fixation was carried out when the anterior fragment was large enough to accept two 1.5 mm screws. Sixty-three fracture-dislocations were treated in 61 patients, of whom 30 underwent internal fixation. Twenty-one of these were assessed in the final study. At a mean follow-up of 29 months, the mean range of joint motion was 80° and 102° for the injured and contralateral hand, respectively. The mean pinch and grip strengths of injured hand were 82% and 83% of contralateral hand, respectively. The mean disabilities of the arm, shoulder and hand score was 5.5. The mean visual analogue pain score was 1.6. Surgery through the versatile shotgun approach allows excellent intra-operative assessment and acceptable outcomes. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Farid Najd Mazhar
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Davod Jafari
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Taraz
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
28
|
Use of a Multivector Mandibular Distractor for Treatment of Pediatric Proximal Interphalangeal Joint Pilon Fractures: A Case-Based Review. J Hand Microsurg 2018; 10:6-11. [PMID: 29706729 DOI: 10.1055/s-0037-1608743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022] Open
Abstract
Background The difficulties in surgical treatment of pilon fractures of the finger include fragment reconstitution and posthealing stiffness. In adults, external fixation with traction and early active range of motion (AROM)/passive range of motion (PROM) during healing is considered necessary for avoiding joint stiffness and attaining realignment. The authors present a unique approach to pediatric pilon fractures that uses open reduction and multivector external fixation with delayed AROM/PROM. Initial immobilization and significant traction allowed for joint realignment and prevented noncompliance with staged distraction. The authors believe this immobilization leads to a superior outcome because, unlike adults, children tend to avoid stiffness and a larger distraction force allowed for sufficient joint realignment to regain range of motion (ROM). Methods A right-handed 13-year-old boy sustained a right ring finger fracture and presented 12 days later. Radiographs revealed a comminuted Salter-Harris 4 fracture of the middle phalanx. The patient underwent open reduction and placement of multivector external fixation using a pediatric mandibular distractor/fixator. Significant traction was applied to distract the finger to length. Results Hardware was removed 6 weeks postoperatively and AROM was initiated after splinting. The patient started PROM 8 weeks postoperatively. Strengthening was initiated 2 weeks later. ROM improved and rehabilitation was continued. The patient exhibited nearly equal grip strength 12 weeks postoperatively. At 14 months follow-up, radiographs showed complete healing and joint realignment. There was no deformity or pain and finger length was restored. Conclusion Management of pediatric pilon fractures is rarely described and presents unique considerations. Early-stage traction and immobilization using a multivector mandibular fixator/distractor is suitable in a child because noncompliance is avoided and there is a decreased risk for stiffness. Combining early immobilization with subsequent-staged AROM, PROM, and strengthening resulted in no loss of ROM and maintained articular symmetry.
Collapse
|
29
|
Packham TL, Ball PD, MacDermid JC, Bain JR, DalCin A. A scoping review of applications and outcomes of traction orthoses and constructs for the management of intra-articular fractures and fracture dislocations in the hand. J Hand Ther 2017; 29:246-68. [PMID: 27496982 DOI: 10.1016/j.jht.2016.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 02/02/2016] [Accepted: 04/08/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Intra-articular hand fractures can have devastating consequences for movement and function. The unique nature of the injury and diverse management strategies are a challenge for conducting trials. PURPOSE OF THE STUDY To conduct a scoping review of traction constructs for the management of intra-articular hand fractures. METHODS We conducted a systematic search of the literature, extracting data on the scope and nature of the evidence for traction constructs. RESULTS Our search yielded 87 articles addressing 3 traction constructs: (1) static traction (n = 17), (2) dynamic external fixation (n = 53), and (3) dynamic orthoses (n = 17). Active range of motion of the target joint was the most frequently reported outcome. Study designs included 36 cohorts, 21 case series, and 9 case studies: 24% contained only technical information. CONCLUSIONS The current literature addressing traction constructs consists primarily of small and low-quality studies. Evidence synthesis could improve the estimation of range of motion outcomes but would not be able to identify the best treatment. Consensus on classification of fracture patterns, routine use of outcome measures, and randomized trials are needed to compare different traction constructs and inform evidence-based care. STUDY DESIGN Scoping review. LEVEL OF EVIDENCE N/A.
Collapse
Affiliation(s)
- Tara L Packham
- Hand Therapy Clinic, Department of Rehabilitation Services, Neurosciences and Trauma Program, Hamilton Health Sciences, Hamilton, Ontario, Canada; School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Pamela D Ball
- Hand Therapy Clinic, Department of Rehabilitation Services, Neurosciences and Trauma Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Joy C MacDermid
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - James R Bain
- Department of Surgery, Hamilton Health Sciences, Hamilton, Ontario, Canada; Faculty of Health Sciences, Department of Surgery and Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Arianna DalCin
- Department of Surgery, Hamilton Health Sciences, Hamilton, Ontario, Canada; Faculty of Health Sciences, Department of Surgery and Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
30
|
Avery DM, Rodner CM, Edgar CM. Sports-related wrist and hand injuries: a review. J Orthop Surg Res 2016; 11:99. [PMID: 27633260 PMCID: PMC5025579 DOI: 10.1186/s13018-016-0432-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/28/2016] [Indexed: 12/15/2022] Open
Abstract
Background Hand and wrist injuries are common during athletics and can have a significant impact especially if initially disregarded. Due to their high level of physical demand, athletes represent a unique subset of the population. Main body The following is an overview of hand and wrist injuries commonly seen in athletics. Information regarding evaluation, diagnosis, conservative measures, and surgical treatment are provided. Conclusion Knowledge of these entities and special consideration for the athlete can help the team physician effectively treat these players and help them achieve their goals.
Collapse
Affiliation(s)
- Daniel M Avery
- University of Connecticut Musculoskeletal Institute, 263 Farmington Avenue, Farmington, CT, 06030-4037, USA.
| | - Craig M Rodner
- University of Connecticut Musculoskeletal Institute, 263 Farmington Avenue, Farmington, CT, 06030-4037, USA
| | - Cory M Edgar
- University of Connecticut Musculoskeletal Institute, 263 Farmington Avenue, Farmington, CT, 06030-4037, USA
| |
Collapse
|
31
|
DeNoble PH, Record NC. A Modification to Simplify the Harvest of a Hemi-hamate Autograft. J Hand Surg Am 2016; 41:e99-e102. [PMID: 27039348 DOI: 10.1016/j.jhsa.2016.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/17/2016] [Indexed: 02/02/2023]
Abstract
Hemi-hamate arthroplasty is a valuable option for subacute dorsal fracture-dislocations of the proximal interphalangeal joint. Various harvesting techniques have been recommended via both anterograde and retrograde directions, both posing some technical challenges. We propose a technique for simplifying the hemi-hamate graft harvest by creating a window of visualization onto the dorsal hamate articular surface. This is achieved by resection of the dorsal-ulnar base of fourth metacarpal and the dorsal-radial base of the fifth metacarpal. This makes it easier to measure and cut the hamate articular surface. It also provides a properly shaped graft that can be inset in the middle phalangeal defect without using backgrafting, and allowing screws to be placed perpendicular to the graft defect to obtain direct compression.
Collapse
Affiliation(s)
| | - Nicole C Record
- Department of Orthopedic Surgery, St. Joseph's Regional Medical Center, Seton Hall University, Paterson, NJ.
| |
Collapse
|
32
|
Bindra R, Colantoni Woodside J. Treatment of Proximal Interphalangeal Joint Fracture-Dislocations. JBJS Rev 2015; 3:01874474-201512000-00001. [PMID: 27490993 DOI: 10.2106/jbjs.rvw.o.00019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Randy Bindra
- Orthopaedic Surgery, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD 4215, Australia
| | - Julie Colantoni Woodside
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Suite 1700, Maywood, IL 60153
| |
Collapse
|
33
|
Dukas AG, Wolf JM. Management of complications of periarticular fractures of the distal interphalangeal, proximal interphalangeal, metacarpophalangeal, and carpometacarpal joints. Hand Clin 2015; 31:179-92. [PMID: 25934195 DOI: 10.1016/j.hcl.2015.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fractures involving the bones of the hand are among the most common injuries in the United States. A significant portion of these fractures are periarticular. Although the great majority of these fractures are treated successfully by nonoperative means, complications arise. We present a comprehensive review of prevention and management of complications of periarticular fractures of the distal interphalangeal, proximal interphalangeal, metacarpophalangeal, and carpometacarpal joints.
Collapse
Affiliation(s)
- Alex G Dukas
- Department of Orthopedic Surgery, UConn Health Center, New England Musculoskeletal Institute, Medical Arts & Research Building, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Jennifer Moriatis Wolf
- Department of Orthopedic Surgery, UConn Health Center, New England Musculoskeletal Institute, Medical Arts & Research Building, 263 Farmington Avenue, Farmington, CT 06030, USA.
| |
Collapse
|
34
|
de Haseth KB, Neuhaus V, Mudgal CS. Dorsal fracture-dislocations of the proximal interphalangeal joint: evaluation of closed reduction and percutaneous Kirschner wire pinning. Hand (N Y) 2015; 10:88-93. [PMID: 25767425 PMCID: PMC4349844 DOI: 10.1007/s11552-014-9660-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study is to evaluate the outcome of closed reduction and percutaneous Kirschner wire pinning in acute dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint. METHODS Eight men and one woman were treated with closed reduction and percutaneous Kirschner wire pinning by one orthopaedic surgeon. The ring finger was injured in six patients, the small finger in two patients and the middle finger in one patient. The mean joint surface involvement was 36 % (range, 26-49 %). The Kirschner wires were removed after an average of 28 days (range, 24-37 days). RESULTS All patients demonstrated a painless, but fusiform, swollen PIP joint after a mean follow-up of 6.5 months. The average flexion of the PIP joint was 106° (range, 80-110), and the average extension of the PIP joint was 4° short of full extension (range, 10 hyperextension-15 flexion contracture). All patients had a concentrically reduced PIP joint with a healed fracture on radiographs. Two patients had radiographic evidence of degenerative changes, but were asymptomatic. One patient developed a superficial pin track infection, which quickly resolved with a short course of antibiotics, and avascular necrosis affecting one of the condyles of the proximal phalanx. CONCLUSIONS In agreement with previous studies, closed reduction and percutaneous Kirschner wire pinning in dorsal fracture-dislocations of the PIP joint is a minimally invasive and simple technique which appears to give satisfactory outcomes in the short to intermediate term.
Collapse
Affiliation(s)
- Kristin B. de Haseth
- />Orthopaedic Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA , />Plastic, Reconstructive and Hand Surgery Department, Medisch Centrum Leeuwarden, 8934 Leeuwarden, Netherlands
| | - Valentin Neuhaus
- />Orthopaedic Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA , />Division of Trauma Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Chaitanya S. Mudgal
- />Orthopaedic Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| |
Collapse
|
35
|
Liodaki E, Xing SG, Mailaender P, Stang F. Management of difficult intra-articular fractures or fracture dislocations of the proximal interphalangeal joint. J Hand Surg Eur Vol 2015; 40:16-23. [PMID: 25427554 DOI: 10.1177/1753193414559464] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Intra-articular fractures or fracture dislocations of the proximal interphalangeal joint are difficult clinically because the bone and soft tissue structures are small and intricate. Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand. This article reviews the current methods of treatment, together with the senior author's experience in treating difficult proximal interphalangeal joint fractures and dislocations. Besides conservative treatments, surgical treatments include open or closed reduction with traditional Osteosynthesis, such as K-wires, screws or plates. Among recent developments are the percutaneous application of thin cannulated compression screws and novel dynamic external fixators. After a preferred minimally invasive treatment with stable reconstruction of the articular surface, sufficient aftercare is necessary to improve surgical outcomes.
Collapse
Affiliation(s)
- E Liodaki
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - S G Xing
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
| | - P Mailaender
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - F Stang
- Department of Plastic, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Luebeck, Germany
| |
Collapse
|
36
|
Abstract
Extensor mechanism injuries are frequently encountered in athletes and can lead to permanent disability or deformity if not promptly and properly treated. This article reviews basic anatomy, and then discusses mallet finger injuries, boutonniere deformity, and sagittal band rupture. Once treatment has begun, return to sport is highly variable because of the varied needs of each athlete and where they fall on the spectrum of disease. As such, each athlete must be carefully evaluated and closely followed to ensure a safe, prompt, and judicious return to athletic pursuits.
Collapse
Affiliation(s)
- John T McMurtry
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, 1200 East Broad Street, 9th Floor East Wing, Richmond, VA 23298, USA
| | - Jonathan Isaacs
- Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, 1200 East Broad Street, 9th Floor East Wing, Richmond, VA 23298, USA.
| |
Collapse
|
37
|
|
38
|
Mei GH, Wang HM, Fan CY, Zhang CQ, Zeng BF. Possibility of the hamatum carpometacarpal joint as a new joint donor site for interphalangeal joint restoration. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:1175-80. [PMID: 23982116 DOI: 10.1007/s00590-013-1300-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 08/17/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This research investigates the anatomic basis for the repair and reconstruction of hand joints using transposition of the carpometacarpal (CMC) joint of the hamatum. METHODS The morphology and structure of the CMC joints of the hamatum and the base joints of the middle phalanx were observed on 22 freshly frozen wrist specimens at Shanghai 6th People's Hospital Research Institute of Microsurgery. The volar dorsal dia, radioulnar dia, depth of concave, and area of the joints were measured. Data were obtained through statistical analysis, and the resemblance of joints was compared in terms of morphology, structure, area, length, and diameter. RESULTS The radioulnar dia of the CMC joints of the hamatum (13.54 ± 1.15 mm) did not exhibit any evident differences in the middle phalanx of the forefinger, middle finger, and ring finger, and in the distal phalanx of the thumb. The volar dorsal dia of the CMC joints of the hamatum (10.71 ± 0.93 mm) exhibited an evident difference in the middle phalanx of the ring finger. In all fingers, the depth of the ulnar and radial concave of the CMC joints of the hamatum (1.30 ± 0.08 and 0.95 ± 0.05 mm, respectively) and the area of the CMC joints of the hamatum (139.89 ± 5.44 mm(2)) showed an evident difference. CONCLUSION The CMC joint of the hamatum could be considered a new and viable joint donor site that could be used to repair and reconstruct the base joints of the middle phalanx.
Collapse
Affiliation(s)
- Guo-Hua Mei
- Department of Orthopaedic Surgery, Shanghai 6th People's Hospital, Shanghai Jiaotong University, Shanghai, 200233, China
| | | | | | | | | |
Collapse
|