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Yang Z, Ong CXL, Jiang JKH. The use of non-invasive skin traction orthosis in managing phalangeal fractures. J Hand Ther 2024:S0894-1130(23)00200-4. [PMID: 38350809 DOI: 10.1016/j.jht.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/20/2023] [Accepted: 12/30/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Phalangeal fractures are amongst the most challenging injuries that hand surgeons and hand therapists treat. Traditionally, these have been managed operatively, but are often fraught with potential problems including contractures, deformities and loss of motion. PURPOSE To provide evidence supporting the use of non-invasive skin traction orthosis as an effective treatment option. STUDY DESIGN Retrospective cohort. METHODS We performed a retrospective review of outpatients with phalangeal fractures treated with non-invasive skin traction orthoses in our institution from January 2021 till June 2022. Demographic information, injury specifics and radiological findings were extracted from medical records. Outcome measures included total arc of motion (TAM) and dorsal angulation angles. RESULTS Fourteen patients (17 fractures) with a mean age of 48 years (SD21.3) were included. Ten patients had single digit injuries, while four patients had two digits in traction within the same splint. 70.6% were proximal phalangeal fractures. 76.5% of the fractures were extra-articular and 58.8% non-comminuted. Median duration of orthosis use was 18 days (IQR 8-21). Patients with forearm-based orthoses had significantly longer traction time. There was a significant improvement (p = 0.001) from median baseline TAM (124°) to final TAM readings (245°). Younger patients with ulnar digit fractures or extra-articular fractures had a shorter rehabilitation period. There is no significant difference in clinical outcomes between the use of forearm-based or hand-based orthoses. CONCLUSION We recommend the use of the hand-based non-invasive skin traction orthosis as an option in managing phalangeal fractures as it is a simple, inexpensive and non-invasive procedure with promising results. Care must be taken to ensure frequent change of traction tapes to maintain good skin integrity, and to avoid loss of tension. Radiological imaging should be performed after each traction tape change to ensure good alignment is maintained.
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Affiliation(s)
- Zixian Yang
- Department of Occupational Therapy, Sengkang General Hospital, Singapore, Singapore.
| | - Charlene Xue Lin Ong
- Department of Occupational Therapy, Sengkang General Hospital, Singapore, Singapore
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Bui GA, Huang JI. Intramedullary Screw Fixation of Metacarpal and Phalangeal Fractures. Hand Clin 2023; 39:475-488. [PMID: 37827601 DOI: 10.1016/j.hcl.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Metacarpal and phalangeal fractures are the second and third most common hand and wrist fractures seen in the emergency department. There are a multitude of operative fixation methods for metacarpal and phalangeal fractures, including closed reduction percutaneous pinning, open reduction internal fixation, external fixation, and intramedullary screw fixation. Although intramedullary fixation is a relatively new surgical technique, it is gaining in popularity as it allows patients to resume range of motion early in the postoperative period with excellent clinical outcomes.
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Affiliation(s)
- Gabrielle Anne Bui
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, 908 Jefferson Street, Ninth Floor, Seattle, WA 98104, USA
| | - Jerry I Huang
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way Northeast, Box 354740, Seattle, WA 98105, USA.
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Silins K, Turkmen T, Vögelin E, Haug LCP. Comparing treatment of proximal phalangeal fractures with intramedullary screws versus plating. Arch Orthop Trauma Surg 2023; 143:1699-1706. [PMID: 35994095 PMCID: PMC9957854 DOI: 10.1007/s00402-022-04516-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/12/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Phalangeal fractures are the most common injuries in humans and account for approximately 10% of all fractures. With plate fixation, anatomic reduction is achievable in most cases, but extension lag is seen in up to 67%. Intramedullary headless screw offers treatment of unstable proximal phalangeal fractures using a minimally invasive procedure with very few complications. One of the major disadvantages of this technique is the transarticular screw position, damaging the articular surface and thus preventing very proximal fractures from being treated with a distally inserted screw. In this study, we present a modified approach to the fixation of the proximal phalangeal fractures and compare outcomes with plate osteosynthesis. MATERIALS AND METHODS Twenty-nine patients with 31 comparable fractures of the proximal phalanx were treated either with a plate (14) or with minimal invasive cannulated compression screw (17). Pain, strength, range of motion (ROM), work disability and QuickDASH score were assessed. RESULTS TAM was significantly better in the screw group. The extension lag was worse in the plate group. Plate removal had to be performed in 13 of 14 the cases, while the screw had to be removed in only 3 cases. The average duration of work disability was 9.9 weeks in the plate group, compared to 5.6 weeks in the screw group. CONCLUSION Minimally invasive screw osteosynthesis not only has the advantage of significantly shorter work disabilities, but also shows remarkably improved postoperative range of motion. In contrast to plate osteosynthesis, removal of the screw is only necessary in exceptional cases. With the antegrade screws position, even difficult fractures close to the base can be treated without destroying any articular surface. In proximal phalanx fractures with both options of plate or single-screw osteosynthesis, we recommend minimal invasive cannulated screw osteosynthesis.
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Affiliation(s)
- Kaspars Silins
- Department of Hand Surgery, Inselspital University Hospital of Bern, Schänzlistrasse 33, 3010 Bern, Switzerland
| | - Tutku Turkmen
- Faculty of Computer Science and Information Technology, Riga Technical University, Ķīpsalas iela 6A, Kurzemes rajons, Riga, LV-1048 Latvia
| | - Esther Vögelin
- Department of Hand Surgery, Inselspital University Hospital of Bern, Schänzlistrasse 33, 3010 Bern, Switzerland
| | - Luzian C. P. Haug
- Department of Hand Surgery, Inselspital University Hospital of Bern, Schänzlistrasse 33, 3010 Bern, Switzerland
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Lucchina S, Kanatani T, Guidi M. Is a Vascularized Interphalangeal Unicondylar Transfer Worth the Efforts? Surgical Technique and Clinical Application. Indian J Orthop 2022; 56:1464-8. [PMID: 35928666 DOI: 10.1007/s43465-022-00664-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/17/2022] [Indexed: 02/04/2023]
Abstract
Interphalangeal joints (IPJ) play a key role in hand function for performing activities of daily living and are frequently involved in complicated injuries resulting in significant functional limitations such as secondary arthritis and stiffness being the most challenging. In adult patients with more than 5 mm bone loss of the proximal articular surface who request a functional interphalangeal joint with minimal pain a vascularized joint transfer is a treatment choice. A unicondylar loss more than 5 mm wide in a 22-year-old carpenter is reported and illustrates our experience with a vascularized unicondylar transfer showing the advantages compared to the "classic" total joint transfer or distal interphalangeal (DIP) joint arthrodesis. By using this technique at the 12-month follow-up, we achieved no donor site complications, a good graft alignment, a good joint congruity, complete bone healing and a normal vascular patency with no signs of bone malunion or resorption of the graft.
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Rojoa DM, Raheman FJ, Irvine E, Sharma V, Macdonald CR, Cutler L. The Impact of COVID-19 on the Choice of Treatment for Hand Fractures: A Single-Centre Concordance Study. J Hand Surg Asian Pac Vol 2022; 27:261-266. [PMID: 35404204 DOI: 10.1142/s2424835522500394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Management of hand trauma has evolved to incorporate assessment, treatment and rehabilitation of patients in a 'one-stop' clinic on initial presentation. Our aim was to evaluate the effect of coronavirus disease 2019 (COVID-19) on the choice of treatment for hand fractures using inter-rater agreement between surgeons. Methods: All patients with hand fractures during the COVID-19 lockdown from March to May 2020 were included in the study. Two experienced hand surgeons blinded to management and outcomes independently reviewed radiographic images and relevant clinical history to provide their opinion on optimal treatment. Weighted kappa analysis was performed to determine concordance and inter-rater agreement between the two surgeons and actual management. Results: The study included 82 patients (62 men and 20 women) with a mean age of 40.3 (SD 19.7). The injuries occurred most often at home following an accident (34%) or a fall (28%). Fractures involved the metacarpals in 29 patients and the distal phalanx in 22 patients. Thirty-five patients underwent surgery, whereas 47 were managed conservatively. Overall agreement between actual management and consultant A and consultant B was moderate (κ = 0.55, p < 0.0001 and κ = 0.63, p < 0.0001, respectively). Subgroup analysis showed a weak agreement between actual management of metacarpal fractures and consultant A and consultant B (κ = 0.22, p = 0.29 and κ = 0.47, p = 0.02, respectively). Inter-rater agreement was substantial for management of metacarpal fractures (κ = 0.73, p < 0.0001), but weak for distal phalanx fractures (κ = 0.29, p = 0.03). Conclusion: Our study has shown that overall management of hand fractures remained optimised throughout the pandemic. However, a lack of concordance was observed in the management of metacarpals. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Djamila M Rojoa
- The Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | - Firas J Raheman
- The Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | - Esmee Irvine
- The Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | - Vivek Sharma
- The Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | | | - Lucy Cutler
- The Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
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Ruterana P, Abitbol A, Castel LC, Gregory T. WALANT technique versus locoregional anesthesia in the surgical management of metacarpal and phalangeal fractures: Lessons from the Covid-19 crisis. Hand Surg Rehabil 2021; 41:220-225. [PMID: 34923166 PMCID: PMC8675121 DOI: 10.1016/j.hansur.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/21/2021] [Accepted: 12/03/2021] [Indexed: 10/27/2022]
Abstract
Wide Awake Local Anesthesia No Tourniquet (WALANT) is an anesthetic method which uses a local injection of anesthetic and epinephrine, avoiding use of a tourniquet. During the COVID-19 pandemic, human and logistic resources had to be reorganized, and WALANT ensured resilience in our department to maintain access to surgical care. The objective of the present study was to compare hand function recovery 3 months after surgery for unstable metacarpal or phalangeal fracture under regional anesthesia versus WALANT. From November 2020 to May 2021, 36 patients presenting a metacarpal or phalangeal fracture requiring surgical treatment were included in a single-center study in a university hospital center. Nineteen patients underwent surgery under locoregional anesthesia with tourniquet, and 17 under WALANT. The main endpoint was functional recovery at 3 months on QuickDASH score. Need for complementary anesthesia, surgery duration, analgesic consumption, reintervention rate, and patient satisfaction were also assessed. There was no significant difference between groups in functional recovery at 3 months or on the secondary endpoints. In the COVID-19 context, WALANT proved to be a safe and effective method in hand fracture surgery, ensuring access to surgical care. It should be included in surgical training to optimize day-to-day surgical care and face future crises.
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Affiliation(s)
- P Ruterana
- Service de Chirurgie Orthopédique, Hôpital Avicenne - Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000 Bobigny, France; Université de Paris, 45 Rue des Saints-Pères, 75006 Paris, France.
| | - A Abitbol
- Service de Chirurgie Orthopédique, Hôpital Avicenne - Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000 Bobigny, France; Université de Paris, 45 Rue des Saints-Pères, 75006 Paris, France
| | - L-C Castel
- Service de Chirurgie Orthopédique, Hôpital Avicenne - Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000 Bobigny, France; Université de Paris, 45 Rue des Saints-Pères, 75006 Paris, France
| | - T Gregory
- Service de Chirurgie Orthopédique, Hôpital Avicenne - Université Sorbonne Paris Nord, 125 Rue de Stalingrad, 93000 Bobigny, France; MOVEO Institute, University Paris Seine-Saint-Denis, 11 Rue de Cambrai, Immeuble 028, 75019 Paris, France
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Tan C, Depiazzi J, Bear N, Blennerhassett L, Page R, Gibson N. Exercise handout and one-on-one hand therapy for management of stiffness after plaster cast immobilization of simple phalangeal and metacarpal fractures in children: A randomized, noninferiority trial. J Hand Ther 2021; 34:423-432.e7. [PMID: 32571602 DOI: 10.1016/j.jht.2020.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a noninferior, single-blind, randomized controlled trial. INTRODUCTION Joint stiffness is common after plaster cast immobilization for simple phalanx and metacarpal fractures in children. The limited literature suggests this joint stiffness in children resolves without one-on-one therapy; however, without robust studies confirming that there is no detrimental effect from withdrawing treatment, many children are still referred. PURPOSE OF THE STUDY The purpose of this study was to determine if an educational handout for self-management of stiffness is noninferior to one-on-one hand therapy for achieving full range of motion (ROM). METHODS Participants were randomly assigned to group one who received the handout or group two who received hand therapy in addition to the handout. The ROM was measured by composite flexion and total active motion (TAM). The noninferiority margin was 10% difference between the two groups in the proportion of participants who achieved full ROM at two weeks after cast removal. RESULTS Sixty participants in each group completed the study. Group difference for composite flexion was 1.7% (95% CI: -3.9% to 7.2%), demonstrating noninferiority. Group difference for TAM was inconclusive at 8.3% (95% CI: -2.1% to 18.7%). Sensitivity analysis adjusting for participants with full composite flexion at the baseline resulted in the group difference for composite flexion of 3.1% (95% CI: -3.6% to 9.8%), maintaining noninferiority, but group difference for TAM at 10.4% (95% CI: 0.0% to 20.9%), was inconclusive with the handout group significantly worse. CONCLUSION An educational handout is noninferior to hand therapy for achieving full ROM in composite flexion but not TAM. This needs to be taken into consideration for changing clinical practise.
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Affiliation(s)
- Cheng Tan
- Physiotherapy Department, Perth Children's Hospital, Perth, Western Australia, Australia.
| | - Julie Depiazzi
- Physiotherapy Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Natasha Bear
- Department of Clinical Research and Education, Child Adolescent Health Service, Perth, Western Australia, Australia
| | - Lewis Blennerhassett
- Department of Plastics and Reconstructive Surgery, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Rohan Page
- Department of Plastics and Reconstructive Surgery, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Noula Gibson
- Physiotherapy Department, Perth Children's Hospital, Perth, Western Australia, Australia
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Hug U, Fiumedinisi F, Pallaver A, van de Wall BJM, Beeres FJP, Giesen T, Liechti R. Intramedullary screw fixation of metacarpal and phalangeal fractures - A systematic review of 837 patients. Hand Surg Rehabil 2021; 40:622-630. [PMID: 33933635 DOI: 10.1016/j.hansur.2021.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
Intramedullary screw (IMS) fixation is increasingly used as an alternative treatment option in metacarpal and phalangeal fractures of the hand. However, this technique is currently the subject of controversy among hand surgeons. The aim of this systematic review was to gain insight on radiological, functional and patient-rated outcomes reported in literature. A comprehensive literature search of PubMed, Embase, CENTRAL and CINAHL databases was conducted on March 1st, 2021. All studies reporting on fracture union, complications, and functional and patient-rated outcome in IMS fixation of metacarpal and/or phalangeal fractures were selected. Two prospective and 16 retrospective cohort studies were included, encompassing a total of 837 patients with 958 fractures (693 metacarpal, 222 proximal phalangeal and 43 middle phalangeal). Mean surgery duration was 26.4 min (range 5-60 min). Union was ultimately achieved in all fractures in a mean of 5.7 weeks (range 2-12 weeks). The procedure-related complication rate was 3.2%. The most frequently reported complication was limitation of joint motion, occurring in 2.0% of cases. Incidence of other complications, including loss of reduction, infection and screw protrusion did not exceed 1%. Overall mean total active motion averaged 243° and grip strength reached 97.5% of the contralateral side. The Disabilities of the Arm, Shoulder and Hand (DASH) score averaged 3.7 points. Duration of sick leave was 7.3 weeks. According to the findings of this systematic review, IMS fixation is a time-saving and safe minimally invasive solution for both metacarpal and phalangeal fractures, with a low rate of complications and promising functional and patient-rated results.
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Affiliation(s)
- U Hug
- Department of Hand and Plastic Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, Switzerland
| | - F Fiumedinisi
- Department of Hand and Plastic Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, Switzerland
| | - A Pallaver
- Department of Hand and Plastic Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, Switzerland
| | - B J M van de Wall
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, Switzerland
| | - F J P Beeres
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, Switzerland
| | - T Giesen
- Department of Hand and Plastic Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, Switzerland
| | - R Liechti
- Department of Hand and Plastic Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne 16, Switzerland.
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Acar E. Management of Allen type III nail bed injuries and distal phalangeal fractures with and without fixation. Hand Surg Rehabil 2021; 40:477-483. [PMID: 33848652 DOI: 10.1016/j.hansur.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/16/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
For combined nail bed injuries and distal phalangeal fractures, fixation may be indicated when there is fracture instability and if a K-wire can be successfully placed in the fracture fragments. We determined the outcomes when these criteria were applied for patients with Allen type III injuries without substantial tissue loss. We retrospectively analyzed 57 patients who had surgery for nail bed injuries with distal phalangeal fractures between October 2017 and January 2020. All patients underwent anatomical nail bed repair, and some had fracture fixation, according to specific surgical criteria. We obtained data about demographic and clinical characteristics, postoperative radiographs, complications, range of motion, and satisfaction. To achieve our primary objective, we evaluated the patient population as a whole. The median follow-up was 12 months (range, 7-21). After 90 days, all 57 patients achieved satisfactory fracture union, 54 (95%) had excellent range of motion, and 54 (95%) were either satisfied or very satisfied with the outcome. Though 6 (10%) patients had residual fracture displacement, none had complications. In patients with Allen type III fingertip injuries without substantial tissue loss, anatomical nail bed repair and triage of patients to fixation or no fixation are likely to result in excellent functional outcomes and high patient satisfaction. However, fixation can neither be recommended nor rejected for these injuries based on this study alone. Level of evidence: IV.
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Affiliation(s)
- E Acar
- Department of Orthopedics and Traumatology, Hand and Upper Extremity Surgery Division, Ankara City Hospital, Üniversiteler Caddesi, Bilkent Bulvarı No:1, 06800 Çankaya/Ankara, Turkey.
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Welman T, Miller R, Pahal GS. Minimally Invasive Screw Fixation of Phalangeal Fractures. Injury 2020; 51:1919-1921. [PMID: 32473733 DOI: 10.1016/j.injury.2020.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/13/2020] [Indexed: 02/02/2023]
Affiliation(s)
- T Welman
- The Royal London Hospital, Barts Health NHS Trust.
| | - R Miller
- The Royal London Hospital, Barts Health NHS Trust.
| | - G S Pahal
- The Royal London Hospital, Barts Health NHS Trust.
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Lopez V, Calvi JP, Slullitel G. Mini thigthrope® fixation of unstable bony avulsion of the extensor hallucis longus tendon. Foot (Edinb) 2019; 40:105-108. [PMID: 31600631 DOI: 10.1016/j.foot.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/03/2019] [Accepted: 08/18/2019] [Indexed: 02/04/2023]
Abstract
Reports of isolated avulsion fracture of the distal phalanx of the hallux that comprise the functionality of the extensor hallucis longus tendon (EHL) are scarce and treatment for such injury has only been described in isolated single case reports. Two patients with an unstable avulsion fracture of the distal phalanx treated with reinsertion of the EHL with a Mini ThigthRope® system are presented in this paper. Two patients whom suffered an extreme plantarflexion mechanism sought attention in our clinic. Plain x-rays depicted a displaced and angulated bony avulsion fracture of the base of the distal phalanx of the hallux. The interphalangeal joint was in a slightly plantarflexed position and the patient was not able to perform active extension upon request. Surgical fixation performed with Mini ThigthRope® system without transarticular immobilization of the interphalangeal joint. In the two patients the Mini ThigthRope® system provided adequate reduction of the displaced articular fragment, restored the extensor function and allowed early postoperative mobilization of the IP joint. Removal of the implants was not necessary and patients were able to resume their previous activity levels. Level of Evidence: IV.
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Affiliation(s)
- Valeria Lopez
- Foot and Ankle Surgery, Instituto de Ortopedia Jaime Slullitel, San Luis 2435, Rosario, Santa Fe, Argentina.
| | - Juan Pablo Calvi
- Foot and Ankle Surgery, Instituto de Ortopedia Jaime Slullitel, San Luis 2435, Rosario, Santa Fe, Argentina
| | - Gaston Slullitel
- Foot and Ankle Surgery, Instituto de Ortopedia Jaime Slullitel, San Luis 2435, Rosario, Santa Fe, Argentina
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Robinson LP, Gaspar MP, Strohl AB, Teplitsky SL, Gandhi SD, Kane PM, Osterman AL. Dorsal versus lateral plate fixation of finger proximal phalangeal fractures: a retrospective study. Arch Orthop Trauma Surg 2017; 137:567-572. [PMID: 28236187 DOI: 10.1007/s00402-017-2650-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Unstable proximal phalanx fractures are relatively common injuries but consensus of standard treatment is lacking. Outcomes following plate fixation are highly variable, and it remains unclear which factors are predictive for poorer results. The purpose of this study was to compare dorsal and lateral plate fixation of finger proximal phalangeal fractures with regard to factors that influence the outcome. MATERIALS AND METHODS A retrospective chart review of proximal phalanx fractures treated with dorsal and lateral plating over a 6-year study interval was performed. Demographic data and injury-specific factors were obtained from review of clinic and therapy notes of 42 patients. Fractures were classified based on the OTA classification using preoperative radiographs. Outcomes investigated included final range of motion (ROM) and total active motion (TAM) of all finger joints. Complications and revision surgeries were also analyzed. RESULTS Fracture comminution, dorsal and a lateral plate position, occupational therapy, and demographic factors did not significantly influence the outcome, complication, and revision rate after plate fixation of finger proximal phalangeal fractures. CONCLUSIONS Based on the results of this study, no differences in the outcome of finger proximal phalangeal fractures treated by both dorsal and lateral plate fixation were observed. LEVEL OF EVIDENCE Therapeutic, retrospective comparative, level III.
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Affiliation(s)
- Luke P Robinson
- Louisville Arm and Hand, Louisville, KY, 40202, USA.,Department of Orthopedic Surgery, The Philadelphia Hand to Shoulder Center, P.C., Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Michael P Gaspar
- Department of Orthopedic Surgery, The Philadelphia Hand to Shoulder Center, P.C., Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA, 19107, USA.
| | - Adam B Strohl
- Department of Orthopedic Surgery, The Philadelphia Hand to Shoulder Center, P.C., Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Seth L Teplitsky
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Shiv D Gandhi
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, 19140, USA
| | - Patrick M Kane
- Department of Orthopedic Surgery, The Philadelphia Hand to Shoulder Center, P.C., Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA, 19107, USA
| | - A Lee Osterman
- Department of Orthopedic Surgery, The Philadelphia Hand to Shoulder Center, P.C., Thomas Jefferson University, The Franklin, Suite G114, 834 Chestnut Street, Philadelphia, PA, 19107, USA
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Zhang W, Li W, Liu Z, Wei J, Li B, Chen Z, Guo Z, Liang B. [EFFECTIVENESS OF MODIFIED Ishiguro TECHNIQUE WITH STRENGTHENING PRESSURE IN TREATMENT OF BONY MALLET FINGERS]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2016; 30:705-708. [PMID: 29786271 DOI: 10.7507/1002-1892.20160143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the effectiveness of modified Ishiguro technique with strengthening pressure in the treatment of bony mallet finger by comparing with the traditional Ishiguro technique. METHODS Between May 2013 and May 2015, 31 cases of bony mallet finger were treated with traditional Ishiguro technique in 16 cases (control group) and with modified Ishiguro technique in 15 cases (improved group, the two Kirschner wires were bound, which were used to fix the distal interphalangeal joint and blocking avulsion fracture block in the classical Ishiguro technique, and play a continuous elastic compression). Difference was not significant in gender, age, cause of injury, injury finger, and the time from injury to operation between 2 groups (P > 0.05). RESULTS The wound healing was delayed in 2 cases of the control group and 1 case of the improved group, and the other patients obtained healing by first intension. The follow-up time was 8-23 months (mean, 11 months) in the improved group and was 9-24 months (mean, 12 months) in the control group. Bending deformation of the Kirschner wire occurred in 2 cases of the control group, obvious separation was found between fracture fragment and the distal phalanx; after manual reduction, brace was used to fix, and distal interphalangeal arthritis occurred during follow-up. The fracture healing time was (6.8±0.8) weeks in the control group, and was (5.7±1.5) weeks in the improved group. There was significant difference in the healing time between 2 groups (t=-2.439, P=0.021). At last follow-up, according to Crawford criteria, the results were excellent in 9 cases, good in 4 cases, fair in 2 cases, and poor in 1 case with an excellent and good rate of 81.25% in the control group; the results were excellent in 10 cases, good in 3 cases, and fair in 2 case with an excellent and good rate of 86.67% in the improved group. There was no significant difference in excellent and good rate between 2 groups (Z=-0.636, P=0.525). CONCLUSIONS Compared with traditional Ishiguro technique, the modified Ishiguro technique with strengthening pressure in treatment of bony mallet finger can facilitate the fracture healing, reduce Kirschner wire loosening and deformation, and decrease the rates of operation failure and complications.
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Affiliation(s)
- Wenping Zhang
- Department of Orthopedics, the Second Hospital, Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China
| | - Wenbin Li
- Department of Orthopedics, the Second Hospital, Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China
| | - Zeyuan Liu
- Department of Orthopedics, the Second Hospital, Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China
| | - Jian Wei
- Department of Orthopedics, the Second Hospital, Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China
| | - Bo Li
- Department of Orthopedics, the Second Hospital, Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China
| | - Zhi Chen
- Department of Orthopedics, the Second Hospital, Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China
| | - Zhenye Guo
- Department of Orthopedics, the Second Hospital, Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China
| | - Bingsheng Liang
- Department of Orthopedics, the Second Hospital, Shanxi Medical University, Taiyuan Shanxi, 030001, P.R.China
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Lucchina S, Maggiulli F, Tos P, Ionac M, Fusetti C. Can an adipofascial flap be used to prevent adhesions after plating of the proximal phalanx? A case report. ACTA ACUST UNITED AC 2015; 34:86-90. [PMID: 25748585 DOI: 10.1016/j.main.2014.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 12/01/2014] [Accepted: 12/12/2014] [Indexed: 11/19/2022]
Abstract
Tendon adhesions in zone IV after proximal phalangeal fractures are common and may lead to loss of range of motion at the proximal interphalangeal joint. The type of fracture, surgical technique and rehabilitation strategy also influence the final functional outcome. Plate fixation is a reliable solution in cases of comminuted phalangeal fracture. This article describes how adhesions between the plate and extensor apparatus in cases of comminuted fractures of the proximal phalanx can be reduced by using an adipofascial flap.
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Affiliation(s)
- S Lucchina
- Hand Surgery Unit, Surgical Department, Locarno's Regional Hospital, Via all'Ospedale, 1, 6600 Locarno, Switzerland.
| | - F Maggiulli
- Hand Surgery Unit, Surgical Department, Locarno's Regional Hospital, Via all'Ospedale, 1, 6600 Locarno, Switzerland
| | - P Tos
- Microsurgery Unit, Department of Orthopaedics and Traumatology, AO City of Health and Science of Turin, 10126 Turin, Italy
| | - M Ionac
- Division of Vascular Surgery and Reconstructive Microsurgery, Victor Babes University of Medicine and Pharmacy, Clinic of Vascular Surgery, Emergency County Hospital Timisoara, 2, Eftimie Murgu Square, 300041 Timisoara, Romania
| | - C Fusetti
- Hand Surgery Unit, Surgical Department, Locarno's Regional Hospital, Via all'Ospedale, 1, 6600 Locarno, Switzerland
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Abstract
The hand is especially prone to traumatic injury. Some sources indicate that injuries to the hand account for somewhere between 10% and 30% of patients treated in emergency care settings. Fractures are the most common injury, followed by tendon injury, then skin lesions. Because the mechanism of injury often results in damage to multiple tissue structures, a detailed history and evaluation are vital to properly identifying and managing these injuries. This article provides the emergency physician with tools to identify and manage orthopedic injuries to the hand.
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Affiliation(s)
- David Hile
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA.
| | - Lisa Hile
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA
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Abstract
Treatment of phalangeal fractures depends on the characteristics of the fracture, condition of the soft tissue envelope, associated injuries, patient functional requirements, and surgeon familiarity and comfort with various techniques. Most phalangeal fractures can be treated successfully with nonoperative means. Surgery is considered to treat unstable injuries, articular incongruity, concomitant soft tissue damage, or other situations in which restoration of anatomy and preservation of function are achieved only via operative stabilization. Careful soft tissue handling and early mobilization are premises on which surgical phalangeal fracture treatment is based.
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Affiliation(s)
- Shannon Carpenter
- Department of Orthopaedic Surgery, Oakland University William Beaumont School of Medicine, Beaumont Health System, 3535 West Thirteen Mile Road #742, Royal Oak, MI 48073, USA
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