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Arslan ÖB, Sığırtmaç İC, Ayvalı C, Baş CE, Ayhan E, Bilgin SS, Öksüz Ç. The Use of Relative Motion Flexion Orthoses for Chronic Boutonniere Deformity. J Hand Surg Am 2024; 49:488.e1-488.e8. [PMID: 36202676 DOI: 10.1016/j.jhsa.2022.08.007] [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] [Received: 10/25/2021] [Revised: 07/01/2022] [Accepted: 08/05/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE This study investigated the effectiveness of a relative motion flexion orthosis (RMFO) for increasing the range of motion for boutonniere deformity. METHODS We included 28 patients aged 13-62 years with chronic boutonniere deformity who could complete 0° proximal interphalangeal (PIP) joint extension with the pencil test and were stage 1 according to the Burton classification of boutonniere deformity. At the initial hand therapy appointment, the RMFO was made. The duration of the orthosis usage at the initial therapy session, after stopping the use of the orthosis (posttreatment), and at the follow-up period were noted. RESULTS The mean time for orthosis usage of all patients was 11.7 weeks (6-40 weeks). The mean initial active distal interphalangeal joint flexion was 47° (0° to 90°) and improved to 66.8° (5° to 110°). The mean initial extension lag of the PIP joint was 22.5° (5° to 55°) and improved to 12° (0° to 30°). This did not change between discontinuation of the orthosis and final follow-up. CONCLUSIONS The use of RMFO is effective in increasing active distal interphalangeal joint flexion and improving PIP extension in patients with Burton stage 1 chronic boutonniere deformity. TYPE OF STUDY/LEVEL OF EVıDENCE: Therapeutic IV.
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Affiliation(s)
- Özge Buket Arslan
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara.
| | - İlkem Ceren Sığırtmaç
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara
| | - Ceren Ayvalı
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara
| | - Can Emre Baş
- Orthopaedics and Traumatology, Atatürk City Hospital, Balıkesir
| | - Egemen Ayhan
- Orthopaedics and Traumatology, University of Health Sciences, Diskapi Y. B. Training and Research Hospital, Ankara
| | - Sırrı Sinan Bilgin
- Department of Hand Surgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Çiğdem Öksüz
- Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara
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Hathaway BA, Burch SJ, Krasnoff CC, Zeiderman MR, Solomon JS. Modification of the Zancolli Lasso Procedure for Simultaneous Correction of Wartenberg's Sign. Tech Hand Up Extrem Surg 2024; 28:45-48. [PMID: 37899550 DOI: 10.1097/bth.0000000000000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Ulnar nerve injury initiates an imbalance between the intrinsic muscles and extrinsic extensors of the ring and small fingers, which leads to the characteristic hyperextension of the metacarpophalangeal (MP) joints and flexion of the proximal interphalangeal joints of these 2 digits-commonly referred to as the ulnar claw hand. In addition to these changes in the static posture of the hand, ulnar nerve palsy severely impairs grasp due to deficient active MP joint flexion. In most cases, motor balance can be restored by preventing MP joint hyperextension and augmenting MP joint flexion using the Zancolli lasso procedure (ZLP). Ulnar neuropathy can cause a second motor imbalance between the ulnar intrinsics and the extensor digit minimi leading to an abduction deformity of the small finger known as Wartenberg's sign. The inability to adduct the small finger can be a great source of frustration to patients. Using a cadaveric biomechanical model, we have developed a simple modification of the Zancolli lasso procedure that simultaneously corrects claw deformity and Wartenberg's sign and we report its efficacy in 2 clinical cases.
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Affiliation(s)
- Brynn A Hathaway
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Oregon Health and Science University, Portland, OR
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Kim BS, Vasella M, Lee CH, Hsu CC, Chen SH, Lin CH, Lien SH, Lin YT. Lambda Repair: A Novel Repair Technique for Chronic Boutonnière Deformity. Plast Reconstr Surg 2024; 153:430-433. [PMID: 37257131 DOI: 10.1097/prs.0000000000010789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
SUMMARY Correction of a boutonnière deformity is one of the most demanding challenges in hand surgery. Surgical interventions are usually considered when functional use of the finger cannot be obtained after intense hand therapy. The authors introduce their newly described lambda (λ) repair, which is an easy-to-learn, straightforward surgical technique. The method involves an end-to-side tenorrhaphy of the lateral bands, resembling the Greek λ. Patients who underwent a lambda repair were retrospectively evaluated with preoperative and postoperative measurements of proximal interphalangeal (PIP) joint movement. Four patients (two male, two female; median age, 35.5 years) with a median follow-up period of 9.1 months were included. Three patients underwent lambda repairs for isolated boutonnière deformities, and one patient received a vascularized free toe transfer combined with a lambda repair. The preoperative average PIP joint extension lag or deficit was 28.75 degrees and could be reduced to 15 degrees. Preoperative average PIP joint active flexion was 60 degrees, which was improved to 88.75 degrees. No complications were observed. The lambda repair is a new tool in the reconstruction of boutonnière deformity, further expanding the armamentarium of hand surgeons.
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Affiliation(s)
- Bong-Sung Kim
- From the Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich
| | - Mauro Vasella
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich
| | - Che-Hsiung Lee
- From the Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chung-Cheng Hsu
- From the Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Shih-Heng Chen
- From the Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Cheng-Hung Lin
- From the Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Shwu-Huei Lien
- From the Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Yu-Te Lin
- From the Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine
- International Master Science Program in Reconstructive Microsurgery, Chang Gung University
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Zhao GZ, Venkatesh S, Zheng L, Nguyen CV. Claw Hand Deformity in Leprosy. Am J Med 2024; 137:110-112. [PMID: 37875219 DOI: 10.1016/j.amjmed.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/24/2023] [Accepted: 10/08/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Grant Z Zhao
- Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Samantha Venkatesh
- Feinberg School of Medicine, Northwestern University, Chicago, Ill; Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Lida Zheng
- Feinberg School of Medicine, Northwestern University, Chicago, Ill; Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Cuong V Nguyen
- Feinberg School of Medicine, Northwestern University, Chicago, Ill; Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Ill.
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Hanson ZC, Thompson RG, Andrews JR, Lourie GM. Boutonniere Versus Pseudoboutonniere Deformities: Pathoanatomy, Diagnosis, and Treatment. J Hand Surg Am 2023; 48:489-497. [PMID: 36593154 DOI: 10.1016/j.jhsa.2022.10.019] [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] [Received: 08/07/2021] [Revised: 03/07/2022] [Accepted: 10/28/2022] [Indexed: 01/01/2023]
Abstract
Finger injuries involving the proximal interphalangeal (PIP) joint are common, particularly among athletes. Injury severity is often underappreciated at initial presentation and may be dismissed broadly as a "jammed finger" injury. Delayed diagnosis and treatment of certain injuries can have an important impact on the patient's chance of regaining full function. Central slip and PIP volar plate injuries are frequently encountered injuries that, if left untreated, can lead to the permanent loss of function of the proximal interphalangeal joint. Despite the differing mechanisms of these 2 pathologies, volar plate hyperextension injuries often present with a PIP joint flexion contracture and mild distal interphalangeal joint hyperextension deformity. This is similar to a boutonniere deformity seen after an injury to the central slip, and thus, has been referred to as a "pseudo-boutonnière" deformity. Distinguishing these 2 diagnoses is important, as treatment differs, and highlights the importance of thoroughly understanding the anatomy and relevant clinical applications when evaluating PIP joint injuries.
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Affiliation(s)
- Zachary C Hanson
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA.
| | - Robert Gil Thompson
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA
| | - James R Andrews
- Division for Orthopaedics and Sports Medicine, The Andrews Institute, Gulf Breeze, FL
| | - Gary M Lourie
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA; Orthopaedic Hand Surgery, The Hand & Upper Extremity Center of Georgia, Atlanta, GA
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Merritt W. The relative motion concept in acute and chronic boutonniere deformity: Invited commentary. J Hand Ther 2023; 36:258-268. [PMID: 37045641 DOI: 10.1016/j.jht.2023.02.005] [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] [Received: 12/20/2022] [Revised: 01/26/2023] [Accepted: 02/07/2023] [Indexed: 04/14/2023]
Abstract
STUDY DESIGN Retrospective. INTRODUCTION Boutonniere deformity (BD) is a troublesome injury occurring from rupture of tissue connecting the extrinsic to intrinsic tendon systems. This causes loss of interphalangeal joint balance, and immobilization often results in adherence and difficulty restoring balance. PURPOSES Review of relative motion flexion (RMF) orthotic use for safe healing during functional activity in 23 patients, and explanation of the rationale. METHODS Anatomic rationale and clinical experience is reviewed in 8 acute BD patients utilizing RMF orthoses for 6 weeks, and for chronic BD patients, 3 months after serial casting. RESULTS All patients met the Strickland and Steichen criteria for "excellent" results following treatment, with an average of 35° increase in ROM. DISCUSSION The anatomic rationale for relative motion recognizes that altering relative positioning between adjacent metacarpophalangeal (MCP) joints produces a protective favorable impact on interphalangeal forces during hand function using 15°-20° greater MCP joint flexion. This provides dorsal and volar protective benefits because the extensor digitorum communis (EDC), a single-muscle-four-tendon system, attaches to the intrinsic lateral band (LB) tendons. With greater MCP flexion, dorsal EDC force is increased, pulling lateral bands medially, while on the volar surface the downward pull of the lumbrical on LB is relaxed due to origin from the flexor digitorum profundus tendon of the injured digit, also a single-muscle-four-tendon system. The RMF orthosis permits protected active motion during functional activity with acute BD. In patients with chronic BD and adequate passive extension, an RMF orthosis for 3 months also produced encouraging results. CONCLUSION Management of acute BD with RMF orthoses provided earlier recovery of motion and hand function. Similar results occurred for chronic BD using serial casting for adequate extension followed by 3 months of RMF orthotic use and should be attempted prior to surgical intervention, with surgery remaining an alternative.
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Affiliation(s)
- Wyndell Merritt
- Division of Plastic & Reconstructive Surgery, Virginia Commonwealth University, Richmond, VA, USA.
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van Strien G, van Zwieten KJ. An in-depth look at zone III and IV anatomy of the finger extensor mechanism and some clinical implications for use of the relative motion flexion orthosis. J Hand Ther 2023; 36:280-293. [PMID: 37085432 DOI: 10.1016/j.jht.2023.01.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND For hand therapists and hand surgeons acute and chronic injuries of the extensor mechanism (EM) in zones III-IV are challenging to treat with satisfying results. INTRODUCTION Early active motion combined with relative motion flexion (RMF) orthoses to manage EM zone III injuries and boutonnière deformity has renewed interest in the complex anatomy and biomechanics of the EM. PURPOSE To provide an in-depth discussion of EM zones III-IV anatomy with emphasis on inter-tendinous structures, often omitted in simplified, model-wise illustrations which focus mostly on the tendinous structures. METHOD In collaboration the authors combined on the one hand extensive clinical experience and knowledge of the EM literature and on the other hand decades of anatomical, biomechanical and kinesiology research of the EM with special interest for the spiral fibers, through gross anatomy and microdissection anatomy laboratory work, MRI and ultrasonography studies. RESULTS The inter-tendinous tissues (i.e., spiral fibers) in zone III are of imminent importance for proper functioning of the EM and to prevent boutonnière deformity to develop after EM surgery or injury. DISCUSSION Inter-tendinous links between the tendinous structures of the EM are necessary for balanced finger motion. The spiral fibers are described in more detail because of their role in controlling volar migration of the conjoined lateral bands and because their disruption makes development of boutonnière deformity more likely. Understanding the anatomy and biomechanics of the EM may assist in progress toward 'proof of concept' for use of RMF orthoses and controlled early active motion after EM injury or surgery. CONCLUSION Hand surgery and hand therapy practice interventions, including use of RMF orthoses for management of non-surgical and surgical EM injuries may benefit from an in-depth look at the EM zone III and IV anatomy and biomechanics.
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Cavanaugh PK, Watkins C, Jones C, Maltenfort MG, Beredjiklian PK, Rivlin M. Effectiveness of Quickcast Versus Custom-Fabricated Thermoplastic Orthosis Immobilization for the Treatment of Mallet Fingers: A Randomized Clinical Trial. Hand (N Y) 2022; 17:1090-1097. [PMID: 33511868 PMCID: PMC9608300 DOI: 10.1177/1558944720988136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/15/2022]
Abstract
BACKGROUND Mallet finger is a common injury involving a detachment of the terminal extensor tendon from the distal phalanx. This injury is usually treated with immobilization in a cast or splint. The purpose of this study is to compare outcomes of mallet fingers treated with either a cast (Quickcast) or a traditional thermoplastic custom-fabricated orthosis. METHODS Our study was a prospective, assessor-blinded, single-center randomized clinical trial of 58 consecutive patients with the diagnosis of bony or soft tissue mallet finger treated with immobilization. Patients were randomized to either an orfilight thermoplastic custom-fabricated orthosis or a Quickcast orthosis. Patients were evaluated at 3, 6, and 10 weeks for bony and 4, 8, and 12 weeks for soft tissue mallets. Skin complications, pain with orthosis, compliance, need for surgical intervention, and extensor lag were compared between the 2 groups. RESULTS Both bony and soft tissue mallet finger patients experienced significantly less skin complications (33% vs 64%) and pain (11.2 vs 21.6) when using Quickcast versus an orfilight thermoplastic custom-fabricated orthosis. The soft tissue mallet group revealed a greater difference in pain, favoring Quickcast (6.2 vs 22). No significant difference in final extensor droop or need for secondary surgery was found between the 2 groups. CONCLUSIONS Quickcast immobilization for the treatment of mallet finger demonstrated fewer skin complications and less pain compared with orfilight custom-fabricated splints.
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Affiliation(s)
| | | | | | | | | | - Michael Rivlin
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Singh AK, Dixit P, Singh V, Vardhan H. Dynamic correction of ulnar claw hand deformity with a simple insertion into the lumbrical muscle. J Plast Reconstr Aesthet Surg 2022; 75:3279-3284. [PMID: 35672246 DOI: 10.1016/j.bjps.2022.04.054] [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] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022]
Abstract
Numerous methods of tendon transfers are available to correct claw hand deformity. In this article, we describe a simple insertion of the transferred flexor digitorum superficialis tendon, into the lumbrical muscle and proximal tendon. Sixty patients underwent surgery for claw hand correction. These were equally divided into three groups undergoing; modified Stiles Bunnell procedure; 'lasso' insertion into A1 pulley and the lumbrical insertion procedure. Evaluation was done with proximal interphalangeal joint angle measurements, grip strength and using the Brand's criteria, 1 year after surgery. The improvements were comparable among the three groups. Insertion into the lateral bands has been a standard method of claw correction. In addition to correcting the hyperextension of the metacarpophalangeal joint, it transmits force for interphalangeal joint extension and restores the sequence of flexion of fingers, thus making the grasp effective. Insertion into the lumbrical muscle belly and proximal tendon shows similar results. It can be performed via a single incision in the palm, reducing operative time.
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Affiliation(s)
- Arun Kumar Singh
- Post Graduate Department of Plastic Surgery, King George's Medical University, Lucknow, UP, India
| | - Pawan Dixit
- Department of Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Veena Singh
- Department of Plastic Surgery, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Harsha Vardhan
- Post Graduate Department of Plastic Surgery, King George's Medical University, Lucknow, UP, India.
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Abstract
Mallet finger describes a fingertip deformity where the distal interphalangeal joint (DIPJ) of the affected digit is held in flexion, unable to extend the distal phalanx actively. The deformity is typically a consequence of traumatic disruption to the terminal extensor tendon at its insertion at the proximal portion of the distal phalanx or slightly proximally at the level of the DIPJ. Patients typically present with a history describing the event of injury with a typical mallet deformity. Common mechanisms include sport activities causing a direct blow to the finger, low energy trauma while performing simple tasks such as pulling up socks or crush injuries from getting the finger trapped in a door. The DIPJ can be passively extended, but this extension of the joint cannot be maintained once the passive extension is stopped. The Doyle classification can be used to categorise and dictate treatment. The extensor lag associated with the deformity does not improve spontaneously without treatment. Inappropriate management can lead to chronic functional loss and stiffness of the finger. The majority of closed mallet splints are Doyle type I, which can be managed non-surgically with external splints, worn full-time to keep the fingertip straight until the tendon injury or fracture heals. Surgical techniques is considered for other types of mallet injuries. Techniques used include closed reduction and Kirschner wire fixation, open reduction and internal fixation, reconstruction of the terminal extensor tendon and correction of swan neck deformity.
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Affiliation(s)
| | - Chad Chang
- University Hospital of North Durham, Durham, U.K..
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Hao Y, Guo JC, Wang XL, Shao JF, Feng JX, He JP. Phalangeal Intra-Articular Osteochondroma Caused a Rare Clinodactyly Deformity in Children: Case Series and Literature Review. Front Endocrinol (Lausanne) 2021; 12:677245. [PMID: 34456858 PMCID: PMC8397412 DOI: 10.3389/fendo.2021.677245] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/09/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Various factors are discovered in the development of clinodactyly. The purpose of this retrospective study was to present a group of children with a rare clinodactyly deformity caused by phalangeal intra-articular osteochondroma and evaluate the efficacy of various treatment methods. METHODS All child patients that were treated for finger problems in our center between Jan 2017 and Dec 2020 were reviewed. A detailed analysis was made of the diagnosis and treatment methods in eight rare cases. X-rays and histopathology were applied. RESULTS A preliminary analysis of 405 patients in total was performed, and we included eight cases in our final analysis. This cohort consisted of 2 girls and 6 boys, with a mean age of 5.74 ± 3.22 years (range: 2y5m to 11y). Overall, four patients had their right hand affected and four patients had their left hand affected. One patient was diagnosed as having hereditary multiple osteochondroma (HMO) while the other seven patients were all grouped into solitary osteochondroma. Osteochondroma was proven in all of them by histopathology examination. Preoperative X-rays were used to allow identification and surgery planning in all cases. All osteochondromas were intra-articular and in the distal end of the phalanges, which is located opposite the epiphyseal growth area. All of the osteochondromas developed in half side of the phalanges. The angulation in the finger long axis was measured, and resulted in a mean angulation of 34.63 ± 24.93 degree (range: 10.16-88.91 degree). All of them received surgery, resulting in good appearance and fingers straightening. No recurrence was recorded. CONCLUSIONS This retrospective analysis indicates that 10 degrees can be selected as the angulation level for diagnosis of clinodactyly deformities. What's more important, the abnormal mass proven by X-rays should be included as the classical direct sign for diagnosis. The first choice of treatment is surgery in symptomatic osteochondromas.
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Affiliation(s)
- Yun Hao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia-Chao Guo
- Department of Pediatric Surgery, Pediatric Orthopedic, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-Lin Wang
- Department of Pediatric Surgery, Pediatric Orthopedic, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing-Fan Shao
- Department of Pediatric Surgery, Pediatric Orthopedic, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie-Xiong Feng
- Department of Pediatric Surgery, Pediatric Orthopedic, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin-Peng He
- Department of Pediatric Surgery, Pediatric Orthopedic, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Jin-Peng He,
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Alqassab S, Mathieu L. Torture-induced hand electrical injury: A case report. J Forensic Leg Med 2020; 77:102085. [PMID: 33242745 DOI: 10.1016/j.jflm.2020.102085] [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] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 10/10/2020] [Accepted: 11/14/2020] [Indexed: 11/17/2022]
Abstract
The authors report an unusual case of hand electrical injury related to torture in a war refugee. The patient was referred for the reconstruction of bilateral hand function several years after being tortured. He presented with severe hand contractures combined with motor and sensory loss. After nonoptimal treatment in the acute period, the reconstruction options were limited by the delayed management. This unique clinical presentation can be explained by repetition of prolonged electrical shocks using a low-voltage current.
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Affiliation(s)
- Sufyan Alqassab
- Reconstructive Surgery Project, Médecins Sans Frontières, Amman, Jordan
| | - Laurent Mathieu
- Department of Orthopedic, trauma and reconstructive surgery, Percy Military Hospital, Clamart, France; Department of surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, 1 place Alphone Laveran, 75005, Paris, France.
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Garg BK, Rajput SS, Purushottam GI, Jadhav KB, Chobing H. Delta Wiring Technique to Treat Bony Mallet Finger: No Need of Transfixation Pin. Tech Hand Up Extrem Surg 2020; 24:131-134. [PMID: 32118869 DOI: 10.1097/bth.0000000000000281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Extension-block pinning is a popular surgical treatment method for mallet fractures but is associated with several pitfalls. Transfixation Kirschner wires used in the extension-block pinning technique may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. The objective of this study was to determine the result of the delta wiring technique in mallet fractures with fracture fragment involving more than one-third of the distal phalanx articular surface. The authors are reporting 5 cases of mallet fractures treated with delta wiring technique with good functional and radiologic outcomes. Radiologic outcomes were evaluated on the basis of postoperative and follow-up x-rays and functional outcomes were evaluated using Crawford's criteria. Five patients (4 males, 1 female) with a mean age of 26.8 years (range, 20 to 33 y) were included. The mean time between the injury and surgery was 5 days (range, 3 to 7 d), and the mean follow-up period was 8.6 months (range, 8 to 10 mo). Radiographic bone union was achieved in all patients within an average of 6.4 weeks (range, 6 to 7 wk). At the final follow-up, the distal interphalangeal joint had an average degree of flexion of 73 degrees (range, 70 to 75 degrees) and an average extension deficit of 5.40 (range, 0 to 8 degrees). According to Crawford's criteria, 1 patient had excellent results and 4 patients had good results. No patient reported pain at the final follow-up with a visual analog scale score mean of 0.6 (range, 0 to 2). Satisfactory clinical and radiologic outcomes were obtained with the delta wiring technique. Future prospective and randomized studies are justified to confirm the efficacy of this technique.
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Affiliation(s)
- Bipul K Garg
- Sir J.J. Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India
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Dwivedi S, Testa EJ, Modest JM, Ibrahim Z, Gil JA. Surgical Management of Rheumatoid Arthritis of the Hand. R I Med J (2013) 2020; 103:32-36. [PMID: 32357591] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Shashank Dwivedi
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | - Edward J Testa
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | - Jacob M Modest
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | - Zainab Ibrahim
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | - Joseph A Gil
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
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15
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Biswas S, Sethi P, Nischal N, Wig N. Classical metacarpal deformities in rheumatoid arthritis. QJM 2019; 112:547-548. [PMID: 30649555 DOI: 10.1093/qjmed/hcz019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Biswas
- Department of Medicine, All India Institute of Medical Sciences, 3rd Floor Teaching Block, AIIMS, New Delhi 29, New Delhi, India
| | - P Sethi
- Department of Medicine, All India Institute of Medical Sciences, 3rd Floor Teaching Block, AIIMS, New Delhi 29, New Delhi, India
| | - N Nischal
- Department of Medicine, All India Institute of Medical Sciences, 3rd Floor Teaching Block, AIIMS, New Delhi 29, New Delhi, India
| | - N Wig
- Department of Medicine, All India Institute of Medical Sciences, 3rd Floor Teaching Block, AIIMS, New Delhi 29, New Delhi, India
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16
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Abstract
We present the case of a professional golf player who gradually developed a boutonniere deformity of the thumb due to chronic repetitive injury to the thumb and was treated with reconstruction of its insertion onto the proximal phalangeal base. The athlete showed an insertion variation of the extensor pollicis brevis, where some slips attached onto the extensor hood and the other slips ran along with the extensor pollicis longus to the distal phalanx, providing no slip to the proximal phalanx. The slips inserting to the distal phalanx were transferred to the base of the proximal phalanx and sagittal band reconstruction. As a result, the boutonniere deformity of the thumb fully recovered with satisfactory outcomes.Level of Evidence: Level V.
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Affiliation(s)
- Jae-Sung Yoo
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
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17
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Pech J, Vlček M, Landor I. [Current Options of Rheumatosurgery of the Hand and Wrist]. Acta Chir Orthop Traumatol Cech 2019; 86:313-319. [PMID: 31748104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Rheumatosurgery is a discipline managing the symptoms of rheumatoid arthritis of the musculoskeletal system. In a vast number of patients this disease starts in the wrist and hand. The portfolio of surgical procedures performed on the skeleton and soft tissues in these regions can be divided into two groups that, however, often times overlap in practice. Commonly, a combination of these surgical interventions is used. The surgical management should commence with prophylactic interventions that aim to slow down the development of rheumatoid deformities. These are followed by reconstructive surgery which shall manage the already developed rheumatoid deformities and their complications. The prophylactic interventions include early and late synovectomy, peritenosynovectomy, tenodeses, tendon transpositions and limited arthrodeses. The reconstructive surgery procedures comprise osteotomy, resection procedures, alloplasties, total arthrodesis and tendon reconstructions. Key words: rheumatoid arthritis, rheumatosurgery, hand, wrist.
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Patel SS, Singh N, Clark C, Stone J, Nydick J. Reconstruction of Traumatic Central Slip Injuries: Technique Using a Slip of Flexor Digitorum Superficialis. Tech Hand Up Extrem Surg 2018; 22:150-155. [PMID: 30204646 DOI: 10.1097/bth.0000000000000205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Multiple reconstruction techniques have been described for correction of boutonniere deformities including direct repair, central slip reconstruction, lateral band reconstruction, transverse retinacular ligament reconstruction, staged reconstruction, and extensor tenotomy. Each technique has been reported to have variable results with complications including capsular contracture, loss of proximal interphalangeal flexion, and residual deformity. We describe a surgical technique for central slip reconstruction using a slip of the flexor digitorum superficialis tendon through a bone tunnel.
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Affiliation(s)
- Shaan S Patel
- Department of Orthopaedic Surgery, University of South Florida
| | - Neil Singh
- Florida Orthopaedic Institute, Hand and Upper Extremity Service, Tampa, FL
| | - Charles Clark
- Department of Orthopaedic Surgery, University of South Florida
| | - Jeffrey Stone
- Florida Orthopaedic Institute, Hand and Upper Extremity Service, Tampa, FL
| | - Jason Nydick
- Florida Orthopaedic Institute, Hand and Upper Extremity Service, Tampa, FL
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Abstract
Scleroderma is a rare autoimmune connective tissue disorder that often affects the hands. Manifestations in the hands include calcium deposits within the soft tissues that cause pain and may ulcerate through the skin, digital ischemia resulting in chronic wounds and digital gangrene, and joint contracture. Because of the underlying disease, patients with scleroderma have poorly vascularized tissue and a deficient soft tissue envelope, which make surgery particularly challenging. However, when undertaken with care, surgical intervention is often the best option for addressing the disabling hand conditions that so often accompany this disease.
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Affiliation(s)
- Ariel A Williams
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Medicine, Baltimore, MD
| | - Hannah M Carl
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Scott D Lifchez
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Medicine, Baltimore, MD.
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20
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Hamada Y, Takai H, Satoh R, Hibino N, Ueda Y, Minamikawa Y. Swan neck deformity due to chronic radial collateral ligament injury of the little finger proximal interphalangeal joint. J Hand Surg Eur Vol 2018; 43:513-517. [PMID: 29105590 DOI: 10.1177/1753193417739248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 02/03/2023]
Abstract
UNLABELLED We present seven cases of a relatively rare swan neck deformity resulting from chronic radial collateral ligament (RCL) injury of the proximal interphalangeal (PIP) joint in the little finger. All patients were middle-aged women (mean 51 years old, range 42-55), and the duration between the initial injury and surgery was 20 years (range 5-40). The chief complaint was painful snapping of the PIP joint. All patients had hyperextension and ulnar deviation of the PIP joint with mobile swan neck deformities that had not improved with conservative treatment. Radiographs revealed osteoarthritis and ulnar deviation of the PIP joints in all cases. We describe a method for reconstruction of both the palmar plate and the RCL of the affected PIP joint using a distally-based ulnar slip of flexor superficialis tendon. The prevention of PIP joint hyperextension was critical for successful resolution of symptoms; the aim of RCL augmentation was to prevent the recurrence of the deformity. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Hiroaki Takai
- 2 Department of Orthopedic Surgery, Kitajima Taoka Hospital, Japan
| | - Ryousuke Satoh
- 3 Department of Orthopedics and Hand Center, Tokushima Naruto Hospital, Japan
| | - Naohito Hibino
- 3 Department of Orthopedics and Hand Center, Tokushima Naruto Hospital, Japan
| | - Yukiko Ueda
- 4 Department of Orthopedic Surgery, Kansai Medical University Kori Hospital, Japan
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21
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Cirillo L, Gallo P, Errichiello C, Sorrentino A, Mehmetaj A, Gregori M, Cannavò R, Cestone G, Cutruzzulà R, Dattolo PC. [Dystrophic Calcinosis Cutis: a rare fearsome issue of Chronic Kidney Disease]. G Ital Nefrol 2018; 35:2018-vol1-6. [PMID: 29390241] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Disorders of calcium-phosphate-parathormone balance, are very important issues in ESRD patients, that may lead to severe complications, as dystrophic calcinosis cutis, a rare disease, caused by calcium salt deposits in cutaneous or subcutaneous tissues and many organs. We present the case of a 47 years old woman, in ESRD due to membranous glomerulopathy, treated by peritoneal dialysis, who, after 7 months of dialysis, developed painful masses on second finger and fifth metacarpus of the right hand. Laboratory and instrumental data showed hyperparathyroidism with a parathyroid mass consistent with adenoma. Increasing of therapy with phosphate binders and cinacalcet only, was not effective to solve cutaneous masses, that were biopsied. Histological exam revealed deposition of amorphic material with calcific component, consistent with cutaneous dystrophic calcinosis. We further increased dialysis and therapy and we observed complete regression of masses in 2 months.
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Affiliation(s)
- Luigi Cirillo
- Università degli Studi di Firenze, scuola di specializzazione in Nefrologia
| | | | | | | | | | - Marco Gregori
- Università degli Studi di Firenze, scuola di specializzazione in Nefrologia
| | | | - Giuseppe Cestone
- Università degli Studi di Firenze, scuola di specializzazione in Nefrologia
| | - Roberta Cutruzzulà
- Università degli Studi di Firenze, scuola di specializzazione in Nefrologia
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22
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Ong CY, Vasanwala FF, Mirpuri TM. Auto-Amputations. Ann Acad Med Singap 2017; 46:480-482. [PMID: 29355287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Chong Yau Ong
- Department of Family Medicine, Sengkang Hospital, Singapore
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Vedel PN, Tranum-Jensen J, Dahlin LB, Brogren E, Søe NH. [Deformities of the finger joints]. Ugeskr Laeger 2017; 179:V04170324. [PMID: 29208202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Extension of the fingers is a complex act. Boutonnière deformity is defined by flexion at the proximal inter-phalangeal (PIP) joint and hyperextension at the distal interphalangeal (DIP) joint due to disruption of the central slip of the extensor tendon. Swan neck deformity is defined by hyperextension at the PIP joint and flexion at the DIP joint, and the pathology is divided into intrinsic, extrinsic, and articular. The deformities are a result of imbalance of the tendons and ligaments in the fingers. Treatment is depending on the underlying cause and includes surgery and non-operative treatment. Functional gain and risk must be realistically assessed.
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25
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Espinoza-Ríos J, Valenzuela Granados V, Ojeda Cisneros M, Gálvez Canseco A, Ramos Aguilar C, Raymundo Villalva B, Aguilar Sánchez V, Pinto Valdivia J, Huerta-Mercado Tenorio J, Bussalleu Rivera A. [Porphyria cutanea tarda as extrahepatic manifestation of chronic hepatitis C: a case report]. Rev Gastroenterol Peru 2017; 37:394-398. [PMID: 29459814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The present case is a 56 year old male who present hyperpigmented and hypopigmented scars in both hands, associated with the presence of milia cysts. It was studied the metabolism of porphyrins and skin biopsy of the lesions which were compatible with porphyria cutanea tarda. In the initial laboratory, elevated transaminases values were found and subsequently identified chronic infection of hepatitis C virus. In order to treat viral infection and resolve the dermal commitment; considered extrahepatic manifestation of hepatitis C virus, treatment was started with pegylated interferon and ribavirin, with favorably development and rapid viral response, with undetectable viral load until now (24 weeks of treatment), decreased level of serum transaminases and improvement of skin lesions.
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Affiliation(s)
- Jorge Espinoza-Ríos
- Servicio de Gastroenterología, Hospital Cayetano Heredia. Lima, Perú; Facultad de Medicina, Universidad Peruana Cayetano Heredia. Lima, Perú
| | - Vanessa Valenzuela Granados
- Servicio de Gastroenterología, Hospital Cayetano Heredia. Lima, Perú; Facultad de Medicina, Universidad Peruana Cayetano Heredia. Lima, Perú
| | | | | | | | | | | | - José Pinto Valdivia
- Servicio de Gastroenterología, Hospital Cayetano Heredia. Lima, Perú; Facultad de Medicina, Universidad Peruana Cayetano Heredia. Lima, Perú
| | - Jorge Huerta-Mercado Tenorio
- Facultad de Medicina, Universidad Peruana Cayetano Heredia. Lima, Perú; Servicio de Gastroenterología, Clínica Angloamericana. Lima, Perú
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26
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Ceccarelli F, Massaro L, Perricone C, Pendolino M, Cipriano E, Truglia S, Miranda F, Spinelli FR, Alessandri C, Valesini G, Conti F. Jaccoud's arthropathy in systemic lupus erythematosus: clinical, laboratory and ultrasonographic features. Clin Exp Rheumatol 2017; 35:674-677. [PMID: 28339366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 11/28/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Jaccoud's arthropathy (JA) is a deforming, non-erosive arthritis, occurring in 2-35% of systemic lupus erythematosus (SLE) patients. We aimed to evaluate JA patients in a wide monocentric SLE cohort in terms of clinical, serological and ultrasonographic features. METHODS Consecutive SLE patients (ACR criteria 1997) were evaluated. The JA index was applied for patients with reducible deformities. Patients with a JA index ≥5 underwent physical examination, blood testing and ultrasound (US) assessment. Detection of anti-citrullinated protein antibodies (ACPA) and rheumatoid factor (RF) was performed. A single rheumatologist performed the US assessment of bilateral wrist and hands. RESULTS Four hundred and eighty SLE patients were evaluated: 17 (3.5%) showed a JA index ≥5 (M:F 1:16; mean age±SD 50.7±11.1 years; mean disease duration±SD 247.8±116.2 months). Four patients (23.5%) showed ACPA positivity. Fifteen patients (88.2%) showed at least one US abnormality. Bone erosions were found in 10 patients (58.8%). ACPA+ve patients showed erosive damage more frequently in at least one joint compared with ACPA-ve (75% vs. 53.8%, p=0.002). CONCLUSIONS JA should no longer be considered a non-erosive condition since bone damage can occur in more than half of patients. Moreover, the erosive damage seems to be associated with the presence of ACPA.
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Affiliation(s)
- Fulvia Ceccarelli
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Italy
| | - Laura Massaro
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Italy
| | - Carlo Perricone
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Italy
| | - Monica Pendolino
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Italy
| | - Enrica Cipriano
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Italy
| | - Simona Truglia
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Italy
| | - Francesca Miranda
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Italy
| | - Francesca Romana Spinelli
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Italy
| | - Cristiano Alessandri
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Italy.
| | - Guido Valesini
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Italy
| | - Fabrizio Conti
- Lupus Clinic, Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Italy
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27
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Dubois E, Teboul F, Bihel T, Goubier JN. Chronic Boutonniere Deformities, Supple, or Stiff: A New Surgical Technique With Early Mobilization in 11 Cases. Tech Hand Up Extrem Surg 2017; 21:37-40. [PMID: 28338524 DOI: 10.1097/bth.0000000000000152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Injuries to the central slip of the extensor mechanism can lead to a Boutonniere deformity with important functional consequences. We report a series of 11 patients treated by lengthening-dorsalizing the lateral bands and tightening the central slip with early mobilization. The average age of the patients was 42 years (14;52). The extension defect of the proximal interphalangeal (PIP) joint was 64 degrees (80;55) and the hyperextension of the distal interphalangeal joint was 10 degrees (15;5). The surgery was performed with peripheral nerve block (sensitive), allowing dynamic adjustment of the tendinous sutures. With a dorsal incision, a tenolysis of the extensor was performed. The central slip was tightened and the lateral bands dorsalized by cross-stitches over the PIP joint. The active flexion/extension was tested, and then lengthening of the lateral bands by "mesh graft" tenotomy was performed over the second phalange. There was no immobilization. The deformity was improved in 10 patients with a total flexion of the finger. The mean lack of extension in the PIP was 8 degrees (0;20) and the active flexion of the distal interphalangeal joint was 80 degrees (70;85). There was 1 failure. The majority of techniques necessitate an immobilization of 3 to 6 weeks. Our procedure uses the elastic properties of the elongation and allows immediate mobilization. The result can be compromised in case of insufficient tendinous surface or if postoperative instructions are not followed.
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Affiliation(s)
- Elodie Dubois
- *CHRU Lille/CH Lens, Lille University Hospital, Lille †Paul d'Egine Private Hospital §Hopital privé Paul d'Egine, Champigny sur Marne ‡CHU Amiens, Amiens University Hospital, Amiens
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28
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Peretz ASR, Madsen OR, Brogren E, Dahlin L, Søe NH. [Rheumatoid arthritis and hand surgery]. Ugeskr Laeger 2017; 179:V09160677. [PMID: 28330532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Rheumatoid arthritis results in characteristic deformities of the hand. Medical treatment has undergone a remarkable development. However, not all patients achieve remission or tolerate the treatment. Patients who suffer from deformities and persistent synovitis may be candidates for hand surgery, for which the main goals are pain relief and improved function. Surgical interventions can be divided into prophylactic and therapeutic procedures. The treatment strategy is individual and depends on close collaboration between rheumatologists, hand surgeons and patients.
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29
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Abstract
Tension in the palmar fascia has been proposed as a factor causing Dupuytren’s disease. If tension does stimulate the growth of new Dupuytren’s tissue, relieving longitudinal tension should reduce the recurrence rate following surgery. Thirty patients with palmar Dupuytren’s contracture of a single ray that affected only the metacarpophalangeal joint were divided into two groups. Both groups had a fasciotomy: one group through a transverse incision that was closed directly and the other through a longitudinal incision with Z-plasty closure. Half the patients (seven of 14) who had direct closure had recurrence at 2 years as compared to two of the 13 in the Z-plasty group. The trial was stopped at the interim analysis stage due to the high recurrence rate in the first group. These results are consistent with the tension hypothesis for the aetiology of Dupuytren’s disease.
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Affiliation(s)
- N Citron
- Nelson Hospital, Kingston Road, Wimbledon, London, UK.
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30
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Gupta P, Joshua KK, Jahan T. Adaptive shortening of long flexor in patients with claw hand: A short report. LEPROSY REV 2016; 87:548-552. [PMID: 30226360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Adaptive shortening of long flexors is the common secondary impairment which can occur in patients with long standing claw hand, particularly in those who do not undergo any supervised physiotherapy programme.¹ The main purpose of this short report is to describe the current physiotherapeutic means which are commonly employed for the management of long flexor tightness. This report further gives an insight into the consequences of the delay in corrective surgery and ultimately describes the dire need for further research on this deformity.² Adaptive shortening of the muscles is a phenomenon which can occur for many reasons, like prolonged immobilisation of the of the body segment, postural imbalance, muscle imbalance, impaired muscle performance due to neuromuscular problems or may be due congenital and acquired deformity.Tightness of the muscles leads to limitation of joint range of motion.³ In leprosy the cause of adaptive shortening of the long flexors is muscle imbalance which occurs due to paralysis of the ulnar nerve at the elbow joint. Adaptive shortening of the muscles is a secondary impairment.⁴ Secondary impairments have multidimensional effects on the management of the deformity, including delay in surgery for the correction of deformity which in turn is responsible for the unemployment, social stigma and problems in social integration.⁵ Secondary impairment in some way or other is responsible for the above stated problems, but adaptive shortening of the long flexor (long flexor tightness) is important because sometimes months of therapy are required to attain full muscle length.
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31
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Affiliation(s)
- R Angalla
- From the Department of Rheumatology, University Hospital Hassan II Fez -Morocco, Faculty of Medicine and Pharmacy Fes, Sidi Mohamed Ben Abdellah University in Fez, Fez, Morocco
| | - A Mounir
- From the Department of Rheumatology, University Hospital Hassan II Fez -Morocco, Faculty of Medicine and Pharmacy Fes, Sidi Mohamed Ben Abdellah University in Fez, Fez, Morocco
| | - S Driouich
- From the Department of Rheumatology, University Hospital Hassan II Fez -Morocco, Faculty of Medicine and Pharmacy Fes, Sidi Mohamed Ben Abdellah University in Fez, Fez, Morocco
| | - F Z Abourazzak
- From the Department of Rheumatology, University Hospital Hassan II Fez -Morocco, Faculty of Medicine and Pharmacy Fes, Sidi Mohamed Ben Abdellah University in Fez, Fez, Morocco
| | - T Harzy
- From the Department of Rheumatology, University Hospital Hassan II Fez -Morocco, Faculty of Medicine and Pharmacy Fes, Sidi Mohamed Ben Abdellah University in Fez, Fez, Morocco
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32
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Fine JD, Johnson LB, Weiner M, Stein A, Cash S, Deleoz J, Devries DT, Suchindran C. Pseudosyndactyly and Musculoskeletal Contractures in Inherited Epidermolysis Bullosa: Experience of the National Epidermolysis Bullosa Registry, 1986–2002. ACTA ACUST UNITED AC 2016; 30:14-22. [PMID: 15620486 DOI: 10.1016/j.jhsb.2004.07.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Accepted: 07/09/2004] [Indexed: 11/27/2022]
Abstract
Mitten deformities of the hands and feet occur in nearly every patient with the most severe subtype (Hallopeau-Siemens) of recessive dystrophic epidermolysis bullosa, and in at least 40–50% of all other recessive dystrophic epidermolysis bullosa patients. Smaller numbers of patients with dominant dystrophic, junctional, and simplex types of epidermolysis bullosa are also at risk of this complication. Surgical intervention is commonly performed to correct these deformities, but recurrence and the need for repeated surgery are common. Higher numbers of epidermolysis bullosa patients also develop musculoskeletal contractures in other anatomic sites, further impairing overall function. Lifetable analyses not only better project the cumulative risk of mitten deformities and other contractures but also emphasize the need for early surveillance and intervention, since both of these musculoskeletal complications may occur within the first year of life.
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Affiliation(s)
- J-D Fine
- National Epidermolysis Bullosa Registry, Nashville, Tennessee, USA.
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33
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Stiefelhagen P. [Painless new nodules on the thumb]. MMW Fortschr Med 2016; 158:7-90. [PMID: 27116130 DOI: 10.1007/s15006-016-8107-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Stiefelhagen P. [The left hand appears completely cramped]. MMW Fortschr Med 2016; 158:7-90. [PMID: 27116129 DOI: 10.1007/s15006-016-8108-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Peter Stiefelhagen
- DRK-Krankenhaus, Alte Frankfurter Str. 12, D-57627, Hachenburg, Deutschland
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35
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Guillaume-Jugnot P, Daumas A, Magalon J, Sautereau N, Veran J, Magalon G, Sabatier F, Granel B. State of the art. Autologous fat graft and adipose tissue-derived stromal vascular fraction injection for hand therapy in systemic sclerosis patients. Curr Res Transl Med 2016; 64:35-42. [PMID: 27140597 DOI: 10.1016/j.retram.2016.01.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 09/12/2015] [Accepted: 01/04/2016] [Indexed: 01/27/2023]
Abstract
Systemic sclerosis is an autoimmune disease characterized by sclerosis (hardening) of the skin and deep viscera associated with microvascular functional and structural alteration, which leads to chronic ischemia. In the hands of patients, ischemic and fibrotic damages lead to both pain and functional impairment. Hand disability creates a large burden in professional and daily activities, with social and psychological consequences. Currently, the proposed therapeutic options for hands rely mainly on hygienic measures, vasodilatator drugs and physiotherapy, but have many constraints and limited effects. Developing an innovative therapeutic approach is crucial to reduce symptoms and improve the quality of life. The discovery of adult stem cells from adipose tissue has increased the interest to use adipose tissue in plastic and regenerative surgery. Prepared as freshly isolated cells for immediate autologous transplantation, adipose tissue-derived stem cell therapy has emerged as a therapeutic alternative for the regeneration and repair of damaged tissues. We aim to update literature in the interest of autologous fat graft or adipose derived from stromal vascular fraction cell-based therapy for the hands of patients who suffer from systemic sclerosis.
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Affiliation(s)
- P Guillaume-Jugnot
- Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), 13915 Marseille cedex 05, France
| | - A Daumas
- Service de médecine interne, gériatrie et thérapeutique, hôpital de la Timone, AP-HM, 13385 Marseille cedex 05, France
| | - J Magalon
- Laboratoire de culture et thérapie cellulaire, Inserm CBT-1409, hôpital de la Conception, AP-HM, 13385 Marseille cedex 05, France
| | - N Sautereau
- Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), 13915 Marseille cedex 05, France
| | - J Veran
- Laboratoire de culture et thérapie cellulaire, Inserm CBT-1409, hôpital de la Conception, AP-HM, 13385 Marseille cedex 05, France
| | - G Magalon
- Service de chirurgie plastique et réparatrice, hôpital de la Conception, AP-HM, 13385 Marseille cedex 05, France
| | - F Sabatier
- Laboratoire de culture et thérapie cellulaire, Inserm CBT-1409, hôpital de la Conception, AP-HM, 13385 Marseille cedex 05, France; Inserm UMR 1076 Vascular Research Centre of Marseille, Aix-Marseille université, 13385 Marseille cedex 05, France
| | - B Granel
- Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), 13915 Marseille cedex 05, France; Inserm UMR 1076 Vascular Research Centre of Marseille, Aix-Marseille université, 13385 Marseille cedex 05, France.
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36
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Thuraisingham C, Sinniah D. Stiff hands and feet, facial deformities. J Fam Pract 2016; 65:121-124. [PMID: 26977463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The appearance of the skin on this woman's face, hands, and feet helped us to recognize an advanced case of an autoimmune disease.
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MESH Headings
- Combined Modality Therapy
- DNA Topoisomerases, Type I
- Diagnosis, Differential
- Facies
- Female
- Foot Deformities, Acquired/etiology
- Hand Deformities, Acquired/etiology
- Humans
- Immunosuppressive Agents/therapeutic use
- Lung/diagnostic imaging
- Lung/physiopathology
- Middle Aged
- Nuclear Proteins/analysis
- PUVA Therapy/methods
- Quality of Life
- Radiography
- Respiratory Function Tests/methods
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/immunology
- Scleroderma, Systemic/physiopathology
- Scleroderma, Systemic/psychology
- Scleroderma, Systemic/therapy
- Serologic Tests/methods
- Treatment Outcome
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Wang N, Liu H, Zhang F. A Lepromatous Leprosy Patient with Permanent Disability. Am J Trop Med Hyg 2015; 93:896-898. [PMID: 26537774 PMCID: PMC4703287 DOI: 10.4269/ajtmh.14-0843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Furen Zhang
- *Address correspondence to Furen Zhang, Shandong Provincial Institute of Dermatovenereology, 27397 Jingshi Lu, Jinan 250022, Shandong Province, People's Republic of China. E-mail:
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Peleg R, Treister-Goltzman Y. Gout. Isr Med Assoc J 2015; 17:726. [PMID: 26757576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Govindasamy K, Das P, Paul VJ, Kumar J. Selection criteria for reconstructive surgery to correct mobile hand deformities in leprosy. LEPROSY REV 2015; 86:278-282. [PMID: 26665364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Prior Á, Rodriguez-Muguruza S, Sanint J, Olivé A. [Efficacy of bosentan in the treatment of digital ulcers secondary to thromboangiitis obliterans]. Med Clin (Barc) 2015; 145:44. [PMID: 25433787 DOI: 10.1016/j.medcli.2014.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/10/2014] [Accepted: 09/18/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Águeda Prior
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
| | | | - Juana Sanint
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Alejandro Olivé
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
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Abstract
The tropical diabetes hand syndrome is a complication affecting patients with diabetes mellitus in the tropics, and consists of localized cellulitis, swelling and ulceration of the hands which may progress to fulminant sepsis and gangrene of the whole limb. It is associated with a poor outcome. We report a 32 year old woman with tropical diabetes hand infection with autoamputation of the digits, review the relevant literature, and highlight the need for prevention and early hospital presentation in diabetics with hand infection, in order to prevent potentially crippling or fatal complications.
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Affiliation(s)
- Taiwo Hussean Raimi
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Oluwole Ojo Alese
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
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44
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Singbal SB, Quek ST. Boutonniere deformity presented in a young male. Ann Acad Med Singap 2014; 43:244-245. [PMID: 24833080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Yang Y, Tian W, Li C, Zhao J, Wang H, Xue Y, Tian G. [Corticoplasty for multiple enchondromatosis of hand]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2014; 28:34-37. [PMID: 24693775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the results of corticoplasty for multiple enchondromatosis of the hand. METHODS Between February 2003 and January 2011, 6 patients with multiple enchondromatosis were treated. Of 6 cases, 1 was boy and 5 were girls with an average age of 10.8 years (range, 9-12 years); 5 cases presented with painless mass as first symptom, and 1 case was found to have mass by X-ray film because of hand injury. Physical examination at admission showed multiple mass on the hands, fingers deformity, and limited range of motion; X-ray film results showed large lesions in the phalanges and metacarpals. Corticoplasty and simple curettage without bone grafting were performed on 24 fingers (60 bones) with multiple enchondromatosis of the hand. The fingers active range of motion was used to evaluate the finger function; the diameter of the tumors was measured on the X-ray films; and according to Tordai's classification, tumor recurrence and new bone formation were observed. RESULTS Once, twice, or three-time operations were performed in 2 cases, respectively. All patients were followed up 17-83 months with an average of 52.2 months. At last follow-up, the active range of motion was significantly increased from (230.8 +/- 53.2) degrees at preoperation to (255.0 +/- 28.7) degrees at postoperation (t = -3.829, P = 0.001); the tumor diameter was significantly decreased from (15.6 +/- 5.8) mm at preoperation to (10.7 +/- 3.7) mm at postoperation (t = 8.304, P = 0.000). Of 60 bones, 34 (56.7%) were rated as Tordai grade 1, and 26 (43.3%) as Tordai grade 2. During follow-up, clinical manifestation, characteristics of radiology and pathological examination showed no pathological fracture or malignant change. CONCLUSION Corticoplasty is a safe and effective treatment for multiple enchondromatosis of the hand in children. The procedure can improve appearance and motion function of the hand.
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Inani K, Mernissi F. Insensibilité congénitale à la douleur. Pan Afr Med J 2014; 18:197. [PMID: 25419324 PMCID: PMC4237581 DOI: 10.11604/pamj.2014.18.197.4753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/30/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kawtar Inani
- Service de Dermatologie, CHU Hassan II, Fès, Maroc
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Möbius D, Müller A, Merkl RK. [Are the bones coming through the skin here? Urate arthritis]. MMW Fortschr Med 2013; 155:5. [PMID: 23573751 DOI: 10.1007/s15006-013-0135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Kim E, Miyake J, Kataoka T, Oka K, Moritomo H, Murase T. Corticoplasty for improved appearance of hands with Ollier disease. J Hand Surg Am 2012; 37:2294-9. [PMID: 23040642 DOI: 10.1016/j.jhsa.2012.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 08/03/2012] [Accepted: 08/05/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Only a few treatment options are available for Ollier disease, especially for improving appearance. The purpose of this study was to evaluate the efficacy of partial resection of the cortical bone with curettage of the tumor (corticoplasty) for treating hand deformity in Ollier disease. METHODS Five hands (3 patients, 30 metacarpals and phalanges) were examined. Windows of thin cortical bone were elevated, the tumors were excised, and the cortex was trimmed and replaced to enhance the appearance. Artificial bone substitute was used as the graft material for 17 lesions to fill the vacant medullary cavity. The other 13 bones had corticoplasty without grafting. Reduction of bone diameter on radiographs and patient satisfaction were rated after an average of 24 months. RESULTS On average, bony union was achieved 9 weeks after surgery (range, 4-12) in all cases. Morphologic changes on radiographs were rated as excellent or good. Complications and tumor recurrence were not observed, and the range of finger motion and grip strength did not decrease. The level of satisfaction with the outcome was very satisfied for 4 hands and satisfied for the remaining hand. CONCLUSIONS Corticoplasty for Ollier disease resulted in cosmetic improvement without functional deterioration.
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Affiliation(s)
- Eugene Kim
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Ebenezer M, Rao K, Partheebarajan S. Factors affecting functional outcome of surgical correction of claw hand in leprosy. Indian J Lepr 2012; 84:259-264. [PMID: 23720890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The objective of this paper is to study the results and the factors that impact the results of claw hand surgery in leprosy. 110 patients who underwent claw hand correction between 2002 and 2006 were followed up and studied. Brand's criteria for objective assessment and a visual analog scale for subjective assessment were used. The factors studied were age, sex, clinical, duration of paralysis, long flexor tightness, degree of contracture and type of surgery. Objective assessment showed Excellent or Good results in 76.6%, Fair in 20% and Poor in 3.4%. Subjective assessment showed that 80.8% were fully satisfied or satisfied. Regression analysis showed that age, degree of contracture,duration of paralysis and long flexor contracture were seen as significant factors impacting results of claw hand correction.
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Affiliation(s)
- M Ebenezer
- Schieffelin Institute of Health-Research and Leprosy Centre, Karigiri- 632106Vellore, India.
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Yacoubi H, Najib A, Daoudi A. [Permanent abduction of the little finger without ulnar nerve palsy: a case report]. Chir Main 2012; 31:266-268. [PMID: 23084653 DOI: 10.1016/j.main.2012.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/09/2012] [Accepted: 07/01/2012] [Indexed: 06/01/2023]
Abstract
Wartenberg's sign, or permanent abduction of the little finger, occurs in the context of sequelae of ulnar nerve palsy. Its presence alone is rarely reported in the literature and is due to avulsion of the insertion of the third volar interosseous muscle. Several surgical techniques to correct this sign are reported in the literature. The authors report the case of a Wartenberg's sign without ulnar nerve palsy due to traumatic avulsion of the third volar interosseous muscle that was treated by a transfer of the extensor digiti minimi onto the radial side of the extensor digitorium communis according to technique of Bellan et al. After 1-year follow-up, result was good with no recurrence of any deformities and a normal active extension.
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Affiliation(s)
- H Yacoubi
- Service d'orthopédie, centre hospitalier d'Oujda, Oujda, Maroc.
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