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Dallas JN, Marchessault JA. Kirschner Wires and Bone Allograft Salvage Finger Motion in Pathologic Fracture of Middle Phalanx Enchondroma: A Case Report. J Orthop Case Rep 2024; 14:151-154. [PMID: 38292105 PMCID: PMC10823805 DOI: 10.13107/jocr.2024.v14.i01.4182] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/07/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Pathologic phalangeal fracture is a common initial presentation of solitary enchondroma of the finger. Enchondromas of the middle phalanx are most frequently associated with post-operative range of motion deficits. This report describes a case in which the use of Kirschner wires (K-wires) and allograft bone were used to salvage finger motion following surgical fixation of pathologic fracture of a middle phalanx enchondroma with extensor tendon injury. Case Report A 37-year-old right hand dominant woman presents with pathologic fracture of the left index finger middle phalanx. The patient elected for surgical intervention to stabilize fracture and enable early motion at the proximal interphalangeal joint (PIP). Surgical fixation involved tumor curettage, fracture stabilization and length preservation with longitudinal K-wires, allograft bone with hardening properties to fill the bony defect, and dorsal K-wires for securing the extensor tendon. At follow-up 11 months postoperatively, the allograft had almost completely resolved, and the patient had regained PIP flexion of 90° and full extension. Conclusion Pathologic fracture of middle phalanx enchondroma is prone to complication by extensor tendon injury and associated post-operative loss of motion. Bone grafting and Kirschner wire fixation allowed for early mobilization of finger motion and thus may be a useful technique for use in treatment of other pathologic fractures.
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Affiliation(s)
- Jamie N Dallas
- Department of Orthopaedic Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Jeffrey A Marchessault
- Department of Orthopaedic Surgery, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
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Liu H, Zhang Y, Li R, Gu J, Ju J. Reconstruction of the central slip insertion of the extensor tendon with the partial slip of the flexor digitorum superficialis tendon. Arch Orthop Trauma Surg 2023; 143:539-544. [PMID: 35451641 DOI: 10.1007/s00402-022-04443-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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/05/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION To introduce the surgical approach and clinical effect of transferring the partial slips of the flexor digitorum superficialis (FDS) tendon to reconstruct the insertion of the central slip of the extensor tendon (CSET) through an established bone tunnel (BT). MATERIALS AND METHODS From April 2019 to March 2021, nine patients (six males and three females) with the CSET insertion rupture or defect were admitted to the institution and the CSET insertion was reconstructed with partial tendon slips on both sides of the FDS. The active range of motion of the interphalangeal joint of the affected finger was measured by a goniometer, the degree of pain was evaluated by visual analogue scale (VAS), and the grip strength of the affected limb was measured by an electronic hand dynamometer. RESULTS The average postoperative follow-up was 12 months. No complications occurred. At the last follow-up, six of the patients were very satisfied and three were satisfied with their recovery. CONCLUSION The reconstruction of the CSET insertion by transferring the partial tendon slips of the FDS seem to be safe and feasible with minimal invasion to the donor tendon. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Hongjun Liu
- Department of Orthopaedics, Clinical Medical college, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, 225009, Jiangsu, China
| | - Yujun Zhang
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou, 215104, Jiangsu, China
| | - Renlong Li
- Department of Orthopaedics, Yangzhou HongQuan Hospital, Yangzhou, 225200, Jiangsu, China
| | - Jiaxiang Gu
- Department of Orthopaedics, Clinical Medical college, Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, 225009, Jiangsu, China
| | - Jihui Ju
- Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou, 215104, Jiangsu, China.
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Toyama S, Tokunaga D, Tsuchida S, Kushida R, Oda R, Kawahito Y, Takahashi K. Comprehensive assessment of alterations in hand deformities over 11 years in patients with rheumatoid arthritis using cluster analysis and analysis of covariance. Arthritis Res Ther 2021; 23:66. [PMID: 33640011 PMCID: PMC7913439 DOI: 10.1186/s13075-021-02448-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although drug therapy for rheumatoid arthritis (RA) has recently improved, treating patients with established disease, whose hands have three major deformities (thumb deformity, finger deformities, and ulnar drift), remains a challenge. The underlying complex pathophysiology makes understanding these deformities difficult, and comprehensive assessment methods require accumulated skill with long learning curves. We aimed to establish a simpler composite method to understand the pathophysiology of and alterations in the hand deformities of patients with RA. Methods We established a rheumatoid hand cohort in 2004 and clinically evaluated 134 hands (67 patients). We repeated the evaluations in 2009 (100 hands of 52 patients) and 2015 (63 hands of 37 patients) after case exclusion. Thumb deformities, finger deformities (swan-neck and boutonnière deformity), and ulnar drift were semi-quantitated and entered as parameters into a two-step cross-sectional cluster analysis for the data in 2004. The parameters in each cluster were plotted at each evaluation point. Two-way analysis of covariance was used to examine whether differences existed between evaluation points and clusters of deformity parameters. Results Five clusters most appropriately described hand deformity: (i) cluster 1, minimal deformity; (ii) cluster 2, type 1 thumb deformity; (iii) cluster 3, thumb deformity and severe boutonnière deformity; (iv) cluster 4, type 2 or 3 thumb deformity and severe ulnar drift; and (v) cluster 5, thumb deformity and severe swan-neck deformity. Clusters 1 and 2 had higher function than cluster 5, and cluster 3 had moderate function. Clusters 1–4 had similar disease duration but showed different paths of deformity progression from disease onset. Clusters 1 and 2 represented conservative deformity parameters and clusters 3, 4, and 5 represented progressive deformity parameters. Over time, thumb deformity evolved into other types of deformities and swan-neck deformity worsened significantly. Conclusions Our comprehensive analysis identified five deformity patterns and a progressive course in the rheumatoid hand. Knowledge of the characteristics of progressive deformity parameters may allow rheumatologists to more easily implement practical interventions and determine functional prognosis.
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Affiliation(s)
- Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Daisaku Tokunaga
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Shinji Tsuchida
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Rie Kushida
- Rehabilitation Unit, Marutamachi Rehabilitation Clinic, Kyoto, Japan
| | - Ryo Oda
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yutaka Kawahito
- Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
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Abstract
UNLABELLED Boutonnière deformity of the thumb without rheumatoid arthritis or trauma is not widely recognised. This study aimed to investigate its prevalence, relation to sex and age, and identifying factors associated with the extensor mechanism using ultrasonography. We examined 248 thumbs from 127 participants who were asymptomatic for hand disorders and had no history of hand injury. Boutonnière deformity was identified in 20 thumbs of 17 participants and was significantly more prevalent among elderly participants than among young participants. No significant differences in sex or hand dominance were noted. The deformity had a significant effect on range of motion and grip and pinch strengths. The extensor pollicis brevis (EPB) tendon was significantly narrower in affected thumbs than in non-affected thumbs. The prevalence of boutonnière deformity without rheumatoid arthritis or trauma was 13%, and the deformity was associated with advanced age and a narrow EPB tendon. LEVEL OF EVIDENCE III.
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Affiliation(s)
- T Hara
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - H Yoneda
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - S Kurimoto
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - M Yamamoto
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - K Iwatsuki
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - H Hirata
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
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Nemoto T, Ishikawa H, Abe A, Nakazono K, Otani H, Lee H, Murasawa A, Toyoshima Y, Inagaki K. Metacarpophalangeal Joint Arthroplasty Using Flexible Hinge Toe Implant with Grommets for Boutonnière Deformity of Rheumatoid Thumb. J Hand Surg Asian Pac Vol 2018; 23:66-70. [PMID: 29409412 DOI: 10.1142/s242483551850008x] [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 MP joint arthroplasty is one of the treatment options for the rheumatoid thumb with boutonniere deformity. The use of flexible hinge toe implant for MP joint reconstruction was introduced; however, the outcome of flexible toe implantation for the reconstruction of the MP joint has not as yet been reported in detail. Therefore, in this study, we retrospectively investigated the clinical outcome and radiological findings. METHODS We assessed 56 Swanson implant arthroplasties that used flexible hinge toe implants with grommets to address boutonnière deformity of the thumb MP joint. The minimum follow-up period was 6 months. Pain, the range of motion, grip strength, pinch strength, General health Visual analogue scale and DASH (Disabilities of Hand, Shoulder and Hand) were assessed. RESULTS For most of the patients, the procedure provided painless motion and stability to the thumb. In the radiological assessments, the preoperative flexion angles at the MP joint were 45° improved to 17°. The origin of arc was shifted toward the extended position and the average arc of motion was 21°, with a flexion arc from 23° to 44°. The severity of boutonniere deformity was improved in most cases. The average grip strength changed from 110 to 121 mmHg and the average side pinch power changed from 1.5 to 2.2 kgf. General health VAS improved from 40 to 29 (p = 0.019), and the DAS28-CRP decreased from 3.3 to 2.4 (p < 0.001). Infection occurred in one case, and there were no implant fractures. CONCLUSIONS Swanson flexible hinge toe implant arthroplasty with grommets applied to the MP joint of the thumb was one of the recommended procedures for the reconstruction of boutonnière deformity of the thumb.
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Affiliation(s)
- Tetsuya Nemoto
- * Department of Rheumatology, Niigata Rheumatic Center, Shibata, Japan.,† Department of Orthopaedic Surgery, Showa University, Tokyo, Japan
| | - Hajime Ishikawa
- * Department of Rheumatology, Niigata Rheumatic Center, Shibata, Japan
| | - Asami Abe
- * Department of Rheumatology, Niigata Rheumatic Center, Shibata, Japan
| | - Kiyoshi Nakazono
- * Department of Rheumatology, Niigata Rheumatic Center, Shibata, Japan
| | - Hiroshi Otani
- * Department of Rheumatology, Niigata Rheumatic Center, Shibata, Japan
| | - Hyunho Lee
- * Department of Rheumatology, Niigata Rheumatic Center, Shibata, Japan
| | - Akira Murasawa
- * Department of Rheumatology, Niigata Rheumatic Center, Shibata, Japan
| | - Yoichi Toyoshima
- † Department of Orthopaedic Surgery, Showa University, Tokyo, Japan
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Bullock J, Rizvi SA, Saleh AM, Ahmed SS, Do DP, Ansari RA, Ahmed J. Rheumatoid Arthritis: A Brief Overview of the Treatment. Med Princ Pract 2018; 27:501-507. [PMID: 30173215 PMCID: PMC6422329 DOI: 10.1159/000493390] [Citation(s) in RCA: 256] [Impact Index Per Article: 42.7] [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: 10/10/2017] [Accepted: 09/02/2018] [Indexed: 12/11/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic autoimmune disease, affecting the joints with varying severity among patients. The risk factors include age, gender, genetics, and environmental exposure (cigarette smoking, air pollutants, and occupational). Many complications can follow, such as permanent joint damage requiring arthroplasty, rheumatoid vasculitis, and Felty syndrome requiring splenectomy if it remains unaddressed. As there is no cure for RA, the treatment goals are to reduce the pain and stop/slow further damage. Here, we present a brief summary of various past and present treatment modalities to address the complications associated with RA.
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Affiliation(s)
| | - Syed A.A. Rizvi
- School of Pharmacy, Hampton University, Hampton, Virginia, USA
- *Dr. Syed A.A. Rizvi, Department of Pharmaceutical Sciences, School of Pharmacy, Hampton University, Hampton, VA 23668 (USA), E-Mail , Dr. Sultan S. Ahmed, College of Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328 (USA), E-Mail , Dr. Ayman M. Saleh, King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center (KAIMRC), Jeddah, 21423 (Saudi Arabia), E-Mail ,
| | - Ayman M. Saleh
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia
| | | | - Duc P. Do
- University of Georgia, Athens, Georgia, USA
| | - Rais A. Ansari
- Nova Southeastern University, Fort Lauderdale, Florida, USA
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Abstract
Treatment goals for the management of extensor tendon injuries include restoration of function, minimizing disability, and decreasing the risk of complications. These goals can be achieved with an accurate understanding of the zone-specific concerns for extensor tendon injuries, early referral to hand therapy, and active communication between hand surgeons and therapists. This article reviews extensor tendon injuries by zone, outlines optimal management strategies that help prevent complications, and describes the treatment of these complications.
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Affiliation(s)
- Kristina Lutz
- Division of Plastic Surgery, Department of Surgery, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, Room D1-204, 268 Grosvenor Street, London, Ontario N6A 4L6, Canada
| | - Joey Pipicelli
- Division of Hand Therapy, Faculty of Rehabilitation Sciences, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, Room D3-148, 268 Grosvenor Street, London, Ontario N6A 4L6, Canada
| | - Ruby Grewal
- Division of Orthopedic Surgery, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, 268 Grosvenor Street, London, Ontario N6A 4L6, Canada.
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