Fixation of Mallet Fractures Using a Modified Hook Plate Technique: A Prospective Case Series of 17 Patients / Fixação de fraturas em martelo com técnica de placa de gancho modificada: Uma série de casos prospectivos de 17 pacientes

Abstract Objective Various modalities have been suggested to manage mallet fractures; however, inappropriate treatment can lead to extension lag, a swan neck deformity, or arthritis of the distal interphalangeal joint (DIPJ). The current study aimed to evaluate the results (functional, radiological, and complications) of open reduction and internal fixation (ORIF) of mallet fractures using low-cost hook plates fabricated from low-profile titanium mini plates. Methods A prospective case series of 17 consecutive patients (average age of 32.3 years) with mallet fractures (six were Wehbe Type IB and 11 were Wehbe Type MB). Eleven (64.7%) were males. The affected hand was dominant in all patients, and the affected digit was the index in 6 (35.3%), the ring in 5 (29.4%), the small in 3 (17.65%), and the middle in 3 (17.65%) patients. The same fellowship-trained hand surgeon performed all surgeries. Results The average operative time was 37.65 minutes. After an average follow-up of 10.94 months (range 6-27), the average DIPJ motion was 50º º (range 20º-70º), the extensor lag was noted in 4 (23.5%) patients, and complications were reported in 6 (35.29%) patients. According to Crawford criteria, 6 (35.3%) patients achieved excellent results, 7 (41.2%) achieved good results, and 4 (23.5%) achieved fair results. Conclusion The modified hook plate technique for fixation of mallet fractures is a beneficiai, economical, yet demanding technique that adequately provides stable fixation to allow early DIPJ motion with acceptable functional outcomes.

Resumo Objetivo Diversas modalidades têm sido sugeridas para o tratamento de fraturas em martelo; no entanto, o tratamento inadequado pode causar retardo de extensão, deformidade em pescoço de cisne ou artrite da articulação interfalangiana distal (AIFD). Este estudo teve como objetivo avaliar os desfechos (funcionais, radiológicos e complicações) da redução aberta e fixação interna (RAFI) das fraturas em martelo com placas de gancho de baixo custo fabricadas com mini placas de titânio de baixo perfil. Métodos Série de casos prospectivos de 17 pacientes consecutivos (idade média de 32,3 anos) com fraturas em martelo (seis do tipo IB e 11 do tipo IIB de Wehbe). Onze (64,7%) pacientes eram do sexo masculino. A mão acometida era a dominante em todos os pacientes, com acometimento do dedo indicador em seis (35,3%), anelar em cinco (29,4%), mínimo em três (17,65%) e médio em três (17,65%) pacientes. O mesmo cirurgião de mão experiente realizou todas as cirurgias. Resultados O tempo operatório médio foi de 37,65 minutos. Após um acompanhamento médio de 10,94 meses (intervalo de 6 a 27), observou-se movimento médio da AIFD de 50º (intervalo de 20º a 70º), retardo de extensão em quatro (23,5%) pacientes e complicações em seis (35,29%) pacientes. De acordo com os critérios de Crawford, os desfechos foram excelentes em seis (35,3%), bons em sete (41,2%) e regulares em quatro (23,5%) pacientes. Conclusão A técnica da placa de gancho modificada para fixação de fraturas em martelo é benéfica e econômica, mas exigente; permite fixação estável e adequada para permitir a movimentação precoce da AIFD com desfechos funcionais aceitáveis.

Classificação e tratamento da mão em fenda: revisão da literatura / Cleft hand classification and treatment: literature review

A mão em fenda é uma deformidade congênita rara caracterizada por uma deficiência longitudinal dos raios centrais da mão, podendo estar associada a outras malformações. Devido ao amplo espectro de manifestações, o tratamento de mãos em fenda é desafiador. Este estudo objetiva apresentar as classificações, técnicas cirúrgicas mais indicadas e seguimentos adotados conforme a manifestação clínica. Foi realizada uma pesquisa nos bancos de dados Web of Science, PubMed, Scopus, Cochrane e Embase, descritores e termos relacionados à anomalia mão em fenda típica. Trinta e dois artigos foram incluídos, sendo analisados quanto a classificação da anomalia, classificação da gravidade de expressão, técnicas cirúrgicas e estudos com informações da intervenção cirúrgica adotada para uma coorte de pacientes. Considerando que estudos sobre mão em fenda são diretamente afetados pelas descobertas embriológicas, genéticas e de biologia molecular, diferentes classificações foram descritas e diversos estudos de complementação de técnicas cirúrgicas já existentes foram encontrados. Estudos inovadores são escassos. A padronização na descrição das técnicas e resultados, além de pesquisas de melhor qualidade, poderiam elucidar lacunas ainda existentes em torno das opções de tratamento.

Cleft hand is a rare congenital deformity characterized by a longitudinal deficiency of the central rays of the hand, which may be associated with other malformations. Due to the wide spectrum of manifestations, the treatment is challenging. This study aims to present the most suitable classifications, surgical techniques and follow-up adopted according to the clinical manifestation. A search was performed in the databases Web of Science, PubMed, Scopus, Cochrane and Embase, descriptors and terms related to the hand anomaly in a typical cleft. Thirty-two articles were included and analyzed regarding the classification of the anomaly, classification of the severity of expression, surgical techniques and studies with information on the surgical intervention adopted for a cohort of patients. Considering that studies about cleft hand could be directly affected by embryological, genetic and molecular biology discoveries, different classifications have been described and several studies to complement existing surgical techniques have been found. Innovative studies are scarce. Standardization in the description of techniques and results, in addition to better quality research, could elucidate gaps that still exist around treatment options.

The effects of kinesthetic and visual motor imagery on interjoint coordination in the hemiplegic index finger: an experimental study using the index of temporal coordination / Os efeitos da imagem cinestésica e viso-motora na coordenação interfalângica do dedo indicador hemiplégico: um estudo experimental usando o "the index of temporal coordination"

Abstract Upper limb hemiparesis is a common impairment following stroke and can affect interjoint coordination. Motor imagery training is one treatment strategy. However, motor imagery can use visual or kinesthetic modalities and there has been a lack of research comparing the effectiveness of these modalities when treating the upper limb. The aim of this study was to compare visual and kinesthetic motor imagery in improving interjoint coordination in the hemiparetic index finger. Fifteen stroke survivors with upper limb hemiparesis were allocated to groups using kinesthetic or visual motor imagery, or a control group using guided relaxation. Reaching and grasping movements of the upper limb were captured using optoelectronic motion capture. Interjoint coordination of the hemiparetic index finger was analysed using the index of temporal coordination. No significant differences were found for interjoint coordination following treatment in either condition. Future work should focus on comparing kinesthetic and visual motor imagery in the rehabilitation of more proximal upper limb joints.

Resumo A hemiparesia do membro superior é uma incapacidade comum após o AVC e pode afetar a coordenação das articulações interfalângicas. A terapia por imagens motoras é uma estratégia de tratamento. No entanto, essa terapia de imagem motora pode usar modalidades visuais ou cinestésicas e há uma escassez de pesquisas que comparem a eficácia dessas modalidades no tratamento do membro superior. O objetivo deste estudo foi comparar a terapia por imagem viso-motora e cinestésica na melhoria da coordenação interfalângica no dedo indicador hemiparético de pessoas com AVC. Quinze participantes com hemiparesia de membro superior foram alocados em grupos cuja terapia foi por imagens cinestésicas ou viso-motoras, e um grupo controle cuja terapia foi de relaxamento guiado. Movimentos de alcance e preensão com o membro superior foram capturados por meio de captura de movimento optoeletrônica. A coordenação interfalângica do dedo indicador hemiparético foi analisada por meio do instrumento "temporal coordination index". Nenhuma diferença significativa foi encontrada para a coordenação interfalângica após o tratamento em qualquer condição. O trabalho futuro deve se concentrar na comparação das imagens cinestésicas e viso-motoras na reabilitação das articulações mais proximais dos membros superiores.

The Therapeutic Effect on Finger Arthralgia by Keishikajutsubuto / 日本東洋医学雑誌

There are many reports that keisikajutsubuto is effective against inflammation of finger and wrist joints, such as from snapping the fingers or scleroderma. We prescribed keisikajutsubuto for 16 orthopedic outpatients with DIP joint arthralgia and pain (Heberden nodes) on the basis of this information. The 16 cases were all women, and the age ranged from 57 to 80 years with an average of 63.4 years. The disease period ranged from 6 months to 15 years with an average of 4 years and 6 months. Eleven cases were diagnosed with deficiency pattern indicating a weak constitution and poor circulation, and 5 cases were medium pattern. Seven of the 16 patients were thin with a BMI of 20 or less. In 4 cases the inflammation of a tendon sheath on the finger was complicated. It took 3 months (from 2 to 8 months) for joint pain to be reduced. Eight patients continued taking 2.5 g of keisikajutsubuto afterwards. The joint deformity was not worse in any case. In all patients, the pain completely disappeared, or partial recovery was obtained. In addition, the local feeling of heat in the joints disappeared in all cases. Keishikajutsubuto was an effective Kampo medicine against finger joint arthritis.

Outcome of non-surgical treatment of mallet finger / Resultado do tratamento não cirúrgico do dedo em martelo

ABSTRACT Objective: To establish the association between initial and residual angulation of the distal interphalangeal joint (DIJ) in mallet finger treated conservatively. Methods: An observational, prospective, descriptive and analytical research developed with uncomplicated closed mallet finger patients between January and December 2017. A total of two measurements of the DIJ were done, at the initial trauma and 6 weeks after conservative treatment. All measurements were ranked according to the Crawford Classification and Relative Risk was measured. Results: In total, 43 patients were studied, in which 53.48% of outcomes obtained were excellent. The sample was divided in two groups; one with less than 30º of DIJ initial angulation, which had 28% of residual angulation. The second group with more than 30º presented 72.22% of residual angulation. The Relative Risk to present a residual angulation in patients that had 30º of DIJ initial angulation was 2.99 (CI 95%) with p = 0.0059. Conclusion: It is suggested that patients with an initial DIJ angulation more than 30º are more likely to present residual angulation with conservative treatment. Level of Evidence IV, Case series.

RESUMO Objetivo: Estabelecer a associação entre a angulação inicial e residual da articulação interfalângica distal em casos de dedo em martelo tratados de forma conservadora. Métodos: Estudo observacional, prospectivo, descritivo e analítico desenvolvido com pacientes que apresentavam dedo em martelo fechado, sem complicações, no período de janeiro a dezembro de 2017. Foram realizadas duas medidas na articulação interfalângica distal, no trauma inicial e seis semanas após o tratamento conservador. Todos foram classificados de acordo com a Classificação Crawford e o Risco Relativo (RR) foi calculado. Resultados: Foram estudados 43 pacientes, dos quais 53,48% apresentaram resultados excelentes. A amostra foi dividida em dois grupos: um com < 30º de angulação interfalângica distal inicial, com 28% de angulação residual, e outro com > 30º, apresentando 72,22% de angulação residual. O risco relativo de apresentar angulação residual em pacientes com 30º de angulação inicial da articulação interfalângica distal foi de 2,99 (IC 95%) com um valor de p = 0,0059. Conclusão: Sugere-se que os pacientes com angulação inicial da articulação interfalângica distal superior a 30º têm maior probabilidade de apresentar angulação residual com tratamento conservador. Nível de Evidência IV, Série de casos.

Prevalence of the Linburg-Comstock Anomaly in a Brazilian Population Sample / Prevalência da anomalia de Linburg-Comstock em uma amostra populacional brasileira

Abstract Objective To determine the prevalence of the Linburg-Comstock anomaly in a Brazilian population sample. Methods A cross-sectional observational study was carried out between October 2017 and April 2018. We included male and female volunteers aged 18 years or older. The presence of the Linburg-Comstock anomaly was determined by performing the clinical tests described by Linburg and Comstock. The data were analyzed using the GraphPad Prism software, and we considered differences with p < 0.05. Results The study analyzed 1,008 volunteers (2,016 hands) with a mean age of 38.3 years, 531 (52.67%) of which were male, and 477 (47.33%) were female. The Linburg-Comstock anomaly was diagnosed in 564 (55.95%) individuals, and it was bilateral in 300 (53.2%) of them, right-sided in 162 (28.72%), and left-sided in 102 (18.08%). No significant differences were found when comparing the prevalence between genders. However, a the prevalence of the right-sided anomaly in the male population (n = 99; 70.21%) was higher than in the female one (n = 63; 51.21%), with p = 0.0016. In addition, the presence of pain by the maneuver described by Linburg and Comstock was more prevalent in women (n = 150; 54.94%) than in men (n = 105; 36.08%), with p = 0.0001. These results show the importance of epidemiological studies on the Linburg-Comstock anomaly, mainly in order to investigate the presence of associated conditions. Conclusion The prevalence of the Linburg-Comstock anomaly in the studied population was of 55.95%, and it was bilateral in 53.2% of the volunteers. The presence of the connection was observed more frequently in the right side and among men, but the pain symptom was more frequent among women.

Resumo Objetivo Determinar a prevalência da anomalia de Linburg-Comstock em uma amostra populacional brasileira. Métodos Estudo observacional transversal realizado no período de outubro de 2017 a abril de 2018. Foram incluídos voluntários dos gêneros feminino e masculino, com idade igual ou superior a 18 anos. A presença da anomalia de Linburg-Comstock foi determinada pela realização dos testes clínicos descritos por Linburg e Comstock. Os dados foram analisados por meio do software GraphPad Prism, sendo consideradas diferenças com valores de p < 0,05. Resultados O estudo analisou 1.008 voluntários (2.016 mãos) com idade média de 38,3 anos, dos quais 531 (52,67%) eram do gênero masculino, e 477 (47,33%) eram do gênero feminino. A anomalia de Linburg-Comstock foi diagnosticada em 564 voluntários (55,95%) da população estudada, sendo bilateral em 300 (53,2%), direita em 162 (28,72%), e esquerda em 102 (18,08%). Não foram encontradas diferenças significativas quando se comparou a prevalência entre os gêneros. Porém, foi encontrada uma maior prevalência da anomalia direita na população masculina (n = 99; 70,21%) do que na feminina (n = 63; 51,21%), com p = 0,0016. Além disso, a presença da dor pela manobra descrita por Linburg e Comstock foi mais prevalente nas mulheres (n = 150; 54,94%) do que nos homens (n = 105; 36,08%), com p = 0,0001. Estes resultados mostram a importância dos estudos epidemiológicos sobre a anomalia de Linburg-Comstock, principalmente com o intuito de investigar a presença de afecções associadas. Conclusão A prevalência da anomalia de Linburg-Comstock na população estudada foi de 55,95%, sendo bilateral em 53,2% dos voluntários. A presença da conexão foi observada com maior frequência do lado direito em homens, mas o sintoma dor foi mais frequente nas mulheres.

Volar plate avulsion fracture alone or concomitant with collateral ligament rupture of the proximal interphalangeal joint: A comparison of surgical outcomes

BACKGROUND: Volar plate avulsion fracture of the proximal interphalangeal (PIP) joint is one of the most common hand injuries. In this study, we divided patients into two groups: patients with pure volar plate avulsion fracture, and patients with volar plate avulsion fracture concomitant with collateral ligament rupture. The purpose of this study was to compare long-term surgical outcomes between the two groups. As a secondary measure, the Mitek bone anchoring and polydioxanone (PDS) bone suturing techniques were compared. METHODS: A single-institutional retrospective review of the surgical treatment of volar plate avulsion fracture was performed. The cases were divided into those with pure volar plate avulsion fracture (group A, n=15) and those with volar plate avulsion fracture concomitant with collateral ligament rupture (group B, n=15). Both groups underwent volar plate reattachment using Mitek bone anchoring or PDS bone suturing followed by 2 weeks of immobilization in a dorsal protective splint. RESULTS: The average range of motion of the PIP joint and extension lag were significantly more favorable in group A (P < 0.05). Differences in age; follow-up period; flexion function; visual analog scale scores; disabilities of the arm, shoulder, and hand scores; and the grip strength ratio between the two groups were non-significant. No significant differences were found in the surgical outcomes of Mitek bone anchoring and PDS bone suturing in group A. CONCLUSIONS: Overall, the surgical outcomes of volar plate reattachment were successful irrespective of whether the collateral ligaments were torn. However, greater extension lag was observed in cases of collateral ligament injury.

Treatment of acute volar plate avulsion fracture of proximal interphalangeal joint with double thread compression suture fixation / 中华骨科杂志

Objective To investigate the treatment and surgical results of acute volar plate avulsion fracture of proximal interphalangeal joint.Methods From August 2013 to June 2016,data of 15 cases of acute volar plate avulsion fracture of proximal interphalangeal joint were retrospectively analyzed.There were 8 males and 7 females aged 18-43 years old with an average of 28.6 years old.There were 4 cases of index finger,6 cases of middle finger,2 cases of ring finger and 3 cases of little finger.Eight injuries resulted from falls,four from finger breaking and three from crushing.The time from injury to operation was 5-9 days,with an average of 6.7 days.The acute volar plate avulsion fracture of proximal interphalangeal joint were treated by double thread compression suture fixation,and Kirschner wires were used to obliquely fix the interphalangeal joint.After the operation,the fore arm was fixed by plaster for 3-4 weeks.After the removal of the plaster,the flexion and extension function of the distal interphalangeal joint and the metacarpophalangeal joint was performed under the guidance of the rehabilitation instructor in a state of no weight.The finger was evaluated by X-ray every 2 weeks until the fracture healing.After 5-8 weeks,the Kirschner wire was removed when the fracture line disappeared,and the active flexion and extension of the proximal interphalangeal joint was guided by the rehabilitation instructor.Resuts In this group of 15 patients,all the incisions healed at the first stage.There was no surgical complications such as skin necrosis,and needle path infection and no abnormal finger feeling or blood circulation disorder.All patients were followed up for 8-32 months (mean,21.7 months).8 months after operation,the DASH score was 1.5 to 7.0 points with an average of 4.6 points.At the latest follow-up,there was no pain,swelling and joint contracture in the proximal interphalangeal joints.The dorsal extension of joints were stable,and the degree of active joint activity was:90°±7° of the metacarpophalangeal joint,80°±6° of the proximal interphalangeal joint,78°±7° of the distal interphalangeal joint,and 248°±22° of total active activity.According to TAM system assessment criteria:there was excellent in 12 cases,good in 2 cases,fair in 1 case,and excellent rate was 93.3％(14/15).Conclusion Double thread compression suture fixation for the treatment of acute volar plate avulsion fracture of proximal interphalangeal joints could reduce the damage to the accessory structure of the joint,and reach adequate exposure in the operationfor fixing the bone block firmly.After operation,good fracture healing and good finger function could be achieved,so the double thread compression suture fixation is an effective surgical method.

Case of Idiopathic Hypereosinophilic Syndrome with Articular Involvement

Idiopathic hypereosinophilic syndrome (IHES) is a rare disease that is characterized by otherwise unexplained persistent eosinophilia and organ damage caused by eosinophilic infiltration. Its manifestations are highly variable but clinically apparent arthritis is uncommonly observed. Although Korean cases of severe eosinophilia in patients with rheumatoid arthritis (RA) or IHES concurrent with RA have been published, there are no reports of IHES with joint involvement. This paper reports a case of IHES presenting with persistent peripheral eosinophilia, fever, skin rash, multiple lymphadenopathy, and polyarthritis, including the distal interphalangeal joints of the hands.

Innervated full thickness grafts in distal finger amputations / 中华创伤杂志(英文版)

Innervated full thickness graft will be presented as an option to reconstruct a fingertip defect which might result in better sensibility than standard reconstruction using a full thickness graft without innervation. Also, anastomosing the nerve stumps can decrease the chance of developing neuroma.

Transplantation of free proximal interphalangeal joint of the second toe with toe preservation for repair of traumatic digital arthritis / 中华创伤杂志

Objective To evaluate the clinical outcome of reconstruction of traumatic digital arthritis by transfer of free proximal interphalangeal joint of the second toe with toe reserving technique.Methods The study enrolled nineteen patients with traumatic digital arthritis treated from May 2013 to April 2016.The patients consisted of fifteen males and four females,and mnean age was 27.3 years (range,18-52 years).Finger involved included index fingers in 10 patients,middle fingers in seven and ring fingers in two.The joint of digit was reconstructed by transplanting the proximal interphalangeal joint of the second toe with a monitoring flap,and bone defect of the second toe was repaired with autogenous iliac bone graft.Wound was closed directly in six patients and covered by island flap from the foot dorsurn in 13 patients.Evaluation indicators contained survival rate of the free joint and island flap,appearance and fracture healing of the finger and toe and mnotion of the proximal digital joint.Finger function was studied using the evaluation standard of upper limb function set up by hand surgery branch of Chinese Medical Association.Healing in the donor site,foot function and related complications were observed.Results All the free joint and island flap survived.Period of follow-up was 6-30 months (mean,14 months).The fractured finger healed at 2.5 months on average,and appearance of the finger was good.Flexion range of the proximal digital joint was 63 °-80° (mean,74°) and extension range was-20°--10° (mean,-14°).Finger function was excellent in eleven patients and good in eight patients,with the excellent-good rate of 100％.Hematoma of the dorsal region of the foot occurred in one patient and the cut healed well after taking out some stitches and drainage.All fractured toe healed at 2.6 months.Except that one patient had fracture malunion with minor outward inclination,all presented good appearance of the toe without influencing walking and running.On the part of iliac,there was only one inconspicuous linear scar without any discomfort.Conclusions Transfer of free proximal interphalangeal joint of the second toe with toe preservation restores the anatomy structure and function of the digital joint.Meantime,autogenous iliac bone grafting combined with island flap from the foot dorsum for coverage of donor site defect retains the toe length and reduces injury of the donor site.

Primary study on finger joints MRI coil and its value in rheumatoid arthritis / 实用放射学杂志

Objective To study the MR performances of finger joints with health subjects and rheumatoid arthritis (RA)patients,and to detect the imaging quality of a custom-made finger coil.Methods Finger coil,extremity coil,flexible surface coil and 3 inch surface coil were used to scan the self-made water phantom with similar T2 WI sequence,then the signal to noise ratio (SNR)on single image was measured for the comparison.The middle finger specimen (1 finger)was used for the research,5 healthy volunteers (8 fingers)and 18 RA patients (22 fingers)were also scanned.Results The SNR of finger coil was over 1.5 times higher than that of the 3 inch surface coil and 4 times higher than that of the extremity coil and flexible surface coil.For the 22 fingers with confirmed RA,synovitis was found in 1 7,joint effusion in 10,bone marrow edema in 5,bone erosion in 7 and tenosynovitis in 6.Conclusion The finger coil has higher SNR.

Análise anatomofuncional da técnica do Pizzicato em contrabaixo: um ensaio teórico / Anatomical analysis of Pizzicato technique for bass: a theoretical essay

A técnica do Pizzicato, recurso de puxar a corda do instrumento com o dedo para produzir o Staccato, é muito comum entre os contrabaixistas, especialmente no Jazz. Nesta técnica utilizam-se os dedos indicador e médio com a desenvoltura de suas articulações, mais comumente, sendo um movimento de repetição que exige habilidades motoras do músico, tais como controle sensório-motor, destreza, precisão, competência muscular e velocidade. Este trabalho promove um ensaio teórico para mostrar a Anatomia envolvida no Pizzicato, criando um esboço de entendimento com análise e desempenho da tarefa de executá-lo, a fim de favorecer uma melhor compreensão para o músico, contribuindo num melhor resultado e menor risco de lesões ocasionadas por movimentos repetitivos. A maneira correta de execução, levando-se em consideração amplitude de movimento e correta posição dos dedos e apoio das mãos é salutar na prática do músico deste instrumento, pois conhecendo a anatomia que favorece esta técnica, o mesmo irá saber como se comportar no momento de tocar e, com isso, executar os movimentos de forma correta, sem comprometimento da eficácia da ação e sem desgaste físico.

The technique of Pizzicato, use the rope to pull the instrument with the finger to produce Staccato, is very common among bassists, especially in Jazz. This technique has been use the index and middle fingers with the ease of your joints, most commonly, with a movement of repetition that requires motor skills of the musician such as sensorimotor control, dexterity, precision, a muscular skill and speed. This paper promotes a theoretical essay to show the anatomy involved in Pizzicato, creating an outline of understanding with analysis and performance of the task to run it in order to foster a better understanding for the musician, contributing to a better outcome and lower risk of injury caused by repetitive movements. The correct way of implementation, taking into account the range of motion and correct position of the fingers and the palm is beneficial in practice for the musician, because knowing the anatomy which favors this technique, he will know how to behave when touching and thereby perform the correctly movements, without compromising the effectiveness of the action and without physical stress.

Proximal Interphalangeal Joint Dislocations and Treatment: An Evolutionary Process

BACKGROUND: Proximal interphalangeal joint (PIPJ) dislocations represent a significant proportion of hand clinic visits and typically require frequent follow-ups for clinical assessment, orthotic adjustments, and physiotherapy. There are a large number of treatment options available for PIPJ dislocations, yet no prospective or controlled studies have been carried out, largely due to the diversity of the various types of injuries. METHODS: We retrospectively reviewed all the PIPJ dislocations in our institution over a five-year period and directly compared the different splinting techniques that we have used over this time frame. RESULTS: There were a total of 77 dislocations of the PIPJ (57 men and 20 women) that were included in our study. We found that our management has shifted gradually from complete immobilisation to controlled early mobilisation with figure-of-eight splints. Following treatment, the range of motion of the PIPJ in the figure-of-eight group was significantly greater than that in the other three methods (P<0.05) used. There were significantly fewer hospital visits in the figure-of-eight splint group than in the other treatment groups. CONCLUSIONS: The treatment of PIPJ dislocations has undergone a significant evolution in our experience. Early controlled mobilisation has become increasingly important, and therefore, splints have had to be adapted to allow for this. The figure-of-eight splint has yielded excellent results in our experience. It should be considered for all PIPJ dislocations, but careful patient selection is required to achieve optimum results.

Acute Tophaceous Gout of the Distal Interphalangeal Joint Misdiagnosed as Cellulitis / 대한정형외과학회잡지

In elderly patients, the first incidence of gout often affects the distal interphalangeal joint (DIP) and usually subsides without specific treatment after about 7 days. A 61-year-old male was presented to our clinic with a 10-day history of tenderness and swelling in his index DIP, which was initially diagnosed as cellulitis. After a skin incision was made to drain the lesion, typical tophaceous deposits were observed around the extensor apparatus, flexor tendons, and joint capsule. The tophi were meticulously removed in order to minimize the injury to its surrounding structures, after which the joint fluid was aspirated. There was no history of gout, laboratory findings suggesting tophaceous gout, or apparent predisposing factors in the patient's history. Pathology confirmed tophaceous deposits and negative birefringent crystals, and the patient has been managed on allopurinol for post-operative six months.

Subluxation of the Extensor Carpi Ulnaris Tendon Associated with the Extensor Digitorum Tendon Subluxation of the Long Finger

A twenty-year-old male visited our clinic with wrist and long finger metacarpophalangeal (MP) joint pain. Dynamic ultrasonography revealed sagittal band (SB) ulnar subluxation and extensor carpi ulnaris (ECU) volar subluxation. Magnetic resonance imaging showed longitudinal splitting and dislocation of the volar half slip of the ECU tendon. The redundant radial SB was augmented and ECU sheath was advanced to the periosteum using suture anchors. He was able to perform his previous activities at the last follow-up. We encountered a case of "simulateous" ECU dislocation with extensor tendon subluxation of the long finger at the MP joint. Therefore, we report this case with a review of the relevant literature.

Open Reduction of Proximal Interphalangeal Fracture-Dislocation through a Midlateral Incision Using Absorbable Suture Materials

BACKGROUND: Fracture-dislocation of the proximal interphalangeal (PIP) joint is a relatively common injury. Various treatments for fracture-dislocation of the PIP joint have been reported. In the present study, we performed open reduction through a midlateral incision using absorbable sutures to reduce the small bone fragments and performed volar plate repair. METHODS: We treated nine patients with fracture-dislocation of the PIP joint with small fractured bone fragments too small for pinning or screw fixation. Patients with volar plate injury were treated with open reduction and volar plate repair at the periosteum of the middle phalangeal bone base by the modified Kessler method using absorbable sutures. All patients were placed in a dorsal aluminum extension block splint, which maintained the PIP joint in approximately 30 degrees of flexion to avoid excessive tension on the sutured volar plate. RESULTS: At a mean final follow-up of postoperative 9 months, all patients were evaluated radiographically and had adequate alignment of the PIP joint and reduction of the displaced bone fragments. Range of motion was improved and there were no complications. CONCLUSIONS: This technique is an excellent alternative to the current method of treating patients with fracture-dislocations that include small fragments that are too small for pinning or screw fixation. It is a less invasive surgical method and enables stable reduction and early exercise without noticeable complications.

Treatment of old fracture-dislocation of proximal interphalangeal joint using a pins-rubber distraction external fixator / 中华骨科杂志

Objective To discuss the clinical outcomes of old fracture-dislocation of proximal interphalangeal joint treated with a self-made distraction external fixator which consists of 3 pins and rubbers.Methods From March 2005 to August 2011,8 cases of old fracture-dislocation of proximal interphalangeal joint treated with a pins-rubber distraction external fixator were retrospectively reviewed.There were 6 males and 2 females,aged from 17 to 58 years,averaged 23.2 years.The middle finger was involved in 5 cases and ring finger was involved in 3 cases.The right hand was affected in six patients,and the left hand was affectd in two patients.The mechanism of injury was sports injury in 6 cases,traffic injuries in 1,and sprain in 1.All of the cases were closed injury.The mean time from injury to surgery was 58 d (range,45-90 d).According to Schenck classification of the proximal interphalangeal joint fracture-dislocation,there were 4 cases of type Ⅰ,3 of type Ⅱ,I of type Ⅲ.Based on the Michigan Hand Outcomes Questionnaire (MHQ) for subjective hand function score,the average preoperative score was 56; the range of motion of proximal interphalangeal joint was 0°.Grip strength was 60％-80％ of the contralateral hand.Results The follow-up lasted 6-51 months,with a mean period of 20.5 months.Solid bone healing was eventually achieved in all patients.The average healing period was 3 months (range,2-5 months).The mean normalized MHQ score was 88 (range,84-92).Grip strength was 85％-100％ of the contralateral hand.Extension of proximal interphalangeal joint was -10°-0° (average,-5°).Flexion angle was 75°-100° (average,89.4°).Postoperative complications included slight joint space narrowing (2 cases),joint incongruity (＜ 1 mm) (2 cases) and fusiform arthrocele (2 cases).No infection,pin loosening,and pin breakage was encounted.Conclusion A pins-rubber distraction external fixator is a minimally invasive,reliable and effective treatment for old fracture-dislocation of proximal interphalangeal joint.

High-frequency ultrasonographic study of finger joints synovial lesions in rheumatoid arthritis / 中华超声影像学杂志

Objective To study the synovial lesions of finger joint of rheumatoid arthritis (RA) with high frequency ultrasound ( HFUS). Methods HFUS examination of finger joints of both hands were performed in 42 patients with RA and 30 healthy volunteers. The ultrasound findings of the finger joints in RA patients included intra-articular fluid,the thickness of synovial membrane,vascular proliferation. and the blood flow characteristics. Results The intra-articular fluid was found in 256 joints and the detection rate was 42. 38% (256/840). Synovial membrane hyperplasia was found in 223 joints with the detection rate of 26.55% (223/840). The detection rate of HFUS for vascular proliferation was 6.07% (51/840). Conclusions HFUS is an easy, safe and effective method for the diagnosis of RA thus providing useful evidences for clinical diagnosis.