Fracture subluxation of proximal interphalangeal joint treated by palmar plate advancement.

A modified technique of palmar plate advancement (PPA) was used to treat certain patients, most with failed previous treatment, with fracture subluxation of the proximal interphalangeal joint. The modification of the original technique consisted of using two sutures to attach the palmar plate and tying them deep to the skin on the dorsum. This allowed consistent maintenance of reduction, and there were no infections. The results of 11 of 23 patients who were treated with this technique and followed from 2 to 9 years postoperatively are reported. The indications for PPA in this injury are discussed.

Interdisciplinary roles in stroke care.

Care of the stroke patient presents a complex challenge to the interdisciplinary stroke team. The physical therapist, occupational therapist, and clinical social worker are important members of that team, each of whom contributes specialized knowledge and interventions in behalf of the patient. The physical therapist focuses on prevention of joint and tissue injury and retraining of lost motor skills. The occupational therapist considers the total patient in his or her environment and assists the patient in regaining or improving function in all areas of daily living. The clinical social worker concentrates on psychosocial assessment and intervention with the patient and family, aiding them in the adjustment process and planning for discharge. The nurse, in addition to playing a unique role in the delivery of nursing care to the stroke patient, is in a position to serve as coordinator of the interdisciplinary team. The nurse can facilitate the work of the physical and occupational therapists and the social worker by providing them with timely referrals, valuable assessment information and insights, and reinforcement of therapeutic activity while the patient is on the nursing unit. The keys to making the interdisciplinary team work for the maximal benefit of the patient are threefold: mutual respect and understanding among team members; ongoing coordination of efforts; and open communication between all team members, the patient, and the family. These elements are interrelated and essential if the interdisciplinary team is to be successful at meeting its ultimate goal: expert care of the total patient to achieve maximal independence.