Active traction splinting for proximal interphalangeal joint injuries.

Proximal interphalangeal joint injuries can severely affect hand function. Early, active motion is important in ensuring a good range of motion and a functional outcome. Active traction splinting is a dynamic splinting system that can be performed with either open or closed reduction of phalangeal joint fractures, especially at the proximal interphalangeal level. This system allows for continued traction on the involved joint and thereby aids in providing a dynamic force that will unload the joint throughout its arc of motion and noticeably decrease pain. Early, active therapy and the continual in-line traction enables the patient to achieve an almost full range of motion early in the course of rehabilitation. This combination contributes significantly to improve patient understanding and compliance. The benefits of the active traction system are reduction of fragments, marked decrease in pain, and early range of motion with improved patient compliance. Early, active motion facilitates improved joint nutrition, contouring, and healing. Active traction splinting for proximal interphalangeal joint injuries is a relatively simple and effective method for treating these complex injuries.

Importance of crossover innervation in digital nerve repair demonstrated by nerve isolation technique.

This study was conducted to determine how testing of nerve repair using nerve isolation techniques compares with standard testing. Nerve isolation consisted of double-gloving, leaving the study finger free, and administering local anesthetic blocks to all other sensory contributions in the exposed digit. Ten patients with 13 single digital nerve repairs of equally severe injuries were studied at a mean of 41 months postoperatively. Standardized tests yielded an excellent result in 77% for static two-point discrimination (S2pd), 85% for moving two-point discrimination (M2pd), and 46.2% for Semmes-Weinstein monofilaments (SWMF). The same studies combined with nerve isolation yielded an excellent result in only 43% for S2pd, 43% for M2pd, and 0% for SWMF. These results indicate a statistically significant difference and the importance of crossover innervation from intact nerves in the long-term result of digital nerve repair. Nerve isolation study techniques are an important adjunct in assessing the outcome of nerve repair and are the only method of evaluating the true end result of nerve regeneration following neurorrhaphy.

Digital nerve repair: relationship between severity of injury and sensibility recovery.

The purpose of this study was to measure the relationship between severity of injury and sensibility outcome. This was done by a retrospective study of 37 digital nerve repairs in 26 patients, with a mean follow-up of 35 months. All patients underwent complete hand examination and standard nerve testing, including static and moving two-point discrimination, Semmes-Weinstein monofilaments (SWMF), object recognition, and the pick-up test. A hand injury severity scoring system based on wound characteristics, mechanism of injury, and number of structures involved was then developed. Severity grading led to three classes, and each study group was well matched. Subjectively, all patients considered their outcome as either good or excellent. Objective results are reviewed individually for each test, with the overall combined result of static and moving two-point discrimination being excellent (Highet S4) in 81% for class I, 41% for class II, and 31% for class III, all different at a statistically significant level. We concluded that the severity of injury in the hand can be graded and does have a relationship to the functional end result of digital nerve repair.