Pins and Rubbers Traction System for Treatment of Intraarticular Fractures of Distal Interphalangeal Joint.

Background: The pins and rubber traction system (PRTS) has proven effective in managing intra-articular fractures of the proximal interphalangeal joint. However, there is scant evidence in the literature regarding its efficacy in treating distal interphalangeal joint (DIPJ). This study aims to investigate the outcomes of PRTS in the treatment of comminuted intra-articular fractures of the DIPJ. Methods: We conducted a retrospective review of patients with comminuted intra-articular fractures of the DIPJ treated with PRTS between 2017 and 2021. At the final follow-up, we measured and compared the active range of motion (ROM) in both affected and non-injured contralateral fingers. The subjective evaluation utilised the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and the Visual Analogue Scale (VAS). Results: Ten patients with a mean follow-up of 13.2 months (range: 12-17) were included in the study. Fracture locations included the base of the distal phalanx in two patients, the condyle of the middle phalanx in seven and both in one patient. At the final follow-up, the average VAS score was 0.5 (range: 0-2). The average active motion of the DIPJ was 61° (range: 50°-70°) for the injured side and 76° (range: 75°-80°) for the opposite side. The mean range of DIPJ movement was 80% (range: 68%-87%) of the non-injured side. Extension deficits were observed in five patients, with a median deficit value of 10° (range: 5°-10°). The average Quick-DASH score was 2.9 (range: 0-11.3). Conclusions: The PRTS can be considered as an effective surgical technique in managing comminuted intra-articular fractures of the DIPJ. Level of Evidence: Level IV (Therapeutic).

Retrospective study of Ishiguro's technique for mallet bone finger in children: long-term follow-up and analysis of predictors in outcomes.

PURPOSE: There is no consensus on the optimal treatment of bony mallet finger in the paediatric population due to a lack of studies in children. The Ishiguro technique is simple and less invasive, and treatment with K-wire fixation seems to provide better results for extension lag in bony mallet finger according to the literature. A retrospective cross-sectional study with long-term follow-up was performed to evaluate the functional and clinical outcomes of this method in children. Preoperative and intraoperative predictors of outcome were investigated. METHODS: From June to December 2022, we evaluated 95 children who underwent extension K-wire block from 2002 to 2012. Eighty-four children were included (mean age 14.8 ± 1.68 years) for a mean long-term follow-up of 11.6 ± 2.3 (8-16) years. Clinical and radiographic features were assessed. Pain and functional outcomes were assessed using Crawford criteria, range of motion (ROM) at the distal interphalangeal joint (DIPJ), loss of extension, and VAS scale. Univariate and multivariate regressions were used to assess which variables might predict the worst outcomes at long-term follow-up. RESULTS: Bone union and pain relief were always achieved. There were no complaints of potential growth impairment or nail deformity. 82.1% of patients showed excellent and good results. Fifteen patients had fair results. CONCLUSIONS: Although there are currently no significant differences between surgery and orthosis in adults, the Ishiguro technique is more effective in children when it comes to outcomes in the treatment of mallet fingers. A high percentage of excellent and good results were achieved, and no epiphyseal damage or nail deformity was reported. A strong and significant correlation was found between the worst outcomes and either delayed treatment time or excessive flexion angle.

Outcomes of Pediatric Proximal Phalanx Base Fractures.

INTRODUCTION: Extra-articular juxtaphyseal fractures of the proximal phalanx are among the most common finger fractures in children. Immobilization of the digit for 3 to 4 weeks after reduction of the fracture is the current standard of care. The purpose of this retrospective study was to evaluate outcomes after intervention among pediatric proximal phalanx base fractures and establish radiographic criteria to guide management. METHODS: A multi-institutional retrospective review of skeletally immature patients treated for proximal phalanx juxtaphyseal fractures between 2002 and 2019 was conducted. Variables collected included Salter-Harris classification; initial, postreduction, early follow-up, and final angulation and displacement on the posterior-anterior and lateral radiographs; clinical rotational deformity at final follow-up; and method of treatment. Exclusion criteria included less than 3 weeks of follow-up; Salter-Harris III, IV, and V fractures; inadequate medical record details; and missing radiographs. RESULTS: Six hundred thirty-four fractures meeting the inclusion criteria were categorized into no reduction, closed reduction (CR), and surgical (OP) groups. Only CR and OP groups saw large decreases in angulation by 11.8° CR (95% confidence interval, 10.1 to 13.6) and 19.0° OP (95% confidence interval, 8.7 to 29.3). Closed reduction patients had a mean coronal angulation value of 6.1° at post-reduction, which was maintained with immobilization to 5.8° at final follow-up. At final follow-up, scissoring was noted, three in the no reduction and three in the CR group for an overall 0.93% rotational malalignment rate. DISCUSSION: Extra-articular proximal phalanx juxtaphyseal fractures rarely require surgical management and can typically be treated with or without CR, based on the degree of deformity, in the emergency department or clinical setting. Low rates of documented sequelae after nonsurgical management were seen in this cohort, allowing for establishment of treatment parameters that can result in clinically insignificant angular and rotational deformity. LEVEL OF EVIDENCE: Therapeutic IV.

Stress Fractures of the Distal Phalanx in Skeletally Immature Sport Climbers.

Stress fractures in the distal phalanx of skeletally immature patients are rare and previously unreported clinical occurrences. We report on 2 adolescent sport climbers with such fractures of the dorsal metaphysis of the distal phalanx at the point where parts of the extensor tendon insert. A conservative treatment approach alone was sufficient in healing this fracture type in both patients after 12 wk. Clinicians should be informed of the existence of this rare clinical phenomenon and counsel patients that a conservative treatment approach may result in complete healing without the need for an invasive procedure.

Posttraumatic Osteoarthritis of the Distal Interphalangeal Joint: A Follow-Up Study of 12 Years After Nonsurgical Treatment of Mallet Finger Fractures.

PURPOSE: In treatment of mallet finger fractures (MFFs), the aim is to minimize residual extension lag, reduce subluxation, and restore congruency of the distal interphalangeal (DIP) joint. Failure to do so may increase the risk of secondary osteoarthritis (OA). However, long-term follow-up studies focusing on OA of the DIP joint after an MFF are scarce. The purpose of this study was to assess OA, functional outcomes, and patient-reported outcome measures (PROMs) after an MFF. METHODS: A cohort study was performed with 52 patients who sustained an MFF at a mean of 12.1 years (range, 9.9-15.5 years) previously and who were treated nonsurgically. A healthy contralateral DIP joint was used as the control. Outcomes were radiographic OA, using the Kellgren and Lawrence and Osteoarthritis Research Society International classifications, range of motion, pinch strength, and PROMs (Patient-Rated Wrist Hand Evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, Michigan Hand Outcome Questionnaire, 12-item Short Form Health Survey). Radiographic OA was correlated with PROMs and functional outcomes. RESULTS: At follow-up, there was an increase in OA in 41% to 44% of the MFFs. Of all the MFFs, 23% to 25% showed a higher degree of OA than the healthy control DIP joint. Range of motion (mean difference ranging from -6° to -14°) and Michigan Hand Outcome Questionnaire score (median difference, -1.3) were decreased after MFFs but not to a clinically relevant extent. Radiographic OA was weakly to moderately correlated with functional outcomes and PROMs. CONCLUSIONS: Radiological OA after an MFF is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint, which does not clinically affect PROMs. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

A Guide to Indoor Rock Climbing Injuries.

ABSTRACT: Rock climbing is an increasingly popular indoor sport with a sizable risk of overuse injuries. Yet, many medical practitioners have little familiarity with evaluating and treating climbing injuries because of the terminology, biomechanical demands, mechanisms of injury, and return to sport counseling needed, unique to the sport. This review seeks to educate practitioners on these aspects. Upper extremity injuries occur more frequently than lower extremity injuries, with finger injuries being most prevalent. Pulley injuries, consisting of rupture of the A2 or A4 annular pulleys are the most common type of injury. Other finger injuries include tenosynovitis of the flexor tendons, as well as lumbrical muscle tears. Elbow injuries occur frequently, with medial epicondylopathy being most common. Brachialis injuries are seldom seen outside of climbing. Lower-extremity injuries are typically more acute in nature, including ankle injuries from falls and knee injuries from strenuous climbing moves.

Finger Metacarpophalangeal Joint Injuries in Athletes: Evaluation, Diagnosis, Treatment, and Return to Play.

Metacarpophalangeal (MCP) joint injuries of the fingers are frequent among athletes and can markedly affect an athlete's ability to perform at a high level. Despite this, MCP finger injuries in athletes are not frequently discussed, particularly in comparison with MCP joint injuries of the thumb, and remain unrecognized and undertreated injuries in this cohort. Accurate diagnosis and treatment of these injuries begins with an understanding of all the potential diagnoses. The purpose of this study was to review the pertinent anatomy and differential diagnoses for MCP joint injuries in athletes, including the evaluation and management to allow for safe and early return to play.

A Prospective Analysis of Patient Characteristics Affecting the Outcome of Dorsal Splinting for Soft Tissue Mallet Injuries.

BACKGROUND: Much has been written about the diagnosis and treatment of soft tissue mallet injuries. However, there has been little regarding the characteristics of this injury affecting patients' prognosis. The purpose of this prospective study was to identify factors influencing the outcome of treatment of soft tissue mallet injuries. METHODS: Patients diagnosed with soft tissue mallet injuries were enrolled prospectively in a protocol of dorsal splinting for 6 to 12 weeks, followed by weaning over 2 weeks and then evaluated at 6, 9, and ≥12 months. RESULTS: Thirty-seven patients (38 digits) completed the study. Treatment success was defined as a final extensor lag of <15° and failure as a final extensor lag of ≥15°. Those failing splint treatment were older compared with those successfully treated. Patient compliance was significantly associated with a successful outcome. Factors that did not significantly affect success included time to treatment, initial injury severity, splinting duration, sex, and ligamentous laxity. Disabilities of Arm, Shoulder, and Hand scores >0 were not associated with treatment failure. Radiographic and clinical extension lag were statistically comparable. CONCLUSIONS: This study shows strong association between the success of splint treatment, younger patient age, and compliance with the treatment protocol. Despite this finding, most patients did not report any functional limitations, irrespective of the treatment success. In contrast to prior results, time to treatment and initial extensor lag did not significantly affect treatment success.

Acute Mallet Finger Injuries-A Review.

Acute disruptions of the terminal extensor tendon are common and can result in significant dysfunction if not recognized and treated appropriately. This article provides a topical review of the contemporary literature concerning acute mallet finger injuries. It also proposes a modification to the Doyle classification to make it more encompassing and less prone to interobserver error.

Primary Periphyseal Stress Injuries of the Fingers in Adolescent Climbers: A Critical Review.

ABSTRACT: The worldwide rise in popularity of climbing and development of climbing as a competitive sport is reflected by its debut at the 2021 Summer Olympic Games in Tokyo. Digital primary periphyseal stress injuries in adolescent climbers may pose a significant risk to long-term skeletal health. The aim of this article is to critically review research on the diagnosis and management of primary periphyseal stress injuries of the fingers in adolescent climbers. We adopted a systematic approach to searching for relevant literature. Articles were identified after searches of the following electronic databases: Discover, Academic Search Complete, PubMed, Embase, SPORTDiscus, and ScienceDirect. Conclusive evidence suggests digital primary periphyseal stress injuries are a consequence of repetitive microtrauma. Pain reported by adolescent climbers on the dorsal aspect of the proximal interphalangeal joint should be investigated promptly to avoid serious negative consequences. Clinicians should be aware of the efficacy of imaging techniques to inform a clinical diagnosis. A conservative management approach is preferred but in rare cases surgical intervention may be necessary. A diagnostic and therapeutic algorithm for digital primary periphyseal stress injuries is presented.

Mallet Finger: Two Different Injuries.

Mallet injuries, either tendinous or bony, are common. They are often studied together and typically treated in the same way with extension splintage for 6 to 8 weeks. Yet the evidence clearly shows there are different injuries that present in the same way. Tendinous mallet injuries present in older patients usually following a low energy injury; they are often painless. The commonly injured fingers are the middle and ring. The injuries are almost always single digit without concomitant injuries. There is an extensor lag of a mean of 310 (range 3°-590) in the patients treated in my unit. In contrast, bony mallet injuries occur at a younger age (mean 40 years) and are always due to high energy injuries. The injuries are always painful. The commonly injured fingers are the ring and little fingers. There are multiple injuries in 3% (range 2%-5%) and in 4% to 8% of cases, there are concomitant (nondigital) injuries according to data in my unit. Radiologically there is an appreciably smaller extensor lag; mean 130 (range 0°-400). In particular, bony mallet injuries are extension compression, not avulsion, fractures which should not logically be treated with an extension splint which will reproduce the direction of injury.

Semi-occlusive management of fingertip injuries with finger caps: A randomized controlled trial in children and adults.

BACKGROUND: Human fingertips can regenerate functionally and cosmetically excellent skin and soft tissues. Physiological conditions suppress scar formation and are thus a prerequisite for regenerative healing. Self-adhesive film dressings can provide such favorable conditions. The semi-occlusive treatment is superior to surgery. However, standard dressings leak malodorous wound fluid eventually until the wound is dry. Therefore, we developed and tested a silicone finger cap that forms a mechanically protected, wet chamber around the injury. Its puncturable reservoir allows access to the wound fluid for diagnostic and research purposes and the delivery of pro-regenerative drugs in the future. METHODS: Patients >2 years with full-thickness fingertip injuries unsuitable for simple primary closure were randomized to start treatment with either the film dressing or the silicone finger cap. After 2 weeks, we changed to the other treatment. Patients' choice on the preferred treatment after 4 weeks was the primary outcome parameter. Additionally, we monitored adverse events, unplanned visits, tissue gain, functionality, cosmetic outcome, and quality of life. RESULTS: We randomized 11 patients 2 to 72 years to each group. Eighteen to 20 (90%, intention-to-treat) patients preferred the finger cap. All patients were satisfied with the cosmetic outcome, 88.9% had no disturbing sensibility changes, and 73.7% could report no distortion in the finger's daily use. Epithelialization took between 5 weeks for Allen II and up to 9 weeks in Allen IV injuries. There were 19 device-related adverse events under film dressing and 13 under the finger cap. There were neither severe adverse device effects nor unexpected severe adverse device effects. CONCLUSION: Employing the summative or synthetic primary endpoint "patient decision for one or the other procedure," our pseudocross-over-designed RCT succeeded in statistically significantly demonstrating the superiority of the silicone finger cap over conventional film therapy. The finger cap was safe and effective, reaching excellent results on all treated injuries without any need for disinfection, antibiotics, shortening of protruding bones, or treatment of hypergranulations. Distal to the tendon insertions, we did not see any limitations regarding injury mechanism, amputation plane, or patients' age.

An Analysis of the Clinical Efficacy of Early Dynamic Orthosis after Finger Extensor Digitorum Rupture.

Objective: The main objective is to compare the clinical efficacy of the early use of dynamic orthosis in patients with a finger extensor digitorum rupture. Methods: A total of 50 patients with hand and foot trauma who received surgical treatment in our hospital from March 2017 to February 2021 were selected, and two patients were excluded from the study. The patients were randomly divided into two groups. The control group (group A) was treated with plaster fixation and routine rehabilitation, and the study group (group B) underwent dynamic low-temperature thermoplastic plate fixation and routine rehabilitation. Total active motion (TAM) and total passive motion (TPM) of the injured finger before treatment, one month after treatment, two months after treatment, and after corrective treatment were compared. Results: After treatment following a finger extensor digitorum rupture, the TAM and TPM of the injured fingers increased significantly in both groups. The TAM and TPM in group B were significantly better than those in group A after one and two months of treatment (P < 0.05). After two months of treatment, the rates of improvement in TAM and TPM in group B were significantly higher than those in group A. Conclusion: The early use of dynamic orthosis can significantly improve the motor function and motion amplitude of the injured finger, increase the elasticity and extension of the finger extensor digitorum, and promote the recovery of muscle strength. It is an effective corrective method for tendon contracture after finger extensor digitorum rupture and has great value in clinical application.

Floating phalanx; simultaneous double dislocation of the interphalangeal joint in a finger: A case report and literature review.

Isolated proximal and distal interphalangeal joint (DIPJ) dislocations are widely seen as a result of sporting injuries and major trauma. The combination of dorsal dislocation of the DIPJ in the same finger concomitant to traumatic dorsal dislocation of the proximal interphalangeal joint (PIPJ) is a rarely seen injury. The case is, here, presented of a 65-year-old female patient with proximal and DIPJ dislocation of the right-hand ring finger accompanied by volar and dorsal plate injuries in the proximal and distal joints. With this case, it was aimed to introduce a new term of 'floating phalanx' into medical literature. The treatment was applied to the patient of closed reduction under peripheral block and the application of an aluminium finger splint in semiflexion. In a 24-month follow-up period, the 4th finger of the patient was observed to be stable and has pain-free range of movement. This case is an uncommon case of volar and dorsal plate avulsion fractures with PIPJ and DIPJ dorsal dislocation treated successfully with closed reduction and conservative treat-ment with excellent functional results.

Common Finger Fractures and Dislocations.

Finger fractures and dislocations are commonly seen in the primary care setting. Patients typically present with a deformity, swelling, and bruising with loss of function. Anteroposterior, lateral, and oblique radiography should be performed to identify fractures and distinguish uncomplicated injuries from those requiring referral. Uncomplicated distal phalanx fractures, caused by a crush injury to the end of the finger, require splinting of the distal interphalangeal joint for four to six weeks. Uncomplicated dorsal avulsion fractures (mallet finger) of the distal interphalangeal joint, caused by forced flexion against resistance, require strict splint immobilization for eight weeks. Flexor digitorum profundus fractures are caused by forceful extension of the distal interphalangeal joint when in a flexed position, resulting in an avulsion fracture at the volar base of the distal phalanx, and usually require surgery. Uncomplicated middle and proximal phalanx fractures, typically caused by a direct blow, can be treated with buddy splinting if there is minimal angulation (less than 10 degrees); however, larger angulations, displacement, and malrotation often require reduction or surgery. Dorsal proximal interphalangeal joint dislocations require reduction and buddy splinting in slight flexion with an extension-block splint. Volar proximal interphalangeal joint dislocations require reduction and splinting in full extension for four to six weeks. Distal interphalangeal joint dislocations require reduction and splinting in full extension (for volar dislocations) or 15 to 30 degrees of flexion (for dorsal dislocations) for two to three weeks. Dorsal metacarpophalangeal joint dislocations are managed with reduction and splitting, but referral to an orthopedic specialist is required if the dislocation is not easily reduced. Volar metacarpophalangeal dislocations are rare and warrant referral.

Traumatic hand injury management and outcomes: A case report.

Acute hand injuries are routinely managed by family medicine and primary care physicians. An appropriate initial assessment and treatment, early referral to a hand surgeon when indicated, and timeous referral to a hand therapist are imperative. A patient case report is presented reporting on the initial and subsequent assessment, treatment and outcomes at 3, 6, 7 and 9 months for a patient who sustained an acute finger injury. Finger range of motion (ROM), sensation, pain, time of wound closure, hand function measured with the standardised disability of the shoulder, arm and hand (DASH) questionnaire were the outcomes used. Pain, crepitus, decreased sensation, decreased ROM right index finger proximal interphalangeal joint (PIPJ) and dense scarring was measured at 9 months. Missed injuries or lack of recognition of injury severity leads to delayed referral to specialist hand surgeons and therapists, which lengthens recovery time and leads to sub-optimal outcomes. This article aims to provide the primary care practitioner with the initial management of a patient who sustained a traumatic hand injury whilst using a power tool.

IV3000 semi-occlusive dressing use in simple and complex fingertip injuries: efficacy and affordability.

OBJECTIVE: This study aimed to explore the efficacy of the IV3000 semi-occlusive, transparent adhesive film dressing in the non-surgical management of simple as well as more complex fingertip injuries. METHOD: In this qualitative study, patients with fingertip injuries were prospectively recruited and treated conservatively with the dressing between 2015 and 2017. Inclusion criteria included any fingertip injury with tissue loss and patient consent for non-surgical treatment consistent with the study protocol. Exclusion criteria included injuries needing surgical intervention for tendon injury or exposure, joint dislocations, distal phalangeal fractures requiring fixation, bone exposure, isolated nail bed lacerations and any patients eligible for surgical repair who did not wish to be managed conservatively. RESULTS: A total of 64 patients took part in the study. The patients treated with the dressing were asked to rate functional outcome, of whom 40 (62.5%) patients reported the outcome as 'excellent', 19 (29.7%) as 'satisfactory', five (7.8%) as 'indifferent' and none (0%) as 'unsatisfactory'. A reduced pulp volume at completion of healing was felt by 21 (32.8%) patients, but all patients were 'satisfied' with the aesthetic appearance of their fingertips at final clinical review. Average healing time was 4.5 weeks across the group, with the average time for return to work being just under one week. We estimate a 60% reduction in cost with the conservative versus the surgical management option. CONCLUSION: This study showed that, for participants, the IV3000 dressing was an affordable and effective option for the conservative treatment of simple fingertip injuries and in the management of more complex fingertip injuries.