Flexor tenotomy for mallet toe with penetration of the middle phalanx head by dual-component intramedullary implant following proximal interphalangeal arthrodesis

This article presented an assessment of quantitative measures of workspace (WS) attributes under simulated proximal interphalangeal (PIP) joint arthrodesis of the index finger. Seven healthy subjects were tested with the PIP joint unconstrained (UC) and constrained to selected angles using a motion analysis system. A model of the constrained finger was developed in order to address the impact of the inclusion of prescribed joint arthrodesis angles on WS attributes. Model parameters were obtained from system identification experiments involving flexion–extension (FE) movements of the UC and constrained finger. The data of experimental FE movements of the constrained finger were used to generate the two-dimensional (2D) WS boundaries and to validate the model. A weighted criterion was formulated to define an optimal constraint angle among several system parameters. Results indicated that a PIP joint immobilization angle of 40–50 deg of flexion maximized the 2D WS. The analysis of the aspect ratio of the 2D WS indicated that the WS was more evenly distributed as the imposed PIP joint constraint angle increased. With the imposed PIP joint constraint angles of 30 deg, 40 deg, 50 deg, and 60 deg of flexion, the normalized maximum distance of fingertip reach was reduced by approximately 3%, 4%, 7%, and 9%, respectively.

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Proximal Interphalangeal Arthrodesis in the Horse A Retrospective Study and a Modified Screw Technique

Veterinary Surgery ◽

10.1111/j.1532-950x.1990.tb01167.x ◽

1990 ◽

Vol 19 (3) ◽

pp. 196-202 ◽

Cited By ~ 33

Author(s):

J. P. CARON ◽

P. B. FRETZ ◽

J. V. BAILEY ◽

S. M. BARBER

Keyword(s):

Retrospective Study ◽

Interphalangeal Arthrodesis ◽

Proximal Interphalangeal Arthrodesis

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Interphalangeal Arthrodesis of the Toe With a New Radiolucent Intramedullary Implant (Toegrip)

Foot & Ankle Specialist ◽

10.1177/1938640015599031 ◽

2015 ◽

Vol 8 (6) ◽

pp. 520-524 ◽

Cited By ~ 6

Author(s):

Christophe Averous ◽

Frederic Leider ◽

Hubert Rocher ◽

Patrice Determe ◽

Stephane Guillo ◽

...

Keyword(s):

Intramedullary Implant ◽

Interphalangeal Arthrodesis

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Biomechanics and Pinch Force of the Index Finger Under Simulated Proximal Interphalangeal Arthrodesis

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2017.04.002 ◽

2017 ◽

Vol 42 (8) ◽

pp. 658.e1-658.e7 ◽

Cited By ~ 3

Author(s):

Paul Arauz ◽

Karen DeChello ◽

Alexander Dagum ◽

Sue Ann Sisto ◽

Imin Kao

Keyword(s):

Index Finger ◽

Pinch Force ◽

Interphalangeal Arthrodesis ◽

Proximal Interphalangeal Arthrodesis

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Proximal Interphalangeal Arthrodesis of Lesser Toes Utilizing K-Wires Versus Expanding Implants: Comparative Biomechanical Cadaveric Study

Foot & Ankle International ◽

10.1177/1071100718805066 ◽

2018 ◽

Vol 40 (2) ◽

pp. 231-236 ◽

Cited By ~ 2

Author(s):

Shane D. Rothermel ◽

Umur Aydogan ◽

Evan P. Roush ◽

Gregory S. Lewis

Keyword(s):

Cortical Bone ◽

Cadaver Study ◽

Initial Stiffness ◽

Fixation Devices ◽

Fusion Site ◽

Load To Failure ◽

Pip Joint ◽

Interphalangeal Arthrodesis ◽

K Wires ◽

Proximal Interphalangeal Arthrodesis

Background: Lesser toe proximal interphalangeal (PIP) joint arthrodesis is one of the most common foot and ankle elective procedures often using K-wires for fixation. K-wire associated complications led to development of intramedullary fixation devices. We hypothesized that X Fuse (Stryker) and Smart Toe (Stryker) would provide stronger and stiffer fixation than K-wire fixation. Methods: 12 cadaveric second toe pairs were used. In one group, K-wires stabilized 6 PIP joints, and 6 contralateral PIP joints were fixed with X Fuse. A second group used K-wires to stabilize 6 PIP joints, and 6 contralateral PIP joints were fixed with Smart Toe. Specimens were loaded cyclically with extension bending using 2-N step increases (10 cycles per step). Load to failure and initial stiffness were assessed. Statistical analysis used paired t tests. Results: K-wire average failure force, 91.0 N (SD 28.3), was significantly greater than X Fuse, 63.3 N (SD 12.9) ( P < .01). K-wire average failure force, 102.3 N (SD 17.7), was also significantly greater than Smart Toe, 53.3 N (SD 18.7) ( P < .01). K-wire initial stiffness 21.3 N/mm (SD 5.7) was greater than Smart Toe 14.4 N/mm (SD 9.3) ( P = .02). K-wire failure resulted from bending of K-wire or breaching cortical bone. X Fuse typically failed by implant pullout. Smart Toe failure resulted from breaching cortical bone. Conclusion: K-wires may provide stiffer and stronger constructs in extension bending than the X Fuse or Smart Toe system. This cadaver study assessed stability of the fusion site at time zero after surgery. Clinical Relevance: Our findings provide new data supporting biomechanical stability of K-wires for lesser toe PIP arthrodesis, at least in this clinically relevant mode of cyclic loading.

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Proximal interphalangeal arthrodesis in 22 horses

Equine Veterinary Journal ◽

10.2746/042516401776249552 ◽

2010 ◽

Vol 33 (4) ◽

pp. 360-365 ◽

Cited By ~ 39

Author(s):

T. P. SCHAER ◽

L. R. BRAMLAGE ◽

R. M. EMBERTSON ◽

S. HANCE

Keyword(s):

Interphalangeal Arthrodesis ◽

Proximal Interphalangeal Arthrodesis

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Anatomy of the Distal End of Flexor Digitorum Longus Tendon and Percutaneous Release Technique: A Cadaveric Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011419884274 ◽

2019 ◽

Vol 4 (4) ◽

pp. 247301141988427

Author(s):

Baofu Wei ◽

Ruoyu Yao ◽

Annunziato Amendola

Keyword(s):

Distal Phalanx ◽

Neurovascular Bundle ◽

Middle Phalanx ◽

Flexor Digitorum Longus ◽

Longus Tendon ◽

Pull Out ◽

Percutaneous Release ◽

Significant Difference ◽

Distal Interphalangeal ◽

Flexor Digitorum

Background: The transfer of flexor-to-extensor is widely used to correct lesser toe deformity and joint instability. The flexor digitorum longus tendon (FDLT) is percutaneously transected at the distal end and then routed dorsally to the proximal phalanx. The transected tendon must have enough mobility and length for the transfer. The purpose of this study was to dissect the distal end of FDLT and identify the optimal technique to percutaneously release FDLT. Methods: Eight fresh adult forefoot specimens were dissected to describe the relationship between the tendon and the neurovascular bundle and measure the width and length of the distal end of FDLT. Another 7 specimens were used to create the percutaneous release model and test the strength required to pull out FDLT proximally. The tendons were randomly released at the base of the distal phalanx (BDP), the space of the distal interphalangeal joint (SDIP), and the neck of the middle phalanx (NMP). Results: At the distal interphalangeal (DIP) joint, the neurovascular bundle begins to migrate toward the center of the toe and branches off toward the center of the toe belly. The distal end of FDLT can be divided into 3 parts: the distal phalanx part (DPP), the capsule part (CP), and the middle phalanx part (MPP). There was a significant difference in width and length among the 3 parts. The strength required to pull out FDLT proximally was about 168, 96, and 20 N, respectively, for BDP, SDIP, and NMP. Conclusion: The distal end of FDLT can be anatomically described at 3 locations: DPP, CP, and MPP. The tight vinculum brevis and the distal capsule are strong enough to resist proximal retraction. Percutaneous release at NMP can be performed safely and effectively. Clinical Relevance: Percutaneous release at NMP can be performed safely and effectively during flexor-to-extensor transfer.

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Hemi-hamate Arthroplasty for Base of Middle Phalanx Fracture: A Systematic Review

Hand ◽

10.1177/15589447211014623 ◽

2021 ◽

pp. 155894472110146

Author(s):

Harrison Faulkner ◽

David J. Graham ◽

Mark Hile ◽

Richard D. Lawson ◽

Brahman S. Sivakumar

Keyword(s):

Systematic Review ◽

Symptomatic Relief ◽

Donor Site ◽

Functional Restoration ◽

Interphalangeal Joint ◽

Posttraumatic Arthritis ◽

Middle Phalanx ◽

Weighted Mean ◽

True Incidence ◽

Fracture Dislocations

Intra-articular fracture dislocations of the base of the middle phalanx are complex and debilitating injuries that present a management conundrum when nonreconstructable. Hemi-hamate arthroplasty (HHA) is a treatment modality of particular use in the setting of highly comminuted fractures. This systematic review aims to summarize the reported outcomes of HHA in this context. A literature search was conducted using MEDLINE, Embase, and PubMed, yielding 22 studies with 235 patients for inclusion. The weighted mean postoperative range of movement at the proximal interphalangeal joint was 74.3° (range, 62.0°-96.0°) and at the distal interphalangeal joint was 57.0° (range, 14.0°-80.4°). The weighted mean postoperative pain Visual Analog Scale was 1.0 (range, 0.0-2.0). The weighted mean postoperative grip strength was 87.1% (range, 74.5%-95.0%) of the strength on the contralateral side. Posttraumatic arthritis was reported in 18% of cases, graft collapse in 4.2%, and donor site morbidity in 3.0%, with a mean follow-up period of 28.4 months (range, 1-87 months). Hemi-hamate arthroplasty is a reliable and effective technique for the reconstruction of intra-articular base of middle phalangeal fracture dislocations, affording symptomatic relief and functional restoration. Further research is required to assess the true incidence of long-term complications.

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