Prescription of exercise relative motion orthoses to improve limited proximal interphalangeal joint movement: A prospective, mulit-center, consecutive case series

2022 ◽  
Author(s):  
Sally Wajon ◽  
Julianne W Howell
Keyword(s):  
Relative Motion ◽  
Case Series ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Joint Movement ◽  
Consecutive Case

scholarly journals Prospective, Multicenter, Clinical and Radiographic Evaluation of a Biointegrative, Fiber-Reinforced Implant for Proximal Interphalangeal Joint Arthrodesis

2020 ◽  
Vol 5 (4) ◽  
pp. 247301142096631
Author(s):  
Luke D. Cicchinelli ◽  
Jurij Štalc ◽  
Martinus Richter ◽  
Stuart Miller
Keyword(s):  
Adverse Events ◽  
Prospective Trial ◽  
Case Series ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Radiographic Evaluation ◽  
Fiber Reinforced ◽  
Level Of Evidence ◽  
Surgery Patient ◽  
Patient Reported

Background: A novel biointegrative implant was developed for proximal interphalangeal joint (PIPJ) arthrodesis to treat hammertoe deformity. Composed of continuous reinforcing mineral fibers bound by bioabsorbable polymer matrix, the implant demonstrated quiescent, gradual degradation with complete elimination at 104 weeks in animal models. This prospective trial assessed the implant’s safety, clinical performance, and fusion rate of PIPJ arthrodesis for hammertoe correction. Methods: Twenty-five patients (mean age 63.9±7.5 years) who required PIPJ arthrodesis were enrolled at 3 centers. Outcomes included radiographic joint fusion, adverse events, pain visual analog scale (VAS) score, Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) score, and patient satisfaction. Patients were evaluated 2, 4, 6, 12, and 26 weeks postoperatively. Results: Twenty-two patients (88%) achieved radiographic fusion at 26 weeks. All joints (100%) were considered clinically stable, with no complications or serious adverse events. Pain VAS improved from 5.3±2.5 preoperatively to 0.5±1.4 at 26 weeks postoperatively. FAAM-ADL total scores and level of functioning improved by mean 19.5±19.0 points and 24.4±15.7 percentage points, respectively, from preoperation to 26 weeks postoperation. Improvements in pain VAS and FAAM scores surpassed established minimal clinically important differences. All patients were very satisfied (84%) or satisfied (16%) with the surgery. Patient-reported postoperative results greatly exceeded (72%), exceeded (20%), or matched (8%) expectations. Conclusion: This prospective, multicenter, first-in-human clinical trial of a novel biointegrative fiber-reinforced implant in PIPJ arthrodesis of hammertoe deformity demonstrated a favorable rate of radiographic fusion at 12 and 26 weeks, with no complications and good patient-reported clinical outcomes. Level of Evidence: Level IV, prospective case series.

scholarly journals Surface Replacement Proximal Interphalangeal Joint Arthroplasty: A Case Series

Hand ◽  
2018 ◽  
Vol 14 (5) ◽  
pp. 669-674
Author(s):  
Pieter W. Jordaan ◽  
Duncan McGuire ◽  
Michael W. Solomons
Keyword(s):  
Patient Satisfaction ◽  
Range Of Motion ◽  
Retrospective Review ◽  
Case Series ◽  
Proximal Interphalangeal Joint ◽  
Joint Arthroplasty ◽  
Interphalangeal Joint ◽  
Surface Replacement ◽  
Significant Difference

Background: In 2012, our unit published our experience with a pyrocarbon proximal interphalangeal joint (PIPJ) implant. Due to high subsidence rates, a decision was made to change to a cemented surface replacement proximal interphalangeal joint (SR-PIPJ) implant. The purpose of this study was to assess whether the change to a cemented implant would improve the subsidence rates. Methods: Retrospective review of all patients who had a cemented SR-PIPJ arthroplasty performed from 2011 to 2013 with at least 12 months follow-up. Results: A total of 43 joints were included with an average follow-up of 26.5 months. There was a significant ( P = .02) improvement in arc of motion with an average satisfaction score of 3.3 (satisfied patient). Subsidence was noted in 26% of joints with a significant difference in range of motion ( P = .003) and patient satisfaction ( P = .001) between the group with and without subsidence. Conclusions: The change to a cemented implant resulted in satisfied patients with an improvement in range of motion. The rate of subsidence improved but remains unacceptably high.

EXTERNAL FIXATION OF THE HAND: A SIMPLE APPROACH TO COMMINUTED PROXIMAL INTERPHALANGEAL JOINT FRACTURES

Hand Surgery ◽  
2014 ◽  
Vol 19 (01) ◽  
pp. 85-89 ◽  
Author(s):  
Alexander Kubitskiy ◽  
Bishoy A. B. Soliman ◽  
Michael B. Dowd ◽  
Paul Curtin
Keyword(s):  
External Fixation ◽  
Treatment Options ◽  
Case Series ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Range Of Movement ◽  
Active Motion ◽  
Non Union ◽  
Poor Treatment ◽  
Total Active Motion

Proximal interphalangeal joint (PIPJ) fractures are a treatment challenge for hand surgeons. Poor treatment options may lead to stiffness, non-union and markedly reduced range of movement (ROM). We describe our experience using the Hoffman-2 micro static external fixation device (Stryker) in a case series of ten patients with closed comminuted intra-articular PIPJ fractures. The use of this device in the management of these fractures has not previously been described. The mean total active motion (TAM) of the injured joint had recovered to 80% of normal at the six-month follow up.

The quantitative role of flexor sheath incision in correcting Dupuytren proximal interphalangeal joint contractures

2015 ◽  
Vol 41 (6) ◽  
pp. 609-613 ◽  
Author(s):  
P. E. Blazar ◽  
E. W. Floyd ◽  
B. E. Earp
Keyword(s):  
Case Series ◽  
Tendon Sheath ◽  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Contracture ◽  
Extension Deficit ◽  
Level Of Evidence ◽  
Joint Contractures ◽  
Dupuytren's Contracture

Controversy exists regarding intra-operative treatment of residual proximal interphalangeal joint contractures after Dupuytren’s fasciectomy. We test the hypothesis that a simple release of the digital flexor sheath can correct residual fixed flexion contracture after subtotal fasciectomy. We prospectively enrolled 19 patients (22 digits) with Dupuytren’s contracture of the proximal interphalangeal joint. The average pre-operative extension deficit of the proximal interphalangeal joints was 58° (range 30–90). The flexion contracture of the joint was corrected to an average of 28° after fasciectomy. In most digits (20 of 21), subsequent incision of the flexor sheath further corrected the contracture by an average of 23°, resulting in correction to an average flexion contracture of 4.7° (range 0–40). Our results support that contracture of the tendon sheath is a contributor to Dupuytren’s contracture of the joint and that sheath release is a simple, low morbidity addition to correct Dupuytren’s contractures of the proximal interphalangeal joint. Additional release of the proximal interphalangeal joint after fasciectomy, after release of the flexor sheath, is not necessary in many patients. Level of Evidence: IV (Case Series, Therapeutic)

Pollicization of the index finger requiring secondary fusion of the new metacarpophalangeal joint

2015 ◽  
Vol 41 (3) ◽  
pp. 295-300 ◽  
Author(s):  
M. M. Al-Qattan
Keyword(s):  
Index Finger ◽  
Case Series ◽  
Metacarpophalangeal Joint ◽  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Long Term Study ◽  
Current Series ◽  
Early Functional Outcome

In children with absent thumbs, some authors have stated that ‘relative’ contraindications of pollicization include severe fixed flexion contracture and instability of the proximal interphalangeal joint of the index finger. The current author does not consider severe proximal interphalangeal joint deformities of the index finger as a contraindication to pollicization; and hence these children are offered the procedure. A literature review did not reveal any study that specifically documents the outcome of pollicization in these cases. The current series included five children: four with severe (over 80°) fixed flexion contracture of the proximal interphalangeal joint of the index finger and one with instability of the proximal interphalangeal joint. All children were initially assessed during infancy at their local hospitals and the parents were informed that a pollicization procedure would yield a poor outcome. Presentation to the author was relatively late at a mean of 9.3 years (range 2.5–12). All children underwent two surgical procedures: a pollicization followed by fusion of the new metacarpophalangeal joint. The overall early functional outcome was good and all children/parents were satisfied with the procedure. These encouraging results warrant a prospective long term study on various conditions that are considered as ‘relative’ contraindications to the pollicization procedure. Level evidence: IV Therapeutic (case series)

scholarly journals Dorsal Plating for Intra-articular Middle Phalangeal Base Fractures With Volar Instability

Hand ◽  
2018 ◽  
Vol 14 (5) ◽  
pp. 620-625 ◽  
Author(s):  
Travis A. Doering ◽  
Andrew S. Greenberg ◽  
David V. Tuckman
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fixation Method ◽  
Common Mechanism ◽  
Rigid Fixation ◽  
Retrospective Case ◽  
Active Motion ◽  
Dorsal Plating

Background: Intra-articular middle phalangeal base fractures with volar instability are rare injuries with scant literature on optimal management. Our purpose is to describe our method of dorsal plating and report postoperative outcomes. Methods: This study is a retrospective case review of 5 patients with intra-articular middle phalangeal base fractures with volar proximal interphalangeal joint instability, measuring subjective, clinical, and radiographic outcomes. Results: Patient age averaged 38.2 years (range, 23-56 years), and 80% were male. Sporting injuries were the most common mechanism (80%). Time to surgery averaged 7 days, and postoperative follow-up duration averaged 19.6 months (median 8 months). All fractures were intra-articular at the proximal interphalangeal joint with volar instability. There were no complications and no patients required secondary surgery. Grip strength was maintained and range of motion was good, based on the American Society for Surgery of the Hand Total Active Motion score. Average Quick Disability of the Arm, Shoulder and Hand was 0.5 (range, 0-2.3), 100% of patients were satisfied, and average visual analog pain score was 1.2. Patients returned to work at a median of 4 days. There was radiographic union at an average of 6.6 weeks (range, 6-7 weeks) in all fractures. Conclusions: Dorsal plating using a 1.5-mm modular hand plate is a viable option for rigid fixation of intra-articular middle phalangeal base fractures with volar instability. This fixation method allows for early range of motion without complications in this case series. All fractures united, and patients had minimal functional deficits and were able to maintain good range of motion.

Pyrocarbon proximal interphalangeal joint arthroplasty: a medium to long term follow-up of a single surgeon series

2015 ◽  
Vol 40 (9) ◽  
pp. 952-956 ◽  
Author(s):  
P. A. Storey ◽  
M. Goddard ◽  
C. Clegg ◽  
M. E. Birks ◽  
S. H. Bostock
Keyword(s):  
Case Series ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Level Of Evidence ◽  
Visual Analogue Pain ◽  
Kaplan Meier ◽  
Long Term Follow Up ◽  
Post Traumatic ◽  
Joint Arthroplasties

We retrospectively reviewed a consecutive single surgeon series of 57 Ascension pyrocarbon proximal interphalangeal joint arthroplasties, with a mean follow-up of 7.1 years (range 2 years to 11 years 6 months). We assessed the ranges of motion, deformity, stability and pain of the operated joints, grip strength of the hand and patient satisfaction. Of the cases, 44 were for osteoarthritis, five for rheumatoid arthritis and eight for post-traumatic arthritis. The median post-operative active arc of motion was from 0° to 60°. The median post-operative visual analogue pain score was 0.3 out of ten. Thirty six of the joints had no complications; 14 had minor complications (squeak, slight swan neck); three required early reoperation (joint release, flexor tenodesis); and five required implant removal. A total of 69% of our patients would have the same operation if they had to make the decision again. The Kaplan-Meier survival method estimates the mean implant survival to be 10.7 years (95% confidence intervals 9.96–11.37 years). All five failures occurred during the first 2 years. Level of evidence 4 (Case-series).

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