Closed Reduction and Percutaneous Pinning of Fractures of the Proximal Phalanx

2001 ◽  
Vol 26 (1) ◽  
pp. 45-49 ◽  
Author(s):  
E. E. HORNBACH ◽  
M. S. COHEN
Keyword(s):  
Flexor Tendon ◽  
Proximal Phalanx ◽  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Joint Motion ◽  
Percutaneous Pinning ◽  
Kirschner Wires ◽  
Rotational Deformity ◽  
Active Motion ◽  
Total Active Motion

This study reports the results of 12 unstable extraarticular fractures of the proximal phalanx treated with transarticular intramedullary Kirschner wires. Early proximal interphalangeal joint motion was allowed and all patients achieved uneventful union, with an average total active motion of 265°. Objective physical assessment revealed one significant flexion contracture, one flexor tendon adhesion and one significant rotational deformity. Excellent results were observed in ten of the 12 patients.

Open Reduction and Cerclage Wire Fixation for Long Oblique/Spiral Fractures of the Proximal Phalanx of the Fingers

2008 ◽  
Vol 33 (2) ◽  
pp. 170-173 ◽  
Author(s):  
M. M. AL-QATTAN ◽  
K. AL-ZAHRANI
Keyword(s):  
Open Reduction ◽  
Full Range ◽  
Proximal Phalanx ◽  
Pain Syndrome ◽  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Active Motion ◽  
Cerclage Wire ◽  
Wire Fixation ◽  
Total Active Motion

Fifteen cases of long oblique/spiral fractures of the shaft of the proximal phalanx of the fingers treated by open reduction, cerclage wire fixation and immediate postoperative mobilisation were studied prospectively. Twelve patients presented early (within 24 hour of injury) and the remaining three cases were treated initially elsewhere by closed reduction and percutaneous oblique K-wire fixation with failure of the fixation. The latter three patients presented to our clinic late (10–14 days after injury). Following internal fixation with cerclage wires, no cases of infection, complex regional pain syndrome (CRPS) Type 1, fracture re-displacement, wire migration or extrusion were noted. One patient complained of a palpable wire which was removed 4 months after surgery. All fractures united and all patients returned to work at a mean of 8 (range 7–11) weeks after surgery. Twelve patients obtained a full range of motion (total active motion–TAM = 260°) and the remaining three patients had a mild (5–15°) flexion contracture of the proximal interphalangeal joint. Cerclage wire fixation is an acceptable technique of fixation for these fractures.

OUTCOME OF TRACTION TENOLYSIS IN OPEN TRIGGER FINGER RELEASE — A RETROSPECTIVE REVIEW

Hand Surgery ◽  
2013 ◽  
Vol 18 (03) ◽  
pp. 375-379 ◽  
Author(s):  
Muntasir Mannan Choudhury ◽  
Shian Chao Tay
Keyword(s):  
Flexor Tendon ◽  
Group Versus ◽  
Trigger Finger ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Active Motion ◽  
Total Active Motion ◽  
The Mean ◽  
Flexor Digitorum ◽  
A1 Pulley

Surgical treatment for trigger finger involves division of the A1 pulley. Some surgeons perform an additional step of traction tenolysis by sequentially bringing the flexor digitorum superficialis and flexor digitorum profundus tendons out of the wound gently with a Ragnell retractor. There is currently no study which states whether flexor tendon traction tenolysis should be routinely performed or not. The objective of this study is to compare the outcome in patients who have traction tenolysis performed (A group) versus those who did not have traction tenolysis (B group) performed. It was noted that even though the mean total active motion (TAM) for the B group in our study was lower preoperatively, it was consistently higher than the A group in all the 3 post-operative visits demonstrating a better outcome in the B group. Even though it was not statistically significant, our data also showed that patients with traction tenolysis appeared to have more postoperative pain compared to those without.

scholarly journals Intramedullary Screws versus Kirschner Wires for Metacarpal Fixation, Functional, and Patient-Related Outcomes

2018 ◽  
Vol 04 (01) ◽  
pp. e29-e33 ◽  
Author(s):  
Jose Couceiro ◽  
Higinio Ayala ◽  
Manuel Sanchez ◽  
Maria De la Red ◽  
Olga Velez ◽  
...  
Keyword(s):  
Return To Work ◽  
Grip Strength ◽  
Kirschner Wire ◽  
Kirschner Wires ◽  
Active Motion ◽  
Contralateral Hand ◽  
Total Active Motion ◽  
Quick Dash ◽  
Dash Questionnaire

Purpose The purpose of our study is to compare the intramedullary fixation of metacarpal fractures with cannulated headless screws and antegrade Kirschner wires in terms of final total active motion, grip strength, patient-related outcomes, need for casting, and return to work times. Methods The authors performed a retrospective review of the hospital records. Thirty fractures were included in the study, 19 in the screw fixation group, and 11 in the Kirschner wire group. Grip strength, and total active motion, was measured at the latest follow-up for both the injured and contralateral hand. Pain was measured on the visual analog scale. Patients were requested to fill a Quick disabilities of the arm and hand score (DASH) questionnaire at the latest follow-up. Satisfaction was measured on a scale from 0 to 10. The time to return to work was quantified from the accident to the point when the patient was back to active duty. Postoperative casting time was also quantified. Results The authors did not find any differences between the two groups in total active motion, grip strength, pain, satisfaction, or Quick DASH scores. We did find a difference in the return to work and casting times; these appeared to be shorter in the screw group. Conclusion Due to the small number of cases, we have been unable to clearly conclude that there were any benefits in the application of one particular technique when compared with the other.

Is there a correlation between patient-reported outcome assessed by the Disabilities of the Arm, Shoulder and Hand Questionnaire and total active motion after flexor tendon repair?

Hand Therapy ◽  
2012 ◽  
Vol 17 (2) ◽  
pp. 37-41 ◽  
Author(s):  
Paola Errera Magnani ◽  
Aline Miranda Ferreira ◽  
Eula Katucha da Silva Rodrigues ◽  
Rafael Inácio Barbosa ◽  
Nilton Mazzer ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Patient Reported Outcome ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Patient Reported ◽  
Total Active Motion

scholarly journals Dual Antegrade Intramedullary Headless Screw Fixation for Treatment of Unstable Proximal Phalanx Fractures

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 494-499 ◽  
Author(s):  
Michael P. Gaspar ◽  
Shiv D. Gandhi ◽  
Randall W. Culp ◽  
Patrick M. Kane
Keyword(s):  
Grip Strength ◽  
Proximal Phalanx ◽  
Retrospective Chart Review ◽  
Active Motion ◽  
Minimally Invasive Surgical ◽  
Number Of Patients ◽  
Total Active Motion ◽  
Minimally Invasive Surgical Treatment ◽  
Study Inclusion

Background: Although intramedullary headless screw (IMHS) fixation is a promising minimally invasive surgical treatment option for unstable proximal phalanx fractures, a single IMHS may provide inadequate fixation for certain fracture patterns. The purpose of this study was to evaluate the short-term clinical outcomes in a pilot series of patients with proximal phalanx fractures treated with dual antegrade IMHS fixation. Methods: We performed a retrospective chart review of proximal phalanx fractures treated with dual antegrade IMHS fixation with a minimum 1 year of follow-up. Demographic information including patient age, sex, occupation, workers’ compensation status, mechanism of injury, hand dominance, and injured digit were obtained. Postoperative outcomes measured included range of motion, grip strength, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome scores, return to full-duty work interval, and complications. Results: Ten fractures in 10 patients (4 male, 6 female) satisfied study inclusion. The mean age of patients was 39 years (range, 20-62), and average follow-up duration was 84 weeks (range, 61-106). Final postoperative total active motion was 258° (range, 245°-270°), mean grip strength was 97% (range, 84%-104%) of the uninjured side, and QuickDASH score was 3.9 (range, 0-13.6). No complications occurred, and no patients required additional intervention. Conclusions: Dual antegrade IMHS fixation of proximal phalanx fractures resulted in excellent postoperative motion, near-normal grip strength, positive self-reported patient outcomes, and no complications with follow-up of at least 1 year. Further study in a larger number of patients is warranted to determine if this promising technique is superior to other modes of fixation.

Range of Motion Following Extensor Tendon Splitting vs. Tendon Sparing Approaches for Plate Osteosynthesis of Proximal Phalangeal Fractures – A Systematic Review and Meta-Analysis

2020 ◽  
Vol 25 (04) ◽  
pp. 462-468
Author(s):  
Brahman S. Sivakumar ◽  
Vincent VG. An ◽  
Kevin Phan ◽  
David J. Graham ◽  
James Ledgard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Proximal Phalanx ◽  
Extensor Tendon ◽  
Preliminary Evidence ◽  
Active Motion ◽  
Total Active Motion ◽  
Randomised Controlled

Background: Several approaches to plate fixation of the proximal phalanx have been proposed, such as the dorsal extensor splitting approach and the lateral or dorso-lateral extensor sparing approach, which aims to minimise invasiveness to promote native extensor tendon glide. This study aimed to meta-analyse the outcomes of these two approaches. Methods: A systematic review of electronic databases was undertaken, and the outcomes of comparative studies meta-analysed. Results: Three studies were included for meta-analysis. Total active motion (TAM) was significantly greater in the extensor sparing group compared to the extensor splitting (Mean difference 8.52 degrees, 95%CI 0.8–16.36, p = 0.03). Conclusions: This study demonstrates that there is preliminary evidence favouring the use of extensor sparing approaches when fixing proximal phalanxes – however, this result requires validation with randomised controlled trials.

Clinical Outcomes of Zone 2 Flexor Tendon Repairs Using the Modified Lim/Tsai Technique

2019 ◽  
Vol 24 (01) ◽  
pp. 83-88
Author(s):  
Min Kai Chang ◽  
Sanchalika Acharyya ◽  
Zeus Yiwei Lim ◽  
Shian Chao Tay
Keyword(s):  
Retrospective Study ◽  
Clinical Outcomes ◽  
Flexor Tendon ◽  
Biomechanical Properties ◽  
Modified Technique ◽  
Active Motion ◽  
Satisfactory Outcome ◽  
Flexor Tendon Injuries ◽  
Total Active Motion

Background: The single looped suture modified Lim/Tsai technique is widely used for flexor tendon repairs. It has been shown to possess better biomechanical properties and require less repair time per tendon as compared to the double looped suture original Lim/Tsai technique. However, there is no clinical data on the modified technique. Methods: The retrospective study included zone 2 flexor tendon repairs made using the modified Lim/Tsai technique from January 2008 to December 2014. Clinical outcome was assessed using the revised Strickland and Glogovac criteria, which categorises repairs based on the total active motion of the repaired digit. Results: Sixty-two patients with 74 digits were included. The overall mean total active motion was 122°. The overall satisfactory outcome of the modified Lim/Tsai technique was 81.1%. The rupture rate of the modified Lim/Tsai technique was 2.7%. Using multivariate linear regression model, we found that outcomes were negatively influenced by subzone 2C and crush/saw injuries, but not by concomitant neurovascular injuries or post-operative follow-up duration. Conclusions: Based on this retrospective study of patients with zone 2 flexor tendon injuries, the clinical outcomes of modified and original Lim/Tsai techniques are comparable. As such, there is no clinical evidence favouring one over the other.

Clinical outcomes of early active mobilization following flexor tendon repair using the six-strand technique: short- and long-term evaluations

2014 ◽  
Vol 40 (3) ◽  
pp. 250-258 ◽  
Author(s):  
K. Moriya ◽  
T. Yoshizu ◽  
Y. Maki ◽  
N. Tsubokawa ◽  
H. Narisawa ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Superficialis ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Total Active Motion ◽  
Active Mobilization ◽  
Flexor Digitorum

We evaluated the factors influencing outcomes of flexor tendon repair in 112 fingers using a six-strand suture with the Yoshizu #1 technique and early postoperative active mobilization in 101 consecutive patients. A total of 32 fingers had injuries in Zone I, 78 in Zone II, and two in Zone III. The mean follow-up period was 6 months; 16 patients (19 fingers) participated in long-term follow-up of 2 to 16 years. The total active motion was 230° SD 29°; it correlated negatively with age. The total active motion was 231° SD 28° after repair of the lacerated flexor digitorum superficialis tendon, and was 205° SD 37° after excision of the flexor digitorum superficialis tendon ends ( p = 0.0093). A total of 19 fingers showed no significant increases in total active motion more than 2 years after surgery. The rupture rate was 5.4% in our patients and related to surgeons’ level of expertise. Five out of six ruptured tendons were repaired by inexperienced surgeons. Level of Evidence IV

The Proximal Interphalangeal Joint in Dupuytren’s Disease

1985 ◽  
Vol 10 (3) ◽  
pp. 358-364
Author(s):  
M. A. TONKIN ◽  
F. D. BURKE ◽  
J. P. W. VARIAN
Keyword(s):  
Surgical Approach ◽  
Proximal Phalanx ◽  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Joint Contracture ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Average Percentage ◽  
Percentage Improvement

In one hundred patients with Dupuytren’s disease, one hundred and fifty-four operations were performed. The average pre-operative proximal interphalangeal joint contracture was 42° and the average percentage improvement in proximal interphalangeal joint extension at post­operative review was 41%. Fourteen amputations were performed (9.1%). The primary deformity is caused by disease involvement of the palmar fascial structures. Secondary changes may prevent correction of the deformity despite excision of the contracted fascia. The anatomy of the joint is reviewed together with the primary and secondary mechanisms of joint contracture in Dupuytren's disease. Arthrodesis, osteotomy of the proximal phalanx and joint replacement are considered as alternatives to amputation when a systematic surgical approach fails to correct the flexion contracture.

Outcomes of grafting intrasynovial tendons of the toes to the hands in 10 patients: a preliminary report

2017 ◽  
Vol 42 (5) ◽  
pp. 469-472 ◽  
Author(s):  
H. Ohi ◽  
S. Uchiyama ◽  
T. Kanda ◽  
M. Mukoda ◽  
M. Hayashi ◽  
...  
Keyword(s):  
Complication Rate ◽  
Preliminary Report ◽  
Flexor Tendon ◽  
High Complication Rate ◽  
Level Of Evidence ◽  
Active Motion ◽  
Tendon Reconstruction ◽  
Total Active Motion ◽  
Distal Interphalangeal

Ten patients had intrasynovial tendon grafting harvested from the toes for secondary flexor tendon reconstruction in nine fingers and one thumb in our institutes from 2009 to 2014. These patients were followed for a mean of 15 (range: 8–36) months. The ranges of total active motion of the proximal and distal interphalangeal joints of these nine fingers were 143° (range: 108–175°) and of the metacarpophalangeal and interphalangeal joints of one thumb were 110°. In conclusion, this technique is feasible and gives a good result when successful but with a high complication rate. Level of Evidence IV

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