scholarly journals Fowler Central Slip Tenotomy or Spiral Oblique Retinacular Ligament Reconstruction? A Cadaveric Biomechanical Study in Swan-Neck Deformity

Hand ◽  
2019 ◽  
Vol 15 (5) ◽  
pp. 620-624
Author(s):  
Christian Deml ◽  
Aslan Baradaran ◽  
Neal Chen ◽  
Michael Nasr ◽  
Amir R. Kachooei
Keyword(s):  
Ligament Reconstruction ◽  
Biomechanical Study ◽  
Mallet Finger ◽  
Distal Interphalangeal Joint ◽  
Finger Extension ◽  
Significant Difference ◽  
Pip Joint ◽  
Central Slip ◽  
Distal Interphalangeal ◽  
Swan Neck Deformity

Background: The goal of this study is to biomechanically compare Fowler central slip tenotomy with spiral oblique retinacular ligament (SORL) reconstruction in correcting a chronic mallet deformity as part of a swan-neck deformity. Methods: We used 24 human cadaver fingers from 6 hands. Mallet finger and swan-neck deformities were created; then, Fowler tenotomy was done on one group including 3 hands with 12 fingers, and SORL reconstruction was done on the others. Results: During simulated finger extension, there was no significant difference between the 2 techniques in correcting the distal interphalangeal joint droop; however, Fowler tenotomy resulted in hyperflexion of the proximal interphalangeal (PIP) joint, whereas it remained straight after SORL reconstruction. Conclusions: This study supports the SORL reconstruction in correcting a chronic mallet deformity, especially when there is a concomitant PIP hyperextension deformity, which lowers the risk of reversing the deformity after a Fowler procedure.

Correction of Swan Neck Deformity in Rheumatoid Arthritis Using a New Lateral Extensor Band Technique

2008 ◽  
Vol 33 (6) ◽  
pp. 712-716 ◽  
Author(s):  
M. SIROTAKOVA ◽  
A. FIGUS ◽  
P. JARRETT ◽  
A. MISHRA ◽  
D. ELLIOT
Keyword(s):  
Flexor Digitorum Superficialis ◽  
Palmar Plate ◽  
Pip Joint ◽  
Distal Interphalangeal ◽  
Distally Based ◽  
Student’S T ◽  
Flexor Digitorum ◽  
Swan Neck Deformity ◽  
Student’S T Test

Swan neck deformity is a progressive and disabling condition that commonly affects rheumatoid arthritic hands. During a 4-year period, 101 fingers in 43 patients had this deformity corrected using a new procedure combining the distally based extensor lateral band technique described by Littler and the flexor digitorum superficialis (FDS)-palmar plate pulley introduced by Zancolli. The ranges of motion of the metacarpophalangeal, proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints were assessed pre-operatively and 12 months after surgery. An average PIP joint hyperextension of −13.3° was converted to +13.4°. The ranges of motion of the proximal and DIP joints were significantly different (Student’s t-test). No patient suffered recurrence of the deformity during an average follow-up of 20 months. This new technique improves some unappealing aspects of previous techniques and provides a stable and reliable correction of swan neck deformity.

The Effect of Ring Finger Distal Interphalangeal Joint Stiffness on Grip Strength: A Simulated Study in Normal Participants

2020 ◽  
Vol 25 (03) ◽  
pp. 296-300
Author(s):  
Robert J. Lambert ◽  
Thomas FM. Yeoman ◽  
Chaoyang Wang ◽  
Jaime Grant ◽  
Philippa A. Rust
Keyword(s):  
Grip Strength ◽  
Ring Finger ◽  
Significant Loss ◽  
Hand Grip Strength ◽  
Interphalangeal Joint ◽  
Rank Test ◽  
Distal Interphalangeal Joint ◽  
Hand Grip ◽  
Significant Difference ◽  
Distal Interphalangeal

Background: Pain of the hand distal interphalangeal joints may result from trauma, osteoarthritis or inflammatory arthritis. When symptoms are not controlled by non-operative means, surgical arthrodesis may be performed, resulting in complete stiffness of the joint and possible weakening of grip strength. This study aims to quantify the effect of a stiff ring finger distal interphalangeal joint on overall grip strength. Methods: One hundred participants were screened to exclude upper limb pathology. A Jamar dynamometer was used to assess overall hand grip strength. A splint was used to prevent distal interphalangeal joint flexion, thus replicating a fused distal interphalangeal joint. Participants were tested with and without the splint and the results compared. The mean of three grip strength tests was taken. Results: The participants included 55 females. Mean age was 31 (18–60 years). 76 participants had a reduction in grip strength with splinting, with a significant difference seen (p < 0.05) on Wilcoxon signed rank test. The median reduction in grip strength with splinting was 1.67 kg. However only 10 participants (10%) had a grip strength loss of greater than 6.5 kg, which is the minimal clinically important difference. Conclusions: This study found a significant loss in overall hand grip strength when the ring finger distal interphalangeal joint was stiffened. However, despite this significant change, only 10 (10%) participants experienced a reduction of greater than 6.5 kg. This is the level of weakness felt to be required to reduce function. Thus our results suggest that 90% of patients with a stiff ring finger distal interphalangeal joint are unlikely to have a clinically identifiable functional reduction in grip strength as a result.

Quantitative Analysis of the Linkage between the interphalangeal Joints of the Index Finger

1995 ◽  
Vol 20 (5) ◽  
pp. 696-699 ◽  
Author(s):  
P. HAHN ◽  
H. KRIMMER ◽  
A. HRADETZKY ◽  
U. LANZ
Keyword(s):  
System Analysis ◽  
Measuring System ◽  
Dominant Hand ◽  
Rectangular Coordinate System ◽  
Simple Method ◽  
Significant Difference ◽  
Pip Joint ◽  
Distal Interphalangeal ◽  
Joint Flexion ◽  
Opening And Closing

We have established a simple method of measuring joint motion under physiological conditions. For this purpose we use an ultrasound measuring system employing marker points consisting of miniaturized ultrasound transmitters. This device was tested on a simple biomeehanical model, the linkage of the proximal and distal interphalangeal joints. The angles of these joints were recorded during opening and closing of the fist in 34 index fingers of 17 healthy persons. The results of the measurements were plotted on a rectangular coordinate system. Analysis showed an approximately linear linkage between the IP joints of the index linger. The curve for extension was the same as that for flexion. The linkage varies greatly. On average 1° of PIP joint flexion is equivalent to 0.76° of DIP joint flexion. Our study showed no significant difference between the dominant and non-dominant hand. The results showed that there is a linear linkage between the proximal and distal interphalangeal joints, which is equal for flexion and extension.

Pull-Out Wire Fixation for Acute Mallet Finger Fractures With K-Wire Stabilization of the Distal Interphalangeal Joint

2010 ◽  
Vol 35 (11) ◽  
pp. 1864-1869 ◽  
Author(s):  
Xu Zhang ◽  
Hui Meng ◽  
Xinzhong Shao ◽  
Shumin Wen ◽  
Hongwei Zhu ◽  
...  
Keyword(s):  
Interphalangeal Joint ◽  
Mallet Finger ◽  
Distal Interphalangeal Joint ◽  
Pull Out ◽  
Wire Fixation ◽  
Distal Interphalangeal

External Fixation for Surgical Treatment of a Mallet Finger

2003 ◽  
Vol 28 (3) ◽  
pp. 228-230 ◽  
Author(s):  
T. KALELI ◽  
C. OZTURK ◽  
S. ERSOZLU
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Interphalangeal Joint ◽  
Mallet Finger ◽  
Distal Interphalangeal Joint ◽  
Distal Interphalangeal ◽  
The Mean ◽  
Extensor Lag ◽  
New Surgical Technique

A new surgical technique is described for the treatment of mallet finger deformity which involves the application of a mini external fixator across the distal interphalangeal joint and resection of a portion of the extensor mechanism. We reviewed 19 patients who were treated with this technique, at a mean follow-up period of 36 (range, 24–48) months. The mean extensor lag was 2° (range, −7° to 13°) and the mean flexion range was 70° (range, 20°–90°).

Open Reduction and Internal Fixation for Dorsal Fracture-dislocation of the Proximal Interphalangeal Joint

2020 ◽  
Vol 52 (01) ◽  
pp. 18-24
Author(s):  
Jun-Ku Lee ◽  
Yoon Seok Kim ◽  
Jin-Hyun Lee ◽  
Gyu-Chol Jang ◽  
Soo-Hong Han
Keyword(s):  
Range Of Motion ◽  
Screw Fixation ◽  
Plate Fixation ◽  
Interphalangeal Joint ◽  
Distal Interphalangeal Joint ◽  
Joint Fracture ◽  
Plate Group ◽  
Pip Joint ◽  
Distal Interphalangeal ◽  
Screw Group

Abstract Purpose The purpose of this study was to investigate and compare the clinical and radiological results of ORIF with inter-fragment screw or buttress plate fixation of acute PIP joint fracture dorsal dislocation. Patients and Methods Between January 2007 to December 2016, nineteen patients – 14 men and 5 women with an average age of 40.9 (19 to 64) years – were included in this study; 9 patients underwent small sized interfragmentary screw fixation and 10 patients underwent small buttress plating. The average follow-up period was 45.1 (13 to 78) months. Clinical assessment included measurement of range of motion (ROM) of the proximal and distal interphalangeal joint (PIP, DIP), grip and pinch strength, and pain with use of the Visual Analog Scale (VAS). At the postoperative X-ray, articular step off, gap, and degree of dorsal subluxation was measured, and maintenance of the reduction, fracture union, and the presence of degenerative changes were assessed. Results All patients achieved solid unions without instability. The overall average range of motion of PIP joint were from 9° to 85° (10–83° in the screw group, 8–87° in the plate group without significant difference). However, the screw group (average: 53°) presented more flexion in the distal interphalangeal joint than the plate group (average: 34°). Plate fixation can cause limited DIP flexion. Six of the ten patients from the plate group, underwent implant removal and two of these patients required PIP joint arthrolysis due to the PIP flexion contracture of more than 30°. Three of the nine patients in screw group underwent implant removal and two of the three patients required PIP joint arthrolysis. Conclusion Mini plate and screw fixation of acute PIP joint fracture dorsal dislocation can achieve comparable favorable clinical and radiographic outcomes through stable fixation and early range of motion exercise. Screw fixation, if possible, is probably preferable to plate fixation because of better DIP joint ROM and lower incidence of hardware removal. If there is a need for plate fixation the use of a short plate is recommended to avoid joint stiffness.

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