The diaphysial axis – metacarpal head angle in the management of fractures of the base of the proximal phalanx in children

2013 ◽  
Vol 38 (9) ◽  
pp. 984-990 ◽  
Author(s):  
M. M. Al-Qattan ◽  
M. I. Al-Motairi ◽  
H. A. Al-Naeem
Keyword(s):  
Closed Reduction ◽  
Objective Assessment ◽  
Proximal Phalanx ◽  
Longitudinal Axis ◽  
Lateral Deviation ◽  
Excellent Outcome ◽  
Metacarpal Head ◽  
Current Series ◽  
A Prospective Study

The diaphysial axis – metacarpal head angle (DHA) is the angle formed between the longitudinal axis of the diaphysis of the proximal phalanx and central point of the metacarpal head. The normal DHA ranges from 177.1° and 180.0°. There were no significant differences between DHA measurements when taken by the same observer at two separate occasions ( P = 0.986) or when taken by two different observers ( P = 0.948). We have put an algorithm of management of paediatric phalangeal base fractures incorporating the DHA in the decision making. A prospective study of 92 children (5–14 years) with phalangeal base fractures was conducted. Closed reduction was possible in all but one case in which open reduction and K-wire fixation was required. Closed reduction of the remaining 91 fractures yielded a ‘good’ reduction in 80 cases (no finger deformity on clinical examination with a post-reduction DHA greater than 177°). After a mean follow-up of 4.2 months, all these 80 cases qualified for an excellent outcome as per Al-Qattan’s criteria. The remaining 11 children were considered to have an ‘acceptable’ reduction (no scissoring, but there was a mild residual lateral deviation of the finger with a DHA angle of 169.4° to 176.2°). At a mean follow-up of 28 months, all these 11 mal-united fractures remodelled with normalization of the DHA; and all 11 children qualified for an excellent outcome as per Al-Qattan’s criteria. The current series stresses on the advantages of using DHA in the objective assessment of paediatric phalangeal base fractures and demonstrates the remodelling of fractures with about 10° of lateral deviation.

OSTEOCHONDROMA PREVENTING CLOSED REDUCTION OF A PROXIMAL INTERPHALANGEAL DISLOCATION OF THE LITTLE FINGER

Hand Surgery ◽  
1998 ◽  
Vol 03 (02) ◽  
pp. 297-302
Author(s):  
K. Horiuchi ◽  
K. Yamauchi ◽  
M. Tanaka
Keyword(s):  
Case Report ◽  
Closed Reduction ◽  
Proximal Phalanx ◽  
Complete Recovery ◽  
Daily Activities ◽  
Joint Function ◽  
Collateral Ligament ◽  
Pip Joint ◽  
Little Finger

We present a case of a 21-year-old male patient who developed an osteochondroma at the neck of the proximal phalanx of the left little finger, which interfered with reduction of a dorsally dislocated PIP joint. This is the first such case report in the literature. At the time of surgery, we excised the osteochondroma and reconstructed the collateral ligament that produced locking of the PIP joint. This treatment brought a quick and essentially complete recovery of the PIP joint function. At 3 years follow-up in the affected digit, the patient has no limitations in daily activities.

scholarly journals Early surgical debridement and fixation for pyogenic lumbar spondylodiscitis

2020 ◽  
Vol 35 (1) ◽  
Author(s):  
Mohamed Ibrahim Refaat ◽  
Omar Y. Abdallah
Keyword(s):  
Good Control ◽  
Pain Scale ◽  
Surgical Debridement ◽  
University Hospitals ◽  
Excellent Outcome ◽  
Functional Pain ◽  
Poor Outcomes ◽  
Lumbar Spinal ◽  
A Prospective Study

Abstract Background Management of pyogenic lumbar spondylodiscitis still represent a major conflict and challenge in neurosurgery due to different pathogens and the different methods available for management. Objective The aim of this study was to evaluate the outcome of posterior lumbar spinal fixation with debridement as a treatment modality in the management of pyogenic lumbar spondylodiscitis. Patients and method This is a prospective study conducted on patients presenting to the Neurosurgery Department of Cairo University hospitals diagnosed to have either spontaneous or iatrogenic pyogenic lumbar spondylodiscitis. All cases were operated upon by surgical debridement, drainage, and posterior lumbar fixation in the same setting. Antibiotics were prescribed according to the obtained culture and sensitivity. Laboratory follow-up was done to all patients. Clinical outcome was evaluated in terms of the Denis Functional Pain Scale. Follow-up period ranged from 5 to 14 months. Results A total of 25 patients comprised of 15 males and 9 females with a mean age of 45.7 years (range 32–63 years) were included in this study. Nine cases had a previous lumbar discectomy surgery, and 15 cases presented with spontaneous spondylodiscitis. L4–5 level was the most frequent site of pyogenic discitis. Excellent outcome and good outcomes (score 1–3 in Denis Functional Pain Scale) were reported in 84% of the patients and poor outcomes (score 4–5) in 16%. Conclusion Surgical fixation and debridement can be considered as an effective modality in the management of pyogenic lumbar spondylodiscitis with early ambulation, good control of pain, and early hospital discharge.

ON-TOP PLASTY USING A FREE METACARPAL HEAD GRAFT FOR LENGTHENING OF PROXIMAL PHALANX IN SYMBRACHYDACTYLY — A CASE REPORT

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 273-275 ◽  
Author(s):  
Kousuke Iba ◽  
Takuro Wada ◽  
Toshihiko Yamashita
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Bone Growth ◽  
Proximal Phalanx ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Soft Tissue Envelope ◽  
Metacarpal Head ◽  
Little Finger

A three-year old patient with symbrachydactyly (didactyly type) presented with a little finger that was too short to allow pinching and consisting of a floppy soft-tissue envelope with hypoplastic phalanges, although the thumb was functional. As the proximal phalanx was too small to permit distraction lengthening or conventional bone grafting, on-top plasty using a 4th metacarpal graft with a cartilage head was undertaken for lengthening the proximal phalanx of the little finger for pinch reconstruction. At ten weeks after surgery, the patient achieved satisfactory pinch function due to the lengthened and bone-stabilised postoperative digit and reconstruction of functional proximal interphalangeal joint. In addition, the grafted metacarpal demonstrated satisfactory bone growth throughout the six-year follow-up period.

LYTIC LESIONS OF DISTAL RADIUS IN CHILDREN: A RARE TUBERCULAR PRESENTATION

Hand Surgery ◽  
2014 ◽  
Vol 19 (03) ◽  
pp. 369-374 ◽  
Author(s):  
Anil Agarwal ◽  
Kumar Shashi Kant ◽  
Anubrat Kumar ◽  
Abbas Shaharyar ◽  
Indreshwar Verma ◽  
...  
Keyword(s):  
Distal Radius ◽  
Fibular Graft ◽  
Pathological Fractures ◽  
Excellent Outcome ◽  
Osteoarticular Tuberculosis ◽  
Lytic Lesions ◽  
Bony Lesions ◽  
One Year ◽  
A Prospective Study

Introduction: We report the presentation, management, and outcome in five children with osteoarticular tuberculosis of distal radius. Patients: Patients were recruited in a prospective study. All patients underwent an open biopsy, curettage and diagnosis confirmed by histopathological/microbiological examination. In cavitary lytic lesions, bone grafting was also undertaken. The multidrug anti-tubercular chemotherapy was given for one year. Observations: Five patients were included in the study. The average follow-up post-completion chemotherapy was 34.8 months. Bony lesions presented as a poorly defined radiolucent lytic area in metaphysis, cavitary lytic lesions with or without sequestrum or spanned the physeal plate. At final follow-up, except for one case, a full pain free range of movements was achieved in all cases. Fibular graft was used in two cases with cavitary lesions and incorporated well in both cases. Conclusions: Tuberculosis can involve the adjacent physis and can be multifocal. The presentation is usually lytic with minimal sclerosis. For smaller ill defined lesions, curettage and multidrug anti-tubercular chemotherapy results in excellent outcome. Cavitary lytic lesions should be bone grafted as there is a risk of pathological fractures.

Outcomes After Surgically Managed Oblique Extra-Articular Proximal Phalanx Fractures: A Comparison of Closed-Reduction Percutaneous Pinning and Open-Reduction Internal Fixation With Lag Screws

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Tyler W. Henry ◽  
Jacob E. Tulipan ◽  
Stephanie A. Kwan ◽  
Pedro K. Beredjiklian ◽  
Kevin F. Lutsky ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Proximal Phalanx ◽  
Open Reduction Internal Fixation ◽  
Complication Rates ◽  
Percutaneous Pinning ◽  
Full Extension ◽  
Extensor Lag

Background Long oblique extra-articular proximal phalanx fractures are common orthopedic injuries. When unstable and without substantial comminution, treatment options include closed-reduction percutaneous pinning (CRPP) and open-reduction internal fixation using lag screws (ORIF-screws). The aims of this study are primarily to compare the functional outcomes and complication rates between these techniques and secondarily to assess potential factors affecting outcomes after surgery. Methods All patients with long oblique extra-articular proximal phalanx fractures treated surgically within a single orthopedic institution from 2010 to 2017 were identified. Outcome measures and complications were assessed at the final follow-up. Results Sixty patients were included in the study with a mean time to the final follow-up of 41 weeks (range: 12-164 weeks). Thirty-four patients (57%) were treated with CRPP and 26 patients (43%) with ORIF-screws. The mean Disabilities of the Arm, Shoulder, and Hand score across both fixation types was 8 (range: 0-43) and did not differ significantly between the 2 groups. Mean proximal interphalangeal extension at the final follow-up was 9° short of full extension after CRPP and 13° short of full extension after ORIF-screws. The rates of flexion contracture and extensor lag were 15% and 41% in the CRPP group compared with 12% and 68% in the ORIF-screws group. Reoperation rates and complication rates did not differ significantly between fixation strategies. Conclusions Acceptable outcomes can be achieved after surgical fixation of long oblique extra-articular proximal phalanx fractures using both CRPP and ORIF-screws. Extensor lag may be more common after ORIF-screws.

Trans-metacarpal Screw Fixation for Extra-articular Proximal Phalangeal Base Fractures

2017 ◽  
Vol 22 (01) ◽  
pp. 35-38 ◽  
Author(s):  
Eichi Itadera ◽  
Takahiro Yamazaki
Keyword(s):  
Screw Fixation ◽  
Proximal Phalanx ◽  
Metacarpophalangeal Joint ◽  
Fixation Method ◽  
Compression Screw ◽  
Metacarpal Head ◽  
Headless Compression Screw ◽  
Articular Fractures ◽  
Intramedullary Canal ◽  
Cannulated Drill

We developed a new internal fixation method for extra-articular fractures at the base of the proximal phalanx using a headless compression screw to achieve rigid fracture fixation through a relatively easy technique. With the metacarpophalangeal joint of the involved finger flexed, a smooth guide-pin is inserted into the intramedullary canal of the proximal phalanx through the metacarpal head and metacarpophalangeal joint. Insertion tunnels are made over the guide-pin using a cannulated drill. Then, a headless cannulated screw is placed into the proximal phalanx. All of five fractures treated by this procedure obtained satisfactory results.

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