Early active motion after rigid internal fixation of unstable extra-articular fractures of the proximal phalanx

2017 ◽  
Vol 42 (8) ◽  
pp. 803-809 ◽  
Author(s):  
Y. Ataker ◽  
S. Uludag ◽  
S. C. Ece ◽  
E. Gudemez
Keyword(s):  
Internal Fixation ◽  
Proximal Phalanx ◽  
Proximal Interphalangeal Joint ◽  
Early Rehabilitation ◽  
Visual Analogue Scale Pain ◽  
Postoperative Rehabilitation ◽  
Level Of Evidence ◽  
Active Motion ◽  
Rigid Internal Fixation ◽  
Articular Fractures

The purpose of this study is to describe active early rehabilitation in proximal phalanx fractures treated with rigid internal fixation. A total of 22 consecutive patients presenting with spiral, oblique or comminuted extra-articular fractures of the proximal phalanx were included in the study. All fractures were rigidly stabilized with plate and screws or screws alone and subsequently entered an active early rehabilitation programme. The mean follow-up period was 15.4 months (SD 10.1). Mean visual analogue scale pain score was 0.3 (SD 0.5) and Disability of the Arm, Shoulder and Hand score was 9.2 (SD 4.1). Mean total active motion was 241.9° (SD 18.3). According to the digital functional assessment, 86.3% of the patients had excellent results. Extension lags of the proximal interphalangeal joint were observed in seven fingers (mean lag, 3.4° (SD 5.5)). The results of this study demonstrated high patient satisfaction and good outcomes after the surgical technique and postoperative rehabilitation protocol described in open reduction and rigid internal fixation of proximal phalangeal fractures. Level of evidence: IV.

Arthroplasty of the Proximal Interphalangeal Joint Using Costal Cartilage Grafts

1992 ◽  
Vol 17 (5) ◽  
pp. 583-585 ◽  
Author(s):  
T. HASEGAWA ◽  
Y. YAMANO
Keyword(s):  
Costal Cartilage ◽  
Proximal Phalanx ◽  
Functional Results ◽  
Clinical Results ◽  
Proximal Interphalangeal Joint ◽  
Range Of Movement ◽  
Cartilage Grafts ◽  
Articular Fractures ◽  
Pip Joint ◽  
Bony Ankylosis

Seven intra-articular fractures in five patients with partial bone loss at the PIP joint were reconstructed using a graft of costal cartilage. In all cases there were total or partial cartilagenous defects of the proximal phalangeal side of the joint. Early treatment of two joints, using only costal cartilage grafts, resulted in bony ankylosis due to necrosis of the grafted cartilage. In five joints the grafted cartilage included osseous portions using the costo-osteochondral junction, leading to an average range of movement of 64° with satisfactory clinical results. The technique is a useful alternative to other forms of arthroplasty or arthrodesis, and can provide satisfactory functional results when there is a partial defect of the head of the proximal phalanx.

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.

Repair of a palmar soft tissue defect of the proximal interphalangeal joint with a transposition flap from the dorsum of the proximal phalanx

2011 ◽  
Vol 38 (4) ◽  
pp. 378-385 ◽  
Author(s):  
X. Zhang ◽  
X. Shao ◽  
M. Zhu ◽  
R. Jiang ◽  
Y. Feng ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Proximal Phalanx ◽  
Soft Tissue Defect ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Transposition Flap ◽  
Active Motion ◽  
Dorsal Branch ◽  
Pedicle Length ◽  
Distal Interphalangeal

This article describes the use of a transposition flap raised from the dorsum of the proximal phalanx for coverage of the volar defects at the proximal interphalangeal joint. The flap was based on the first dorsal branch of the proper digital artery. From January 2007 to March 2009, 14 digits in 14 patients (10 males and 4 females) were treated. There were 5 index, 6 middle, 2 ring, and 1 little finger. All patients underwent surgery 2–9 hours (mean 5 hours) after injury. Soft tissue defects ranged in size from 1.2 × 1.7 cm to 2.1 × 2.3 cm (mean 1.7 × 2 cm). Flap size ranged from 1.5 × 1.7 cm to 2.4 × 2.7 cm (mean 2 × 2.4 cm). Mean pedicle length was 1.1 cm (range 0.8–1.4 cm). All flaps completely survived. At final follow-up from 24–29 months (mean 26 months), mean active motion arcs of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints were 84° (range 75–91°), 86° (range 65–100°) and 54° (range 32–80°), respectively. Our technique is useful and reliable for coverage of a palmar defect over the proximal interphalangeal joint.

Distal Tibial Articular Fractures in Racing Greyhounds: A Review of Six Cases

1993 ◽  
Vol 06 (03) ◽  
pp. 146-152 ◽  
Author(s):  
J. F. Dee ◽  
R. Weiss ◽  
P. M. Montavon
Keyword(s):  
Conservative Treatment ◽  
Internal Fixation ◽  
Functional Results ◽  
Tibial Fractures ◽  
Anatomical Reduction ◽  
Distal Tibial Fractures ◽  
Rigid Internal Fixation ◽  
Articular Fractures ◽  
Fracture Patterns ◽  
Methods Of Treatment

SummarySix spontaneously occurring distal tibial fractures extending into the posterior articular margin of young racing greyhounds were reviewed. Concomitant fractures of both malleoli occurred in three cases. Fracture patterns, methods of treatment and functional results were determined. Open anatomical reduction and rigid internal fixation promoted healing with minimal osseous reaction and showed better results than conservative treatment. Complications adversely affecting the outcome were periarticular deformity and osteoarthritis, these were observed as early as five to seven weeks following the operations.Six spontaneously occurring distal tibial fractures extending into the posterior articular margin of young racing greyhounds were reviewed. Fracture patterns, methods of treatment and functional results were determined.

Lessons Learned from the Management of Complex Intra-Articular Fractures at the Base of the Middle Phalanges of Fingers

2003 ◽  
Vol 28 (6) ◽  
pp. 559-565 ◽  
Author(s):  
S. MAJUMDER ◽  
F. PECK ◽  
J. S. WATSON ◽  
V. C. LEES
Keyword(s):  
Proximal Interphalangeal Joint ◽  
Lessons Learned ◽  
Active Motion ◽  
System A ◽  
Articular Fractures ◽  
Active Range Of Motion ◽  
Total Active Motion ◽  
The Mean ◽  
Traction System ◽  
Phalangeal Fractures

The use of dynamic traction splintage is established in the treatment of complex intra-articular phalangeal fractures. Several different systems have been used and we report our experience with one of these, the Pins and Rubber Traction System. A cohort of 14 patients with complex intra-articular fractures at the base of the middle phalanges of the fingers were treated and assessed prospectively over a 2.5-year period (mean, 20 months; range, 7–28 months). The mean active range of motion regained, at the proximal interphalangeal joint, was 74° (range, 0–100°). The mean total active motion of the injured digit was 196° (range, 40–275°). Refinements in the regime are suggested as a result of this investigation.

scholarly journals Assessment of Flexion Elongation Relation and Type of Failure after Capsulodesis

2020 ◽  
Vol 09 (05) ◽  
pp. 382-387
Author(s):  
Daniel Bakker ◽  
Gerald A. Kraan ◽  
Nina M. C. Mathijssen ◽  
Joost W. Colaris ◽  
Gert-Jan Kleinrensink
Keyword(s):  
Biomechanical Properties ◽  
Surrounding Tissue ◽  
Bone Anchor ◽  
Postoperative Rehabilitation ◽  
Level Of Evidence ◽  
Interosseous Ligament ◽  
Active Motion ◽  
Rehabilitation Process ◽  
The Mean ◽  
Type Of Failure

Abstract Background Injury of the scapholunate interosseous ligament is the most frequently diagnosed cause of carpal instability and can be treated with a Mayo capsulodesis procedure. During this procedure, a radially based flap of the dorsal radiocarpal complex is attached to the lunate. The procedure attempts to reduce flexion of the scaphoid and restore the scapholunate relationship by crossing the scapholunate interval. To obtain a better understanding of the biomechanical properties and possibly improve the postoperative rehabilitation process, a better understanding of the reconstructions biomechanics is needed. Methods Ten dorsal intercarpal ligament capsulodesis were performed on embalmed wrists to assess the flexion elongation relation at the dorsal intercarpal reconstruction, the dorsal intercarpal complex, and the type of failure during flexion of the wrist. Results The mean elongation of the dorsal intercarpal reconstruction at 70-degree flexion was 0.8 mm. During flexion, the dorsal intercarpal reconstruction showed no ligament tears or failure of the bone anchor. The mean elongation of the dorsal intercarpal complex was 3.9 mm at 70 degrees. During subsequent repeated flexion, four sutures to connect the dorsal intercarpal complex to the surrounding tissue loosened between 55 and 60 degrees. Conclusions These findings suggest that capsulodesis can safely withstand flexion of the wrist until 50 degrees. Clinical Relevance Clinicians should consider the opportunity to start early with controlled active motion. Level of Evidence Not applicable.

The non-operative management of hand fractures

2014 ◽  
Vol 40 (1) ◽  
pp. 33-41 ◽  
Author(s):  
G. E. B. Giddins
Keyword(s):  
Operative Treatment ◽  
Current Knowledge ◽  
Proximal Phalanx ◽  
Operative Management ◽  
Metacarpophalangeal Joint ◽  
Level Of Evidence ◽  
Avulsion Fractures ◽  
Articular Fractures ◽  
Joint Fracture ◽  
Hand Fractures

Most hand fractures can be treated non-operatively. Some hand fractures, such as open injuries or markedly displaced intra-articular fractures, are almost always treated operatively. The treatment of many fractures, such as proximal interphalangeal joint fracture subluxations or spiral phalangeal fractures, is unclear. The aim of this review is to establish those injuries where the outcome of non-operative treatment is unlikely to be improved with surgery. This may help to prevent unnecessary surgery, concentrate work on finding the sub-groups that may benefit from surgery and to establish which injuries do so well with non-operative treatment that the only valuable clinical research in future will be large cohort studies of non-operative treatment or randomized controlled trials comparing operative and non-operative treatments. The relevant fractures are spiral metacarpal fractures, transverse metacarpal shaft and neck (boxer’s) fractures, base of proximal phalanx avulsion fractures, thumb metacarpophalangeal joint ulnar and radial collateral ligament injuries and bony mallet injuries. For the majority of these injuries, current knowledge suggests that the outcome of non-operative treatment cannot reliably be improved upon with surgery. Level of evidence IV

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