Technical keys in maximizing finger proximal interphalangeal joint motion after vascularized toe joint transfers

2019 ◽  
Vol 44 (7) ◽  
pp. 667-675 ◽  
Author(s):  
Yu-Te Lin
Keyword(s):  
Range Of Motion ◽  
Skin Flap ◽  
Surgical Techniques ◽  
Extensor Tendon ◽  
Limited Range ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Joint Motion ◽  
Limited Range Of Motion ◽  
Central Slip

Vascularized toe joint transfers to the fingers have been performed for more than four decades, but their outcomes are not comparable with implant arthroplasty. Limited range of motion and extensor deficits of about 30° remain major problems with the constructed joints. We observed that the central extensor tendon of the toe is often attenuated proximally in its course on the dorsum of the proximal interphalangeal joint. A tight repair of the toe extensors to finger extensors limits joint motion. We reviewed our surgical techniques with this consideration. Thirty-eight fingers that we followed for 6 to 123 months had active range of motion of the reconstructed proximal interphalangeal joint in the finger of 58° (range 17°–76°) with an extensor deficit of 18° (range 0°–30°). We consider that the extensor mechanism and central slip insertion to the middle phalanx must be reconstructed meticulously to improve joint motion and decrease extension lag, and design of a lateral skin flap paddle to better cover vessels and allow extensor repairs.

A novel technique for proximal interphalangeal joint fracture-dislocations: the second toe middle phalanx osteochondral graft

2021 ◽  
pp. 175319342110292
Author(s):  
Danielle Nizzero ◽  
Nicholas Tang ◽  
James Leong
Keyword(s):  
Range Of Motion ◽  
Surgical Techniques ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Middle Phalanx ◽  
Joint Fracture ◽  
Acute Injuries ◽  
Fracture Dislocations ◽  
Chronic Injuries ◽  
Second Toe

Many different surgical techniques have been used to treat unstable dorsal proximal interphalangeal joint fracture-dislocations. The authors have used the base of the middle phalanx of the second toe base as an alternative autograft to treat this type of injury. This retrospective study assessed the clinical outcomes of this procedure in 11 patients. Range of motion, grip strength, Disability of the Arm, Shoulder and Hand score and donor site morbidity were assessed at regular intervals postoperatively. Nine patients had acute injuries and two had chronic injuries. The mean range of motion in the proximal interphalangeal joint at final review was 65° for patients with acute injuries and 41° for patients with chronic injuries. Other outcomes were satisfactory and there were no complications. Level of evidence: IV

The extensor tendon splitting approach to the proximal interphalangeal joint: do we need to reinsert the central slip?

2009 ◽  
Vol 35 (3) ◽  
pp. 188-191 ◽  
Author(s):  
A. M. Afifi ◽  
A. Richards ◽  
A. Medoro ◽  
D. Mercer ◽  
M. Moneim
Keyword(s):  
Extensor Tendon ◽  
Proximal Interphalangeal Joint ◽  
Joint Arthroplasty ◽  
Interphalangeal Joint ◽  
Middle Phalanx ◽  
Dorsal Approach ◽  
Pip Joint ◽  
Central Slip ◽  
Extensor Lag

Current approaches to the proximal interphalangeal (PIP) joint have potential complications and limitations. We present a dorsal approach that involves splitting the extensor tendon in the midline, detaching the insertion of the central slip and repairing the extensor tendon without reinserting the tendon into the base of the middle phalanx. A retrospective review of 16 digits that had the approach for a PIP joint arthroplasty with a mean follow up of 23 months found a postoperative PIP active ROM of 61° (range 25–90°). Fourteen digits had no extensor lag, while two digits had an extensor lag of 20° and 25°. This modified approach is fast and simple and does not cause an extensor lag.

scholarly journals Proximal interphalangeal joint replacement with an unconstrained pyrocarbon prosthesis (Ascension®): a long-term follow-up

2012 ◽  
Vol 38 (6) ◽  
pp. 680-685 ◽  
Author(s):  
G. Heers ◽  
H. R. Springorum ◽  
C. Baier ◽  
J. Götz ◽  
J. Grifka ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Limited Range ◽  
Degenerative Joint Disease ◽  
Proximal Interphalangeal Joint ◽  
Joint Disease ◽  
Long Term Results ◽  
Complication Rates ◽  
Limited Range Of Motion

There have been limited publications that report long-term outcomes of pyrocarbon implants. This report describes both clinical and radiographic long-term results for patients who have been treated with pyrocarbon proximal interphalangeal implants. Thirteen implants in ten patients are reported for an average follow-up of 8.3 years (range 6.2–9.3). All patients were suffering from degenerative joint disease. Five of the 13 digits were free of pain, the remaining eight digits had mild to moderate pain (visual analogue scale 2–5). The average active range of motion was 58° (SD 19°) at latest examination. X-ray results were unremarkable in six digits with an acceptable position of the prosthesis. However, in seven patients significant radiolucent lines (≥ 1 mm) were observed. Three prostheses demonstrated a migration of the proximal component, and one a subsidence of the distal component. Our study does not support the use of this implant for treatment of osteoarthritis of the finger joint owing to high complication rates and limited range of motion.

The Dorsal Plate of the Proximal Interphalangeal Joint

1990 ◽  
Vol 15 (1) ◽  
pp. 68-73
Author(s):  
P. G. SLATTERY
Keyword(s):  
Knee Joint ◽  
Articular Surface ◽  
Extensor Tendon ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dorsal Plate ◽  
Palmar Plate ◽  
Constant Structure ◽  
Central Slip

There exists on the articular surface of the central slip of the extensor tendon slip overlying the P.I.P. joint a constant structure which is morphologically similar to the patella of the knee joint and histologically similar to the fibro-cartilaginous palmar plate of the P.I.P. joint. It has been termed the dorsal plate. A study of 70 fingers, including 30 examined under magnification and 20 examined histologically, confirmed its constant presence and structure. Its functions appear to include stabilisation of the central extensor tendon and participation in stabilisation of the proximal interphalangeal joint.

Dorsal Dupuytren’s Disease Causing A Swan-Neck Deformity

2004 ◽  
Vol 29 (6) ◽  
pp. 636-637 ◽  
Author(s):  
D. E. BOYCE ◽  
M. A. TONKIN
Keyword(s):  
Range Of Motion ◽  
Complete Resolution ◽  
Full Range ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Lateral Band ◽  
Central Slip ◽  
Swan Neck Deformity

A previously undescribed lesion of Dupuytren’s disease is presented. An oblique cord coursed parallel to the oblique retinacular ligament of Landsmeer, but inserted proximal to the proximal interphalangeal joint, tethering the central slip and radial lateral band across the intervening transverse retinacular ligament. Contraction of this cord caused a rigid swan-neck deformity. Excision of the cord resulted in complete resolution of the deformity and a full range of motion in the affected digit.

Simulated Compensatory Motion of Transradial Prostheses

2008 ◽  
Author(s):  
Derek Lura ◽  
Rajiv Dubey ◽  
Stephanie L. Carey ◽  
M. Jason Highsmith
Keyword(s):  
Range Of Motion ◽  
Shoulder Joint ◽  
Degrees Of Freedom ◽  
Biomechanical Model ◽  
Elbow Flexion ◽  
Limited Range ◽  
Joint Movement ◽  
Range Of Movement ◽  
Limited Range Of Motion ◽  
Compensatory Motion

The prostheses used by the majority of persons with hand/arm amputations today have a very limited range of motion. Transradial (below the elbow) amputees lose the three degrees of freedom provided by the wrist and forearm. Some myoeletric prostheses currently allow for forearm pronation and supination (rotation about an axis parallel to the forearm) and the operation of a powered prosthetic hand. Older body-powered prostheses, incorporating hooks and other cable driven terminal devices, have even fewer degrees of freedom. In order to perform activities of daily living (ADL), a person with amputation(s) must use a greater than normal range of movement from other body joints to compensate for the loss of movement caused by the amputation. By studying the compensatory motion of prosthetic users we can understand the mechanics of how they adapt to the loss of range of motion in a given limb for select tasks. The purpose of this study is to create a biomechanical model that can predict the compensatory motion using given subject data. The simulation can then be used to select the best prosthesis for a given user, or to design prostheses that are more effective at selected tasks, once enough data has been analyzed. Joint locations necessary to accomplish the task with a given configuration are calculated by the simulation for a set of prostheses and tasks. The simulation contains a set of prosthetic configurations that are represented by parameters that consist of the degrees of freedom provided by the selected prosthesis. The simulation also contains a set of task information that includes joint constraints, and trajectories which the hand or prosthesis follows to perform the task. The simulation allows for movement in the wrist and forearm, which is dependent on the prosthetic configuration, elbow flexion, three degrees of rotation at the shoulder joint, movement of the shoulder joint about the sternoclavicular joint, and translation and rotation of the torso. All joints have definable restrictions determined by the prosthesis, and task.

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.

Sign in / Sign up

Export Citation Format

Share Document