Outcome of Thumb Replantation following Traumatic Amputation: A Review of Three Cases

2002 ◽  
Vol 7 (4) ◽  
pp. 124-128
Author(s):  
N Burr ◽  
Al Pratt ◽  
N Bulstrode ◽  
R Sanders
Keyword(s):  
Functional Outcome ◽  
Metacarpophalangeal Joint ◽  
Interphalangeal Joint ◽  
Hand Dominance ◽  
Traumatic Amputation ◽  
Sensory Assessment ◽  
Pinch Grip ◽  
Post Operation ◽  
Joint Flexion ◽  
Protective Sensation

This paper presents the functional outcome in three patients who sustained a traumatic level-three thumb amputation and replantation during a six-week period and evaluates their functional outcome. It also discusses the current literature on this subject and suitable methods for assessing and reporting the outcomes of these injuries. Assessment was carried out at a mean of 40 weeks post operation (range 36-47) by the same independent therapist. Mean active interphalangeal joint flexion was 47° (range 30-75°) and metacarpophalangeal joint 42° (range 35-50°). Grip strength was a mean of 89 lbs (range 79-101 lbs) and pinch grip was a mean of 12.5 lbs (range 9-18 lbs). On sensory assessment two of the participants had a good return of sensibility with 5-7mm of two-point discrimination and at least diminished protective sensation. Overall satisfaction, sensibility and functional use of the thumb did not appear to be related to age but rather due to the demands placed on their replanted thumb for occupation and hand dominance.

Immediate Repair and Early Mobilization of the Extensor Pollicis Longus Tendon in Zones 1 to 4

2004 ◽  
Vol 29 (3) ◽  
pp. 250-258 ◽  
Author(s):  
A. R. KHANDWALA ◽  
J. BLAIR ◽  
S. B. HARRIS ◽  
A. J. FOSTER ◽  
D. ELLIOT
Keyword(s):  
Early Mobilization ◽  
Metacarpophalangeal Joint ◽  
Tendon Injuries ◽  
Interphalangeal Joint ◽  
Functional Importance ◽  
Extensor Pollicis Longus ◽  
Functional Problem ◽  
Rare Occasion ◽  
Joint Flexion ◽  
Functional Problems

We present the results of repair and early mobilization of 100 extensor pollicis longus (EPL) tendon injuries in zones 1 to 4 in 100 patients using a dynamic outrigger splint which controlled metacarpophalangeal joint movements but allowed free movement of the interphalangeal joint. Eighty-two were complete divisions of the tendon and 18 were 80% to 99% tendon divisions. Analysis of measurements obtained routinely at 8 weeks showed 81% excellent and good results using the TAM system. There were 90% excellent and good results in the 72 patients who were followed-up and received therapy for 12 weeks. Except on the rare occasion when the repair ruptures, loss of thumb extension was not a common functional problem, but scar tethering of the repaired tendon can result in loss of thumb flexion. While loss of metacarpophalangeal joint flexion appeared to have little functional importance, loss of interphalangeal joint flexion and slowing of the movements of this joint can cause functional problems. When interphalangeal joint hyperextension is present before the injury, it is frequently lost but this generally goes unnoticed by the patients. The problems of analysing the EPL injury using the methods of assessment available are discussed.

Arthroplasty in the hand: what works and what doesn’t?

2021 ◽  
pp. 175319342110177
Author(s):  
Daniel B. Herren ◽  
Hajime Ishikawa ◽  
Marco Rizzo ◽  
Mark Ross ◽  
Michael Solomons
Keyword(s):  
Surgical Technique ◽  
Metacarpophalangeal Joint ◽  
Distal Radioulnar Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Radioulnar Joint ◽  
What Works ◽  
Thumb Carpometacarpal

This review describes the different possibilities for arthroplasties at the proximal interphalangeal joint, thumb carpometacarpal joint, distal radioulnar joint, metacarpophalangeal joint and the wrist. For each joint, the indication for arthroplasty is explained, the surgical technique with the suitable implant is described and a brief summary of the outcomes reported in the literature is given.

Osteoarthritis of the Interphalangeal and Metacarpophalagneal Joints of the Hand

2020 ◽  
Author(s):  
Andrew J. Straszewski ◽  
Jennifer Moriatis Wolf
Keyword(s):  
Hyaluronic Acid ◽  
Physical Examination ◽  
Female Gender ◽  
Metacarpophalangeal Joint ◽  
Interphalangeal Joint ◽  
Hand Osteoarthritis ◽  
Progression Of Disease ◽  
Initial Work ◽  
Distal Interphalangeal ◽  
Work Up

Hand surgeons frequently treat osteoarthritis of the interphalangeal (IP) and metacarpophalangeal (MCP) joints. Age, female gender, occupation, genetics, biomechanics, obesity, and joint laxity have been implicated in the progression of disease. Physical examination and standard three-view imaging of the hand aid in initial work up. Many conservative treatments exist, including physical therapy, splinting, anti-inflammatories, and injection of corticosteroid or hyaluronic acid.  With the failure of conservative therapies, surgical management is dictated by the particular joint in question. The distal interphalangeal (DIP) joints of fingers and IP joint of the thumb are more commonly treated by arthrodesis, whereas proximal interphalangeal (PIP) joints are treated with arthroplasty. Likewise, MCP  joints of the fingers are typically managed with arthroplasty. The thumb MCP joint is more commonly fused.  This review contains 7 figures, 4 tables, and 54 references. Keywords: hand osteoarthritis, interphalangeal joint, metacarpophalangeal joint, anatomy, arthroplasty, silicone, arthrodesis, biomechanics, outcomes

Postburn Nailfold Retraction: A Reconstructive Technique

1986 ◽  
Vol 11 (3) ◽  
pp. 385-387
Author(s):  
R. C. K. NGIM ◽  
K. SOIN
Keyword(s):  
Interphalangeal Joint ◽  
Distal Interphalangeal Joint ◽  
Transposition Flap ◽  
Left Thumb ◽  
Nail Deformity ◽  
Distal Interphalangeal ◽  
Joint Flexion ◽  
Reconstructive Technique

Postburn nailfold retraction often results in nail deformity and loss of distal interphalangeal joint flexion. A technique of reconstruction of the nailfold using a proximally based transposition flap is described in a patient with postburn nailfold retraction of the left thumb, index and middle fingers.

Extensor Indicis Opposition Transfer in The Ulnar and Median Palsied Thumb in Leprosy

1996 ◽  
Vol 21 (5) ◽  
pp. 617-621 ◽  
Author(s):  
R. MEHTA ◽  
G. N. MALAVIYA ◽  
S. HUSAIN
Keyword(s):  
Index Finger ◽  
Donor Site ◽  
Metacarpophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Flexor Pollicis Longus ◽  
Extensor Pollicis Longus ◽  
Extensor Indicis Proprius ◽  
Leprosy Patients ◽  
Significant Deficit

Twenty seven opponensplasties for ulnar and median paralysis in 25 leprosy patients were performed using extensor indicis proprius. An additional transfer of the radial half of flexor pollicis longus to extensor pollicis longus was done to stabilize the metacarpophalangeal joint of the thumb. The biomechanical aspects of extensor indicis proprius tendon transfer were studied and results evaluated using various anatomical and functional parameters. Extensor indicis proprius provides adequate strength to position the thumb. However, sometimes it does not reach its new insertion. There is no significant deficit at the donor site but in a few cases the index finger may lose its capability for independent extension and sometimes a proximal interphalangeal joint contracture may develop.

scholarly journals Treatment of Severe Ulnar Instability of the MCP Joint Improves Function in LRTI Arthroplasty for Osteoarthritis of the Thumb CMC Joint

2019 ◽  
Vol 09 (02) ◽  
pp. 105-115
Author(s):  
Johanna Wirth ◽  
Eva-Maria Baur
Keyword(s):  
Patient Satisfaction ◽  
Strength Function ◽  
Ulnar Collateral Ligament ◽  
Metacarpophalangeal Joint ◽  
Metacarpal Bone ◽  
Control Group ◽  
Level Of Evidence ◽  
Pinch Grip ◽  
Significant Difference ◽  
Retrospective Comparative Study

Abstract Background Comorbidity in the metacarpophalangeal joint (MCPj) of the thumb, i.e., hyperextension or ulnar collateral instability, could affect the outcome of arthroplasty in the thumb carpometacarpal joint (CMCj). Objective In a retrospective study, we evaluated the effect of arthrodesis of the MCPj for thumbs with unstable MCPj and simultaneous ligament reconstruction tendon interposition (LRTI) arthroplasty for the CMCj in terms of strength, function, and patient satisfaction. Patients and Methods A total of 69 thumbs treated with a LRTI arthroplasty of the CMCj were included. In 14 of those cases, an arthrodesis of the MCPj was performed as well. In 12 thumbs, both procedures were done simultaneously; in one case MCPj arthrodesis followed LRTI arthroplasty, whereas one patient already had MCPj arthrodesis at time of LRTI arthroplasty. Those 14 thumbs were compared with the control group of 55 thumbs who had only undergone LRTI. At a mean follow-up of 4 to 5 years (mean 54 [10–124] months) postoperative assessments included range of motion (ROM) of the CMC, MCP, and interphalangeal (IP) joint of the thumb, as well as any instability of the MCPj. Pinch and grip strength were examined, also the visual analogue scale (VAS), patient satisfaction, QuickDASH, PRWE-Thumb, and the Kapandji's Opposition Score. Radiologically, proximalization of the first metacarpal bone was measured. Student's t-test was used to determine significance, p < 0.05 was considered significant. Results Additional arthrodesis of the MCPj provided no significant difference of function in thumbs that only had a hyperextension-instability. However, in thumbs with marked ulnar instability, stronger pinch-grip was obtained with arthrodesis, compared with only LRTI. Conclusion In patients with advanced painful thumb CMCj osteoarthritis, we recommend (simultaneous) arthrodesis of the MCPj, to allow a stable thumb grip if there is additional marked ulnar collateral ligament instability. Level of Evidence This is a Level III, retrospective comparative study.

scholarly journals Effects of Modified Dynamic Metacarpophalangeal Joint Flexion Orthoses after Hand Burn

2011 ◽  
Vol 35 (6) ◽  
pp. 880 ◽  
Author(s):  
Ji Soo Choi ◽  
Jeong Hyeon Mun ◽  
Ju Youn Lee ◽  
Jong Hyun Jeon ◽  
Yun Jae Jung ◽  
...  
Keyword(s):  
Metacarpophalangeal Joint ◽  
Joint Flexion

scholarly journals Tethering the Extensor Apparatus Limits PIP Flexion Following K-wire Placement for Pinning Extra-articular Fractures at the Base of the Proximal Phalanx

Hand ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. 433-437 ◽  
Author(s):  
Yaron Sela ◽  
Caitlin Peterson ◽  
Mark E. Baratz
Keyword(s):  
Insertion Site ◽  
Proximal Phalanx ◽  
Extensor Tendon ◽  
Metacarpophalangeal Joint ◽  
Minimally Invasive Surgical ◽  
Articular Fractures ◽  
Pip Joint ◽  
Joint Flexion ◽  
The Mean ◽  
K Wires

Background: Closed reduction with percutaneous Kirschner wires (K-wires) is the most minimally invasive surgical option for stabilizing phalanx fractures. This study examines the effect of K-wire placement on proximal interphalangeal (PIP) joint motion. Methods: PIP joint flexion was measured in the digits of 4 fresh-frozen cadaver hands after placing a suture loop through the flexor tendons and placing tension on the flexors via a mechanical scale. The load necessary to flex the PIP joint to 90° or to maximum flexion was recorded. The load was removed and K-wires were inserted in 3 locations about the metacarpophalangeal joint (MPJ): through the extensor tendon and across the MPJ, adjacent to the extensor tendon insertion site and across the MPJ, and through the sagittal band and into the base of the proximal phalanx (P1). The load on the tendons was reapplied, and angles of PIP joint flexion were recorded for each of the 3 conditions. Results: The mean angle of PIP joint flexion prior to K-wire insertion was 87°, and the mean load applied was 241 g. The angles of flexion were 53° when the K-wire was placed through the extensor tendon, 70° when the K-wire was placed adjacent to the tendon, and 75° when the K-wire was placed into the base of P1 by going through the sagittal band, midway between the volar plate and the extensor tendon. Conclusions: K-wires placed remote from the extensor tendon create less of an immediate tether to PIP joint flexion than those placed through or adjacent to the extensor tendon.

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