The Experts below are selected from a list of 279 Experts worldwide ranked by ideXlab platform
Peter J. Stern - One of the best experts on this subject based on the ideXlab platform.
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Complications following dislocations of the proximal Interphalangeal Joint.
The Journal of bone and joint surgery. American volume, 2013Co-Authors: John J Mangelson, Peter J. Stern, Joshua M. Abzug, James Chang, A. Lee OstermanAbstract:Dislocations of the proximal Interphalangeal Joint can be challenging injuries, both from a clinical decision-making and technical standpoint. Although the “jammed” finger is at times ignored by clinicians and coaches, failure to properly diagnose and treat these injuries can result in a permanently stiff, deformed, and painful finger. The proximal Interphalangeal Joint is susceptible to injury because of its long lever arm and the high level of congruity between the proximal and middle phalanges. This congruity provides stability and strength through a wide range of motion, but is unforgiving to angular, axial, and rotational stress. Dorsal fracture-dislocation, the most common injury pattern, results from hyperextension and axial load1,2. This mechanism leads to either distal pull-off of the volar plate or fracture of the volar base of the middle phalanx. Loss of both the cup-shaped geometry of the articular surface and the ligamentous restraint of the volar plate can lead to an unstable Joint. Even with timely and appropriate treatment, many complications may happen. Although the treatments for proximal Interphalangeal Joint dislocations are diverse, several principles have repeatedly been shown to be important. Obtaining and maintaining a concentric reduction while allowing early motion is the key to successful treatment of proximal Interphalangeal Joint injuries. The appropriate balance between stability and motion can be difficult to determine and requires judgment on the part of the treating physician. Early motion at the proximal Interphalangeal Joint must be physiologic gliding, rather than hinging at the fracture site. Edema control is also important to reduce stiffness and contracture. Last, while accomplishing a perfect reduction of displaced articular bone might seem critical, it seems to be less important than maintaining reduction of the dislocation and reproducing gliding motion1. Determining the stability of the Joint is an essential first step in …
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pyrolytic carbon resurfacing arthroplasty for osteoarthritis of the proximal Interphalangeal Joint of the finger
Journal of Bone and Joint Surgery American Volume, 2011Co-Authors: Thomas M Sweets, Peter J. SternAbstract:Background: Pyrolytic carbon resurfacing arthroplasty of the proximal Interphalangeal Joint has been reported to provide favorable results. The purpose of this study was to evaluate the effectiveness of pyrolytic carbon Joint replacement at an average follow-up of fifty-five months. Methods: A retrospective review of thirty-one arthroplasties of the proximal Interphalangeal Joint performed by a single surgeon in seventeen patients with Interphalangeal Joint osteoarthritis was conducted. Assessment included range of motion, patient satisfaction, and pain scores. Radiographs were evaluated for alignment, implant subsidence, and implant failure. The Michigan Hand Outcomes Questionnaire was administered at the time of the final follow-up. Results: The average follow-up period was fifty-five months (minimum, two years). No patient was lost to follow-up. The arc of motion of the Interphalangeal Joint decreased from 57° preoperatively to 31° (p < 0.05) at the time of the final follow-up. The average score for pain was 3 of 10 on a visual analog scale. Satisfaction averaged 3.4 points on a 5-point Likert scale, and twelve of seventeen patients stated that they would repeat the surgery. Data from the Michigan Hand Outcomes Questionnaire were compared for the involved and noninvolved hands of the fifteen patients who received implants unilaterally. Significant deficits were observed in the total outcome score, activities of daily living, function, and satisfaction for the operatively treated hand. Pain was also greater in the operatively treated hand. Complications included implant fracture (one Joint), dislocation (five Joints), squeaking (eleven), loosening (fifteen), and Interphalangeal Joint contracture (twenty). Six Joints required a reoperation (an arthrodesis in four Joints, a silicone arthroplasty in one, and excision of exostosis in one). Implant migration was severe for seven proximal phalanx implants and three distal phalanx implants, and one implant breached the phalangeal cortex. Conclusions: Interphalangeal Joint motion decreased significantly at the final follow-up evaluation, following short-term gains in the initial postoperative period. Complications were numerous, and implant loosening with migration was a major problem. Arthroplasty of the proximal Interphalangeal Joint with a pyrolytic carbon implant has a high complication rate, poor outcomes, and variable patient satisfaction. On the basis of these findings, we no longer use this implant in our practice. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
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Interphalangeal Joint arthrodesis.
Hand clinics, 1994Co-Authors: Peter J. SternAbstract:Interphalangeal Joint fusion is a salvage procedure to achieve stability and pain relief and to correct deformity. The multiple fixation techniques for fusion are outlined. Paramount to successful arthrodesis are appropriate preparation of the Joint surfaces and careful positioning and coaptation of the bone ends. If this is not accomplished, regardless of fixation technique, a pseudoarthrosis will ensue.
William P. Cooney - One of the best experts on this subject based on the ideXlab platform.
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Lateral stability of proximal Interphalangeal Joint replacement
The Journal of hand surgery, 1994Co-Authors: Yoshitaka Minamikawa, Ronald L Linscheid, Toshihiko Imaeda, Peter C. Amadio, William P. CooneyAbstract:Abstract The lateral stability of the cadaver proximal Interphalangeal Joint was studied with an electromagnetic tracking system before and after implant replacement. Ten middle fingers were retrieved and randomly divided into two groups for Joint replacement with either a silicone rubber flexible finger Joint implant or a custom surface replacement prosthesis. Each finger was mounted on a fixture that allowed loading of the proximal Interphalangeal Joint with tension through the flexor, extensor, and intrinsic tendons. For the intact proximal Interphalangeal Joint under lateral stress, lateral angulation averaged 4° in extension and 8° with the Joint in 60° of flexion. Although lateral angulation increased after surface replacement prosthesis implantation when the Joint was flexed more than 20°, comparison with the intact Joint showed no statistical difference. With the silicone implant, lateral angulation became more pronounced even in the extended position and showed a significant difference when the proximal Interphalangeal Joint was flexed more than 20°.
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Stability and constraint of the proximal Interphalangeal Joint
The Journal of hand surgery, 1993Co-Authors: Yoshitaka Minamikawa, Peter C. Amadio, William P. Cooney, Emiko Horii, Ronald L LinscheidAbstract:The kinematics of the intact proximal Interphalangeal Joint of 12 fresh cadaver index fingers were measured by means of an electromagnetic tracking system. The specimens were then randomly divided into two groups for ligament sectioning in two different sequences and for testing under lateral stress. Lateral stress of the intact proximal Interphalangeal Joints produced an average of 5 degrees of adduction and 9 degrees of supination motion throughout the arc of flexion/extension. Maximum lateral angulation was 15 degrees under 1 kg of force (30 N cm) applied at the distal end of the middle phalanx. Joint angulation increased to 20 degrees after total sectioning of the collateral ligament. Joint laxity was greatly reduced in full extension, in full flexion, and when the muscles were loaded. The proximal Interphalangeal Joint remained stable when one half of the collateral ligament was left intact. The results indicate that lateral stability of the proximal Interphalangeal Joint is provided primarily by the collateral ligament. When the lateral stress test is normal in proximal Interphalangeal Joint extension, an additional test in 20 to 30 degrees of flexion should be considered to avoid a false-negative result. Angulation greater than 20 degrees is abnormal and indicates a loss of collateral ligament integrity.
Yoshitaka Minamikawa - One of the best experts on this subject based on the ideXlab platform.
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Lateral stability of proximal Interphalangeal Joint replacement
The Journal of hand surgery, 1994Co-Authors: Yoshitaka Minamikawa, Ronald L Linscheid, Toshihiko Imaeda, Peter C. Amadio, William P. CooneyAbstract:Abstract The lateral stability of the cadaver proximal Interphalangeal Joint was studied with an electromagnetic tracking system before and after implant replacement. Ten middle fingers were retrieved and randomly divided into two groups for Joint replacement with either a silicone rubber flexible finger Joint implant or a custom surface replacement prosthesis. Each finger was mounted on a fixture that allowed loading of the proximal Interphalangeal Joint with tension through the flexor, extensor, and intrinsic tendons. For the intact proximal Interphalangeal Joint under lateral stress, lateral angulation averaged 4° in extension and 8° with the Joint in 60° of flexion. Although lateral angulation increased after surface replacement prosthesis implantation when the Joint was flexed more than 20°, comparison with the intact Joint showed no statistical difference. With the silicone implant, lateral angulation became more pronounced even in the extended position and showed a significant difference when the proximal Interphalangeal Joint was flexed more than 20°.
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Stability and constraint of the proximal Interphalangeal Joint
The Journal of hand surgery, 1993Co-Authors: Yoshitaka Minamikawa, Peter C. Amadio, William P. Cooney, Emiko Horii, Ronald L LinscheidAbstract:The kinematics of the intact proximal Interphalangeal Joint of 12 fresh cadaver index fingers were measured by means of an electromagnetic tracking system. The specimens were then randomly divided into two groups for ligament sectioning in two different sequences and for testing under lateral stress. Lateral stress of the intact proximal Interphalangeal Joints produced an average of 5 degrees of adduction and 9 degrees of supination motion throughout the arc of flexion/extension. Maximum lateral angulation was 15 degrees under 1 kg of force (30 N cm) applied at the distal end of the middle phalanx. Joint angulation increased to 20 degrees after total sectioning of the collateral ligament. Joint laxity was greatly reduced in full extension, in full flexion, and when the muscles were loaded. The proximal Interphalangeal Joint remained stable when one half of the collateral ligament was left intact. The results indicate that lateral stability of the proximal Interphalangeal Joint is provided primarily by the collateral ligament. When the lateral stress test is normal in proximal Interphalangeal Joint extension, an additional test in 20 to 30 degrees of flexion should be considered to avoid a false-negative result. Angulation greater than 20 degrees is abnormal and indicates a loss of collateral ligament integrity.
Ronald L Linscheid - One of the best experts on this subject based on the ideXlab platform.
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Lateral stability of proximal Interphalangeal Joint replacement
The Journal of hand surgery, 1994Co-Authors: Yoshitaka Minamikawa, Ronald L Linscheid, Toshihiko Imaeda, Peter C. Amadio, William P. CooneyAbstract:Abstract The lateral stability of the cadaver proximal Interphalangeal Joint was studied with an electromagnetic tracking system before and after implant replacement. Ten middle fingers were retrieved and randomly divided into two groups for Joint replacement with either a silicone rubber flexible finger Joint implant or a custom surface replacement prosthesis. Each finger was mounted on a fixture that allowed loading of the proximal Interphalangeal Joint with tension through the flexor, extensor, and intrinsic tendons. For the intact proximal Interphalangeal Joint under lateral stress, lateral angulation averaged 4° in extension and 8° with the Joint in 60° of flexion. Although lateral angulation increased after surface replacement prosthesis implantation when the Joint was flexed more than 20°, comparison with the intact Joint showed no statistical difference. With the silicone implant, lateral angulation became more pronounced even in the extended position and showed a significant difference when the proximal Interphalangeal Joint was flexed more than 20°.
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Stability and constraint of the proximal Interphalangeal Joint
The Journal of hand surgery, 1993Co-Authors: Yoshitaka Minamikawa, Peter C. Amadio, William P. Cooney, Emiko Horii, Ronald L LinscheidAbstract:The kinematics of the intact proximal Interphalangeal Joint of 12 fresh cadaver index fingers were measured by means of an electromagnetic tracking system. The specimens were then randomly divided into two groups for ligament sectioning in two different sequences and for testing under lateral stress. Lateral stress of the intact proximal Interphalangeal Joints produced an average of 5 degrees of adduction and 9 degrees of supination motion throughout the arc of flexion/extension. Maximum lateral angulation was 15 degrees under 1 kg of force (30 N cm) applied at the distal end of the middle phalanx. Joint angulation increased to 20 degrees after total sectioning of the collateral ligament. Joint laxity was greatly reduced in full extension, in full flexion, and when the muscles were loaded. The proximal Interphalangeal Joint remained stable when one half of the collateral ligament was left intact. The results indicate that lateral stability of the proximal Interphalangeal Joint is provided primarily by the collateral ligament. When the lateral stress test is normal in proximal Interphalangeal Joint extension, an additional test in 20 to 30 degrees of flexion should be considered to avoid a false-negative result. Angulation greater than 20 degrees is abnormal and indicates a loss of collateral ligament integrity.
Peter J. Ronchetti - One of the best experts on this subject based on the ideXlab platform.
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Volar plate arthroplasty for osteoarthritis of the proximal Interphalangeal Joint: A preliminary report
The Journal of hand surgery, 2002Co-Authors: Richard I. Burton, Robert M. Campolattaro, Peter J. RonchettiAbstract:Osteoarthritis of the hand, including involvement of the proximal Interphalangeal Joint, is common in the aging population. The purpose of this study is to provide a preliminary retrospective report on 12 volar plate arthroplasties in 9 patients who had volar plate advancement arthroplasty for osteoarthritis of the proximal Interphalangeal Joint. The average age of the patients was 67.6 years. All of the patients' data were obtained from office notes and hand therapy assessment sheets. The average time from surgery to follow-up evaluation was 36.5 months. All patients had significant pain relief. Range of motion was maintained; there was no significant difference between preoperative and final arc of motion values. Preoperative pinch and grip strengths did not differ significantly from the final values. Postoperative position was similar to preoperative angulation, with recognized lateral stability. Our results suggest that volar plate advancement arthroplasty represents a good primary surgical therapeutic option for the osteoarthritic proximal Interphalangeal Joint, providing pain relief while preserving motion, strength, and stability.
