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David Ring - One of the best experts on this subject based on the ideXlab platform.

  • postoperative dorsal proximal interphalangeal joint subluxation in volar base Middle Phalanx fractures
    Journal of Hand and Microsurgery, 2020
    Co-Authors: Kamilcan Oflazoglu, David Ring, Hinne A Rakhorst, Suzanne C Wilkens, Kyle R Eberlin, Neal C Chen
    Abstract:

    Introduction This study was designed to assess factors associated with postoperative dorsal proximal interphalangeal (PIP) joint subluxation after operative treatment of volar base Middle Phalanx fractures. Our second purpose was to study the association between postoperative dorsal subluxation with postoperative arthritis. Materials and Methods We identified 44 surgically treated volar base PIP joint fractures with available pre- and postoperative radiographs between 2002 and 2015 at two academic medical systems with a median follow-up of 3.5 months. Demographic, injury, radiographic, and treatment data that might be associated with postoperative dorsal subluxation were collected. Three hand surgeons independently assessed subluxation and arthritis on radiographs. Bivariate analysis was performed to analyze our two study purposes. Results Six of 44 (14%) had postoperative dorsal subluxation after initial surgery. Bivariate analysis showed no factors with statistically significant association with postoperative subluxation, assessed independently by three hand surgeons on radiographs. Fifty per cent of the joints with postoperative arthritis had postoperative subluxation compared with 21% of joints without postoperative subluxation. No significant association was found between postoperative dorsal subluxation with postoperative arthritis. Conclusion The association of persistent subluxation and early arthrosis in dorsal PIP joint fracture dislocations needs further study. At this time, it is unclear in what ways persistent subluxation or arthrosis affects the rate of reoperation. Level of Evidence This is a therapeutic level IV study.

  • what Middle Phalanx base fracture characteristics are most reliable and useful for surgical decision making
    Clinical Orthopaedics and Related Research, 2015
    Co-Authors: Stein J Janssen, Thierry G Guitton, Jeroen Molleman, David Ring
    Abstract:

    Background Fracture-dislocations of the proximal interphalangeal joint are vexing because subluxation and articular damage can lead to arthrosis and the treatments are imperfect. Ideally, a surgeon could advise a patient, based on radiographs, when the risk of problems merits operative intervention, but it is unclear if Middle Phalanx base fracture characteristics are sufficiently reliable to be useful for surgical decision making.

  • quantitative 3 dimensional ct analyses of fractures of the Middle Phalanx base
    Hand, 2015
    Co-Authors: Stein J Janssen, Dirk P Ter Meulen, Michiel G J S Hageman, Brandon E Earp, David Ring
    Abstract:

    Background Quantitative 3-dimensional computed tomography (3DCT) analyses can provide a more detailed understanding of fracture morphology. For fracture-dislocation of the proximal interphalangeal joint, the extent of fragmentation of the volar lip of the Middle Phalanx—a factor that might influence treatment—is not always apparent from radiographs. We hypothesized that there is no correlation between number of fracture fragments and the percentage of articular surface area involved in intra-articular fractures of the base of the Middle Phalanx using quantitative 3DCT analyses.

  • estimation of base of Middle Phalanx size using anatomical landmarks
    Journal of Hand Surgery (European Volume), 2014
    Co-Authors: Stein J Janssen, Teun Teunis, Dirk P Ter Meulen, Michiel G J S Hageman, David Ring
    Abstract:

    Purpose To determine whether there is a measurable and reproducible relationship between the articular surface size of the Middle Phalanx base and the size of the Middle Phalanx head and proximal Phalanx length of the same finger. Methods Size of the articular surface of the Middle Phalanx base, size of the Middle Phalanx head, and proximal Phalanx length were measured in 84 lateral radiographs by 3 observers. Results The ratio of articular surface size of the Middle Phalanx base to the proximal Phalanx length of the same finger was 0.17. The ratio of articular surface size of the Middle Phalanx base to the size of the Middle Phalanx head of the same finger was 1.34. The intraclass correlation (ICC) among 3 raters was 0.99 for proximal Phalanx length and 0.88 for size of the Middle Phalanx head. Conclusions Knowledge of this relationship and ratios allow for accurate estimation of the percentage of articular surface involvement in a fracture of the Middle Phalanx base. The ICC was highest for measuring proximal Phalanx length, making it the most reliable measurement for estimation of the articular surface size. Clinical relevance This quantitative estimate may be useful for clinical research and is applicable to patient care.

Laura Clare Hamilton - One of the best experts on this subject based on the ideXlab platform.

  • the acute management of unstable intra articular fractures of the base of the Middle Phalanx a systematic review
    The Journal of Hand Surgery, 2018
    Co-Authors: Laura Clare Hamilton
    Abstract:

    Background: Within hand trauma, the management of unstable, intra-articular fractures of the base of the Middle Phalanx remains highly controversial. The objective of this research was to determine...

  • The Acute Management of Unstable Intra-Articular Fractures of the Base of the Middle Phalanx: A Systematic Review.
    The journal of hand surgery Asian-Pacific volume, 2018
    Co-Authors: Laura Clare Hamilton
    Abstract:

    Within hand trauma, the management of unstable, intra-articular fractures of the base of the Middle Phalanx remains highly controversial. The objective of this research was to determine which operation gives the best outcome in the management of displaced, intra-articular fractures of the base of the Middle Phalanx causing instability of the proximal interphalangeal joint. A scoping study was performed to determine the evidence available and the terminology used. A Systematic Review was then performed along PRISMA guidelines. This Systematic Review looked specifically for papers available in English, published over the last ten years, with clinical data for at least five cases of acute unstable fractures of the base of the Middle Phalanx. There must be two years follow-up with less than 30% loss to follow-up. There were no Systematic Reviews or Cochrane reviews. There were no randomized controlled trials and the best studies were simply cohort studies with level III or IV evidence. There was a paucity of high quality studies, with small, heterogeneous groups, short length of follow-up and high loss to follow up. Only seven papers met the Systematic Review criteria. General trends show excellent return of grip strength and good function despite some ongoing pain and stiffness. There were high complication rates for all techniques and the possible reasons for different outcomes are discussed.

M M Alqattan - One of the best experts on this subject based on the ideXlab platform.

  • k wire fixation for extraarticular transverse short oblique fractures of the shaft of the Middle Phalanx associated with extensor tendon injury
    Journal of Hand Surgery (European Volume), 2008
    Co-Authors: M M Alqattan
    Abstract:

    In a prospective study, 22 cases of extraarticular transverse/short oblique fractures of the shaft of the Middle Phalanx associated with extensor tendon injury had fixation of the fracture as well as immobilisation of the distal interphalangeal joint using a K-wire. Mobilisation of the proximal interphalangeal and metacarpophalangeal joints was started immediately after surgery. The wires were removed after 6 weeks. No post-operative complications were noted. At final follow-up (mean = 15 weeks, range = 12–24 weeks), 18 of 22 patients obtained excellent and good total active motion (TAM) scores. Stiffness was confined to the distal interphalangeal joint, and hence when the results were re-analysed for motion at that joint only, only 11 patients had excellent and good outcomes.

Stein J Janssen - One of the best experts on this subject based on the ideXlab platform.

  • what Middle Phalanx base fracture characteristics are most reliable and useful for surgical decision making
    Clinical Orthopaedics and Related Research, 2015
    Co-Authors: Stein J Janssen, Thierry G Guitton, Jeroen Molleman, David Ring
    Abstract:

    Background Fracture-dislocations of the proximal interphalangeal joint are vexing because subluxation and articular damage can lead to arthrosis and the treatments are imperfect. Ideally, a surgeon could advise a patient, based on radiographs, when the risk of problems merits operative intervention, but it is unclear if Middle Phalanx base fracture characteristics are sufficiently reliable to be useful for surgical decision making.

  • quantitative 3 dimensional ct analyses of fractures of the Middle Phalanx base
    Hand, 2015
    Co-Authors: Stein J Janssen, Dirk P Ter Meulen, Michiel G J S Hageman, Brandon E Earp, David Ring
    Abstract:

    Background Quantitative 3-dimensional computed tomography (3DCT) analyses can provide a more detailed understanding of fracture morphology. For fracture-dislocation of the proximal interphalangeal joint, the extent of fragmentation of the volar lip of the Middle Phalanx—a factor that might influence treatment—is not always apparent from radiographs. We hypothesized that there is no correlation between number of fracture fragments and the percentage of articular surface area involved in intra-articular fractures of the base of the Middle Phalanx using quantitative 3DCT analyses.

  • estimation of base of Middle Phalanx size using anatomical landmarks
    Journal of Hand Surgery (European Volume), 2014
    Co-Authors: Stein J Janssen, Teun Teunis, Dirk P Ter Meulen, Michiel G J S Hageman, David Ring
    Abstract:

    Purpose To determine whether there is a measurable and reproducible relationship between the articular surface size of the Middle Phalanx base and the size of the Middle Phalanx head and proximal Phalanx length of the same finger. Methods Size of the articular surface of the Middle Phalanx base, size of the Middle Phalanx head, and proximal Phalanx length were measured in 84 lateral radiographs by 3 observers. Results The ratio of articular surface size of the Middle Phalanx base to the proximal Phalanx length of the same finger was 0.17. The ratio of articular surface size of the Middle Phalanx base to the size of the Middle Phalanx head of the same finger was 1.34. The intraclass correlation (ICC) among 3 raters was 0.99 for proximal Phalanx length and 0.88 for size of the Middle Phalanx head. Conclusions Knowledge of this relationship and ratios allow for accurate estimation of the percentage of articular surface involvement in a fracture of the Middle Phalanx base. The ICC was highest for measuring proximal Phalanx length, making it the most reliable measurement for estimation of the articular surface size. Clinical relevance This quantitative estimate may be useful for clinical research and is applicable to patient care.

Hemant S Patankar - One of the best experts on this subject based on the ideXlab platform.

  • treatment of atrophic nonunion of Middle Phalanx in a nine year old boy with external distraction and bone grafting
    Hand Surgery, 2014
    Co-Authors: Anoop C Dhamangaonkar, Hemant S Patankar
    Abstract:

    Nonunion of phalangeal fractures is uncommon and even rarer in the paediatric age group. There is paucity of literature relating to the treatment of atrophic non-union of phalangeal fractures in the paediatric age group. We present a case of five years old atrophic non-union of the Middle Phalanx of the index finger of the dominant hand in a nine-year-old male child, managed with a staged treatment protocol of initial fracture site distraction with a threaded external fixator followed by delayed bone grafting. This treatment was successful in attaining length and bony union in case of atrophic non-union of the Middle Phalanx with a good pinch strength and gaining a good range of motion at the proximal interphalangeal joint with little soft tissue dissection.

  • antegrade joint sparing intramedullary wiring for Middle Phalanx shaft fractures
    Journal of Hand Surgery (European Volume), 2014
    Co-Authors: Anoop C Dhamangaonkar, Hemant S Patankar
    Abstract:

    Purpose To evaluate the outcome for surgical stabilization of Middle Phalanx shaft fractures with joint-sparing antegrade intramedullary K-wire fixation. Methods We treated 15 extra-articular transverse or short oblique shaft fractures of the Middle Phalanx in 13 patients. All fractures were treated with closed reduction internal fixation with antegrade joint-sparing intramedullary K-wires. Patients had a minimum follow-up of 1 year (range, 1–10 y). We assessed the objective outcome at 6 months by calculating total active range of motion. Results All fractures healed. Based on the total active motion score at 6 months, 10 digits showed excellent results, 3 digits were good, 1 was fair, and 1 was poor. Among 3 patients with an associated flexor tendon injury, 2 had excellent outcomes and one had a poor outcome. For 2 patients with an associated extensor tendon injury, 1 had a good outcome and the other had a fair outcome. Conclusions Antegrade intramedullary wiring for extra-articular transverse and short oblique shaft  fracture of Middle Phalanx is a simple, safe, inexpensive, and joint-sparing technique that provides enough fracture stability, even in cases of associated injuries, for early rehabilitation and functional recovery with the expectation of a good to excellent outcome. Type of study/level of evidence Therapeutic IV.