The Experts below are selected from a list of 306 Experts worldwide ranked by ideXlab platform
Paul Binhammer - One of the best experts on this subject based on the ideXlab platform.
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Three-dimensional remodelling to determine best fit for hemihamate autograft arthroplasty
Canadian Journal of Plastic Surgery, 2014Co-Authors: Jessica G. Shih, Dale J. Podolsky, Paul BinhammerAbstract:Comminuted fractures of the middle phalangeal base are common and difficult to reconstruct. Early stabilization and mobilization of the damaged intra-articular joint is important to restoring proximal interphalangeal function. Many techniques have been described as treatments for middle Phalanx fractures including methods of both open reduction, internal fixation and closed reduction using external fixation devices (1–6). However, hemihamate arthroplasty should be considered when >30% of the palmar lip of the proximal middle Phalanx is comminuted because it is difficult to reconstruct using other methods (7,8). Hemihamate arthroplasty involves harvesting an osteochondral graft from the dorsal hamate, which includes the articular ridge between the fourth and fifth metacarpals, to repair the comminuted palmar lip of the middle phalangeal base. The graft is fixed to the middle Phalanx using screws. Published studies investigating this surgical technique have stressed the importance of recreating the curvature of the volar lip of the middle Phalanx (9). Published case reports and examples of hemihamate arthroplasty tend to place the dorsal cortex of the hamate flat with the volar cortex of the middle Phalanx when reconstructing the volar lip (7–9); however, this fails to recreate the curvature of the middle Phalanx articular surface. Capo et al (10) used cadaveric reconstructions to demonstrate that to achieve biomechanical stability with no subluxation of the joint, the hamate graft must be tilted slightly to exaggerate the volar buttress so that the hamate graft is no longer flush with the middle Phalanx along the volar cortex. Clearer guidelines regarding the amount to which the hamate graft should be prominent along the volar cortex of the middle Phalanx to achieve the most anatomically ideal reconstruction have yet to be described. We hypothesize that the dorsal cortex of the hamate must always be prominent compared with the volar cortex of the proximal middle Phalanx. The purpose of the present study was to use three-dimensional (3D) remodelling to recreate a palmar lip defect of the middle Phalanx and determine the best fit of the graft to recreate the middle phalangeal base. The results will provide information for intraoperative planning.
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Comparison of third toe joint cartilage thickness to that of the finger proximal interphalangeal (PIP) joint to determine suitability for transplantation in PIP joint reconstruction.
Journal of Hand Surgery (European Volume), 2011Co-Authors: Dale J. Podolsky, Catherine Mcmillan, James G Mainprize, Paul BinhammerAbstract:Purpose To compare the cartilage thickness of the third toe joints to the finger proximal interphalangeal (PIP) joints to assess the appropriateness of using third toe osteochondral grafts for finger PIP joint reconstruction. Methods A laser scanner was used to construct 3-dimensional computer models of 6 matched cadaver right third toe PIP joints, condyles of the third toe middle Phalanx, and finger PIP joints with and without cartilage. Cartilage distribution patterns were computed and analyzed for each surface. The cartilage thickness of both sides of the third toe PIP joint and the third toe middle Phalanx condyles were compared to the PIP joint of the fingers. A total of 18 third toe and 48 finger joint surfaces were analyzed. Results For the third toe middle Phalanx condyles, the mean thickness was 0.20 ± 0.09 mm with a maximum of 0.52 ± 0.18 mm, and a coefficient of variation (CV%; a measure of uniformity of cartilage distribution) of 62. For the third toe proximal Phalanx condyles, the mean cartilage thickness was 0.26 ± 0.10 mm with a maximum thickness of 0.56 ± 0.14 mm and a CV% of 44. The mean thickness, maximum thickness, and CV% of the finger proximal Phalanx condyles was 0.43 ± 0.11 mm, 0.79 ± 0.16 mm, and 31, respectively. For the third toe middle Phalanx base, the mean thickness was 0.28 ± 0.06 mm with a maximum of 0.47 ± 0.09 mm and a CV% of 34, compared to the finger middle Phalanx base mean of 0.40 ± 0.12 mm with a maximum of 0.67 ± 0.14 mm and a CV% of 27. Conclusions There were significant differences in cartilage thickness between the third toe and the fingers in this study. However, fewer differences were observed with the third toe middle Phalanx base cartilage thickness than with the third toe condyles in comparison to the fingers. Type of study/level of evidence Therapeutic IV.
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Structural comparison of the finger proximal interphalangeal joint surfaces and those of the third toe: suitability for joint reconstruction.
Journal of Hand Surgery (European Volume), 2011Co-Authors: James Michael Hendry, Catherine Mcmillan, James G Mainprize, Paul BinhammerAbstract:Purpose This study compared the degree of surface structural similarity between finger proximal interphalangeal joints and third toe articular surfaces to assess the appropriateness of using partial toe articular osteochondral grafts for finger joint reconstruction. Methods Computer models were generated from 4 paired cadaver hands and feet and compared the radius of curvature of toe and finger articular surfaces. The angle created by the palmar divergence of adjacent condyles of the same Phalanx was also compared and described as the angular difference. The distal articular surfaces of the third toe proximal and middle Phalanx were compared to distal articular surfaces of all 4 finger proximal phalanges. The radius of curvature was also compared between the third toe middle Phalanx base and those of all 4 fingers. Results The toe middle Phalanx medial and lateral condyles were 66% and 60% the size of the respective finger condyles. The mean angular difference between adjacent condyles of the toe middle Phalanx compared to the finger was 20°. The toe proximal Phalanx medial and lateral condyles were 75% and 70% the size of the respective finger condyles, with a mean angular difference between adjacent condyles of 6°. The toe middle Phalanx medial base was closer in size to that of the finger (95% to 178%) compared to the toe middle Phalanx lateral base (205% to 254%). Conclusions This study revealed that the third toe proximal Phalanx distal articular surface more closely matched the geometric characteristics of the finger proximal Phalanx distal articular surface than did the toe middle Phalanx distal articular surface. The medial base of the toe middle Phalanx more closely approximated the size of the finger middle Phalanx base than did the lateral toe middle Phalanx base. Clinical relevance Quantitative data have been provided to help guide third toe osteochondral donor site selection when reconstructing traumatic finger proximal interphalangeal joint defects. Type of study/level of evidence Therapeutic IV.
Chih Hung Lin - One of the best experts on this subject based on the ideXlab platform.
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arterial and venous revascularization with bifurcation of a single central artery a reliable strategy for tamai zone i replantation
Plastic and Reconstructive Surgery, 2010Co-Authors: Chung Chen Hsu, Yu Te Lin, Steven L Moran, Cheng Hung Lin, Fu Chan Wei, Chih Hung LinAbstract:Background:Replantation of the distal Phalanx and pulp can be performed to improve finger function and finger aesthetics; however, establishing adequate venous drainage is a challenge. Slattery et al. reported microsurgical reattachment of a partial distal Phalanx with the use of a bifurcated termin
Junichiro Hayashi - One of the best experts on this subject based on the ideXlab platform.
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Long-term Outcomes of Free Nonvascularized Toe Phalanx Transfer for Symbrachydactyly
HAND, 2016Co-Authors: Hidehiko Kawabata, Chikahisa Higuchi, Daisuke Tamura, Akio Nakura, Junichiro HayashiAbstract:Objective: The purpose of this study was to evaluate long-term outcomes of free nonvascularized toe Phalanx transfer to reconstruct synbrachydactylic hands in children. Materials and Methods: We retrospectively reviewed 54 free nonvascularized toe transfers in 29 children with congenitally short fingers. Growth rate was calculated at 5-year follow-up and 10-year follow-up. Percent length against the original Phalanx, remaining in the contralateral foot, was also calculated. When bilateral Phalanx of the fourth toes was used, average length of the proximal Phalanx of the third and fifth toes was used as a substitute. Incidence of the early physeal closure was recorded. Toe Phalanx was harvested according to the technique described by Buck-Gramko in 1990. Fingers were explored using mid-dorsal longitudinal incisions. If remnant of the proximal Phalanx was present, the toe Phalanx was placed on the top of the remnant with 3 or 4 nonabsorbable sutures. If there was no remnant, loop of the extensor and flexor tendons were cut at the metacarpal head, and they were sutured with the toe Phalanx that was held on the top of the metacarpal with 1 Kirschner wire. Collateral ligaments were also reconstructed. Results: Age at operation was 1.5 years on average. The proximal Phalanx of the fourth toe was used in 51 and that of the third toe in 3. Seven toes were trimmed because the skin pocket was tight. Silastic expander was used for tissue expansion before toe Phalanx transfer in 4 cases. Five cases required revision surgery for partial necrosis of the skin pocket. Five children (7 toes) were lost before 5-year follow-up, and hence excluded for evaluation. Six children underwent bone lengthening procedure between 5- and 10-year follow-up period, and 10 children did not reach 10 years after surgery. They, too, were excluded for the evaluation at 10-year follow-up. At 5-year follow-up, the physis was closed in 30%, growth rate was 0.8 mm/year, and %length was 87%. At 10-year follow-up, closure rate increased to 85%, growth rate decreased to 0.5 mm/year, and %length was 69%. Conclusion: Free nonvascularized toe Phalanx transfer is a versatile procedure for reconstruction of the congenital finger deficit. Growth ability remains at least 5 years in most of the cases but it decreases when they reached 10-year follow-up period.
Fatih Parmaksizoglu - One of the best experts on this subject based on the ideXlab platform.
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lengthening of a thumb distal Phalanx replanted to its metacarpus because of loss of the proximal Phalanx case report
Journal of Hand Surgery (European Volume), 2011Co-Authors: Mehmet Unal, Eren Cansu, Fatih ParmaksizogluAbstract:We report a successful thumb replantation by resecting the remnants of the crushed proximal Phalanx and uniting the distal Phalanx with the thumb metacarpal. The procedure resulted in extreme shortening, which we managed by distraction lengthening and deepening of the first webspace.
Catherine Mcmillan - One of the best experts on this subject based on the ideXlab platform.
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Comparison of third toe joint cartilage thickness to that of the finger proximal interphalangeal (PIP) joint to determine suitability for transplantation in PIP joint reconstruction.
Journal of Hand Surgery (European Volume), 2011Co-Authors: Dale J. Podolsky, Catherine Mcmillan, James G Mainprize, Paul BinhammerAbstract:Purpose To compare the cartilage thickness of the third toe joints to the finger proximal interphalangeal (PIP) joints to assess the appropriateness of using third toe osteochondral grafts for finger PIP joint reconstruction. Methods A laser scanner was used to construct 3-dimensional computer models of 6 matched cadaver right third toe PIP joints, condyles of the third toe middle Phalanx, and finger PIP joints with and without cartilage. Cartilage distribution patterns were computed and analyzed for each surface. The cartilage thickness of both sides of the third toe PIP joint and the third toe middle Phalanx condyles were compared to the PIP joint of the fingers. A total of 18 third toe and 48 finger joint surfaces were analyzed. Results For the third toe middle Phalanx condyles, the mean thickness was 0.20 ± 0.09 mm with a maximum of 0.52 ± 0.18 mm, and a coefficient of variation (CV%; a measure of uniformity of cartilage distribution) of 62. For the third toe proximal Phalanx condyles, the mean cartilage thickness was 0.26 ± 0.10 mm with a maximum thickness of 0.56 ± 0.14 mm and a CV% of 44. The mean thickness, maximum thickness, and CV% of the finger proximal Phalanx condyles was 0.43 ± 0.11 mm, 0.79 ± 0.16 mm, and 31, respectively. For the third toe middle Phalanx base, the mean thickness was 0.28 ± 0.06 mm with a maximum of 0.47 ± 0.09 mm and a CV% of 34, compared to the finger middle Phalanx base mean of 0.40 ± 0.12 mm with a maximum of 0.67 ± 0.14 mm and a CV% of 27. Conclusions There were significant differences in cartilage thickness between the third toe and the fingers in this study. However, fewer differences were observed with the third toe middle Phalanx base cartilage thickness than with the third toe condyles in comparison to the fingers. Type of study/level of evidence Therapeutic IV.
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Structural comparison of the finger proximal interphalangeal joint surfaces and those of the third toe: suitability for joint reconstruction.
Journal of Hand Surgery (European Volume), 2011Co-Authors: James Michael Hendry, Catherine Mcmillan, James G Mainprize, Paul BinhammerAbstract:Purpose This study compared the degree of surface structural similarity between finger proximal interphalangeal joints and third toe articular surfaces to assess the appropriateness of using partial toe articular osteochondral grafts for finger joint reconstruction. Methods Computer models were generated from 4 paired cadaver hands and feet and compared the radius of curvature of toe and finger articular surfaces. The angle created by the palmar divergence of adjacent condyles of the same Phalanx was also compared and described as the angular difference. The distal articular surfaces of the third toe proximal and middle Phalanx were compared to distal articular surfaces of all 4 finger proximal phalanges. The radius of curvature was also compared between the third toe middle Phalanx base and those of all 4 fingers. Results The toe middle Phalanx medial and lateral condyles were 66% and 60% the size of the respective finger condyles. The mean angular difference between adjacent condyles of the toe middle Phalanx compared to the finger was 20°. The toe proximal Phalanx medial and lateral condyles were 75% and 70% the size of the respective finger condyles, with a mean angular difference between adjacent condyles of 6°. The toe middle Phalanx medial base was closer in size to that of the finger (95% to 178%) compared to the toe middle Phalanx lateral base (205% to 254%). Conclusions This study revealed that the third toe proximal Phalanx distal articular surface more closely matched the geometric characteristics of the finger proximal Phalanx distal articular surface than did the toe middle Phalanx distal articular surface. The medial base of the toe middle Phalanx more closely approximated the size of the finger middle Phalanx base than did the lateral toe middle Phalanx base. Clinical relevance Quantitative data have been provided to help guide third toe osteochondral donor site selection when reconstructing traumatic finger proximal interphalangeal joint defects. Type of study/level of evidence Therapeutic IV.
