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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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pyrolytic carbon Proximal Interphalangeal Joint resurfacing arthroplasty
Journal of Hand Surgery (European Volume), 2006Co-Authors: Harrison G Tuttle, Peter J SternAbstract:Purpose To evaluate the clinical results of a pyrolytic carbon resurfacing Proximal Interphalangeal Joint (PIPJ) arthroplasty in patients with osteoarthritis. Methods A retrospective review of 18 PIPJ arthroplasties in 8 women with severe osteoarthritis performed by a single surgeon was completed with an average follow-up period of 13 months. Clinical assessment included range of motion (ROM), stability, and deformity. Radiographs were reviewed for evidence of loosening, subsidence, fracture, and osseointegration. Six patients, representing 16 Joints, answered a questionnaire regarding pain relief, appearance, and overall satisfaction with the arthroplasty. Complications also were recorded. Results The average preoperative ROM was 10° to 63°, and the average postoperative ROM was 18° to 71°. Although the average arc of motion was unchanged, 9 Joints had an increase in ROM and 9 Joints had a decrease in ROM. All Joints were stable laterally. Radiographic review indicated 2 Joints with loosening at 4 months after surgery. Complications included 8 squeaky Joints, 5 Joint contractures, and 2 dislocations. Pain was relieved completely in 8 Joints, and the pain rating on a visual analog scale was 3.6 out of 10 for the 8 patients who had residual pain. Patients were satisfied completely with the results of 9 Joints. Although there was residual deformity in 4 Joints, patients believed that 15 of 16 Joints had improved in appearance. Five of 6 patients responded that they would have the surgery again. There have been no secondary procedures performed by us. Conclusions The insertion of pyrolytic carbon implants for PIPJ arthroplasty is a technically demanding procedure, but it has the potential to achieve pain relief, stability, satisfactory ROM, and correction of the deformity; however, the results in this review were unpredictable and may not be superior to those achieved with other methods of arthroplasty. Type of study/level of evidence Therapeutic, Level IV.
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dorsal fracture dislocations of the Proximal Interphalangeal Joint surgical complications and long term results
Journal of Hand Surgery (European Volume), 1999Co-Authors: Mark A Deitch, Thomas R Kiefhaber, Rodney B Comisar, Peter J SternAbstract:This retrospective study assessed the short-term complications and long-term subjective and objective results of operative treatment of acute unstable dorsal Proximal Interphalangeal Joint dislocations treated by 2 methods: open reduction internal fixation and volar plate arthroplasty. Fifty-six patients were included in this study. Twenty-three (41%) were treated by volar plate arthroplasty and 33 (59%) were treated by open reduction internal fixation. Postoperative complications occurred in 10 patients (18%). The most frequent complication was redislocation, which occurred in 6 patients (volar plate arthroplasty, 3 patients; open reduction internal fixation, 3 patients) and necessitated salvage surgery in 4 of these 6 cases. In all 6 cases, the fracture of the base of the middle phalanx involved more than 50% of the articular surface. Twenty-four patients (43%) returned for long-term evaluation at an average follow-up period of 46 months (range, 13-125 months). Twenty of these 24 patients (83%) reported little or no pain despite a high incidence (96%) of posttraumatic degenerative changes. Eighteen (75%) reported no difficulty with work activities; 92% continued leisure activities with little or no modification. Proximal Interphalangeal Joint flexion contractures and extension lag at the distal Interphalangeal Joint were common. These data indicate that if reduction is maintained, patients may expect few functional deficits despite radiographic degenerative changes and loss of mobility.
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fracture dislocations of the Proximal Interphalangeal Joint
Journal of Hand Surgery (European Volume), 1998Co-Authors: Thomas R Kiefhaber, Peter J SternAbstract:Fracture dislocations of the Proximal Interphalangeal Joint may occur by several different mechanisms of injury and are of 3 basic fracture patterns: palmar lip fractures, dorsal lip fractures, and pilon fractures. Proper treatment of these injuries is predicated on maintenance of concentric reduction of the Joint, restoration of Joint stability, and institution of early motion. Anatomic reconstitution of the articular surface, though ideal, is less important. Many methods are available to treat these injuries. Understanding the fracture within the context of a stability-based classification system helps to guide in the selection of the most appropriate treatment. Copyright © 2002 by the American Society for Surgery of the Hand
T R C Davis - One of the best experts on this subject based on the ideXlab platform.
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dorsal fracture dislocation of the Proximal Interphalangeal Joint a comparative study of percutaneous kirschner wire fixation versus open reduction and internal fixation
Journal of Hand Surgery (European Volume), 2005Co-Authors: A Aladin, T R C DavisAbstract:Nineteen patients with a dorsal fracture–dislocation of the Proximal Interphalangeal Joint of a finger were treated with either closed reduction and transarticular Kirschner wire fixation (eight cases) or open reduction and internal fixation, using either one or two lag screws (six cases) or a cerclage wire (five cases). At a mean follow-up of 7 (range 6–9) years, most patients reported satisfactory finger function, even though some of the injuries healed with Proximal Interphalangeal Joint incongruency (seven cases) or subluxation (four cases). Those treated by open reduction complained of more “loss of feeling” in the affected finger and those specifically treated by cerclage wire fixation reported more cold intolerance and had a significantly larger fixed flexion deformity (median, 30°: range 18–38°) and a smaller arc of motion (median, 48°: range 45–60°) at the Proximal Interphalangeal Joint, despite having the best radiological outcomes. Closed reduction and transarticular Kirschner wire fixation produced satisfactory results, with none of the eight patients experiencing significant persistent symptoms despite a reduced arc of Proximal Interphalangeal Joint flexion (median=75°; range 60–108°). The results of this relatively simple treatment appear at least as satisfactory as those obtained by the two techniques of open reduction and internal fixation, both of which were technically demanding.
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dorsal fracture dislocation of the Proximal Interphalangeal Joint a comparative study of percutaneous kirschner wire fixation versus open reduction and internal fixation
Journal of Hand Surgery (European Volume), 2005Co-Authors: A Aladin, T R C DavisAbstract:Nineteen patients with a dorsal fracture-dislocation of the Proximal Interphalangeal Joint of a finger were treated with either closed reduction and transarticular Kirschner wire fixation (eight cases) or open reduction and internal fixation, using either one or two lag screws (six cases) or a cerclage wire (five cases). At a mean follow-up of 7 (range 6-9) years, most patients reported satisfactory finger function, even though some of the injuries healed with Proximal Interphalangeal Joint incongruency (seven cases) or subluxation (four cases). Those treated by open reduction complained of more "loss of feeling" in the affected finger and those specifically treated by cerclage wire fixation reported more cold intolerance and had a significantly larger fixed flexion deformity (median, 30 degrees : range 18-38 degrees ) and a smaller arc of motion (median, 48 degrees : range 45-60 degrees ) at the Proximal Interphalangeal Joint, despite having the best radiological outcomes. Closed reduction and transarticular Kirschner wire fixation produced satisfactory results, with none of the eight patients experiencing significant persistent symptoms despite a reduced arc of Proximal Interphalangeal Joint flexion (median=75 degrees ; range 60-108 degrees ). The results of this relatively simple treatment appear at least as satisfactory as those obtained by the two techniques of open reduction and internal fixation, both of which were technically demanding.
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the treatment of dorsal fracture dislocation of the Proximal Interphalangeal Joint by closed reduction and kirschner wire fixation a 16 year follow up
Journal of Hand Surgery (European Volume), 2001Co-Authors: D P Newington, T R C Davis, N J BartonAbstract:Ten patients who had sustained 11 unstable dorsal fracture-dislocations of finger Proximal Interphalangeal Joints were reviewed at a mean follow-up of 16 years. All had been treated acutely by closed reduction and transarticular Kirschner wire fixation of the Proximal Interphalangeal Joint, without any attempt at reduction of the fracture of the base of the middle phalanx, which probably involved 30–60% of the articular surface. Seven of the ten patients complained of no finger pain or stiffness, and none complained of severe pain. There was a mean fixed flexion deformity of 8° at the Proximal Interphalangeal Joint, which had a mean arc of movement of 85°. Although subchondral sclerosis and mild Joint space narrowing were observed in some instances, there were no severe degenerative changes. These results confirm that this technique is a reliable treatment method for these injuries, and produces satisfactory long-term results.
Kevin C. Chung - One of the best experts on this subject based on the ideXlab platform.
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Complications of Proximal Interphalangeal Joint Injuries: Prevention and Treatment
Hand clinics, 2018Co-Authors: Sirichai Kamnerdnakta, Helen E. Huetteman, Kevin C. ChungAbstract:Proximal Interphalangeal Joint injuries are one of the most common injuries of the hand. The severity of injury can vary from a minor sprain to a complex intra-articular fracture. Because of the complex anatomy of the Joint, complications may occur even after an appropriate treatment. This article provides a comprehensive review on existing techniques to manage complications and imparts practical points to help prevent further complications after Proximal Interphalangeal Joint injury.
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a systematic review of different implants and approaches for Proximal Interphalangeal Joint arthroplasty
Plastic and Reconstructive Surgery, 2017Co-Authors: Michiro Yamamoto, Sunitha Malay, Yuki Fujihara, Lin Zhong, Kevin C. ChungAbstract:Background Outcomes after implant arthroplasty for primary degenerative and posttraumatic osteoarthritis of the Proximal Interphalangeal Joint were different according to the implant design and surgical approach. The purpose of this systematic review was to evaluate outcomes of various types of implant arthroplasty for Proximal Interphalangeal Joint osteoarthritis, with an emphasis on different surgical approaches. Methods The authors searched all available literature in the PubMed and EMBASE databases for articles reporting on outcomes of implant arthroplasty for Proximal Interphalangeal Joint osteoarthritis. Data collection included active arc of motion, extension lag, and complications. The authors combined the data of various types of surface replacement arthroplasty into one group for comparison with silicone arthroplasty. Results A total of 849 articles were screened, yielding 40 studies for final review. The mean postoperative arc of motion and the mean gain in arc of motion of silicone implant with the volar approach were 58 and 17 degrees, respectively, which was greater than surface replacement implant with the dorsal approach at 51 and 8 degrees, respectively. The mean postoperative extension lag of silicone implant with the volar approach and surface replacement with the dorsal approach was 5 and 14 degrees, respectively. The revision rate of silicone implant with the volar approach and surface replacement with the dorsal approach was 6 percent and 18 percent at a mean follow-up of 41.2 and 51 months, respectively. Conclusion Silicone implant with the volar approach showed the best arc of motion, with less extension lag and fewer complications after surgery among all the implant designs and surgical approaches.
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Proximal Interphalangeal Joint fibromatosis after pyrocarbon implant insertion a case report
Hand, 2016Co-Authors: Jacob Rinkinen, Matthew D Chetta, Kevin C. ChungAbstract:Background: Pyrocarbon implants represent an increasingly popular method to treat Proximal Interphalangeal Joint dysfunction. To this point, no association has been shown between pyrocarbon biomaterials and fibromatosis. We present a potentially serious and destructive complication associated with pyrocarbon arthroplasty. Methods: We demonstrate a clinical case involving pyrocarbon arthroplasty and subsequent fibromatosis development in an otherwise healthy 23-year-old female. To present this association, we illustrate the diagnostic workup involved in a rapidly expanding soft tissue mass of the hand and explain the appropriate treatment. Results: Pyrocarbon arthroplasty was associated with development of locally destructive fibromatosis confirmed by histopathological examination. Treatment involved wide resection with preservation of local structures. Conclusion: We describe the first association between fibromatosis and pyrocarbon biomaterial. Due to fibromatosis destructive effects, clinicians should be aware of potential complications associated with these materials and know how to accurately diagnose and treat these lesions.
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current concepts in treatment of fracture dislocations of the Proximal Interphalangeal Joint
Plastic and Reconstructive Surgery, 2014Co-Authors: Steven C Haase, Kevin C. ChungAbstract:Background Proximal Interphalangeal Joint fracture-dislocations are common injuries that require expedient and attentive treatment for the best outcomes. Management can range from protective splinting and early mobilization to complex operations. In this review, the current concepts surrounding the managment of these injuries are reviewed.
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current concepts in treatment of fracture dislocations of the Proximal Interphalangeal Joint hand peripheral nerve
2014Co-Authors: Steven C Haase, Kevin C. ChungAbstract:Background: Proximal Interphalangeal Joint fracture-dislocations are common injuries that require expedient and attentive treatment for the best outcomes. Management can range from protective splinting and early mobilization to complex surgery. In this review, the current concepts surrounding the management of these injuries are reviewed. Methods: A literature review was performed of all recent articles pertaining to Proximal Interphalangeal Joint fracture-dislocation, with specific focus on middle phalangeal base fractures. Where appropriate, older articles or articles on closely related injury types were included for completeness. The methodology and outcomes of each study were analyzed. Results: When small avulsion fractures are present, good results are routinely obtained with reduction and early mobilization of stable injuries. Strategies for management of the unstable dorsal fracture-dislocation have evolved over time. To provide early stability, a variety of techniques have evolved, including closed, percutaneous, external, and internal fixation methods. Although each of these techniques can be successful in skilled hands, none has been subjected to rigorous, prospective, comparative trials. Volar dislocations fare less well, with significant loss of motion in many studies. Pilon fractures represent the most complicated injuries, and return of normal motion is not expected. Conclusions: The best outcomes can be achieved by (1) establishing enough stability to allow early motion, (2) restoring gliding Joint motion rather than noncongruent motion, and (3) restoring the articular surface congruity when possible. Although the majority of literature on this topic consists of expert opinion and retrospective case series, the consensus appears to favor less invasive techniques whenever possible. (Plast. Reconstr. Surg. 134: 1246, 2014.)
A Aladin - One of the best experts on this subject based on the ideXlab platform.
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dorsal fracture dislocation of the Proximal Interphalangeal Joint a comparative study of percutaneous kirschner wire fixation versus open reduction and internal fixation
Journal of Hand Surgery (European Volume), 2005Co-Authors: A Aladin, T R C DavisAbstract:Nineteen patients with a dorsal fracture–dislocation of the Proximal Interphalangeal Joint of a finger were treated with either closed reduction and transarticular Kirschner wire fixation (eight cases) or open reduction and internal fixation, using either one or two lag screws (six cases) or a cerclage wire (five cases). At a mean follow-up of 7 (range 6–9) years, most patients reported satisfactory finger function, even though some of the injuries healed with Proximal Interphalangeal Joint incongruency (seven cases) or subluxation (four cases). Those treated by open reduction complained of more “loss of feeling” in the affected finger and those specifically treated by cerclage wire fixation reported more cold intolerance and had a significantly larger fixed flexion deformity (median, 30°: range 18–38°) and a smaller arc of motion (median, 48°: range 45–60°) at the Proximal Interphalangeal Joint, despite having the best radiological outcomes. Closed reduction and transarticular Kirschner wire fixation produced satisfactory results, with none of the eight patients experiencing significant persistent symptoms despite a reduced arc of Proximal Interphalangeal Joint flexion (median=75°; range 60–108°). The results of this relatively simple treatment appear at least as satisfactory as those obtained by the two techniques of open reduction and internal fixation, both of which were technically demanding.
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dorsal fracture dislocation of the Proximal Interphalangeal Joint a comparative study of percutaneous kirschner wire fixation versus open reduction and internal fixation
Journal of Hand Surgery (European Volume), 2005Co-Authors: A Aladin, T R C DavisAbstract:Nineteen patients with a dorsal fracture-dislocation of the Proximal Interphalangeal Joint of a finger were treated with either closed reduction and transarticular Kirschner wire fixation (eight cases) or open reduction and internal fixation, using either one or two lag screws (six cases) or a cerclage wire (five cases). At a mean follow-up of 7 (range 6-9) years, most patients reported satisfactory finger function, even though some of the injuries healed with Proximal Interphalangeal Joint incongruency (seven cases) or subluxation (four cases). Those treated by open reduction complained of more "loss of feeling" in the affected finger and those specifically treated by cerclage wire fixation reported more cold intolerance and had a significantly larger fixed flexion deformity (median, 30 degrees : range 18-38 degrees ) and a smaller arc of motion (median, 48 degrees : range 45-60 degrees ) at the Proximal Interphalangeal Joint, despite having the best radiological outcomes. Closed reduction and transarticular Kirschner wire fixation produced satisfactory results, with none of the eight patients experiencing significant persistent symptoms despite a reduced arc of Proximal Interphalangeal Joint flexion (median=75 degrees ; range 60-108 degrees ). The results of this relatively simple treatment appear at least as satisfactory as those obtained by the two techniques of open reduction and internal fixation, both of which were technically demanding.
David R. Steinberg - One of the best experts on this subject based on the ideXlab platform.
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Fractures of the Proximal Interphalangeal Joint.
Journal of The American Academy of Orthopaedic Surgeons, 2000Co-Authors: Philip E. Blazar, David R. SteinbergAbstract:Fractures of the Proximal Interphalangeal Joint constitute a broad spectrum of injuries. An understanding of the anatomy, the potential for Joint instability, and the treatment options is essential to management of these fractures. Commonly observed fracture patterns involve one or both condyles of the Proximal phalanx or the base of the middle phalanx. Fractures of the middle phalanx may involve the palmar lip or the dorsal lip or may be a "pilon" type of injury involving both the palmar and the dorsal lip with extensive intra-articular comminution. Intra-articular injuries may lead to Joint subluxation or dislocation and must be identified in a timely manner to limit loss of motion, degenerative changes, and impaired function. These injuries range from those requiring minimal intervention to obtain an excellent outcome to those that are challenging to the most experienced surgeon. The treatment options include extensionblock splinting, percutaneous pinning, traction, external fixation, open reduction and internal fixation, and volar-plate arthroplasty. Prompt recognition of the complexity of the injury and appropriate management are essential for an optimal functional outcome. J Am Acad Orthop Surg 2000;8:383-390
