Background. Traditional teaching recommends against arthroplasty in the
Author’s experience in surgical treatment of aplasia of the thumb according to the Buck-Gramcko procedure introduced by this author in 1971 is reported. Inidcation of the pollicization of the
Aims: To describe a new &
safe technique of gradual distraction for pollicisation of
Background. Bouchard -arthrose is often familial and affect predominantly females. It starts as acute inflammation of the soft tissue and with time may progress to severe deformity and limitation of movement. In the early phases one of the most commen operation in the management is the synovialectomy. In late stages with severe destruction and deformity of the joint arthrodesis can be carried out. However, arthrodesis may lead to severe loss of function. One of the most commonly and world wide used prothesis to maintain movement is the Swanson –spacer. Material and Methods. 20 Swanson-implants in 14 patients (12 female,2 male) were evaluated subjectively and objectively using PIJA-score (Interphalangeal-joint –score) and Dash –score. The follow period was 4.6 years (range 1-11 years). Results. The IPJA-score ranged 8-14 points (median 11.8) and the median Dash- score was 28 points. Improvement of pain was oberserved in 90% of the cases. Flexion more than 30° in 85% and full extention in 75%. Ulnar deviation was noted in 7 patients (35%), mostly of the
Clinician expectation and anatomical studies suggest that the distribution of sensory dysfunction in carpal tunnel syndrome (CTS) should be confined to the thumb, index, middle and half of the ring fingers. We mapped the distribution of disturbance to evaluate the accuracy of these assumptions. We evaluated 64 wrists in 64 patients with nerve conduction study confirmed CTS. Each patient filled out a Katz hand diagram and we collated the distribution of pain and non-painful (tingling, numbness &
decreased sensation) sensory disturbance. Frequency of reporting was analysed; dividing symptoms into thenar and hypo-thenar eminence, distal palm, each digit, posterior hand and forearm. Non-painful sensory disturbance occurred in all patients. The
Purpose. To analyse the early results of unconstrained pyrocarbon joint replacements in patients with osteo-arthritis of the metacarpo-phalangeal joints. Background. Silicone arthroplasty, as introduced by Swanson in 1962 has remained the most popular procedure to treat arthritis of the metacarpo-phalangeal (MCP) joints. However, despite providing good pain relief, they have shown to demonstrate breakage rates up to 82% at 5 years. This is of great concern in the osteoarthritis (OA) patient group, who tend to be younger and have higher functional demands compared to their rheumatoid counterparts. The newer unconstrained pyrolytic carbon MCP joint prostheses may therefore be more suitable in OA patients whose soft tissue constraints are intact and whose hand function is strong. This study is the first to analyse the results of this implant in a cohort of OA patients only, with prospective data. Methods. 19 primary pyrocarbon metacarpo-phalangeal joint replacements, in 11 patients (5 men and 6 women) were reviewed, with prospective data collection. The diagnosis was primary osteoarthritis in all patients. The mean age at operation was 66.4 years (range 55–82 years). 2 patients underwent concomitant trapiezectomy and one underwent DIPJ fusion. All patients were right hand dominant −75% underwent surgery in their dominant hand. Eleven of the nineteen joints were performed in the
Objective. We explanted NeuFlex metacarpophalangeal (MP) joint prostheses to identify common features, such as position of fracture, and thus better understand the reasons for implant failure. Methods. Explanted NeuFlex MP joint prostheses were retrieved as part of an-ongoing implant retrieval programme. Following revision MP joint surgery the implants were cleaned and sent for assessment. Ethical advice was sought but not required. The explants were photographed. The position of fracture, if any, was noted. Patient demographics were recorded. Results. Thirty NeuFlex MP explants were available. Seven (23%) were not fractured. Eleven explants (37%) had fractured at the hinge; nine (30%) had fractured at the junction of the distal stem and hinge; and three (10%) had fractured at both the hinge and distal stem. NeuFlex MP joint explants ranged in size from 0 to 40. Smaller sizes were retrieved from smaller fingers; larger implants came from the middle and
Aggressive digital papillary adenocarcinoma (ADPACa) is a rare skin adnexal tumour, which has a predilection for the digits. We report a case with this tumour in a 51 year old insulin dependent diabetic man, who presented as a paronychia of right
Objective. Surgical treatment of trigger finger is usually performed as an outpatient surgery under local anesthesia n this study we present our results of surgical treatment of trigger finger performed with an ophthalmic knife which is less invasive for patient and easer for surgeon. Material and Method. 19 gauges microvitreoretinal ophthalmic knifes have a rhombus like edge with both sharp sides. The length of the knife's cutting side is 3 mm at each side. There were 40 women and 10 men with a mean age of 51.7 ± 5.7 (min: 40 max: 62). The thumb was involved in 32, the
Introduction. Various methods to manage medial tibial defects in primary total knee arthroplasty (TKA) have been described. According to Vail TP, metal augmentation is usually indicated for defect depth of >10 mm of the medial tibial plateau. The outcomes of metal augmentation have been described as excellent. Nevertheless, we believe that it is mandatory to preserve as much of the bone as possible for future revision surgeries. Therefore, we performed autologous impaction bone grafting even for large bone defects (defect depth of ≥10 mm) in primary TKA. The objectives of this study are to describe our bone grafting technique in detail and to assess the radiological outcomes of the grafted bone. Methods. Between 2003 and 2011, 26 TKAs with autologous impaction bone grafting for ≥10 mm medial tibial defects were performed. The preoperative diagnoses were osteoarthritis in 17 knees, rheumatoid arthritis in 2 knees, osteonecrosis of the medial tibial condyle in 6 knees, and Charcot's joint in 1 knee. The average mediolateral width and depth of the medial tibial defects, measured after the horizontal osteotomy of the tibial articular surface, were 17.8 mm (range, 10–25 mm) and 12.0 mm (range, 10–23 mm), respectively. The average patient age at surgery was 73.2 years (range, 56–85 years). The patients were followed up for an average of 55 months (range 27–109 months). Bone grafting technique: Multiple drill holes (white arrow) were made on the floor of the defect (A) and a morselized cancellous bone was impacted using the grip end of a metal hammer (white asterisk) and firm manual pressure to fill the defect. Thus, the firm impaction prevented bone cement from entering the space between the graft and the tibial host bed. An assistant's
This study measured the three bony axes usually used for femoral component rotation in total knee arthroplasty and compared the accuracy and repeatability of different measurement techniques. Fresh cadaveric limbs (n=6) were used. Three observers (student, trainee and consultant) identified the posterior condylar (PCA), anteroposterior (AP) and the transepicondylar (TEA) axes, using a computer navigation system to record measurements. The AP axis was measured before and after being identified with an ink line. The TEA was measured by palpation of the epicondyles both before and after an incision was made in the medial and lateral gutters at the level of the epicondyles, allowing the
The authors studied the characteristics that would be desirable for a metacarpo-phalangeal joint prosthesis to be used in patients with rheumatoid disease. In these patients the severe destruction of the capsulo-ligamentous structures of the joint often makes prosthetic substitution dissatisfactory, particularly for the
Firecracker injuries to the hands can cause permanent functional loss and disfigurement. We assessed the injuries and treatment of 16 men, three women, five boys and two girls injured around New Year’s Eve between 1999 and 2004. In 16 of the adult patients, who included a typist and a teacher, it was necessary to amputate one or more digits. Four patients lost both the thumb and the
Introduction and Objectives: One of the techniques used to improve function in thumb hypoplasia is Pollicisation, this is used in thumb hypoplasia Blauth grade 3b, 4 and 5. The objectives of this technique are: to modify the position of the
Introduction: In 1979 Linburg and Comstock described anomalous tendon slips between flexor pollicus longus and the flexor digitorum profundus in 31% of individuals (Linburg, Comstock; J Hand surg 1997, Jan). The purpose of this study is to find out the incidence of Linburg-Comstock Syndrome in the British population. Methods: A clinical examination of the hands of healthy volunteers, including office workers and medical professionals was carried out. It was determined if flexion of the thumb causes concomitant flexion of index or/and middle finger. Additionally, pain on passive extension of the fingers was also documented. Summary of Results: 70 volunteers were included, the test for Linburg-Comstock syndrome was positive in 55% of people who had concomitant flexion of the fingers with the thumb and pain in the wrist with passive extension. In 70% of people just concomitant finger flexion was seen. In 10 cadaveric dissections no connecting tendon slips were found but one fibrinous connection between FPL and FDP was noted. Conclusion: Our study shows that the incidence of Linburg –Comstock Syndrome is much higher than previously thought based on the clinical examination. However cadaveric dissections did not confirm a distinct structural connection except in one case where there was a fibrinous connection. It is likely that at least in some cases it is a acquired anomaly in response to repeated use/overuse of thumb and
Suture anchors have changed the practice of repair of tendons in modern Orthopaedics. The purpose of the study was to identify the ideal suture anchor length for anchoring flexor digitorum profundus tendon to the distal phalanx. We dissected 395 distal phalanges from 80 embalmed hands. Phalanges from two little fingers and three thumbs were damaged, hence were excluded from the study. We measured the Anteroposterior and Lateral dimensions at three fixed points on the distal phalanges of all 395 fingers using a Vernier’s Callipers with 0.1mm accuracy. The mean value of the Anteroposterior width of the distal phalanx at the insertion of the FDP was found to be 3.4mm for the little finger; 3.9mm for the ring finger; 4.3mm for the middle finger; 4.0mm for the
Introduction: It is said that God gave us paired bilateral anatomical structures so that the trauma surgeon can compare the injured side with its uninjured counterpart. The axial rotational alignment of fingers, when disrupted by injury, may lead to scissoring. During examination, comparison is made between the rotational alignment of injured and uninjured fingers. This assumes that the rotational alignment of the fingers is symmetrical. A study was performed to ascertain normal rotational alignment, and establish whether this assumption is valid. Materials and Methods: Standardised digital images were taken with fingers in extension. These were analysed using the angle-measuring tool on Adobe Photoshop software. The rotational angle used was that between a line joining the radial and ulnar borders of the nail plate, and the horizontal. Results: Mean angles of rotation were 13° for the
The aims of the study presented here were to compare the frequency of surgical glove perforation among major and minor orthopaedic surgical procedures and to determine the efficacy of use of double glove in these procedures. A prospective study was performed to assess the perforation rate of surgical gloves in 100 major (total hip and knee arthroplasty) and 100 minor (arthroscopy) orthopaedic procedures. Glove perforation rate, location of perforation, and time of operation were analysed. In 200 procedures, 1528 gloves were inspected; 622 inner gloves, 906 outer gloves were examined. All members of the surgical team wore double gloves in major and minor surgical procedures. The overall perforation rate was 242 out of 1528 gloves (15.8%), and 70 out of 200 operations (35%) (major versus minor surgical procedures, 21.6% versus 5.6%, p<
0.05, and 63% versus 11%, p<
0.001, respectively). For major procedures, 224 glove perforations were determined, of which 23 were in the inner glove and 201 in the outer glove. For minor procedures, 13 glove perforations were observed, and no perforation were found in the inner gloves used by the surgical team for minor procedures. The right thumbs and left
Objective. Destruction and deformity in both PIP and MP joints are not uncommon and cause sever disabilities. Arthroolasty of the MP joint combined with arthrodesis of the PIP joint are the usual choice for this condition. Some motion in ulnar digits provides great benefits for rheumatoid patients. We report implant arthroplasty of the PIP joint and also simultaneous replacement of PIP and MP joint in same finger. Material &
Methods. Twenty-five joints in 15 patients underwent PIP arthroplasty either with silicone or surface replacement implant. Twelve PIP joints in 6 patients used Silicone implant (6 Swanson and 6 Avanta) alone and mean follow up was 42(6–84) months. New cementless surface implant (Self Locking Finger Joint, SLFJ) were developed and clinically used for about 3 years. Because of the stem design, SLFJ are able to use both PIP and MP joint simultaneously or combined with silicone implant. Four PIP joints in 3 patients used SLFJ alone and 6 patients underwent both PIP and MP joint with implant simultaneously. Combination of SLFJ PIP and silicone MP was 4 finger in 2 hand, SLFJ PIP and SLFJ MP was 3 finger in 2 hand, silicone PIP and SLFJ MP was 3 finger in 2 patients and silicone PIP and silicone MP was 1 finger. Mean follow up for SLFJ in either PIP or MP was 18(4–37) months. Results. Average arc of the PIP with silicone implant alone was 38(10–50 ° and SLFJ alone was 55(45–60) °. One PIP SLFJ dislocates immediate after surgery and was converted silicone later on. Of 7 SLFJ with combined PIP and MP arthroplasties, 2 PIP lost motion completely, one PIP move only 15°, 4 PIP move 75 °in average. Four silicone PIP combined with MP arthroplasties move 45°in average. One PIP SLFJ had breakage in stem legs, which believed to occur during interaction of stem insertion from both side of the basal phalanx, and was seen at immediate post op X-ray. There was one instability in index replaced with SLFJ for sever Swan neck deformity and no infection. Patient satisfaction for simultaneous replacement in PIP and MP joint were excellent except one whose age was 72. Discussion. Stability of the PIP joint in
We aimed to establish the short- and long-term efficacy of corticosteroid injection for coccydynia, and to determine if betamethasone or triamcinolone has the best effect. During 2009 to 2016, we treated 277 patients with chronic coccydynia with either one 6 mg betamethasone or one 20 mg triamcinolone cortisone injection. A susequent injection was given to 62 (26%) of the patients. All were reviewed three to four months after injection, and 241 replied to a questionnaire a mean of 36 months (12 to 88) after the last injection. No pain at the early review was considered early success. When the patient had not been subsequently operated on, and indicated on the questionnaire that they were either well or much better, it was considered a long-term success.Aims
Methods