Level Of Distal Interphalangeal Joint Research Articles

A man with a human bite to the finger

A 29 year old man presented to the emergency department with increasing pain, redness, and swelling of his right middle finger. Two weeks previously he had been bitten during an alleged assault, but had not sought medical attention. Examination of the digit showed a discharging sinus at the distal inter-phalangeal joint level on the dorsal surface, with swelling, localised erythema, tenderness, and reduced active and passive motion (30 degrees active and passive flexion compared with 45 degrees on the opposite side).⇑⇑ Systemically, the patient was apyrexial and had normal vital signs. Routine investigations showed a normal white cell count, a C reactive protein of 52 (normal range: < 5 mg/L). He had two radiographs taken—anteroposterior and lateral. The lateral radiograph is shown. (1) What does the radiograph show? (2) Based on the case history and radiograph, what diagnosis does this patient have? (3) What other investigations may be helpful? (4) How might this patient be managed? (5) What are the possible complications of this presentation? (6) What are the micro-organisms typically isolated in a bite injury? (1) This is a lateral radiograph of a right index finger, showing soft tissue swelling, …

Double reverse-flow island flaps for two adjacent finger tissue defect.

Soft-tissue reconstruction of fingertip injuries remains a challenge for hand surgery. Tissue loss of multiple digits is a serious problem for hand surgeons. Surgical possibilities include regional, distant and local flaps. In this study, five patients presented with tissue loss of two adjacent fingers and were treated by double reverse-flow island flaps. The surgical technique is an application of the reverse-flow homodigital island flap for two adjacent finger tissue defects. Instead of one flap, double island flaps are applied to two adjacent finger tissue defects. The flaps are raised from the lateral or medial palmar surface of the proximal phalanx level. Anastomoses between the radial and ulnar digital arteries at the distal interphalangeal joint level are preserved. Three of the patients had tissue defects at the fingertip. In these cases, digital nerve anastomosis with the counter lateral digital nerve made the flaps sensitive. In two patients, the tissue defect was on the dorsum of the middle phalanx level. In these cases, the flaps were non-sensitive. Neither infection nor flap failure was seen in the patients. Sensitive function was satisfactory in fingertip applications. The reverse-flow homodigital island flap is a commonly used surgical technique for tissue defects in the fingers. The double reverse-flow island flaps involve the application of this technique for two adjacent fingers. The important point in the surgical technique is that the vascular supply of the two flaps should originate from the same common palmar digital artery. This technique offers a possibility to repair the defects of two adjacent fingers.

Infantile digital fibromatosis: An unusual localization

Infantile digital fibromatosis (recurrent digital fibromatosis) is a rare, benign fibrous growth of childhood. The authors present a case of a 16-year-old child with an infantile digital fibromatosis on the volar surface of the right little finger at the distal interphalangeal joint level. After excision of the tumor, histopathologic diagnosis was shown to be infantile digital fibromatosis. The patient has been free of recurrence for 3 years after surgery. J Pediatr Surg 36:1587-1589. Copyright © 2001 by W.B. Saunders Company.

Ischaemia of the Hand in Infants Following Radial or Ulnar Artery Catheterisation.

Radial and ulnar arterial catheterisation have become frequently used methods of monitoring in neonatal and pediatric intensive care units. Minor complications are common and temporary ischaemic changes in the form of blanching are well described. However, permanent ischaemia in the infant has rarely been reported. This series is the first in the hand surgery literature to address the issue of digital ischaemia following radial artery catheterisation in the infant population and adds three to the six previously reported cases in the English literature. One patient had fingertip necrosis to the distal interphalangeal joint level of the middle, ring and little fingers, while two other patients required amputation at the carpometacarpal joint level.

Total Anterior Tenoarthrolysis to Treat Inveterate Flexion Contraction of the Fingers: A Series of 16 Patients

Total anterior tenoarthrolysis was originally described by Saffar to treat flexion contractions of the fingers. This procedure consists of releasing the entire flexor apparatus and the interphalangeal volar plates through a lateral incision and a volar subperiosteal dissection. The anterior flap slides proximally in relation to the bone, leaving a pulpar defect. To maintain the digital pulp intact, we proposed advancing the volar flap and transposing the defect at the base of the finger. A series of 16 patients who underwent total anterior tenoarthrolysis are presented; 6 patients underwent surgery according to our modification. Postoperative range of motion was improved in 11 of 16 patients and correlated with subjective patient appreciation. Fingers that had a preoperative interphalangel total active motion greater than 55 degrees were significantly improved. No improvement was seen among patients with stiff, crooked fingers. The average total extension deficit decreased from 33 degrees at the proximal interphalangeal joint level and 6 degrees at the distal interphalangeal joint level. Total anterior tenoarthrolysis is considered a salvage procedure to treat flexion contractures of the fingers with articular cartilages that are in good condition and tendons that are still working.