Extension Block Research Articles

Reverse Ishiguro Extension Block Technique as an Alternative for Irreducible Osseous Mallet Finger.

Subacute or late-presenting unstable osseous mallet finger might be hard to reduce and, therefore, remain subluxed when using the traditional Ishiguro technique. In such cases, we suggest it is best to prioritize correction of joint subluxation over step-by-step adherence to the traditional Ishiguro technique. Specifically, we contend that carrying out the procedure in reverse order typically results in an easier and more stable reduction of both joint and fracture.

Neglected Dorsal Proximal Interphalangeal Joint Dislocation Treated by Volar Plate Arthroplasty: A Case Series.

Chronic unreduced dislocations of the proximal interphalangeal joint are uncommon, and management principles for these injuries have not been defined. The dislocation can be volar or dorsal and closed reduction is rarely successful owing to soft tissue contractures. Treatment options in literature reviews for such rare injuries included open reduction of pip joint with volar plate arthroplasty, extension block pinning, hemi hamate arthroplasty, pip joint arthrodesis, Suzuki dynamic frame fixation, open reduction and repair of capsule and collateral ligaments with suture anchors. Few cases of amputation following treatment were even reported in literature emphasizing the role of meticulous soft tissue handling in such neglected cases of hand. We report six cases of neglected (more than threemonths old) dorsal dislocation of the PIP joint of the hand, treated with volar plate arthroplasty and extension block pinning. A functional range of motion with a stable joint can be achieved in such injuries with volar plate arthroplasty, as long as the articular cartilage is relatively preserved andbone loss is <30%.

Extension block pinning for chronic volar base fractures of the middle phalanges.

Due to the simplicity, low cost and benefit of avoiding long-term joint immobilization, extension block pinning could be a suitable option for treating the volar base fractures of the middle phalanges. The aim of the present study was to evaluate the outcomes of using extension block pinning in chronic volar base fractures of the middle phalanges. In total, 26 patients with chronic closed volar base fractures of the middle phalanges were included our study. The mean age was 37 years (SD 11.59), and the mean follow-up time was 35 months (SD 19.41). The mean active range of motion (ROM) after surgery was 93° (SD 12.9). There was a negative correlation between the age and the ROM of the injured proximal interphalangeal joint after surgery. ROM did not correlate with the articular surface involvement or the interval between injury and surgery. We obtained a satisfactory result from extension block pinning for volar base fractures of the proximal interphalangeal joint in patients with chronic injuries.Level of evidence: IV.

Functional and radiological outcome of mallet finger fixation with extension block wiring

Functional and radiological outcome of mallet finger fixation with extension block wiring

Surgical Treatment of the Bony Mallet Injuries with Augmented Extension Block Technique: Clinical Outcomes of a New Modification

Surgical Treatment of The Bony Mallet Deformity with Augmented Extension Block Technique: Clinical Outcomes of a New Modification Introduction: Mallet finger deformity is a common pathology and the ‘Extension Block Technique’, is one of the most popular surgical techniques for the treatment of this condition. However, several complications may occur with this method such as fixation failure, compression failure of the dorsal part and loss of reduction. In the current study, it is aimed to report the result of our modification which is augmented extension block technique. Materials &amp; Method: The medical records of patients, who were operated with the diagnosis of bony mallet finger between 2015 and 2021, were evaluated retrospectively. Demographic data, mechanism of trauma, duration of operation, time from injury to surgery, follow-up period, implant removal time, and postoperative complications were collected from hospital records. Patients aged between 18 - 65 years who had been operated with augmented extension block technique with a minimum follow-up period of 6 months were included in the study. A total of 10 patients who met these criteria constituted the study group. Radiological evaluation of the cases was performed with anteroposterior and lateral radiographs. Range of motion and presence of pain were questioned and these data were evaluated according to Crawford criteria. Results: The mean age of the all patients was 40.2 ± 10.9 (range, 24-56) years. The mean follow-up period was 39.6 ± 26.7 (range, 13-76) months. Complete union was achieved in all patients on the final follow-up radiographs. According to Crawford evaluation criteria, the results were ‘excellent’ in six of the patients and ‘good’ in four of them. There were no patients with loss of flexion however, 5° extension loss was observed in four of the subjects. Discussion: This study demonstrates that the augmented extension block technique is a suitable option for the surgical treatment of bony mallet cases with lower complication rate and successful functional results. This modification can be considered as an alternative option for traditional extension block technique which avoids some related complications as postoperative reduction loss, rotational instability and extension loss. Keywords: Mallet finger, Bony mallet, Extension Block

Midterm Outcomes of Closed Extension Block Pinning for Mallet Fractures

Objectives Mallet fractures constitute approximately 30% of mallet finger injuries and their treatment remains controversial. This study aimed to assess the functional and radiological outcomes of mallet fractures treated with closed extension-block pinning. Methods A retrospective review was conducted on patients who underwent closed extension-block pinning for mallet fractures between December 2013 and May 2023. Twenty-one patients (76% male) included in the study were analyzed. Clinical and radiological assessments were performed to evaluate bone healing, joint function, pain, and daily functional limitations via QDASH, VAS, Crawford criteria. Results The mean age was 36 ± 13 years, with a follow-up duration averaging 53,1 ± 40 months. Mallet finger predominantly occurred due to sports injuries and falls (15 patients, 71,5%). Overall, bone union was achieved in 19 (90,5%) cases. The mean flexion of the DIP joint post-surgery was 67,1 ± 10,9 degrees, with three cases (14,2%) exhibiting extension lag and a mean extension limitation of 6,1 ± 10,3 degrees. Overall, patients reported high satisfaction with finger movements after surgery, with significantly lower postoperative pain and functional impairment scores, particularly among males (p&lt;0,05). According to the Crawford evaluation criteria, 6 patients were classified as excellent, 11 patients as good, 2 patients as fair, and 2 patients as poor outcomes. One instance of postoperative complication noted a pin tract infection. Conclusion The closed extension-block pinning technique for mallet fractures offers minimally invasive, easy-to-learn application, fast procedure times, and safe outcomes in short to medium term, but complications such as nonunion may increase in delayed cases

Comparative analysis of kirschner wire joystick vs. extension block pinning techniques in the management of mallet fractures at al-yarmouk teaching hospital

Comparative analysis of kirschner wire joystick vs. extension block pinning techniques in the management of mallet fractures at al-yarmouk teaching hospital

Speech Perception Improvement Algorithm Based on a Dual-Path Long Short-Term Memory Network.

Current deep learning-based speech enhancement methods focus on enhancing the time-frequency representation of the signal. However, conventional methods can lead to speech damage due to resolution mismatch problems that emphasize only specific information in the time or frequency domain. To address these challenges, this paper introduces a speech enhancement model designed with a dual-path structure that identifies key speech characteristics in both the time and time-frequency domains. Specifically, the time path aims to model semantic features hidden in the waveform, while the time-frequency path attempts to compensate for the spectral details via a spectral extension block. These two paths enhance temporal and spectral features via mask functions modeled as LSTM, respectively, offering a comprehensive approach to speech enhancement. Experimental results show that the proposed dual-path LSTM network consistently outperforms conventional single-domain speech enhancement methods in terms of speech quality and intelligibility.

Current concepts in traumatic mallet finger management

Mallet finger deformities can be divided into tendinous deformities caused by tendon rupture and bony deformities caused by fracture. In many cases, conservative treatment is possible. The goal of treating traumatic mallet finger deformities is to accurately restore the ruptured tendon or fractured bone to its proper position, correct extension lag or flexion contracture, prevent joint arthritis, and restore the full range of motion through appropriate range of motion exercises at the right time. In cases of tendinous mallet finger, immobilization with a splint or cast for at least 6 weeks in the extended position is required. During this period, flexion at the distal interphalangeal joint should be strictly limited, while movement at the proximal interphalangeal joint is allowed. Patient compliance with the protocol is essential for achieving good treatment outcomes. If conservative treatment fails or if the deformity recurs after initial surgery, satisfactory results can be achieved through tenodermodesis surgery. If the bony mallet finger involves a bone fragment of 3 mm or more or subluxation of the distal phalanx, surgical treatment is recommended. The primary surgical treatment involves closed reduction and percutaneous pinning with the extension block technique.

Phenanthroline Derivatives as Efficient Organic Photocatalysts for Visible‐Light‐Mediated PET‐RAFT Polymerization

Comprehensive SummaryPhenanthroline is an excellent and stable π‐electron acceptor with a large conjugated chromophore. Phenanthroline derivatives are widely used in adsorption, photodegradation, solar cells, biology, and so on. At present, there are still limited organic molecules utilized to efficiently photocatalyze reversible‐deactivation radical polymerization (RDRP). Therefore, the design of organic photocatalysts (OPCs) for RDRP remains a challenge. Herein, according to the strategy of combining the donor groups and weak acceptor groups, donor‐acceptor (D‐A) type OPCs based on phenanthroline were utilized for the first time in photoinduced electron transfer‐reversible addition‐fragmentation chain transfer (PET‐RAFT) polymerization. 1,10‐Phenanthroline‐5‐amine (Aphen) with a donor group‐amino was screened out for efficacious photo‐controlled radical polymerization under blue light for various monomers with conjugated and unconjugated structures with high monomer conversion and well‐defined narrow dispersity polymers (Đ &lt; 1.20). Controllable homo‐polymers and block copolymers were successfully realized by chain extension reaction and block copolymerization of structurally diverse monomers.

Extension block pinning combined with traction using towel clamps for effective reduction of mallet fracture: a technical tip

Purpose: Although closed reduction and extension block pinning have been widely used for acute mallet finger fracture, the problem of reduction remains a concern. We describe a tip for the reduction technique using a towel clamp, which provides a longitudinal traction force to the distal phalanx, and report the results of the technique.Methods: The medical records of 14 consecutive cases from 12 patients with acute mallet fractures were retrospectively reviewed. Reduction was achieved using the towel clamp reduction technique. The radiologic results were evaluated by simple radiographs, the functional results were analyzed in terms of range of motion, and remaining pain was assessed using Crawford criteria.Results: The mean follow-up period was 8.4 months. The mean union duration was 6 weeks. The mean range of motion was 73°. Eight cases had excellent outcomes, one had good outcomes, four had fair outcomes, and one had poor outcomes. One case of superficial infection and one case of skin necrosis developed, and three cases showed arthritic changes in the distal interphalangeal joint.Conclusion: The towel clamp technique can provide good reduction during surgery, with favorable radiologic and clinical results.

Dynamic Suzuki frame for the interphalangeal joint fracture: A case report

Proximal interphalangeal (PIP) joint injuries are one of the common injuries of hand. Most common in motor vehicle accidents and sports injury. Various treatment modalities are available to treat such fractures like buddy strapping with or without extension block splint, CRPP, ORIF with interfragmentary screws, Schenck dynamic traction, Hynes and Giddings device and many other modalities. This is one of the challenging fractures as there is high incidence of stiffness, loss of function and deformity leading to disability following the treatment. The pins and rubber traction frame (Suzuki frame) system is one of the novel technique to reduce the disability.Case: 66 years old male with history of motor vehicle accident, presented with comminuted intra-articular fracture of base of middle phalanx (PIP joint) extending distally to DIP joint of the fourth finger of left hand. We used Suzuki frame for the treatment of the fracture.Suzuki frame technique is a simple, minimally invasive, soft tissue sparing, cost effective, dynamic external fixation technique, can be done at minimal resource setting, which allows early ROM at PIP and DIP joint, enabling good bone and joint remodeling and good function of the finger, leading to disability free hand with minimal complication rate.

Super-Grignard reagents (R2Mg·LiCl) mediated covalent-anionic-radical polymerization capable of low Đ and reactive hydrogen compatibility

The precise synthesis of polymer with narrow molecular weight distribution (Đ) and well-defined architectures is very essential to exploring the functions and properties of polymer materials. Here, a universal polymerization method capable of low Đ and reactive hydrogen compatibility is reported by introducing super-Grignard reagents (R2Mg·LiCl) into polymer chemistry. Under mild conditions, various monomers, including nonpolar polystyrene and 4-methoxystyrene that cannot be initiated by Grignard reagents, and polar methacrylate, are successfully polymerized with full monomer conversion and low Đ. This approach is amenable to wide varieties of initiators, polymerization temperature, and feed ratio, which makes it attractive for applications in polymer synthesis. By adding methanol and water during the polymerization process, the reactive hydrogen compatibility of this method is confirmed, which makes this method avoid the rigorous restriction on polymerization conditions of anionic polymerization. Moreover, chain extension polymerization and block copolymerization are achieved and demonstrate the livingness of chain propagation, enabling the facile synthesis of well-defined macromolecular architectures. This work therefore expands the methodology libraries of living polymerization, which may cause inspirations to polymer science.

Proximal phalanx fracture treated with extension block Splint: An observational study at a tertiary care centre

Proximal phalangeal fractures are common fractures of the hand. The fracture are difficult to treat because of vicinity of 2 important joints and presence of tight osseofascious tunnel. The purpose of this study was to evaluate the efficacy of extension block splint in the management of selective proximal phalangeal fracture of hand. 21 Patients with proximal phalangeal fractures were treated by extension block splint and evaluated prospectively. Patient were followed up after 1 week, 3 weeks, and thereafter on monthly basis. Average follow up period was 9.8 months and outcomes were assessed by Belsky’s criteria. In our study, 76.19% patients had excellent outcomes, 19.04% had good, 4.76% had poor outcomes. 2 patients had extensor lag which subsided at further follow up at 1 year. The results of this prospective study shows that with careful selection of patients extension block splint is a simple, safe and effective technique for managing proximal phalanx fracture of hand.

Type 4 congenital proximal radio-ulnar synostosis mimicking as malunited radial neck and deformed radial head with insidious onset extension block: a case report and results after excision

&lt;p class="abstract"&gt;Proximal radio ulnar synostosis is a rare entity presenting with restriction of supination and pronation. Among the various types, type 4 variety is even more-rare and its presentation, can pose a diagnostic challenge specially, if with history of trauma. Radiologically, it is usually overlooked as a malunited radial neck and therefore needs thorough evaluation. We presented a case of a 15-year-old male who complains of new onset extension block following trauma, with chronically restricted supination and pronation. History suggested the restriction in supination and pronation since birth, and the extension block occurring de novo. Radiographs and CT scan of the elbow revealed proximal radio-ulnar synostosis and anteriorly dislocated, mushroom-shaped radial head, misleading and mimicking like an old, neglected and malunited radial neck fracture with a deformed radial head. The family insisted to not address the restriction of supination pronation but, asked for solution to more disabling extension block. Thus, patient was managed with open procedure, involving radial head-neck excision and removal of malformed radial head. At 1-year follow-up, the child has a well-reduced and stable elbow joint with a functional range of flexion and extension movements with restricted supination and pronation. Type 4 congenital radio ulnar synostosis not only leads to conventionally known restriction of supination pronation but also give rise to extension block de novo as presented in this case. Excision of the deformed head and neck can treat the restriction in extension, however the synostosis will require various other augmented procedures.&lt;/p&gt;

Complete Closed Rupture of the Medial Bundle of the Flexor Hallucis Brevis Tendon Off the Medial Sesamoid Insertion

Category: Midfoot/Forefoot; Basic Sciences/Biologics; Sports; Trauma Introduction/Purpose: Flexor tendon injuries of the hallux are uncommon overall but when they happen, the flexor hallucis longus (FHL) tendon is the most frequent one affected. The rupture of FHL usually results from open injuries and deep cuts in the sole at the base of the toe;4 complete subcutaneous ruptures are extremely rare.5 There are around 36 cases reported of complete or partial closed ruptures of the FHL tendon along its entire course6 and the majority of the partial ruptures correspond to dancers and athletes.7 As far as FHB, we found a few reports of calcific tendinitis of the medial bundle and cases of calcifying tendinitis.8 To the best of our knowledge, this is the only case report of isolated closed rupture of the FHB tendon. Methods: A 33-year-old man, amateur soccer player, presented with mild swelling, ecchymosis, and increasing pain in the left hallux triggered by movement and palpation, relieved by rest. He sustained a direct axial blow and blunt force trauma with a soccer ball plus hyperextension. Standard bilateral weightbearing feet radiographs were normal. Physical exam revealed the left hallux normally aligned but with limited painful motion of 20° each way and no obvious instability. Palpation of the left first metatarsophalangeal joint was tender but not particularly over the sesamoids. MRI revealed an avulsion of the flexor Hallucis Brevis tendon off the proximal aspect of the medial sesamoid accompanied by fluid and edema, effusion in the first MTP joint and bone contusions in the first metatarsal head and dorsal base of the first proximal phalanx. Treatment with a toe spacer and postop sandal with the toe straight with an extension block was decided. Results: Tendon's blood flow around the sesamoids is limited making it susceptible to degenerative rupture. The most common mechanism of complete tendon rupture is direct open injury. Closed rupture is very rare and complete rupture in closed injury is even more. We did not find reports on third degree type of injuries, neither for any kind of isolated rupture of FHB. In our patient's case, dorsiflexion stretched all plantar soft tissue around the first MTP but he was able to do active movement of the great toe probably due to the FHL and lateral FHB insertion integrity. We found few reports of second-degree strain injury of FHL and FHB in a chronic setting, all treated conservatively with partial immobilization and strapping of the hallux to prevent extension. After conservative treatment at 3 months follow-up, our patient presented with no subjective complains, normal motion, stability and alignment of the hallux. Conclusion: Despite an extensive literature search, we did not find a similar injury, and this is probably the first time it is described. As found in our research, the most common injury related to the flexor tendons of the hallux are in soccer players and involve the FHL or both.23 These findings made us conclude that these injuries are either under-diagnosed or exceptional.

A case of mucoid hypertrophic degeneration of anterior cruciate ligament with ganglion cyst causing extension block treated with arthroscopic debridement of the cyst and partial debulking surgery

&lt;p class="abstract"&gt;&lt;span lang="EN-US"&gt;Mucoid degeneration of anterior cruciate ligament (ACL) is an uncommon cause of knee pain and restriction of movements. It uncommonly presents with a coexisting ACL ganglion cyst. Typically present between ages of 40-60 years, however, the true incidence and symptoms are variable. We present our experience with one such case with loss of knee extension treated with arthroscopic debulking. The patient regained both full range of motion and resolution of symptoms after the treatment.&lt;/span&gt;&lt;/p&gt;

Performance of Submergence Tolerant Shallow Lowland Rice Variety Swarna sub-1 under Frontline Demonstrations in East and South Eastern Coastal Plain Zone of Odisha, India

Frontline demonstrations on rice crop in 15.4 ha area using submergence tolerant variety Swarna sub-1 were carried out in participatory mode in farmers’ field during Kharif season of 2016, 2017 and 2018 at Ranapur village of Khordha district under East and South Eastern Coastal Plain Zone of Odisha by University Extension Block programme (UEBP) of Odisha University of Agriculture and Technology, Odisha, India. Major constraints of traditional rice cultivation are low productivity in shallow lowland areas due to lack of knowledge and partial adoption of recommended package of practices by rice growing farmers. Therefore, present demonstration programmes have been undertaken to popularize/introduce stress tolerant rice var. Swarna sub-1 in flood prone and shallow lowland areas of Khordha district of Odisha, India. The present study revealed that there was 20.4% increase in average yield of demonstrated field over the farmers practice field of rice crop. An average yield of 45.68 q ha-1 was recorded in demonstration as compared to 37.84 q ha-1 in farmers practice during consecutive three years demonstrations. It might be due to considerable variation in the extent of adoption of improved/recommended technology which was resulted lower yield in farmers practice. Average technology gap, extension gap and technology index was found 12.32 q ha-1, 7.84 q ha-1 and 28.39%, respectively. The demonstrations with improved practice gave higher net return of Indian Rupee (INR) 18180, 26538 and 35605 ha-1 as compared to farmers practices with INR 12987, 16361 and 17294, respectively during Kharif seasons of 2016, 2017 and 2018. The benefit cost ratio (B:C ratio) of rice cultivation under improved practices were found to be 1.42, 1.60 and 1.80 as compared to 1.31, 1.38 and 1.39 under farmers practices. Moreover, the demonstration practice showed maximum 105.88% increase in net returns over farmers practice.

Long-term outcomes after extension block pinning for fracture-dislocations of the proximal interphalangeal joint.

IV.

Clinical Outcome after Extension Block Pinning for Mallet Fractures with Long Fragments: A Never-ending Debate.

Clinical Outcome after Extension Block Pinning for Mallet Fractures with Long Fragments: A Never-ending Debate.