Extension Lag Research Articles

Posttraumatic Osteoarthritis of the Distal Interphalangeal Joint: A Follow-Up Study of 12 Years After Nonsurgical Treatment of Mallet Finger Fractures

In treatment of mallet finger fractures (MFFs), the aim is to minimize residual extension lag, reduce subluxation, and restore congruency of the distal interphalangeal (DIP) joint. Failure to do so may increase the risk of secondary osteoarthritis (OA). However, long-term follow-up studies focusing on OA of the DIP joint after an MFF are scarce. The purpose of this study was to assess OA, functional outcomes, and patient-reported outcome measures (PROMs) after an MFF. A cohort study was performed with 52 patients who sustained an MFF at a mean of 12.1 years (range, 9.9-15.5 years) previously and who were treated nonsurgically. A healthy contralateral DIP joint was used as the control. Outcomes were radiographic OA, using the Kellgren and Lawrence and Osteoarthritis Research Society International classifications, range of motion, pinch strength, and PROMs (Patient-Rated Wrist Hand Evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, Michigan Hand Outcome Questionnaire, 12-item Short Form Health Survey). Radiographic OA was correlated with PROMs and functional outcomes. At follow-up, there was an increase in OA in 41% to 44% of the MFFs. Of all the MFFs, 23% to 25% showed a higher degree of OA than the healthy control DIP joint. Range of motion (mean difference ranging from-6° to-14°) and Michigan Hand Outcome Questionnaire score (median difference,-1.3) were decreased after MFFs but not to a clinically relevant extent. Radiographic OA was weakly to moderately correlated with functional outcomes and PROMs. Radiological OA after an MFF is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint, which does not clinically affect PROMs. Therapeutic IV.

Temporary arthrodesis through static spacer implantation in two-stage treatment of periprosthetic joint infections of the knee.

Treatment of chronic periprosthetic joint infection of the knee requires the removal of the implant and thorough debridement, with reimplantation in asecond stage surgery. Intramedullary spacers can be helpful during the interval between explantation and reimplantation and provide atemporary arthrodesis which fixes the knee in extension preserving leg length and administers local antibiotic therapy. Periprosthetic joint infection of the knee with large bony defects and severe infection of the native joint with advanced destruction/infiltration of the cartilage and bone and/or ligament insufficiency. Suspected antibiotic resistance of the microbiological pathogen to local antibiotic drugs, incompliant patient, and known allergy to bone cement or antibiotic. After implant removal, suitable metal rods are coated with antibiotic-loaded bone cement and inserted into the cleaned intramedullary canals of femur and tibia. Rods are joined at the joint line with aconnector and joint space is filled with more bone cement to achieve temporary and very stable arthrodesis. Partial weight-bearing and no flexion/extension while spacer is in place; second stage reimplantation as soon as infection is controlled. Complications related to the spacer were rare (5.3%). Reimplantation of an implant was possible in 95 of 113patients (84%), of those, 23 (20%) received an arthrodesis. Of the 95patients that were reimplanted, 14 showed signs of recurrent infection. Mean time to last follow-up was 15.6months post reimplantation. Mean knee pain was 2.9/10; overall function was good; 6patients had an extension lag; mean total range of motion was 88°.

Relative motion orthoses for early active motion after finger extensor and flexor tendon repairs: A systematic review

The relative motion (RM) orthosis was introduced over 40 years ago for extensor tendon rehabilitation and more recently applied to flexor tendon repairs. We systematically reviewed the evidence for RM orthoses following surgical repair of finger extensor and flexor tendon injuries including indications for use, configuration and schedule of orthosis wear, and clinical outcomes. Systematic review. A PRISMA-compliant systematic review searched eight databases and five trial registries, from database inception to January 7, 2022. The protocol was registered prospectively (CRD42020211579). We identified studies describing patients undergoing rehabilitation using RM orthoses after surgical repair of acute tendon injuries of the finger and hand. For extensor tendon repairs, ten studies, one trial registry and five conference abstracts met inclusion criteria, reporting outcomes of 521 patients with injuries in zones IV-VII. Miller's criteria were predominantly used to report range of motion; with 89.6% and 86.9% reporting good or excellent outcomes for extension lag and flexion deficit, respectively. For flexor tendon repairs, one retrospective case series was included reporting outcomes in eight patients following zones I-II repairs. Mean total active motion was 86%. No tendon ruptures were reported due to the orthosis not protecting the repair for either the RME or RMF approaches. Variation was seen in use of RME plus or only, use of night orthoses and orthotic wear schedules, which may be the result of evolution of the RM approach. Since Hirth etal's 2016 scoping review, there are five additional studies, including two RCTs reporting the use of the RM orthosis in extensor tendon rehabilitation. There is now good evidence that the RM approach is safe in zones V-VI extensor tendon repairs. Limited evidence currently exists for zones IV and VII extensor and for flexor tendon repairs. Further high-quality clinical studies are needed to demonstrate its safety and efficacy.

Separate vertical wiring plus bilateral anchor girdle suturing fixation for the fractures of the inferior pole of the patella

BackgroundThe fixation of inferior pole fractures of the patella (IPFPs) is still a great challenge for surgeons.Materials and methodsWe introduced a new fixation method for IPFP fixation, that is, separate vertical wiring plus bilateral anchor girdle suturing fixation (SVW-BSAG). Three finite element models including the anterior tension band wiring (ATBW) model, separate vertical wiring (SVW) model and SVW-BSAG model, were built to evaluate the fixation strength of different fixation methods. A total of 41 consecutive patients with IPFP injury were enrolled in this retrospective study, including 23 patients in the ATBW group and 18 patients in the SVW-BSAG group. The operation time, radiation exposure, full weight-bearing time, Bostman score, extension lag versus contralateral healthy leg, Insall–Salvati ratio, and radiograph outcomes were employed to assess and compare the ATBW group and SVW-BSAG group.ResultsThe finite element analysis confirmed that the SVW-BSAG fixation method was as reliable as the ATBW fixation method in terms of fixed strength. Through retrospective analysis, we found that there was no significant difference between the SVW-BSAG and ATBW groups in age, sex, BMI, fracture side, fracture type, or follow-up time. There were no significant differences between the two groups in the Insall–Salvati ratio, 6-month Bostman score, and fixation failure. Compared with the ATBW group, the SVW-BSAG group showed advantages in intraoperative radiation exposure, full weight-bearing time, and extension lag versus the contralateral healthy leg.ConclusionThe finite element analysis and clinical results showed that SVW-BSAG fixation methods are a reliable and valuable for IPFP treatment.

Simultaneous bilateral quadriceps tendon rupture in a healthy young male: a case report

BackgroundSimultaneous bilateral quadriceps tendon rupture is rare, particularly in young individuals with no prior medical history. We present the case of a young man who presented with bilateral quadriceps tendon rupture.Case presentationA 27-year-old Japanese man missed a step while descending a flight of stairs, stumbled, and became aware of severe pain in both knees. He had no past medical history, but was severely obese, with a body mass index of 43.7 kg/m2 (height 177 cm, weight 137 kg). Five days after injury, he was referred to our hospital for examination and treatment. Bilateral quadriceps tendon rupture was diagnosed based on magnetic resonance imaging, and quadriceps tendon repair with suture anchor was performed on both knees 14 days after injury. The postoperative rehabilitation protocol was to immobilize both knees in extension for 2 weeks, then to gradually proceed with weight-bearing and gait training using hinged knee braces. Both knees obtained a range of motion from 0° to 130° without any extension lag by 3 months postoperatively. One year postoperatively, tenderness was evident at the suture anchor in the right knee. That suture anchor was therefore removed in a second operation, and histological evaluation of the tendon of the right knee revealed no pathological changes. As of 19 months after the primary surgery, the patient showed a range of motion from 0° to 140° in both knees, did not complain of any disability, and had fully returned to normal daily activities.ConclusionsWe experienced simultaneous bilateral quadriceps tendon rupture in a 27-year-old man with no past medical history other than obesity. Suture anchor repair was performed for both quadriceps tendon ruptures and achieved a favorable postoperative outcome.

Achilles Tendon-Bone Allograft is Advantageous for Chronic Patellar Tendon Ruptures Using a Modified Fixation Technique

Objectives: A patellar tendon rupture is an extremely disabling extensor mechanism injury. This follow-up study describes the clinical and radiologic outcomes of a new modified technique for reconstructing chronic patellar tendon ruptures. Materials and Methods: From 2014 to 2018, we reconstructed 15 chronic patellar tendon ruptures using Achilles tendon-bone allograft. Clinical and radiologic outcomes were evaluated preoperatively and during the final follow-up, 2 to 7 years after reconstruction. Assessments involved the International Knee Documentation Committee (IKDC), Lysholm, and Kujala scores, as well as quadriceps muscle strength and extension lag. Radiologic results were evaluated using the Insall-Salvati index on plain radiography and allograft integration through magnetic resonance imaging. Results: At the final follow-up, the Lysholm, IKDC, and Kujala scores improved by 57, 58, and 54 points, respectively (P<0.001). The average quadriceps muscle strength improved from 2.6 (2 to 3) before the operation to 4.6 (4 to 5) at the final follow-up (P<0.001). The extension lag also improved significantly from 31.7 degrees (25 to 40) to 0.6 degrees (0 to 10). The preoperative Insall-Salvati index was 1.6 (1.5 to 1.9), which improved significantly to 1.2 (1 to 1.3) postoperatively (P<0.001). Two years after the operation, magnetic resonance imaging showed good allograft integration in all pateints. Conclusion: Combining an Achilles tendon-bone allograft with a robust fixation method led to favorable clinical and radiologic outcomes. Level of Evidence: Level IV.

Complications Following Intramedullary Screw Fixation for Metacarpal Fractures: A Systematic Review

There has been a recent increase in the use of intramedullary screws (IMS) for the surgical treatment of metacarpal fractures. While IMS fixation has been shown to produce excellent functional outcomes, postoperative complications have yet to be fully explored in a comprehensive way. This systematic review quantified the incidence, treatment, and results of complications following IMS fixation for metacarpal fractures. A systematic review was performed using PubMed, Cochrane Central, EBSCO, and EMBASE databases. All clinical studies that documented IMS complications following metacarpal fracture fixation were included. Descriptive statistics were analyzed for all available data. Twenty-six studies were included: 2 randomized trials, 4 cohort studies, 19 case series, and 1 case report. Among the 1,014 fractures studied, 47 complications were reported across all studies (4.6%). Stiffness was the most common, followed by extension lag, loss of reduction, shortening, and complex regional pain syndrome. Other complications included screw fracture, bending, and migration; early-onset arthrosis; infection; tendon adhesion; hypertrophic scar; hematoma; and nickel allergy. Eighteen of the 47 (38%) patients with complications underwent revision surgery. Complications following IMS fixation of metacarpal fractures are relatively uncommon. Therapeutic IV.

Treatment of chronic mallet finger with swan neck deformity using a modified Spiral Oblique Retinacular Ligament (SORL) reconstruction procedure: A case series and technical note.

Chronic terminal extensor tendon injury produces mallet deformity and secondary swan neck deformity. It can be found in neglect cases and in a failed cases after conservative treatment or primary surgical repair. Surgery is considered in cases with extensor lag of more than 30° and functional deficit. Reconstruction of the spiral oblique retinacular ligament (SORL) has been reported in literatures to correct swan neck deformity by a dynamic mechanical basis. Three cases of chronic mallet finger associated with swan neck deformity were treated by the modified technique of SORL reconstruction. Range of motion (ROM) of distal interphalangeal (DIP) joints and proximal interphalangeal (PIP) joints were measured along with the complications. The clinical outcome was reported using the Crawford's criteria. All patients had an average age of 34years (20-54). Average time to surgery was 16.67months (2-24) and average of DIP extension lag was 66.67°. All patient gave excellent Crawford criteria at the latest follow up (average 15.3months). The average PIP joint ROM were -1.60 (00 to -50) of extension and 1100 (1000-1200) of flexion for the PIP joint and -1.60 (00 to -50) of extension and 83.330 (800-850) of flexion for the DIP joint. We present our technique to manage chronic mallet injury which only utilized two skin incisions and one button at the distal phalanx to minimize risk of skin necrosis and patient discomfort. This procedure can be considered as one of the options for the treatment of chronic mallet finger deformity associated with swan neck deformity.

Medial gastrocnemius rotational flap for the reconstruction of extensor mechanism disruption in periprosthetic knee infections: a retrospective series with minimum twoyear follow-up.

Extensor mechanism disruption following total knee arthroplasty has a prevalence ranging from 0.3 to 3%. Its management is challenging, especially in case of associated infection of the prosthetic implant. Surgical options are limited due to the septic process, and the use of allograft or synthetic mesh are not recommended. The aim of this study was to report clinical outcomes, complications, survival, and surgical technique of medial gastrocnemius flap for the treatment of extensor mechanism disruptions associated with periprosthetic knee infection. This is a retrospective study from a prospectively collected arthroplasty registry from 2012 to 2019. Patients who received the gastrocnemius flap in the setting of a two-stage knee replacement for periprosthetic infection were included. Results of physical examination, Knee Society Score, Oxford Knee Score, and measurement of the range of motion registered pre-operatively were compared to those obtained at last follow-up. Survival was analysed through Kaplan-Meier curve. A total of 15 patients were included, with a mean age of 63.4 years (range 36-77). The reconstruction of the extensor mechanism demonstrated a success rate of 73.3%. The mean extension lag at final follow-up was 7.5° (range, 0-30). The mean Knee Society Score and Oxford Knee Score improved from 29.0 (range, 21-36) and 17.5 (range, 13-22) respectively, to 82.9 (range, 74-89) and 36.0 (range, 33-39). Medial gastrocnemius rotational flap is a reliable option for joint and limb salvage in case of periprosthetic knee infection associated with wide soft tissue degeneration and extensor mechanism disruption. The technique and surgical protocol presented in this study are reproducible and guaranteed good clinical outcomes and infection control.

Plating versus Ilizarov Technique for Complex Tibial Plateau Fractures: A Comparative Study on Functional Outcome and Patient Satisfaction

Objective To compare clinical and functional outcomes and complications of open reduction internal fixation (ORIF) by plating and Ilizarov technique in complex tibial plateau fractures. Methods This study is a randomized clinical trial accompanying 56 patients having Schatzker type V and VI tibial plateau fractures. We divided patients into two groups for management. Group I; open reduction internal fixation and Group II; ilizarov technique. We conducted study at the orthopedics department, Jinnah Post-Graduate Medical Center, Karachi, from April-2018 to Oct-2020. The endpoint was to assess patients’ satisfaction and clinical and functional outcomes up to an 18-month follow-up. Results The etiology of tibial fracture was mainly road traffic accident (RTA); 17 (70.9%) in ORIF versus 23 (71.8%) in the Ilizarov group. According to clinical outcomes, excellent extension lag was achieved in 100% of patients in both groups. Most patients had excellent knee flexion, thigh atrophy and instability outcomes (54.1% vs 59.37%, 87.5% vs 81.2% and 83.3% vs. 87.5%). The functional outcome assessment was done and recorded for 18 months of follow-up. There was no significant difference in normal walking, stair climbing, squatting, jumping and duck walking between the groups. The overall rate of complications was similar; 11 (45.8%) in ORIF versus 17 (53.12%) in the illizarov group (p=0.78). Conclusion Our study concludes that there is an excellent clinical and functional outcome found in both procedures as both are safe and effective procedures with fewer complications Keywords Complex Tibial Plateau Fractures, ORIF, Ilizarov Technique

The sitting active and prone passive lag test: a validity study in a symptomatic knee population.

[Purpose] This study aimed to determine the diagnostic utility of the sitting active and prone passive lag test in identifying terminal extension lag in unilaterally symptomatic knees. The lack of full extension at the knee leads to greater force of quadriceps activation, overloading of the weight bearing joints, abnormal gait mechanics, resulting in pain and dysfunction. [Participants and Methods] Participants were randomly assigned and evaluated by two blinded examiners, to determine the presence of extension lag at the knee. The reproducibility of test results between examiners was determined, for reliability. In addition, the ability of the test to identify the presence of extension lag in symptomatic knees and absence of extension lag in asymptomatic knees was assessed, for validity. [Results] The results revealed the test to possess an 'almost perfect' inter-rater reliability, high sensitivity, and moderate specificity. [Conclusion] The sitting active and prone passive lag test may be incorporated as a reliable and valid test to determine the presence of terminal knee extension lag in a unilaterally symptomatic knee population.

Satisfactory outcomes of patellar tendon reconstruction using achilles’ tendon allograft with bone block after infected total knee arthroplasty

PurposeExtensor mechanism disruption is an uncommon and devastating complication after total knee arthroplasty. It negatively affects patients’ quality of life and leads to significant functional limitations and the inability to stand and walk. The purpose of the present study was to evaluate the outcomes of the extensor mechanism reconstruction using Achilles’ tendon allograft after infected total knee arthroplasty. It was hypothesized that it is a safe procedure and that patients will present good clinical and functional results.MethodsTen patients treated for infra-patellar extensor mechanism disruption after infected total knee arthroplasty were prospectively followed for two years. The mean age of patients was 70.8 (range 55–85), with a median BMI of 28.72 ± 2.2 kg/m2. All patients underwent reconstruction using a fresh frozen Achilles tendon allograft. Preoperative and postoperative evaluation included knee-related clinical and functional assessment based on objective and subjective scores, including the knee flexion, the extension lag, the Knee Society Score (KSS) clinical and functional, and the visual analog scale (VAS) for pain at 12 and 24 months. Radiological evaluation was also performed using the Caton-Deschamps index. Reported complications were also recorded.ResultsClinical and functional outcomes recorded significant improvements (p < 0.05) at the final follow-up compared with baseline as follows: Knee flexion was improved from 66° ± 4.8 to 99.7° ± 3.9, and the extension lag was decreased from 28.3° ± 4.4 to 9° ± 2.7. The mean KSS clinical and functional were also improved from 22.6 ± 7.9 to 73.4 ± 3.9 and from 10 ± 13.8 to 55 ± 13.8, respectively. The VAS for pain was decreased from 8.1 ± 1.2 to 1.9 ± 1.2. The Caton-Deschamps index demonstrated a tendency to patella Alta. Two treatment failures were recorded, one patellar dislocation and one re-rupture revised to arthrodesis.ConclusionsExtensor mechanism reconstruction using Achilles’ tendon allograft after infected total knee arthroplasty is an efficient and safe procedure for infra-patellar disruption. The present study’s findings demonstrate that most of the patients (80%) presented significant clinical and functional improvement at two-year follow-up.

Comparison the Range of Motion Following Early Versus Late Active Mobilization after Repairing Surgery on Flexor Tendon Injury in the Zone II: A Randomized Clinical Trial.

Early or delayed mobilization of limb after flexor tendon rupture repairing has an effect on postoperative outcomes, however it is not yet clear whether early or late organ mobilization leads to more likelihood of recovery. We aimed to assess the effects of early and late active limb mobilization through rehabilitation after surgery on the range of motion and hand recovery. This randomized clinical study was performed in Sina Hospital, Tehran, Iran in 2022 on 80 patients with flexor tendon damage in the zone II, who underwent reconstructive surgery of superficial and deep tendons. Patients were randomly (using random number table) divided into two groups that for one group, rehabilitation was done early (starting after three days, n = 53) and for the other group, rehabilitation was done late (starting after three weeks, n = 27). The patients were examined postoperatively and following occupational therapy and the range of motion of their involved joints was calculated. The means PIP extension Lag, PIP active flexion, DIP extension Lag, DIP active flexion and total active motion were all significantly higher in those patients planned for early mobilization as compared to those who considered for late mobilization(P=0.031). Such a significant difference was also revealed adjusting baseline parameters. Compared to the delayed start of hand flexor tendon mobility, the early start of these activities is associated with a much greater improvement in the movement function of this tendon.

CLINICAL RESULTS OF COLLAGENASE TREATMENT FOR DUPUYTREN'S DISEASE: A CASE SERIES STUDY WITH 2-YEARS FOLLOW-UP.

This study aims to report our experience with Clostridium Histolyticum collagenase (CCH) to support the importance of its clinical use and assess its clinical efficacy, complications, and recurrences. This prospective observational study of 66 patients with a 2-year follow-up. Patients with an extension lag major of 20° at the metacarpophalangeal joint (MPJ) and/or proximal interphalangeal joint (PIPJ) were included. We collected data on demographic and anamnestic details, MPJ and PIPJ contracture degrees, DASH score, complications, and recurrences. The mean pre-injection contracture was 34° for MPJ and 31° for PIPJ. At the 2-year follow-up, the mean contracture for the MPJ and PIPJ were respectively 3° and 14.5°. The mean DASH score decreased from 21.8 before injection to 10,4 after 2 years. The disease recurrence occurred in 34.8% of the patients, all with PIPJ contracture. The main complication was skin breakage (25.7%). The CCH injections remain a consistent option in treating DD; withdrawal from the European market deprives surgeons and patients of low invasiveness and safe tool for treating DD. Level of evidence IV, Therapeutic study investigating treatment results, Case series .

Functional Outcome Following Proximal Tibial Osteosarcoma Resection and Reconstruction by Modular Endoprosthesis

PurposeThe proximal tibia is a common location for osteosarcoma. Modular endoprosthesis is a popular reconstructive option, yet it has been associated with many complications. Our study aimed to evaluate the functional outcome and complications of proximal tibial osteosarcoma patients treated by limb salvage using modular endoprosthesis.MethodsA retrospective study of a prospective database was performed during the period between January 2000 and July 2017. Fifty-five patients with proximal tibial osteosarcoma underwent resection and modular endoprosthetic reconstruction. The functional outcome was evaluated using the Musculoskeletal tumor society scoring system and knee range of motion. Postoperative complications were classified according to Henderson classification; Type 1 (soft tissue failure), Type 2 (aseptic loosening), Type 3 (structural failure), Type 4 (infection) and Type 5 (local tumor progression).ResultsThe mean follow-up period was 71.69 ± 49.76 months. The mean musculoskeletal tumor society score was 26.5 ± 2.22; the mean range of motion was 72.63 ± 25.07, and the mean extension lag was 15.09 ± 15.38. Type 1, type 2, type 3, type 4, and type 5 complications occurred in 7.3%, 14.5%, 21.8%, 23.6%, and 5.5%, respectively. Chest metastasis developed in 10 patients (18.2%). The estimated 5-year and 10-year survival rates for the treated patients were 83.6% and 79.9%.ConclusionsProximal tibial osteosarcoma reconstruction with a modular endoprosthesis is a reliable treatment option for retaining limb function. Most complications are manageable.

Determinants of Garlic Producers Market Outlet Choices in Goncha Siso Enese District, Northwest Ethiopia: A Multivariate Probit Regression Analysis

This study investigates the factors influencing garlic producers’ market outlet selection decisions in Goncha Siso Enese District, Ethiopia. A total of 359 garlic producer households were polled, and the results were analyzed using a multivariate probit (MVP) model. According to the MVP model results, extension contact, access to market information, quantity of garlic sold, and farm experience in farming were negatively and significantly associated with the choice of consumer outlet. Besides this, the estimated MVP for retailer outlet choice is positively influenced by the amount of quantity sold, and farm experiences in garlic have a significant and positive effect on the choice of retailer outlets. In contrast, education level, access to credit, extension contact, and land area allocated for garlic have a negative influence on the choice of retail outlet. Moreover, wholesaler outlet choice is significantly and positively influenced by education level, access to credit, amount of quantity sold, extension contact, and distance to market, whereas it is negatively influenced by lagged price. Assembler outlet is also positively influenced by sex, distance to market, access to market information, and quantity sold, and negatively affected by extension contact and lag price. The implication is that, if smallholder garlic producers have access to alternative market outlets, they must select an appropriate combination of market outlets to maximize their income in the long run. It is suggested that equal access to marketing infrastructure in potential production areas, the garlic production system, and rural-urban development infrastructure should be improved and made more accessible.

Management of chronic mallet finger: Indications and long-term results of Fowler central slip tenotomy and distal interphalangeal joint arthrodesis

IntroductionMany surgical techniques have been described to correct the sequelae of chronic mallet fingers (MF), but no clear therapeutic strategy has been defined. We have reported the choice of their management according to the severity of the deformities. Two procedures were compared: Fowler's central slip tenotomy (CST) and arthrodesis of the distal interphalangeal joint (DIP). HypothesisThe use of our decision tree, based on the severity of deformity (flexion deformity at the DIP and recurvatum at the proximal interphalangeal joint), allows good long-term clinical results to be obtained. Material and methodsThirty-three patients (34 fingers) were operated on for sequelae of chronic MF either by CST or by DIP arthrodesis. Patients with ≤35° DIP flexion deformity and <25° proximal interphalangeal (PIP) recurvatum, without DIP joint involvement (osteoarthritis, subluxation, stiffness), were treated with CST. For the others, arthrodesis of the DIP joint was performed. ResultsThirteen patients (13 fingers) were evaluated in the CST group with a mean follow-up of 13 years. There were no postoperative complications and no failures. The mean DIP residual extension lag was 4.23° with complete correction of the PIP recurvatum. All patients would redo the intervention in hindsight. The improvement in Quick-DASH was statistically significant (p=0.01). Twenty patients (21 fingers) were included in the DIP arthrodesis group with a mean follow-up of 10 years. Two failures (9.5%) occurred due to failed correction of the PIP recurvatum. No worsening of the deformities was reported, and they were corrected in 90% of cases. The absence of correction of the PIP recurvatum was more frequent in MF bone (p=0.01). All except 1 (95%) patient, who reported a lack of mobility of the DIP joint, would repeat the procedure. Quick-DASH was improved for all patients. DiscussionCST is effective in correcting deformities in chronic MFs for ≤35° DIP flexion deformity and <25° PIP recurvatum without DIP joint involvement. In other cases, it is preferable to perform a DIP arthrodesis by combining, if necessary, a complementary procedure to correct the PIP recurvatum. Level of evidenceIV, retrospective study.

Early patellar tendon rupture after total knee arthroplasty: A direct repair method.

Patellar tendon rupture after total knee arthroplasty (TKA) is a catastrophic complication. Although the occurrence of this injury is rare, it can lead to significant dysfunction for the patient and is very tricky to deal with. There has been no standard treatment for early patella tendon rupture after TKA, and long-term follow-up data are lacking. To introduce a direct repair method for early patella tendon rupture following TKA and determine the clinical outcomes and complications of this method. During the period of 2008 to 2021, 3265 consecutive TKAs were retrospectively reviewed. Twelve patients developed early patellar tendon rupture postoperatively and were treated by a direct repair method. Mean follow-up was 5.7 years. Demographic, operative, and clinical data were collected. The clinical outcomes were assessed using the Western Ontario and McMaster Universities (WOMAC) score, the Hospital for Special Surgery (HSS) score, knee range of motion, extensor lag, and surgical complications. Descriptive statistics and paired t test were employed to analyze the data. For all 12 patients who underwent direct repair for early patellar tendon rupture, 3 patients failed: One (8.3%) for infection and two (17.6%) for re-fracture. The two patients with re-fracture both underwent reoperation to reconstruct the extensor mechanism and the patient with infection underwent revision surgery. The range of motion was 109.2° ± 10.6° preoperatively to 87.9° ± 11° postoperatively, mean extensor lag was 21° at follow-up, and mean WOMAC and HSS scores were 65.8 ± 30.9 and 60.3 ± 21.7 points, respectively. This direct repair method of early patellar tendon rupture is not an ideal therapy. It is actually ineffective for the recovery of knee joint function in patients, and is still associated with severe knee extension lag and high complication rates. Compared with the outcomes of other repair methods mentioned in the literature, this direct repair method shows poor clinical outcomes.

Volar Transfer of the Lateral Band With Transverse Retinacular Ligament for the Correction of Swan Neck Deformity.

This retrospective study was designed to evaluate a surgical treatment for swan neck deformity of the fingers involving the volar transfer of the lateral band using the transverse retinacular ligament. Ten patients who underwent this surgical procedure for swan neck deformity treatment and were followed up for a mean of 26 months (range: 12-65 months) were included in the study. The dorsally located lateral bands were transferred toward the volar aspect of the finger, and their position was maintained using the transverse retinacular ligament. Improvement of the snapping and swan neck deformity was confirmed by intraoperative active motion of the finger. The active range of motion of the affected finger was evaluated pre- and postoperatively. Extension of the proximal interphalangeal (PIP) joint averaged 30° (range: 20°-40°) preoperatively and improved to -2° (range: -5°-0°) postoperatively. Extension of the distal interphalangeal (DIP) joint averaged -30° (range: -15° to -70°) preoperatively and improved to -15° (range: 0° to -55°) postoperatively. The mean improvement in range of motion of the DIP joint was 15° (range: 10°-25°). The flexion of both the PIP and DIP joint did not significantly change in any of the patients postoperatively. Surgical transfer of the lateral band using the transverse retinacular ligament is effective in correcting mild swan neck deformity. Hyperextension of the PIP joint is corrected well, but the severe extension lag of the DIP joint remains uncorrected postoperatively.

The Use of Relative Motion Flexion Orthoses for Chronic Boutonniere Deformity

This study investigated the effectiveness of a relative motion flexion orthosis (RMFO) for increasing the range of motion for boutonniere deformity. We included 28 patients aged 13-62 years with chronic boutonniere deformity who could complete 0° proximal interphalangeal (PIP) joint extension with the pencil test and were stage 1 according to the Burton classification of boutonniere deformity. At the initial hand therapy appointment, the RMFO was made. The duration of the orthosis usage at the initial therapy session, after stopping the use of the orthosis (posttreatment), and at the follow-up period were noted. The mean time for orthosis usage of all patients was 11.7 weeks (6-40 weeks). The mean initial active distal interphalangeal joint flexion was 47° (0° to 90°) and improved to 66.8° (5° to 110°). The mean initial extension lag of the PIP joint was 22.5° (5° to 55°) and improved to 12° (0° to 30°). This did not change between discontinuation of the orthosis and final follow-up. The use of RMFO is effective in increasing active distal interphalangeal joint flexion and improving PIP extension in patients with Burton stage 1 chronic boutonniere deformity. TYPE OF STUDY/LEVEL OF EVıDENCE: Therapeutic IV.