Interphalangeal Joint Flexion Research Articles

Motion Analysis of the Wrist and Finger Joints in Sport Climbing.

Climbing is a fast-growing sport, with one of the most common injuries being a rupture of the finger flexor tendon pulley. The strain on pulleys increases as finger joints flex. However, to our knowledge, no study has conducted a kinematic analysis of climbers' fingers. Thus, this study aimed to examine finger kinematics during typical climbing tasks. Eleven elite climbers performed a sequence of four climbing moves, which were recorded by an optical motion capture system. Participants used crimp, half-crimp, and open-hand grips for three trials each, with the fourth condition involving campusing using any grip except crimp. Mean proximal interphalangeal joint (PIP) flexion during the holding phase was 87° (SD 12°), 70° (14°) and 39° (27°) for the crimp, half-crimp and open-hand grip, respectively. Hence, inter-individual PIP flexion ranges overlap between different gripping conditions. Two different movement patterns emerged in the open-hand grip, possibly influenced by the use of the little finger, leading to varying degrees of flexion in the middle and ring fingers. Avoiding little finger usage in the open-hand grip may reduce load during pulley rupture rehabilitation. The implications of PIP joint angle variability on individual pulley injury risk or prevention warrant further investigation. Motion capture proved effective for understanding finger kinematics during climbing and could guide future studies on pulley injury risk factors.

Correction of Complex Clawing after Cerebral Infarct via All-Dorsal ECRB Tendon Transfer using Four-Tailed Plantaris Autograft

Clawing refers to pathologic hand posture of metacarpophalangeal joint hyperextension and proximal interphalangeal joint flexion, with variable presentation in appearance and functional deficits depending on underlying etiology, chronicity, and attempts at treatment. Characteristic deficits include the clawed appearance, loss of synchronous finger flexion, weakened grip and pinch strength, and impaired dexterity from loss of fine motor control. Surgical treatment varies for simple versus complex clawing, with additional nuances for associated pathology such as extensor mechanism attenuation, flexor myotendinous tightness, and intrinsic joint contracture. Conditions such as stroke or combined ulnar and median neuropathy require special consideration, as median-innervated myotendinous donors are not suitable. The present technique describes all dorsal extensor carpi radialis brevis tendon transfer via four-tailed plantaris autograft to the lateral bands for treatment of complex clawing after cerebral infarct.

Outcomes of antegrade homodigital neurovascular island flap in fingertip amputations

BackgroundAntegrade homodigital neurovascular island flap (AHIF) is one of the methods used in fingertip amputations to cover the defect area, preserve finger length and obtain a painless and sensitive fingertip. The aim of this study was to evaluate the functional and sensory outcomes in patients who underwent AHIF for fingertip amputation and to analyze the relationship between patient satisfaction and outcome measures. MethodsTwenty patients with a mean age of 37 (18–63) years were analyzed retrospectively. The patients were evaluated in terms of hook nail development, active interphalangeal joint movements, cold intolerance, and sensory function of the flap covered area. Static two-point discrimination test and Semmes Weinstein monofilament test were performed for sensory evaluation. ResultsAll flaps survived completely at the end of follow-up (mean, 36 months; range 11–64 months). Five patients had cold intolerance and two had hook nails. In total, proximal interphalangeal or distal interphalangeal joint flexion contracture developed in 25 % of the patients. The mean static two-point discrimination score was 4.6 ± 1.6 (2–8) and Semmes–Weinstein monofilament test score was 3.48 ± 0.6 (2.44–4.17). Subjective satisfaction levels of the patients were found to be high and did not show a statistical relationship with the measured clinical outcome parameters (p > 0.05). ConclusionsSince AHIF contains a solid and continuous neurovascular pedicle, the probability of necrosis and loss of sensation is low in AHIF. In addition, the graft need of the donor area is not high. Its disadvantage is the rate of restriction of joint movements. Level of evidenceIV.

Direct fixation of fracture fragment with modified double Kirschner wires for the treatment of old bony mallet finger.

The management of old bony mallet fingers is complicated. The purpose of this study was to describe direct fixation of fracture fragment with modified double Kirschner wires (K-wires) for treatment of old bony mallet finger, and to evaluate the functional outcomes during long-term follow-up. Forty-nine patients with old bony mallet finger were enrolled and underwent surgical treatment from August 2014 to January 2021 in our hospital. Patients were divided into two groups according to whether they had undergone triple K-wires fixation or modified double K-wires with a dorsal brace fixation. The operation time, mean number of intraoperative fluoroscopy, bone union time, functional recovery and incidence of complications were monitored. Neither QuickDASH nor visual analogue scale measurement found statistically significant difference between the two groups (P > 0.05). However, the patients that underwent fixation with double K-wires and a dorsal brace required a shorter operation time and fewer intraoperative fluoroscopy, and exhibited a significantly greater mean final active range of the distal interphalangeal joint flexion, compared to those treated with triple K-wires (P < 0.01). Direct fixation of fracture fragment with modified double K-wires was an easy and feasible procedure which could achieve anatomical reduction and stable fixation of the dorsal fracture block of old bony mallet finger with relatively few complications.

Using active or functional range of motion as a further indicator to detect hand osteoarthritis. A preliminary study

Purpose Propose further indicators for helping to detect hand osteoarthritis (HOA) using either active or functional ranges of motion (AROM or FROM). Method Hand kinematics data of 16 hand joint angles from previous studies were used, taken from healthy participants and HOA patients with differently affected joints and distinct levels of compromise. Data consisted of: (i) AROM (extreme values and ranges); (ii) FROM while performing the Sollerman Hand Function Test (mean, extreme percentiles and ranges). Two linear discriminant analyses (stepwise method) were conducted, one per dataset (AROM and FROM), with condition (healthy/patient) as the grouping variable. The potential predictors were the data from the joints with significant differences between samples for each analysis (A-predictors and F-predictors). Results Good sensitivity-specificity values of 85.2–90.9% and 93.8–93.9% for F-predictors and A-predictors, respectively. Sets of predictors corresponded to the joints more commonly affected by HOA. F-predictors: lower maximal flexion of carpometacarpal and interphalangeal thumb joints, higher maximal flexion of thumb metacarpal joint, lower flexion/extension range of ring proximal interphalangeal joint and higher maximal little finger adduction. A-predictors: narrower flexion/extension range of the thumb carpometacarpal joint, lesser extension of the ring metacarpophalangeal joint; lower flexion of the middle finger proximal interphalangeal joint along with a narrower palmar arch range. Conclusion Both sets of predictors provide discrimination capacity of HOA with good sensitivity-specificity, slightly better for A-predictors. The AROM measurement is technically less demanding and can be clinically applied even with manual goniometry.

Clinical Outcomes of Closed Reduction and External Fixation for Isolated Second Metacarpal Base Fracture-Dislocations.

The isolated second metacarpal base fracture-dislocations in adults are rare, and the traditional main treatments include closed reduction with the plaster or splint and open reduction with internal fixation (ORIF). However, closed reduction with the plaster or splint is not solid enough and ORIF can damage the surrounding important tissues. The purpose of this study was to explore the clinical outcomes of closed reduction and external fixation (CREF) for the treatment of isolated second metacarpal base fracture-dislocations. Ten patients who suffered isolated second metacarpal base fracture-dislocations between January 1, 2010, and February 1, 2020, were reviewed. All of the patients were treated by CREF. Radiographs and computed tomography scans were performed regularly after the operation. The grip and pinch strength, visual analog scale (VAS) pain score, American Society for Surgery of the Hand total active movement (TAM) and total active flexion (TAF) scores, Cooney score, Sollerman hand function test (SHFT) score, QuickDASH score, and range of motion of the index finger were recorded at the last follow-up visit to evaluate functional recovery; the injured and healthy hands were compared and we also recorded postoperative complications. The paired samples t-test was used to compare the healthy and injured sides. The patients were followed up for a median of 29.50 ± 4.2 months. There were no significant differences in the grip strength, pinch strength, angle of proximal interphalangeal joint (PIPJ) flexion, or angle of distal interphalangeal joint (DIPJ) flexion between the injured and healthy sides at the final follow-up visit (all p > 0.05). The mean TAM (268.20 ± 4.21) and TAF scores (270.60 ± 4.17) on injured side were significantly lower than those on healthy side (all p < 0.05). The mean Cooney score (93.50 ± 7.47) and SHFT score (78.50 ± 1.08) on injured side were lower, while the mean QuickDASH score (7.05 ± 3.11) on injured side was higher than those on healthy side (all p < 0.05). The mean VAS pain score was 0.50 ± 0.53 on injured side. There were no significant postoperative complications except for traumatic arthritis in one patient without obvious clinical symptoms. CREF achieves the satisfactory curative effect, and the patients obtain the good functional recovery without significant postoperative complications. CREF is a safe and effective treatment for isolated second metacarpal base fracture-dislocations with satisfactory clinical outcomes.

Outcomes Following Repeat Collagenase Treatment of Dupuytren Contracture

Injectable collagenase Clostridium histolyticum has been an effective and well-tolerated nonsurgical treatment option for the management of Dupuytren contracture of the hand. The purpose of this study was to determine the efficacy of collagenase injection and adverse event rate in patients who had undergone previous collagenase treatment. A retrospective chart review was performed on 332 patients treated with collagenase injection for Dupuytren contracture by three fellowship-trained hand surgeons at a single institution from 2009 to 2019. Fifty-nine joints in 45 patients underwent repeat collagenase therapy for recurrent contracture in the same digit. Pretreatment and posttreatment total metacarpophalangeal and proximal interphalangeal joint flexion contractures were recorded, with complete correction defined as <5° residual digital flexion contracture. Postmanipulation skin tears and adverse events were recorded. A comparison was made between average contracture improvement after initial collagenase injection and that after repeat injection. Forty-five patients with an average duration of 30 months (range, 6-73 months) between initial and repeat collagenase therapies were identified. The mean improvement after first collagenase injection was 45° ± 24° (39° for metacarpophalangeal joint and 50° for proximal interphalangeal joint) compared with a mean improvement of 43° ± 23° (41° for metacarpophalangeal joint and 44° for proximal interphalangeal joint) after second injection. Although similar complete correction rates and skin tear rates (32.2 % for initial and 30.5% for repeat) were observed between initial (80%) and repeat injections (73%), the occurrence of adverse events was 3 times higher (3.4% for initial and 10.2% for repeat) in the latter group. Collagenase treatment of Dupuytren contracture yields effective total flexion contracture correction. Repeat collagenase treatment of previously treated digits yields similar deformity correction and complete correction rates but a higher incidence of adverse events. Therapeutic IV.

A Case of Mononeuopathy Multiplex in the Setting of Durvalumab Therapy (P13-8.002)

<h3>Objective:</h3> NA <h3>Background:</h3> As immune checkpoint inhibitors (ICIs) become a mainstay of treatment for several malignancies, neurological complications associated with their use have been increasingly recognized. We present a case of mononeuropathy multiplex (MM) in the setting of durvalumab (PD-L1 inhibitor) use. <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 68-year-old man with stage III non-small cell lung cancer (NSCLC) was seen for the evaluation of asymmetric, painful bilateral upper extremity weakness of 2 months’ duration. He had pre-existing painless glove-and-stocking sensory loss, attributed to cisplatin-induced peripheral neuropathy. Following 4 cycles of cisplatin-based chemotherapy, the patient was started on durvalumab 4 months prior to presentation. Key exam findings included weakness affecting right digit I flexion, wrist and finger extension as well as left interphalangeal joint flexion affecting digits II–V, glove-and-stocking sensory loss, and diffuse areflexia. Upper extremity EMG findings were notable for active denervation changes restricted to multiple bilateral radial- and median-innervated muscles. Following initial assessment, the right wrist drop continued to progress, and a decision was taken to discontinue durvalumab given the concern for peripheral neurotoxicity. The left arm weakness resolved over 3–4 weeks, while the right wrist drop had improved only partially at last assessment 5 months later. The patient had declined a trial of steroids or IVIG. <h3>Conclusions:</h3> The clinical and EMG findings were consistent with MM and bore a temporal relation to durvalumab use. No alternate etiology was identified. ICI-mediated toxicity can result in sensory, motor and autonomic peripheral nerve involvement with a myriad of clinical presentations. In the existing literature, MM has been described with both ipilimumab and nivolumab, but to our knowledge, this is the first reported case of MM with durvalumab use. Early identification of often severe neurological adverse events is crucial due to implications for treatment and decisions regarding continued immune checkpoint therapy. <b>Disclosure:</b> Miss Scurfield has nothing to disclose. Miss Kelly has nothing to disclose. Dr. Desai has nothing to disclose. Dr. Dhanjal has nothing to disclose.

A Cadaver Based Comparison of Two Elastic Tension Proximal Interphalangeal Joint (PIPJ) Extension Orthoses with Focus on Force Generation and Pressure Distribution.

Proximal interphalangeal joint flexion contracture is a frequent condition in hand therapy. Clinicians most frequently apply orthosis management for conservative treatment. Orthoses should apply forces for long periods of time following the total end range time (TERT) concept. These forces necessarily transmit through the skin; however, skin has physiological limitations determined by blood flow. Using three fresh frozen human cadavers, this study quantified and compared forces, skin contact surfaces and pressure of two finger orthoses, an elastic tension digital neoprene orthosis (ETDNO) and an LMB 501 orthosis. The study also investigated the effects of a new method of orthosis construction (serial ETDNO orthoses) that customizes forces to a specific finger position. We evaluated forces and contact surfaces for multiple ETDNO models tailored to the cadaver fingers in multiple PIP flexion positions. The results showed that the LMB 501 orthosis applied pressures beyond the recommended limits if applied for more than eight hours a day. This fact was the cause of time limited LMB orthosis application. This results also show that, at 30° of PIPJ flexion, straight ETDNOs created a mean pressure approaching the end of the recommended pressure limits. If the therapist modified the ETDNO design, the skin pressure decreased and reduced the risk of skin damage. With the results of this study, we concluded that for PIPJ flexion contracture, the upper limit of force application is 200 g (1.96 N). Forces beyond this amount would likely cause skin irritation and possibly skin injuries. This would cause a reduction in the daily TERT and limit outcomes.

Use of a relative motion flexion orthosis with dorsal hood to protect a middle phalanx finger fracture and zone III extensor tendon repair, while correcting a secondary fixed flexion proximal interphalangeal joint flexion contracture: A case report

BackgroundProximal interphalangeal joint (PIPJ) contractures, zone III extensor tendon injuries and phalanx fractures are challenging to treat in isolation. In this case the patient presented with all 3 of these issues in a single digit, presenting a unique problem for the hand therapist. PurposeA case report to examine the effectiveness of using single orthosis to treat an index finger following a combined zone III extension tendon repair, surgically stabilized second phalanx fracture and PIPJ flexion contracture. MethodsA patient presented to therapy with a 40° PIPJ flexion contracture and minus 70° of active PIPJ extension (ICD10 M25.64) after left index surgical fixation of a middle phalanx fracture (ICD10 S62.621B) and zone III extensor tendon repair (ICD10 S66.321A). To correct the contracture, a distal elastic strap was added to a relative motion flexion orthosis with dorsal hood. This applied a gentle extension force to the PIPJ. Once the contracture resolved a short arc motion program (SAM) was initiated using the same orthosis. ResultsAt 20 weeks post initial therapy evaluation, active range of motion (extension/flexion) of the PIPJ was 5°/100° and distal interphalangeal joint (DIPJ) 0°/60°. The Quick DASH score improved 50 points from an initial 59 points to 9 points. The patient reported good satisfaction and full function of the hand. ConclusionOur case report demonstrated the effective use of a single relative motion flexion orthosis with a dorsal hood when treating a complex hand injury involving an open zone III injury, second phalanx fracture and 40-degree PIPJ contracture.

A Comparison between Two Intervals of Daily Total End Range Time for Treatment of Proximal Interphalangeal Joint Flexion Contracture Using an Elastic Tension Digital Neoprene Orthosis

Focusing on fingers with proximal interphalangeal joint flexion contractures, this study seeks to determine whether significant differences exist between the joint passive range of motion PROM improvement when receiving higher doses of daily total end range time (TERT) compared to those that receive lower doses. The study randomized a parallel group of fifty-seven fingers in fifty patients with concealed allocation and assessor blinding. Divided into two groups receiving different doses of daily total end range time with an elastic tension digital neoprene orthosis, they also participated in an identical exercise program. Patients reported orthosis wear time, and the researchers performed goniometric measurements at every session during the three-week period. The primary outcome related the time patients wore the orthosis to the degrees of improvement in PROM extension. Compared to group B (daily TERT of twelve hours), group A (TERT, twenty+ hours) showed a statistically significant greater improvement in PROM after three weeks of treatment. Group A improved by a mean of 29° compared to group B's mean of 19° improvement. This study provides evidence that a higher dose of daily TERT can generate better results in the treatment of the proximal interphalangeal joint flexion contractures.

A randomised clinical trial comparing outcomes of a single digit volar plate injury — Buddy loops versus dorsal thermoplastic orthosis in a neutral position: study protocol

BackgroundVolar plate injuries are a common hand injury and complications associated with this injury such as a fixed flexion deformity, persistent pain and oedema can have a significant impact on a person’s function. The literature reports these injuries are treated using various splinting materials such as thermoplastic, in varying degrees of proximal interphalangeal joint flexion or buddy loops. Despite volar plate injuries being reported as common, optimal non-surgical treatment of these injuries remains unclear.This study aims to investigate whether a dorsal blocking orthosis in a neutral position (00) is more effective than buddy loops for a volar plate injury to the proximal interphalangeal joint in preventing a fixed flexion deformity, reducing pain, managing oedema, and promoting function.MethodsThis study is a single-centre, prospective parallel-group, single blinded (assessor), randomised clinical trial. Patients between 18–65 years, who have sustained a volar plate injury to a single digit, have adequate cognitive functioning and give written informed consent will be invited to participate in this study. Patients will be randomised to either the control group where they will be fitted with buddy loops and commence early active motion exercises or the experimental group where they will receive a dorsal thermoplastic orthosis in a neutral position and commence early active motion exercises. The primary outcome measure is passive proximal interphalangeal joint extension and secondary outcome measures include passive range of motion, total passive motion, active range of motion, total active motion, grip strength, oedema, pain, function and adherence to treatment. Assessments will be completed until 8 weeks following commencement of treatment. The sample size calculation indicates that 23 patients is required in each group. With an expected dropout rate of 25% a total of 32 patients will be enrolled in each group.DiscussionThis study will assist in trying to improve treatment of volar plate injuries and assist in reducing complications associated with volar plate injuries, potentially reducing the need for prolonged hand therapy.Trial registrationThis trial has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622001425785p). Ethical approval has been granted by the South Eastern Sydney Local Health District ethical committee (2022/ETH01697).

What's New in Hand and Wrist Surgery.

What's New in Hand and Wrist Surgery.

Mathematical analysis in the design of digital artery-based V–Y advancement flap in treating proximal interphalangeal joint flexion contracture

BackgroundThe digital artery-based V–Y advancement flap is a widely used flap for soft tissue coverage in the treatment of flexion contracture of the proximal interphalangeal (PIP) joint. A standard method for the flap design and a mathematical method to predict the advance distance have not been well established. In this study, we proposed a simplified method for the design of V–Y advancement flaps based on digital arteries and used a geometric model to predict the advance distance for the flexion contracture correction surgery.MethodsAccording to the general concept of hand flap design and law of cosine, we proposed three principles in the design of the digital artery-based V–Y advancement flap that should be followed. Since 2021 to 2022, finger geometric data of 120 fingers (index, middle, ring, and small fingers) from 30 healthy participants were collected and analysed to evaluate the necessary advance distance and flap tip angle for PIP flexion contracture correction of different fingers by our flap design method.ResultsThe middle finger needed a significantly longer advance distance compared to other fingers in the same degree flexion contracture correction. The ring finger had the largest length-to width ratio and smallest flap tip angle among the four fingers in the V–Y flap design. No vertical scar crossed the flexion creases and flap tip angle < 20° was found in the tentative V–Y flap design for the 120 fingers.ConclusionsOur flap design method provides a proper advance distance and flap length-to-width ratio without common skin complications in the flap design for PIP flexion contracture of index, middle, ring and small fingers. This geometric model provides a mathematical basis for prediction of advance distance and flap tip angle in the design of a digital artery-based V–Y advancement flap.

Evaluation of range of motion of hallux metatarsophalangeal and interphalangeal joints after periarticular osteotomies

Objective: Evaluate the impact of Chevron and extended Chevron techniques associated with Akin osteotomy on the range of motion (ROM) of hallux metatarsophalangeal joint (MPJ) and interphalangeal joint (IPJ) after three months and one year. Methods: Sixteen patients (17 feet) were evaluated for the ROM of hallux MPJ and IPJ pre-and postoperatively, the flexion-extension measurements were performed using a goniometer. Results: Comparing the pre-and postoperative measurements at three months and one year, the ROM decreased in MPJ extension and flexion, 9o and 5o, respectively, and IPJ flexion, 5o. The values presented statistical significance according to the analysis demonstrated (p&gt;0.05). However, the decrease in IPJ extension was not statistically significant (decrease of 0.8o and p&lt;0.05). Conclusions: Periarticular osteotomies of hallux MPJ had a significant decrease in the ROM after three months and one year. Level of Evidence II; Therapeutic Studies - Investigating the Results of Treatment; Prospective Comparative Study.

Precision and accuracy of measuring finger motion with a depth camera: a cross-sectional study of healthy participants.

The purpose of this cross-sectional study was to determine the precision and accuracy of the measurement of finger motion with a depth camera. Fifty-five healthy adult hands were included. Measurements were done with a depth camera and compared with traditional manual goniometer measurements. Repeated measuring showed that the overall repeatability and reproducibility of extension measured with the depth camera were within 3° and 4° and that of flexion were within 13° and 14°. Compared with traditional manual goniometry, biases of extension of all finger joints and flexion of metacarpophalangeal joints were less than 5°, and the average bias of flexion of proximal and distal interphalangeal joints was 29°. We conclude that the measurement of finger extension and flexion of the metacarpophalangeal joints with a depth camera was reliable, but improvement is required in the precision and accuracy of interphalangeal joint flexion.

Evaluation of the activities of the intrinsic and extrinsic muscles of the foot during toe flexion with or without interphalangeal joint flexion using ultrasound shear wave elastography

The intrinsic muscles of the foot are important to maintain the arch of the foot and to participate in sports activities. Using ultrasound shear wave elastography, we investigated the effect of different toe flexion methods on the activity of the intrinsic and extrinsic muscles of the foot. The study included 15 healthy adults who performed toe flexion under 2 conditions: with interphalangeal (IP) joint flexion and without IP joint flexion. The applied load during flexion was 500 g. Muscle stiffness was measured in the abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, quadratus plantae, flexor hallucis longus, and flexor digitorum longus muscles using ultrasound shear wave elastography. Muscle stiffness was statistically compared with IP flexion and without IP flexion (P < 0.05). The stiffness of the abductor hallucis (P < 0.0005), flexor hallucis brevis (P = 0.022), and flexor digitorum brevis muscles (P < 0.0005) was significantly greater without IP flexion than with IP flexion. In contrast, the muscle stiffness of the flexor hallucis longus (P = 0.001) and the flexor digitorum longus (P = 0.004) was significantly greater during with IP flexion than without IP flexion. This study shows that the abductor hallucis, flexor hallucis brevis, flexor digitorum brevis muscles are more active during toe flexion without IP flexion. These results suggest that the toe flexion method is important for more effective training of the intrinsic muscles of the foot.

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.

Neglected tendoachilles tear treated with flexor hallucis longus tendon transfer

Background: Neglected tendoachilles tear is one of the common condition that surgeons encounter and also difficult to manage. In Indian setting the most common reason for tendoachilles tear is lavatory pan injury, followed by road traffic accident. Various methods of treating neglected tendoachilles tear are described in literature but no single method is stated as ideal.Aim: The purpose of this study is to evaluate the technique, difficulties and functional outcome of neglected tendoachilles tear treated with flexor hallucis longus tendon transfer.Materials and Methods: 10 Patients with neglected tendoachilles tear (>4 weeks) are treated with flexor hallucis longus tendon transfer are included in this study. Pre-operative evaluation done both clinically and radio logically. All patients are followed up for a maximum period of 9 months and evaluated at 2 weeks,1,3,6, and 9 months. During follow-up all patients are evaluated using American Orthopaedic Association Foot and Ankle Score.Results: All patients with neglected tendoachilles tear treated with flexor hallucis longus tendon transfer showed an average AOFAS score of 88 and was able to do single heel raise test. All patients have difficulty in hallux interphalangeal joint flexion, but no patients have difficulty in doing day to day activities.Conclusion: Flexor hallucis longus tendon transfer for neglected tendoachilles showed good clinical outcome and patient’s satisfaction with insignificant and minimal complications.

Üç Boyutlu Yazıcı ile Kuğu Boynu Deformitesi için Kişiye Özgü Parmak Ortez Üretimi ve Kullanıcı Memnuniyeti

Amaç: Kuğu boynu deformitesi, proksimal interfalangeal eklemin hiperekstansiyonu, distal interfalangeal eklemin fleksiyonu ile karakterizedir. Tedavi sürecinde, konservatif yöntemlere ek olarak kullanılan ortezlerin çeşitli şekillerde üretimi mevcuttur. Son dönemlerde öne çıkan üç boyutlu (3B) yazıcı teknolojileri ortez üretiminde de kullanılmaktadır. Bu çalışmanın amacı kuğu boynu parmak deformitesi olan kişilere 3B yazıcı kullanarak yüzük ortezi üretmek ve bu kişilerin ortez memnuniyet düzeyini değerlendirmekti.Materyal ve Metot: Çalışma, kişiye özel ortez üretimi ve katılımcıların kullanım memnuniyetinin değerlendirilmesi olarak iki aşamalı olarak yapılandırıldı. Ortezin tasarım aşamasında bilgisayar destekli modelleme kullanıldı. 3B yazdırma sürecinde erimiş birikimli modelleme yöntemi kullanıldı. Termoplastik malzeme olarak polilaktik-asit tercih edildi. Çalışma 10 gönüllü (7 Erkek, 3 Kadın, yaş ortalaması 55,2±5,31) ile gerçekleştirildi. Katılımcıların ortez kullanım memnuniyetleri Quebec Yardımcı Teknoloji Kullanıcı Memnuniyeti Değerlendirme anketi (Q-YTKMD) ile değerlendirildi.Bulgular: 3B yazıcı teknolojisi kullanılarak kişiye özel yüzük ortez üretildi. Q-YTKMD anketindeki 8 soru için kaydedilen ortalama puanlar 5 puan üzerinden 4.00 ile 5.00 arasında değişmekteydi. Katılımcıların yardımcı cihaz memnuniyet ortalamalarının 4,57±0,38 olduğu belirlendi. Katılımcıların öne çıkan 3 memnuniyet kriteri ortez ağırlığı, kullanım kolaylığı ve işe yararlılığı olduğu belirlendi.Sonuç: Çalışma, günümüzde sağlık sektöründe kullanımı giderek artan 3B yazıcılarla kuğu boynu deformitesi için yüksek kullanıcı memnuniyetli, kişiye özel ortezler üretilmesinin mümkün olduğunu ileri sürmektedir.