Motion Of Distal Interphalangeal Joint Research Articles

Carbodiimide-Derivatized Synovial Fluid for Tendon Graft Coating Improves Long-Term Functional Outcomes of Flexor Tendon Reconstruction.

Flexor digitorum profundus (FDP) tendon injury is common in hand trauma, and flexor tendon reconstruction is one of the most challenging procedures in hand surgery because of severe adhesion that exceeds 25% and hinders hand function. The surface properties of a graft from extrasynovial tendons are inferior to those of the native intrasynovial FDP tendons, which has been reported as one of the major causations. Improved surface gliding ability of the extrasynovial graft is needed. Thus, this study used carbodiimide-derivatized synovial fluid and gelatin (cd-SF-gel) to modify the surface of the graft, thus improving functional outcomes using a dog in vivo model. Forty FDP tendons from the second and fifth digits of 20 adult women underwent reconstruction with a peroneus longus (PL) autograft after creation of a tendon repair failure model for 6 weeks. Graft tendons were either coated with cd-SF-gel ( n = 20) or not. Animals were euthanized 24 weeks after reconstruction, and digits were collected after the animals were euthanized for biomechanical and histologic analyses. Adhesion score (cd-SF-gel, 3.15 ± 1.53; control, 5 ± 1.26; P < 0.00017), normalized work of flexion (cd-SF-gel, 0.47 ± 0.28 N-mm/degree; control, 1.4 ± 1.45 N-mm/degree; P < 0.014), and distal interphalangeal joint motion (cd-SF-gel, 17.63 ± 6.77 degrees; control, 7.07 ± 12.99 degrees; P < 0.0015) in treated grafts all showed significant differences compared with nontreated grafts. However, there was no significant difference in repair conjunction strength between the two groups. Autograft tendon surface modification with cd-SF-gel improves tendon gliding ability, reduces adhesion formation, and enhances digit function without interfering with graft-host healing. The authors demonstrate a clinically relevant and translational technology by using the patient's own synovial fluid to "synovialize" an autologous extrasynovial tendon graft to improve functional outcomes following flexor tendon reconstruction.

Complications and Clinical Outcomes Following Zone I Flexor Tendon Repair Using All-Inside Suture Fixation

The purpose of this study was to evaluate complications and outcomes of an all-inside repair technique for flexor digitorum profundus (FDP) avulsions. A retrospective review of a single institution database identified all FDP avulsions that were repaired using an all-inside technique by a single surgeon. In this method, 2 Keith needles are drilled from the volar to dorsal aspect, exiting proximal to the nail matrix and within the extensor tendon. Nonabsorbable sutures were placed in the flexor tendon and passed through the bone tunnels, tying dorsally over the distal phalanx. The demographics characteristics, injury characteristics, the surgical procedure, postoperative complications, and outcomes were reviewed. Seventeen patients were included in the study. The average age was 40 years (range, 21-68 years), and 2 patients were women. Seventeen fingers were included: 14 ring fingers, 1 index finger, and 2 little fingers. Six patients had an associated distal phalanx fracture and one had an associated distal interphalangeal joint dislocation. The average time between injury and surgery was 9 days (range, 2-18 days). Four patients had complications: 3 with erythema related to infection, which appeared to be a reaction to the suture prompting removal, and 1 with a subungual mass related to the suture at removal. One patient had persistent pain. Postoperative range of motion, assessed using the Strickland criteria, was excellent or good in 5 (33%) of 15 patients, but this was predominantly due to motion at the proximal joints as overall DIP motion was limited. Patients had a mean distal interphalangeal joint range of motion of 24° (range, 0° to 55°). In our series, repair of FDP avulsions via all-inside suture fixation is associated with limited distal interphalangeal joint motion and an incidence of infection (24%) at final follow-up. Therapeutic V.

Efficacy of Tenodermodesis Method in Chronic Mallet Finger Surgery

Objective: To report the efficacy of tenodermodesis surgery on a chronic mallet finger injury.&#x0D; Background: Mallet finger is an injury commonly emerging due to a partial or complete rupture of the extensor tendon's terminal insertion distal to the distal interphalangeal (DIP) joint. Commonly caused by a forced flexion of the DIP joint. &#x0D; Material-Method: A total of 15 patients data was investigated retrospectively. All the patients whose conservative treatment failed and underwent a mallet finger surgery with the tenodermodesis method were included. The technic was slightly modified: Sutures were applied, so they traverse the skin and tendon together after suturing the tendon and capsule.&#x0D; Results: The patients were followed up for up to 24 months. All patients had improvements in DIP joint motion. Nine patients reached a full extension of the DIP joint. According to Crawford's criteria, all the patients have no pain and had an excellent and good score after the procedure. No postop complication was reported. &#x0D; Conclusion: Tenodermodesis method a curative surgery technic with a high success outcome rate for chronic tendinous mallet finger deformity.

Functional improvement by body-powered 3D-printed prosthesis in patients with finger amputation

Rationale:The most common upper limb amputations are finger amputations, resulting in functional limitations that lead to problems with activities of daily living or job loss. For many years, prosthetic options for finger amputations have been limited to passive prostheses. In many countries including South Korea, body-powered finger prostheses have rarely been prescribed due to high cost, lack of experience of physicians and prosthetists, low interest and no coverage by insurance benefits. We report 2 cases of work-related finger amputations in patients who received body-powered 3D-printed finger prostheses.Patient concerns and diagnosis:Patient 1 was a 25-year-old woman with second and third finger amputations at the proximal interphalangeal level. Patient 2 was a 26-year-old man who sustained a second finger amputation at proximal interphalangeal level.Interventions:We created body-powered 3D-printed finger prostheses that mimicked distal interphalangeal joint motion through patient-driven metacarpophalangeal joint motion using a string connected to a wrist strap and a linkage system. The source code “Knick Finger” was downloaded from e-NABLE.Outcomes:After 1 month of prosthesis training, both patients were satisfied with the prostheses and showed improved performance in patient-derived goals of cooking (patient 1) and typing on a computer (patient 2).Lessons:Over the past decade, significant advances have been made in 3D-printed prosthetics owing to their light weight, low cost, on-site fabrication, and easy customization. Although there are still several limitations in the general application of 3D-printed finger prostheses, our study suggests that for patients with finger amputations, body-powered 3D-printed finger prostheses have high potential as an additional prosthetic option to the existing passive cosmetic prostheses.

Conservative versus Surgical Treatment in Management of Closed Mallet Finger:A Systematic Review and MetaAnalysis

Abstract Background Several methods of treatment have been mentioned in management of closed mallet finger injury, as conservative methods using stack splint,dorsal aluminum splint or custom thermoplastic splint, or surgical procedures as direct pinning method, extention block technique or hook plate fixation, there is no consensus for the best method of treatment. Objectives to review and meta-analyze the outcomes of conservative versus surgical treatment in management of closed mallet finger injury and statistically compare between their results of pain, extensor lag, range of motion of distal inter-phalangeal joint. Materials and Methods The review will be restricted to randomized controlled trials (RCTs), clinical trials, and comparative studies, either prospective or retrospective, which studied the outcome of conservative versus surgical treatment in management of closed mallet finger, articles published in English. PRISMA flow chart 950 articles were found using search keywords. By filtration and screening of the title and exclusion of unrelated articles, 150 articles were found. By applications of all inclusion and exclusion criteria, only 55 articles which met all inclusion criteria, 50 studies were systematically reviewed, and 5 randomized controlled trials were fit to undergo a meta-analysis, after conducting meta-analysis we found that P value for pain svore based on visual analogue score (VAS) was 1, extensor lag P value &amp;lt; 0.001, and range of motion P value &amp;lt;0.001. Conclusion No significant differences was found between the conservative and the surgical groups regarding the pain score, distal inter-phalangeal joint extensor lag, and distal inter-phalangeal joint range of motion in treatment of closed mallet finger.

A New Triangular Rotation and Advancement Pulp Flap for Lateral Oblique Fingertip Defect.

Background:The fingertip is one of the most common sites of traumatic injuries faced by hand surgeons. In cases of lateral oblique amputation, only limited alternatives are available for reconstruction. This study introduced a new method involving rotation and use of an advancement pulp flap for covering lateral oblique defect and evaluated its outcome.Method:A series of 12 patients with 14 lateral oblique fingertip defects were recruited in this study. All fingertips were unreplantable and were injured distal to the proximal one-third of nail bed, with phalanx exposed. All cases received surgical reconstruction using a triangular rotation and advancement pulp flap. Static 2-point discrimination, cold intolerance, pain, hypersensitivity, range of motion, and aesthetic satisfaction were evaluated 6 months to 12 months postoperation.Result:Bone defect was noted in 7 cases. The area of defect was 10×7–20×12 mm2, and the angle of defect was 30–60 degrees. Mean follow-up was 14.3 months. No hook nail deformity, cold intolerance, and hypersensitivity were observed. One patient complained about pain postoperation, demanding a second operation. Static 2-point discrimination was between 5 and 8 mm in all cases. Range of motion of distal interphalangeal joint recovered to 20–45 degrees at the last follow-up. No stiffness was observed in the interphalangeal or metacarpophalangeal joints. All patients were satisfied with the appearance of the flap.Conclusion:The triangular rotation and advancement pulp flap is simple, safe, and reliable for treating lateral oblique defect of fingertip, providing scope for anatomical reconstruction and fair sensation and aesthetic recovery.

Silicone arthroplasty versus screw arthrodesis in distal interphalangeal joint osteoarthritis.

The aim of this study was to evaluate patient satisfaction after distal interphalangeal joint silicone arthroplasty and compare this outcome to that achieved with screw arthrodesis. On average 4.4years after surgery, range of motion of the distal interphalangeal joint, pain on a numeric rating scale, satisfaction, and hand appearance of 48 patients (78 treated fingers) were assessed. For arthroplasty patients, mean distal interphalangeal joint motion was 28° with an extension deficit of 17°. Pain was low for arthroplasty and arthrodesis patients with scores of 0.2 and 0.6 out of a total of 10 points, respectively. The patients in both groups were satisfied with their outcomes, but arthroplasty patients were less satisfied with the appearance. Twenty-one percent of the arthroplasties and 15% of the arthrodeses underwent reoperation. We suggest the motion-preserving distal interphalangeal arthroplasty as an alternative to distal interphalangeal arthrodesis for patients with higher functional demands and whose joints are stable preoperatively. In patients attaching importance to hand aesthetics and for unstable joints, distal interphalangeal joint arthrodesis is preferable. Level of evidence: III.

Reconstruction of reflux in fingertip replantation by anastomosis of nailfold vein

Objective To explore the clinical efficacy of anastomosis of nailfold vein in reconstruction of reflux of fingertip replantation. Methods From November 2016 to December 2017, 18 patients with 23 fingers of fingertip amputation in IshikawaⅡ area (from middle nail to nail root plane) were replanted. The parathyroidal longitudinal incision was used to explore and anastomose the nailfold vein to reconstruct the severed finger reflux, and the clinical efficacy was followed up. Results The follow-up period ranged from 8 to 15 months, with an average of 11.1 months. Twenty-one of the 23 fingers survived and two were necrotic. The survival rate was 91.3%. The protective sensation was restored in all surviving fingertips. The two-point discrimination was (8.8±2.4) mm. The active range of motion of distal interphalangeal joint was (49.8±12.3)°, which was 63.4% of the healthy side. The average blood perfusion volume of finger pulp was 89.3% of the healthy side. The complications included cicatricial contracture (5/23), nail deformity (7/23), nonunion (1/23), distal interphalangeal joint dysfunction (4/23), and cold intolerance (4/23). Conclusion The nailfold vein can provide reliable venous reflux in fingertip replantation and restore the good appearance and function of replanted fingertips. Key words: Finger injuries; Replantation; Vein; Microsurgery

Scar overlapping suture for treating chronic tendinous mallet finger in children

PurposeTo evaluate the effect of scar overlapping suture for treating chronic tendinous mallet finger deformity in children.MethodsSix patients younger than 18 years were investigated retrospectively. The active extensor lags of the distal interphalangeal joint (DIPJ) were all more than 40°, and the passive ranges of DIPJ motion were normal. They were all treated surgically by scar overlapping suture technique, featuring careful overlapping suture of the extensor scar and temporary transarticular Kirschner wire fixation of the DIPJ.ResultsAverage follow-up was 3.1 years (ranging from 2 to 5 years). All patients made significant improvement in DIPJ activity. Three patients achieved full active DIPJ extension, whereas one patient had a 10° extensor lag and two patients had 5° extensor lags. All patients achieved normal active flexion ranges and full passive motion ranges of DIPJ compared with their uninjured side. There was no bone dysplasia, pain, or deformity recurrence.ConclusionsScar overlapping suture for treating chronic tendinous mallet finger in children is safe and effective. According to the Crawford criteria, all patients were graded as excellent.

Dorsal transosseous reduction and locking plate fixation for articular depressed middle phalangeal base fracture.

An articular depressed fragment at the base of the middle phalanx can be an obstacle to congruent reduction and stable fixation. This study assessed the outcomes of a transosseous reduction technique combined with locking plate fixation for the treatment of articular depressed middle phalangeal base fracture. Between 2015 and 2017, seven patients (eight fingers) with intraarticular comminuted middle phalangeal base fracture were included in this study. Mean follow-up was 19 months (range 12-30 months). All patients showed depression of the articular fragment on sagittal computed tomography (CT) scan and were treated with a transosseous reduction technique and dorsal locking plate fixation. Radiographic evaluation was performed to ensure restoration of a concentric articular surface postoperatively. Total active range of motion (TAM) of the finger, grip strength, and the quick Disabilities of the Arm, Shoulder and Hand (quick DASH) score were evaluated at the last follow-up. Complications were also assessed. All fractures obtained bony union with a concentric joint. There was no significant loss of reduction during the follow-up period. The mean active proximal interphalangeal (PIP) joint and distal interphalangeal joint motion arcs at follow-up were 89° and 61°, respectively. Mean TAM of the affected finger and mean grip strength were 94% (range 80-100%) and 94% (range 86-100%) of the contralateral side, respectively. Mean quick DASH score was 2.3 (range 0-9.1). All patients returned to work. No surgery-related complications occurred. This technique provides satisfactory restoration of articular congruence and enables the early joint mobilization of articular depression-type fractures of the base of the middle phalanx. Therapeutic, level IV.

Osteomyelitis following Domestic Animal Bites to the Hand: Two Case Reports and Practical Guidelines.

Recently, the number of cases of animal bite wounds has increased significantly in concordance with an increase in the pet population around the world. The authors report two rare cases of osteomyelitis of the phalanx following cat and dog bites. On initial physical examination, signs of a severe infection were observed. Radiographs of both patients showed the presence of osteomyelitis, and in one of the patients, the diagnosis was confirmed with a bone biopsy. After use of empirical antibiotics, intravenous antibiotic therapy that matched the identified bacterium's sensitivity was initiated, and at the same time, secure dressing including debridement was performed to induce secondary healing. In addition, the patients were closely monitored with serial X-rays, and culture and blood test follow-up. One patient fully recovered without sequelae, but the other patient suffered a loss of distal interphalangeal joint motion. When dealing with bite wounds located on the hand, it is important to visit the hospital as soon as possible and receive the appropriate treatment early. Moreover, to prevent severe complications such as osteomyelitis, it is important to administer antibiotic therapy to which the cultured bacteria are sensitive, along with proper wound management and prophylactic antibiotic treatment.

Fingertip replantation (zone I) without venous anastomosis: clinical experience and outcome analysis.

PurposeThe purpose of this study was to report our experience of fingertip replantation without venous anastomosis using alternate method to counter post-operative venous congestion.Methods30 Patients (18 men and 12 women) with 30 fingertip amputations (Tamai zone I) were treated with artery-only anastomosis fingertip replantation between March 2010 and July 2014. Postoperative venous outflow was maintained by allowing bleeding through wound gaps combined with topical (12500u:250mlNS) and systemic (4000 IU SC once daily) heparin. The outcomes of replantation were evaluated using standard evaluating systems.ResultsThe average duration of hospital stay was 10 days (range 7–14 days). Twenty-eight (93 %) replanted fingertips survived. Five replanted fingertip experienced postoperative vascular crisis. The estimated post-operative blood loss was about 200–450 ml (mean, 292 ml). Follow-up period ranged from 12 to 24 months (average, 18 months). At final follow-up examinations, the average value of static two point discrimination test was 5.6 mm (range 3–9 mm) and Semmes–Weinstein monofilament test was 3.35 g (range 2.83–4.56 g). The mean range of motion of distal interphalangeal joint was 65.2° (range 0–90°) and all patients returned to their work within 7–18 weeks (average, 11 weeks).ConclusionArtery-only fingertip replantation can provide satisfactory cosmetic and functional results. Adequate venous outflow can be obtained by allowing minimal external bleeding through wound gaps combined with topical and systemic heparin.

A Systematic Review of Outcomes and Complications of Primary Fingertip Reconstruction Using Reverse-Flow Homodigital Island Flaps.

Fingertip reconstruction using reverse-flow homodigital island flaps has been very popular over the years. However, the outcomes of reconstruction have not been clearly understood. In these circumstances, a systematic review of available literature is warranted. To assess the outcomes and complications of fingertip reconstruction using reverse-flow homodigital island flaps. To justify the usage of reverse-flow homodigital island flaps for fingertip reconstruction. A PubMed [MEDLINE] electronic database was searched (1985 to 15 April 2015). Retrospective case series that met the following criteria were included: (1) Study reported primary data; (2) Study included at least five cases of fingertip defects treated using reverse-flow homodigital island flaps; (3) Study reported outcomes and complications of fingertip reconstruction, either primary or delayed, using reverse-flow homodigital island flaps; (4) The study presented at least one of the following functional outcomes: Static two-point discrimination, return-to-work time, range of motion of distal interphalangeal joints; (5) The study presented at least one complication. Two review authors independently assessed search results, and two other review authors analyzed the data and resolved disagreements. The following endpoints were analyzed: survival rate of the flap, sensibility, and functional outcomes and complications. Eight studies were included in this review. The included studies were published between 1995 and 2014, and a total of 207 patients with 230 fingertip defects were reported. The overall survival rate of the flap was 98 % (including partial survival). The mean static two-point discrimination (2PD) was 7.2 mm. The average range of motion of the DIP joint was 63°. The average return-to-work time was 7 weeks after injury. On average, 2 % of the patient had complete flap necrosis, 5 % had partial flap necrosis, 4 % developed venous congestion, 4 % developed flexion contracture, and 12 % experienced mild-to-moderate cold intolerance. Survival of reconstructed fingertips (98 %) is better with reverse-flow homodigital island flaps than fingertip replantation (86 %). The sensibility outcome using sensate flaps (mean s2PD = 7.2 mm) is similar to the sensibility outcome following replantation (mean s2PD = 7 mm). The common complications include cold intolerance, venous congestion, and flexion contracture. Therefore, reverse-flow homodigital island flaps may not be the ideal choice but are a very reliable alternative for fingertip reconstruction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Reverse second dorsal metacarpal artery vascularized bone flap for index distal bone loss: A case report

Fingertip trauma with resultant bony loss is optimally reconstructed with an autologous bone substitute, offering a unique opportunity for use of a local vascularized bone graft. The second dorsal metacarpal artery is well-described for use in soft tissue and bony reconstruction, with recent cadaveric studies suggesting a reverse-flow second dorsal metacarpal artery bone flap could reach defects in the distal phalanx. The aim of the current report is to illustrate the use of this technique in reconstructing the distal digit in a traumatized index finger with bony loss of the middle third of the distal phalanx. A 49-year-old man presented with a traumatic circular saw injury to his left index finger, with the unique finding of distal phalanx bony loss to the middle third of this bone, with no associated disruption of palmar or dorsal structures. Reconstructive goals were solely that of bony reconstruction, with no soft tissue coverage required. A reverse SDMA vascularized bone flap was successfully used for reconstruction, with the vascularized bone flap mobilized on its reverse SDMA pedicle and pivoted at the level of the distal anastomoses between the palmar and dorsal metacarpal arteries. There was uncomplicated donor and recipient site closures, and good functional outcomes with the ability to retain full distal interphalangeal joint motion and force on distal pinch grip. This case shows that the reverse second dorsal metacarpal artery vascularized bone flap may be undertaken to reconstruct bony loss in the distal phalanx.

A Comparison of K-Wire Versus Screw Fixation on the Outcomes of Distal Phalanx Fractures

To compare K-wire and screw fixation of distal phalanx (DP) fractures with respect to union and functional outcome. This retrospective study identified patients with DP fractures from a clinic registry taken from 2007 to 2013. Clinical data collected included patient demographics, range of motion (ROM), removal of implant (ROI), and complications. Radiographic data collected included fracture type, location, configuration, fracture displacement, and radiographic union. Statistical analysis was done using a chi-squared test for categorical variables and paired Student's t test for continuous variables. A total of 172 patients with DP fractures were seen in our clinic between 2007 and 2013. Of these, 141 patients were managed conservatively and 31 patients had surgery for 33 DP fractures, of which 12 had K-wire and 21 had screw fixation. Mean union incidence for screw was 100% compared with 83% for K-wire. Time to union was 2.4 months for screw fixation compared with 4.1 months for K-wire fixation. ROM for screw fixation was significantly better (60°) compared with K-wire fixation (45°). ROM for non-transarticular K-wire (46°) was similar to transarticular K-wire (44°). ROI was performed in 52% of patients with screw fixation. Other than fingertip tenderness, which resolved after ROI, no other complications were noted. Our study showed that the union incidence and time to union for screw fixation were comparable to those for K-wire fixation. Screw fixation of DP fractures resulted in greater distal interphalangeal joint motion compared with K-wire fixation but required removal in half of cases. Therapeutic III.

Clinical research on finger lateral veins anastomosis for restoring venous return of severed fingertip

Objective To investigate effect of finger lateral veins anastomosis for restoring venous return of severed fingertip.Methods From March 2008 to December 2012,36 patients underwent finger lateral veins anastomosis,including 21 males and 15 females,aged from 15 to 52 years (average,29.5±6.6 years).The thumb was involved in 3 cases,the index finger in 9 cases,the middle finger in 9 cases,the ring finger in 7 cases,and the little finger in 8 cases.The causes of injury included crush injury in 12 cases,electric saw injury in 8 cases,and incised injury in 16 cases.According to type of fingertip injury,there were 14 cases of type Ⅰ,5 cases of type Ⅱ,10 cases of type Ⅲ,and 7 cases of type Ⅴ.The ratios of anastomotic artery and veins were 1∶1,1∶2 or 2∶2 (average,1∶2).Results Thirty-six fingertips survived completely and no venous return obstruction happened,arterial crisis occurred in 3 cases after operation,which were cured after operative and medication treatment.Thirty patients were successfully followed up for 6 to 24 months (average,12.4±2.8 months).The fingers' appearances were satisfactory,finger pulps were plump with good flexibility,and no obvious atrophy of finger was found.The nails were nearly smooth,and the length of nails ranged from 10.5 to 18.9 mm (average,14.4±3.2 mm).The motion of distal interphalangeal joints,the two point discrimination,and the results of sensation measurement ranged from 0° to 70° (average,63°±5°),4.2 to 6.0 mm (average,4.6±0.4 mm),and S3 to S4,respectively.According to Tamai's classification,Tamai score increased from 68 to 100 at final follow-up,the results were excellent in 28 cases,good in 2 cases,with an excellent and good rate of 100％.Conclusion The finger lateral veins anastomosis is an effective method for restoring venous return of severed fingertip,which can avoid venous return obstruction,promote growth of nail,and restore motion and sensation of fingers. Key words: Finger injuries; Veins; Replantation; Reconstructive surgical procedures

Comparison of Surgical Outcomes of Percutaneous K-Wire Fixation in Bony Mallet Fingers with Use of Towel Clip versus 18-Gauge Needle

Purpose: The purpose was to describe comparative analysis of the surgical outcome of percutaneous K-wire fixation of bony mallet fingers reduced with towel clip and 18-gauge needle. Methods: We analyzed the bony mallet finger patients with more than twelve months follow-up after percutaneous K-wire fixation. The patients were randomly divided into two groups. Eighteen fingers were treated with closed reduction using towel clip and 18 other fingers were treated with closed reduction using 18-gauge needle. Results: Radiographs showed bony union and no subluxation in all cases after K-wire removal. The average extension lag was 2.8°/1.9°, and range of motion of distal interphalangeal joint was 70.3°/75° respectively. According to Crawford’s criteria, excellent results were obtained in 9/11 fingers, good results in 8/7 fingers, and poor result in 1/0 finger, respectively. Conclusion: 18-gauge needle reduction in percutaneous K-wire fixation is considered less invasive and useful method for treatment of bony mallet finger with comparable results with towel clip reduction.

Finger Tendon Travel Associated with Sequential Trigger Nail Gun Use

OCCUPATIONAL APPLICATIONS This article reports a method for assessing finger tendon motion associated with the use of a sequential actuation trigger pneumatic nail gun. The two-stage actuation process of the sequential actuation trigger reduces risk of nail puncture injury from unintended nail discharge (relative to the higher risk of the contact actuation trigger). However, widespread adoption of the sequential actuation trigger nail gun throughout the construction industry has been hindered by beliefs about productivity and musculoskeletal concerns about the repetitive trigger actuation and finger motion for each nail fired. Though existing guidelines for finger tendon travel exposure are not well established, predictions derived with the present method combined with productivity standards suggest insufficient evidence to contradict the safety-based recommendation to adopt the sequential actuation trigger trigger. TECHNICAL ABSTRACT Background: Pneumatic nail guns used in wood framing are equipped with one of two triggering mechanisms. Sequential actuation triggers have been shown to be a safer alternative to contact actuation triggers because they reduce traumatic injury risk. However, the sequential actuation trigger must be depressed for each individual nail fired as opposed to the contact actuation trigger, which allows the trigger to be held depressed as nails are fired repeatedly by bumping the safety tip against the workpiece. As such, concerns have been raised about risks for cumulative trauma injury, and reduced productivity, due to repetitive finger motion with the sequential actuation trigger. Purpose: This study developed a method to predict cumulative finger flexor tendon travel associated with the sequential actuation trigger nail gun from finger joint kinematics measured in the trigger actuation and productivity standards for wood-frame construction tasks. Methods: Finger motions were measured from six users wearing an instrumented electrogoniometer glove in a simulation of two common framing tasks—wall building and flat nailing of material. Flexor tendon travel was calculated from the ensemble average kinematics for an individual nail fired. Results: Finger flexor tendon travel was attributable mostly to proximal interphalangeal and distal interphalangeal joint motion. Tendon travel per nail fired appeared to be slightly greater for a wall-building task than a flat nailing task. The present study data, in combination with construction industry productivity standards, suggest that a high-production workday would be associated with less than 60 m/day cumulative tendon travel per worker (based on 1700 trigger presses/day). Conclusion and Applications: These results suggest that exposure to finger tendon travel from sequential actuation trigger nail gun use may be below levels that have been previously associated with high musculoskeletal disorder risk.

Results of vertical figure-of-eight tension band suture for finger nail disruptions with fractures of distal phalanx.

Background:Fingertip injuries involve varying degree of fractures of the distal phalanx and nail bed or nail plate disruptions. The treatment modalities recommended for these injuries include fracture fixation with K-wire and meticulous repair of nail bed after nail removal and later repositioning of nail or stent substitute into the nail fold by various methods. This study was undertaken to evaluate the functional outcome of vertical figure-of-eight tension band suture for finger nail disruptions with fractures of distal phalanx.Materials and Methods:A series of 40 patients aged between 4 and 58 years, with 43 fingernail disruptions and fracture of distal phalanges, were treated with vertical figure-of-eight tension band sutures without formal fixation of fracture fragments and the results were reviewed. In this method, the injuries were treated by thoroughly cleaning the wound, reducing the fracture fragments, anatomical replacement of nail plate, and securing it by vertical figure-of-eight tension band suture.Results:All patients were followed up for a minimum of 3 months. The clinical evaluation of the patients was based on radiological fracture union and painless pinch to determine fingertip stability. Every single fracture united and every fingertip was clinically stable at the time of final followup. We also evaluated our results based on visual analogue scale for pain and range of motion of distal interphalangeal joint. Two sutures had to be revised due to over tensioning and subsequent vascular compromise within minutes of repair; however, this did not affect the final outcome.Conclusion:This technique is simple, secure, and easily reproducible. It neither requires formal repair of injured nail bed structures nor fixation of distal phalangeal fracture and results in uncomplicated reformation of nail plate and uneventful healing of distal phalangeal fractures.

Volar Plating for Unstable Proximal Interphalangeal Joint Dorsal Fracture-Dislocations

To report our results of open reduction internal fixation with volar mini plate and screw fixation for unstable dorsal fracture dislocations (DFDs) of the proximal interphalangeal (PIP) joint. We performed a retrospective review of 13 consecutive DFDs of the PIP joint treated with volar mini plate and screw fixation, measuring both clinical and radiological outcomes. The age range of our patients was 15 to 56 years (average, 33 y). Six injuries were related to work, 5 to sports, and 2 to motor vehicle accidents. Of the 13 DFDs, 6 were comminuted. Articular involvement ranged from 30% to 70% (average, 44%). The average time to surgery was 7 days (range, 0-23 d). Patients had follow-up of 12 to 60 months (average, 25 mo). Four patients had a postoperative course complicated by plate and screw removal at an average of 4 months later, either as part of a secondary procedure to improve range of motion or owing to patient request. All patients returned to their original occupation. Of the 13 patients, 11 were satisfied with the result, and 12 of 13 had either no or mild pain. All 13 DFDs united in good alignment but 3 showed degenerative changes. Average grip strength was 85% of the unaffected side, and average active PIP joint and distal interphalangeal joint motion arcs were 75° and 65°, respectively. Average Quick Disabilities of Arm, Shoulder, and Hand score was 4 (range, 0-9). All patients had non-tender swelling of the proximal interphalangeal joints but no signs of flexor tenosynovitis or infection. Fixation of unstable PIP joint DFDs via a volar approach is technically feasible with mini plates and screws. This treatment allows early active range of motion and provides good objective and subjective outcomes; however, noteworthy complications occurred in 39% of patients. Therapeutic IV.