Finger Proximal Interphalangeal Joint Research Articles

A Suture Method for Collateral Ligaments of the Finger Proximal Interphalangeal Joint: A Cadaver Study.

In a cadaveric model, a comparison was made of the strength of a suture method for collateral ligaments (the N method) with that of simple sutures using suture anchors for the repair of collateral ligaments in the proximal interphalangeal joint. We obtained 72 fingers from 18 upper limbs of fresh-frozen cadavers and compared the left and right sides of the same specimens. In experiment 1, we examined the rupture strength and rupture sites of intact collateral ligaments in 24 fingers. In experiment 2, we compared the rupture strength and failure modes of the N method (three locking sutures) with those of simple sutures (S group) on 32 fingers. In experiment 3, we examined the rupture strength and failure modes between the N method with three locking sutures (N3 group) and the N method with two locking sutures (N2 group) on 16 fingers. All the experiments involved mechanical testing by applying lateral stress to the collateral ligaments at a rate of 1 mm/s using testing equipment. In Experiment 1, the mean rupture strength of intact collateral ligaments was 80.6 ± 27.5 N. Proximal tears were the most common rupture sites. In Experiment 2, the mean rupture strength was significantly higher in the N group (46.3 ± 19.2 N) than in the S group (24.1 ± 12.7 N). In the N group, suture breakage occurred more frequently than in the S group, whereas in the S group, there was a higher incidence of suture cut out. In Experiment 3, the N3 and N2 groups exhibited nearly identical rupture strength values. This study showed that the N method had better rupture strength than the simple suture method following finger collateral ligament repair. The outcome provides useful information for informing the choice of suture method in clinical practice.

Time-domain diffuse optical imaging technique for monitoring rheumatoid arthritis disease activity: experimental validation in tissue-mimicking finger phantoms

Objective. Effective treatment within 3–5 months of disease onset significantly improves rheumatoid arthritis (RA) prognosis. Nevertheless, 30% of RA patients fail their first treatment, and it takes 3–6 months to identify failure with current monitoring techniques. Time-domain diffuse optical imaging (TD-DOI) may be more sensitive to RA disease activity and could be used to detect treatment failure. In this report, we present the development of a TD-DOI hand imaging system and validate its ability to measure simulated changes in RA disease activity using tissue-mimicking finger phantoms. Approach. A TD-DOI system was built, based on a single-pixel camera architecture, and used to image solid phantoms which mimicked a proximal interphalangeal finger joint. For reference, in silico images of virtual models of the solid phantoms were also generated using Monte Carlo simulations. Spatiotemporal Fourier components were extracted from both simulated and experimental images, and their ability to distinguish between phantoms representing different RA disease activity was quantified. Main results. Many spatiotemporal Fourier components extracted from TD-DOI images could clearly distinguish between phantoms representing different states of RA disease activity. Significance. A TD-DOI system was built and validated using finger-mimicking solid phantoms. The findings suggest that the system could be used to monitor RA disease activity. This single-pixel TD-DOI system could be used to acquire longitudinal measures of RA disease activity to detect early treatment failure.

Modern aspects in the treatment of intra-articular fractures and fractures of the proximal interphalangeal joints of the three-phalangeal fingers of the hand, as well as their consequences

BACKGROUND: Proximal interphalangeal joint intra-articular fractures are a prevalent problem in traumatology and orthopedics. Damage typically develops at the base of the middle phalanx due to a collision with the head of the proximal phalanx. As a result, the fingers function declines significantly, which inevitably impacts the function of the entire brush. Compared with long-standing injuries, treating patients with this pathology in the acute period of injury is more likely to result in limb function restoration. Suppose an intra-articular fracture is underestimated or missed in the early stages. In that case, the doctor may eventually encounter chronic pain syndrome, joint and/or stiffness, and more time-consuming treatment procedures. There are many methods of treatment for both acute and long-standing injuries, each with advantages and disadvantages.
 OBJECTIVE: To describe, in our opinion, the most effective modalities of therapy for patients with these injuries in the early stages (up to 4 weeks from the time of injury) and long-term periods (more than 4 weeks).
 MATERIALS AND METHODS: The Suzuki external fixation spoke device (pins and rubber traction system [PRTS]) was used to treat 26 patients with fractures and dislocations of the base of the middle phalanx of the three-phalangeal fingers of the hand in the acute period of injury. Arthroplasty of the base of the middle phalanx with a hook bone graft (hemihamate) with its modifications was used in the treatment of 23 patients with inadequately fused intra-articular fractures of the base of the middle phalanx of the three-phalangeal fingers of the hand. All patients underwent physical examinations, X-rays, and/or CT scans to diagnose and confirm or clarify the nature of the damage. All patients developed passive/active movements early in the operated section during the postoperative period.
 RESULTS: The patient estimated the VAS pain syndrome at 46 points on the scale; however, after 68 weeks, this indicator was 01 points. After 68 weeks, the amplitude of movements in the proximal interphalangeal joint of the fingers from the average of 3050 after 68 weeks, was reached the average of 1595. There was a 1520 extensor contracture in two patients.
 CONCLUSION: The treatment of patients with intra-articular fractures and fracture-dislocations in the proximal interphalangeal joint of the three-phalangeal fingers of the hand, as well as their consequences, is a complex current problem in traumatology and orthopedics with no one-word universal solution. To select treatment strategies, a comprehensive evaluation of the patient, correct verification and interpretation of the existing damage, and a thorough understanding of the anatomy of the fingers and the hand are required.

Charcot Arthropathy of the Digit

Case: Charcot arthropathy (CA) is a progressive degenerative joint disease typically affecting lower extremity weight-bearing joints, with only a few cases reported in the fingers. We present 2 cases of interphalangeal joint CA: the long finger distal interphalangeal joint in a 73-year-old man with severe carpal tunnel syndrome and the ring finger proximal interphalangeal joint of a 71-year-old woman with diabetic neuropathy. Conclusion: Two cases of CA of the digits were treated with splinting with resolution of symptoms and no wound complications.

Treatment of intra-articular fractures and fracture-dislocations fingers of the wrist in acute and long-distant periods

This review is devoted to the problem of treating patients with intra-articular fracture dislocations affecting the finger proximal interphalangeal joint and their consequences. Although these traumas are quite common among hand injuries, there is currently no single universal approach to their treatment. The review was conducted using literature databases, PubMed and eLibrary. The work highlights the joint anatomy, injury mechanisms, diagnostic methods, classification variations, and treatment methods.

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.

Histology of the volar plate of the thumb metacarpophalangeal joint

BackgroundThe aim of the study was to describe the histology of the thumb MCPJ volar plate. MethodsFive fresh-frozen thumbs were dissected. The volar plates were harvested from the thumb MCPJ. Histological analyses were performed using 0.04% Toluidine blue and counterstained with 0.005% Fast green. ResultsThe thumb MCPJ volar plate comprised two sesamoids, dense fibrous tissue and loose connective tissue. The two sesamoids were connected by dense fibrous tissue, with collagen fibers oriented transversely (perpendicular to the long axis of the thumb). In contrast, the collagen fibers within the dense fibrous tissue on the lateral sides of the sesamoid were oriented longitudinally in line with long axis of the thumb. These fibers blended with the fibers of the radial and ulnar collateral ligaments. The collagen fibers in the dense fibrous tissue distal to the sesamoids ran transversely, perpendicular to the long axis of the thumb. The proximal aspect of the volar plate showed only loose connective tissue. The volar plate of the thumb MCPJ was largely uniform with no division of layers from the dorsum to the palmar surface. There was no fibrocartilaginous component in the thumb MCPJ volar plate. ConclusionsThe histology of the volar plate of the thumb MCPJ differs significantly from the conventional understanding of the volar plate, based on the volar plate of finger proximal interphalangeal joints. The difference is likely due to the presence of the sesamoids, which confer additional stability, reducing the need for a specialized trilaminar fibrocartilaginous structure with the lateral check-rein ligaments found in the volar plate of finger proximal interphalangeal joints to confer additional stability.

The Clinical Characteristics of Psoriatic Arthritis: A Cross-Sectional Study Based on the Psoriatic Arthritis Cohort of West China Hospital.

This study aims to describe the demographic, clinical, laboratory, and ultrasonic characteristics of patients with psoriatic arthritis (PsA) in the Psoriatic Arthritis cohort of West China Hospital. In this cross-sectional study, we included patients diagnosed with PsA according to the Classification Criteria for Psoriatic Arthritis, collected their demographic information, medical histories, and treatments, evaluated all domains (skin and nail lesions, tenderness, swelling, enthesitis, dactylitis, and axial arthritis) related to PsA, and then performed descriptive statistical analyses of all data. A total of 275 patients with PsA were included in this study. The ratio of male to female patients was 2.16:1. Skin lesions preceded arthritis in 86.5% of these patients with PsA with a mean interval of 10.1years. The metacarpophalangeal (MCP) joints, proximal interphalangeal (PIP) joints of fingers, and sacroiliac joints are the most commonly involved sites of tenderness, swelling, and the spine, respectively. Among all comorbidities, fatty liver has the highest incidence with 33.1%. Finally, we noted that the mean disease duration of PsA was 4.2years, suggesting a delay in the diagnosis of PsA. Our study proposes that the prevalent population of PsA are male patients with psoriasis over 40years of age who have a long disease course. For patients with PsA, MCP, PIP joints of fingers, and sacroiliac joints are the most frequently affected anatomical sites. With respect to comorbidities, the association between PsA and fatty liver and the underlying molecular mechanisms are worthy of further exploration.

Dynamic study of the finger interphalangeal joint volar plate—motion analysis with magnetic resonance cinematography and histologic comparison

ObjectiveWe aimed to further improve knowledge about volar plate (VP) motion of the finger proximal interphalangeal joint (PIP), by analyzing the dynamic VP shape during a full range of finger flexion using magnetic resonance cinematography of the fingers (MRCF), and to compare the results with anatomical cross sections from cadaver specimens.Materials and methodsThe dynamic sagittal VP shape was visualized with MRCF in a total number of 23 healthy volunteers. The length, angle, and thickness as well as the contact length of the VP to the PIP joint base were measured. Statistical analysis included t-test or rank-sum testing. Anatomical cross sections with differing degrees of PIP joint flexion were obtained from 12 cadaver specimens (fingers) for comparison.ResultsSignificant positive correlations between PIP joint flexion angle and VP area, length, depth and the VP contact length were found. This matched histologically to fiber rearrangements especially within the loose third VP layer.ConclusionOur study analyzed the full range of motion dynamic VP shape of the PIP joint using MRCF. This contributes to a more precise understanding of the complex interaction of the VP with the PIP joint and may facilitate evaluation of clinical cases such as VP avulsion or pulley rupture.

Functional evaluation of optimal index finger proximal interphalangeal joint fusion angle using a simulated joint arthrodesis

This study aims at qualitatively and quantitatively evaluating the effects of simulated index finger proximal interphalangeal (PIP) joint fusion angles on hand kinematic function and performance. Although arthrodesis of the index finger PIP joint is an effective medical procedure that produces a durable, pain-free, and stable joint, it permanently immobilizes the joint. Twenty healthy subjects performed basic functional hand activities with the index finger PIP joint unconstrained (UC) and constrained to selected angles under surveillance of a motion capture system. Our results indicate differences in perceived difficulty, time performance, and the functional ROM of the hand joints when the index finger PIP joint is UC and constrained to 0, 20, and 40 degrees of flexion. The mean total perceived difficulty scores for all 6 tasks were higher for the PIP at 0 degrees than for the UC condition (p < 0.001) and for the PIP at 40 degrees (p = 0.048). The functional ROM presented a smaller total number of hand joints affected by the PIP at 20 degrees (25 in total) than the PIP at 0 (31 in total) and 40 (27 in total) degrees during execution of all 6 tasks tested. Therefore, the decision on the appropriate index finger PIP angle for arthrodesis may be between 20 and 40 degrees, as globally for all 6 tasks tested, 0 degrees exhibited the worst results regarding perceived difficulty, performance time, and number of joints with affected ROM. Selecting the appropriate angle for arthrodesis should consider a more complete set of functional activities.

Mechanical Evaluation of Knee Ligament Allografts for Thumb Metacarpophalangeal and Finger Proximal Interphalangeal Reconstruction

Purpose This study evaluated knee collateral ligaments for use as allografts in small joint reconstruction in the hand, specifically the thumb metacarpophalangeal (MCP) joint ulnar collateral ligament (UCL) and the index finger proximal interphalangeal (PIP) joint radial collateral ligament (RCL), and compared them to the current gold standard, tendon autograft. Methods Uniaxial tensile testing was performed on native thumb MCP UCLs and index finger PIP RCLs and 2.5-mm–diameter grafts prepared from hemi-flexor carpi radialis (hemi-FCR) tendons and knee medial collateral ligaments (MCLs) cadaveric allografts. In situ angular testing was performed in thumb MCP and index finger PIP joints. Each MCP/PIP joint was secured to a mechanical testing system and cyclically loaded. The UCL/RCL was resected and reconstructed with either an MCL or hemi-FCR. Cyclic loading was repeated, followed by angular load to failure. Results Uniaxial testing of MCL allografts demonstrated greater ultimate stress, ultimate load, and elastic modulus than hemi-FCR grafts and native UCLs/RCLs. The maximum angular deviation of the reconstructed MCP and PIP joints was not significantly different compared with the intact joint with either an MCL or hemi-FCR graft. In situ load to failure demonstrated no differences in failure torque or angular stiffness between MCPs reconstructed with a hemi-FCR and MCL allograft, whereas reconstructed PIP joints demonstrated improved angular stiffness with an MCL allograft compared with a hemi-FCR. Conclusions Medial collateral ligament allografts demonstrated improved mechanical properties compared with hemi-FCR tendon grafts during uniaxial testing, and grafts performed equivalently in in situ testing of reconstructed thumb/finger joints. Clinical relevance Prepared knee ligament allografts may provide a viable graft material for use in reconstruction of small hand ligaments. This new allograft material avoids the need to harvest a tendon autograft and has a biologic structure similar to native hand ligaments. This study evaluated knee collateral ligaments for use as allografts in small joint reconstruction in the hand, specifically the thumb metacarpophalangeal (MCP) joint ulnar collateral ligament (UCL) and the index finger proximal interphalangeal (PIP) joint radial collateral ligament (RCL), and compared them to the current gold standard, tendon autograft. Uniaxial tensile testing was performed on native thumb MCP UCLs and index finger PIP RCLs and 2.5-mm–diameter grafts prepared from hemi-flexor carpi radialis (hemi-FCR) tendons and knee medial collateral ligaments (MCLs) cadaveric allografts. In situ angular testing was performed in thumb MCP and index finger PIP joints. Each MCP/PIP joint was secured to a mechanical testing system and cyclically loaded. The UCL/RCL was resected and reconstructed with either an MCL or hemi-FCR. Cyclic loading was repeated, followed by angular load to failure. Uniaxial testing of MCL allografts demonstrated greater ultimate stress, ultimate load, and elastic modulus than hemi-FCR grafts and native UCLs/RCLs. The maximum angular deviation of the reconstructed MCP and PIP joints was not significantly different compared with the intact joint with either an MCL or hemi-FCR graft. In situ load to failure demonstrated no differences in failure torque or angular stiffness between MCPs reconstructed with a hemi-FCR and MCL allograft, whereas reconstructed PIP joints demonstrated improved angular stiffness with an MCL allograft compared with a hemi-FCR. Medial collateral ligament allografts demonstrated improved mechanical properties compared with hemi-FCR tendon grafts during uniaxial testing, and grafts performed equivalently in in situ testing of reconstructed thumb/finger joints.

Smartphone goniometer for reliable and convenient measurement of finger range of motion: a comparative study

**Objective**: Goniometer measurements are commonly used in hand clinics to follow progress or as an outcome measure for acute and chronic conditions. The use of a smartphone goniometer application may provide a practical alternative for clinicians. This study sought to assess accuracy in range-of-motion measurements obtained by a smartphone goniometer application compared to a traditional universal goniometer in healthy and diseased hands.**Methods**: Patients with various hand disease processes were recruited through a tertiary hospital hand clinic, as well as healthy volunteers. Middle and little fingers were assessed at the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints for flexion and extension. Measurements were taken using a universal goniometer and an iPhone® smartphone goniometer application by two independent evaluators using a standardised proforma.**Results**: Twenty patients were recruited (50% male; 13 healthy volunteers and seven with hand pathology). There were no significant differences in measurements using the smartphone goniometer. The only significant difference found using the universal goniometer was for little finger PIP joint flexion; however, the difference was only 2.5°. Comparison of the average measurements using universal and smartphone goniometers found significant differences for six joints, with none of these &gt;5° (largest 4.6°).**Conclusion**: The goniometer iPhone® application is as reliable as traditional goniometry techniques and would be a practical tool for everyday use in hand clinics. Its uptake may provide broader utility for patient self-measurement and telemedicine.

Does Inclination of the Toe Proximal Phalangeal Head Affect the Outcomes of Vascularized Joint Transfers? Retrospective Study of 22 Joint Transfers.

Different shapes of the proximal phalangeal head of toe proximal interphalangeal joints (e.g., oval and circular) are observed in vascularized joint transfers. The difference in shape implies the varying degrees of inclination of the articular surfaces between toes. This study investigated the impact of articular inclination on outcomes after toe joint transfers for finger proximal interphalangeal joint reconstruction. Twenty-one patients who underwent vascularized joint transfer from May of 2009 to May of 2018 were included. Their mean age was 33.4 years and mean follow-up period was 28.9 months. All patients had a type I central slip according to the Te classification. Articular surface inclination was measured on lateral radiographic views. Passive range of motion of the toe proximal interphalangeal joint before vascularized joint transfer was 71.1 ± 9.6 degrees. The functional range of motion of the reconstructed proximal interphalangeal joint was 60.0 ± 17.0 degrees. The extensor lag after the joint transfer was 9.4 ± 19.6 degrees. The articular inclination of the toe joint was 71.9 ± 9.7 degrees. A Pearson correlation analysis of all variables, including age, preoperative range of motion of the toe joint, postoperative range of motion of the reconstructed joint, articular inclination of the toe joint, and extensor lag of the reconstructed joint with toe articular inclination, was performed. There was no significant correlation between articular inclination of the toe joint and extensor lag of the reconstructed joint ( p = 0.226). The articular surface inclination of the toe did not affect the functional range of motion after joint transfer. Risk, III.

Hand kinematics in osteoarthritis patients while performing functional activities

Purpose To identify the impact of kinematic limitations on hand osteoarthritis patients’ ability to perform daily living activities. Methods An experiment was performed on 33 patients and 32 healthy subjects. Active ranges of motion (AROM) of 16 hand joint angles were measured, together with scores of different hand tests of dexterity (Box and Block, Nine Hole Peg, Kapandji) and function (Sollerman Hand Function Test, SHFT). Functional ranges of motion (FROM) were recorded during SHFT tasks. Results by task are also reported. Results Patients’ AROM is limited in flexion of thumb carpometacarpal and interphalangeal, and finger metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, and in palmar arch. Patients scored worse in gross dexterity and opposition, but only Kapandji score was correlated with AROM limitations. Pain is mostly reported in patients with limited extension of finger MCP and PIP joints. Patients used significantly different FROM in almost all the joints, and needed more time to accomplish the SHFT tasks. Conclusions AROM measurements can be used as indicators for early diagnosis. Patients use specific strategies to accomplish each task, arising from AROM limitations; some tasks with very extreme postures. The tasks where precision or force are required for thumb are the most affected ones. Implications for rehabilitation Active range of motion is an indicator for early hand osteoarthritis diagnosis. Patients' functional ranges are reduced, and thumb opposition and gross dexterity are hindered. Rehabilitation should focus especially on tasks requiring precision and thumb strength. Rehabilitation should favor the improvement of task completion times.

The impact of various simulated arthrodesis angles of the proximal interphalangeal joint of the ring and middle finger on grip strength.

Arthrodesis of the proximal interphalangeal (PIP) joint at 40° angle has been proposed by many authors. A smaller angle of arthrodesis results in weaker grip strength of the hand from the quadriga effect. However, arthrodesis at 40° compromises other aspects of hand function including poor aesthetic appearance. This paper aims to quantify the decrease in grip strength at 40°, 20°, and 0° of arthrodesis. Grip strengths of the hand were measured using a BASELINE dynamometer at settings II, III, and IV. Baseline grip strength of the subjects were first measured without wearing a splint. Thereafter, subjects wore thermoplastic splints to simulate arthrodesis of the middle and ring finger PIP joint at 40°, 20°, and 0°, and grip strengths were measured again. The grip strength of the hand with simulated arthrodesis was then calculated as a ratio of the baseline. There were 50 subjects yielding 100 sets of results. The results show that average grip strength ratio of the hand decreases progressively from 40° and 20° and to 0° of arthrodesis for both the middle and ring finger. However, the difference in grip strength ratio between 40° and 20° of arthrodesis was minimal. Simulated arthrodesis of the middle finger affected the grip strength ratio more than arthrodesis of the ring finger, and compromised gripping of a smaller handle more than a wider one. The decrease in grip strength from 40° to 20° simulated fusion of PIP joint was minimal. Therefore, in so far as grip strength loss is concerned, arthrodesis of the PIP joint at an angle less than 40° can be considered for patients with individual functional and aesthetic concerns.

Treatment of Fracture-Dislocations of Proximal Interphalangeal Joint by Applying of Dynamic Mini External Fixator: Clinical and Radiographic Results.

Fracture-dislocations of the proximal interphalangeal joint of fingers are believed to be challenging injuries that usually lead to residual pain and stiffness. To date, several treatment options have been applied. Dynamic traction-external fixation is a safe and easy technique offering good results in many works of literature. The dynamic mini external fixator using K-wires and mini rods provide sufficient dynamic traction and facilitate early mobilization of the injured joint. The present study was conducted to evaluate the results of a dynamic mini external fixator for the treatment of those lesions. In total, 40 patients who suffered from proximal interphalangeal fracture-dislocations were treated at our institution between November 2017 and November 2019. Dynamic mini external fixator device was utilized for their treatment. Clinical and radiographic parameters were evaluated at 2, 4, 6, 12, and 24 weeks after surgery. This study included 30 (75%) males and 10 (25%) females with a mean age of 38.7±9.9 years. In total, 6 (15%) patients had concomitant fractures or fractures in their hands. All the fractures, including 27 (67.5%) dorsal fracture-dislocations and 13 (32.5%) Pilon fractures, were united without the occurrence of any malunion or major residual subluxation. One Pilon fracture needed to be realigned by reassembling the device at the second week of follow-up. Furthermore, 36 (90%) patients achieved full range of joint motion, and 4 (10%) patients had mild loss of motion arc. In addition, 8 (20%) patients developed mild pin site infection treated with oral antibiotics without device removal. Following six months, one (2.5%) patient mentioned minimal residual pain. The dynamic mini external fixator was found to be a safe and applicable technique to manage proximal interphalangeal fracture-dislocations. To obtain significantly accurate results, regular follow-up and accurate device care are of great necessity.

Volar dislocation of the proximal interphalangeal joint

The author reports a volar dislocation of the right-hand ring finger's proximal interphalangeal joint in 65-year-old women presented two days after the injury. Apparent shortening, rotation and ulnar deviation of the finger are the classical clinical findings. Radiographs are essential in differentiating between the variants of volar dislocation. Type 1 dislocation presents as irreducible dislocation because of the entangled proximal phalanx in the buttonhole and always associated with the same side collateral ligament injuries. Type 2 dislocation is reducible because of the central slip rupture and a resultant boutonniere deformity. The author reported a case with a complex spectrum of injury, causing the volar dislocation of the proximal interphalangeal joint with the proximal migration of the middle phalanx and radial displacement. This was because of the same side collateral ligament rupture and central slip avulsion. Central slip reconstruction and radial collateral ligament repair produced a stable, painless joint and a full range of movement at the final follow-up. V • Type 2 Volar dislocation of the proximal interphalangeal joint is rare. • It is reducible and has central slip injury with boutonniere deformity. • Central slip reconstruction and collateral ligament repair produce stable joint.

Is a Right Angle the Right Angle? Normal Coronal Radiographic Alignment in the Pediatric Finger Phalanges.

Quantifying pediatric phalanx fracture displacement requires understanding the normal radiographic alignment of pediatric phalanges, which has never been assessed in the coronal plane, although prior studies have assumed the articular surfaces and physes to be perpendicular to the diaphyses. This study tests the hypothesis that these relationships are not uniformly perpendicular and instead vary by digit and age. Normal hand bone age radiographs were retrospectively reviewed from 40 males and 40 females 2 to 18 years old. For each finger proximal phalanx (P1) and middle phalanx (P2), 2 raters each measured twice the angle between the diaphysis and distal articular surface (D-DA), diaphysis and physis (D-P, when physis present), and diaphysis and proximal articular surface (D-PA). Intra-rater and inter-rater reliability were calculated with intraclass correlation coefficients. 95% confidence intervals were calculated for each angle for each digit, phalanx, age group, and sex to determine which angles ~90 degrees. Variability among ages and sex was assessed with analysis of variance. Intra-rater and inter-rater intraclass correlation coefficients were >0.90, except in P2 ∠D-DA in children under 8 years old with unossified P2 condyles. Overall, only 173 (47.8%) of 362 confidence intervals included 90 degrees. Three angles of the small finger (P1 ∠D-DA, P2 ∠D-P, P2 ∠D-PA) never ~90 degrees at any age or sex, with an average 10 degrees ulnar tilt of the small finger proximal interphalangeal joint. Of the 24 angles across digits and phalanges, 10 varied significantly with age, especially in the index and middle finger P1 where initially wedge-shaped epiphyses progressively became more symmetric with age. The coronal radiographic angles between the phalangeal diaphyses and articular surfaces or physes differ from 90 degrees more than half the time in pediatric fingers, and nearly half the angles vary by age. These findings demonstrate that the articular surfaces and physes of the pediatric finger phalanges are not uniformly perpendicular to the diaphyses, underscoring the need to consider the variability among digits, phalanges, ages and subjects. Level IV.

P046 Pointing the finger: an unusual presentation of dactylitis

Abstract Background/Aims Dactylitis is commonly associated with psoriatic arthritis, and regularly presents at Rheumatology clinics. We discuss a case where progressive systemic symptoms lead to the consideration of alternate diagnoses. Methods A 46-year-old Nepalese woman presented to the Rheumatology department with a 3 month history of diffuse swelling of the right middle finger proximal interphalangeal joint, with the appearance of dactylitis. There was pain on movement, but no other joint involvement. Simultaneously she noticed blurred and decreased vision, which on review by the ophthalmologists, was diagnosed with bilateral uveitis. There was no history of psoriasis, inflammatory bowel disease, or other past medical history of note. There was no travel history in the past 12 months. A diagnosis of a presumed inflammatory arthritis was made. Results Blood tests showed elevated c-reactive protein 55 (normal &amp;lt;4 mg/l), erythrocyte sedimentation rate 138 (normal 0-22 mm/hr) and an iron deficiency anaemia. Rheumatoid factor and Anti-CCP antibody were negative. Hand radiographs were reported as normal. MRI of the third digit confirmed an enhancing soft tissue collection at the proximal phalanx of the right middle finger. She was referred for a biopsy of this lesion. Interestingly over the subsequent few months, she developed progressive breathlessness. Chest radiograph showed a left pleural effusion. Further tests showed negative serum ACE, Lyme and Toxoplasma screen. Quantiferon test was negative. Pleural aspirate showed a transudate with negative Acid-fast bacillus (AFB) test and culture. CT chest and abdomen showed a persistent pleural effusion, inflammatory changes in the small bowel and thickening of the peritoneum and omentum. In view of the systemic involvement, a peritoneal tissue biopsy was performed. This confirmed chronic granulomatous inflammation with positive AFB stain for mycobacterium tuberculosis. Our patient was started on quadruple anti- TB antibiotics for 6 months. Her systemic symptoms and dactylitis have improved, although there is on-going treatment for her ocular involvement. Conclusion Approximately 10% of all cases of extrapulmonary TB have osteoarticular involvement. Dactylitis is a variant of tuberculous osteomyelitis affecting the long bones of the hands and feet. It occurs mainly in young children; however adults may be affected also. The first manifestation is usually painless swelling of the diaphysis of the affected bone followed by trophic changes in the skin. The radiographic changes are known as spina ventosa, because of the ballooned out appearance of the bone, although this was not seen in our case. Fibrous dysplasia, congenital syphilis, sarcoidosis and sickle cell anaemia may induce similar radiographic changes in the metaphysis of long bones of hands and feet, but do not cause soft tissue swelling or periosteal reaction. This case highlights the importance of testing for TB, especially in atypical cases of dactylitis, with other systemic features. Disclosure N. Cernovschi - Feasey: None. J. Wajed: None.

Chronic post-traumatic volar plate avulsions of the finger proximal interphalangeal joint: A literature review of different surgical techniques.

Avulsions of the volar plate of the finger proximal interphalangeal joint (PIPJ) following sprains are often undiagnosed in the acute setting. Therefore, the chronic outcomes of this injury are most frequently the object of study and treatment. Different techniques for volar plate chronic avulsion repair are described in the literature. The most used among these are mainly two: the direct suturing with or without the use of bone anchors and the tenodesis techniques with flexor digitalis superficialis (FDS). The aim of this systematic review is to determine outcomes and complications associated with these surgical treatments of post-traumatic volar plate avulsions without phalangeal fractures. An electronic literature research was carried out and pertinent articles were selected. Surgical techniques details, outcomes and complications for direct sutures and tenodesis technique are discussed. Outcomes (Range of motion and pain) seem to be comparable, whereas authors that use the direct suture technique describe more frequently PIPJ flexion contracture complication. From this review of the literature, authors believe that both techniques are available for the repair of chronic injuries of the volar plate of the PIPJ, although direct suturing can be considered as less reproducible.