Swan Neck Research Articles

Multiple dermatofibromas in a patient with Ehlers–Danlos syndrome: a case report

BackgroundDermatofibromas, also known as benign fibrous histiocytomas, are among the most common cutaneous soft-tissue lesions. Association of multiple dermatofibromas with some diseases was described and it has not been reported with Ehlers–Danlos syndrome before. We present a case with Ehlers–Danlos syndrome and multiple dermatofibromas.Case presentationAn 18-year-old Iranian woman presented with multiple purple nodules ranging from 0.5 to 1.5 cm in diameter, which were mobile and located on the proximal part of the lower limb. The dimple sign of these lesions was positive. During the physical examination, several features suggestive of Ehlers–Danlos syndrome were observed, including hyperextensibility and fragility of the skin, wide atrophic scars on the upper limb, hypermobility of joints and fingers, swan neck deformities of the digits, nodules on the knee, and striae alba on the leg. The patient was previously unaware of having Ehlers–Danlos syndrome. She had a history of asthma and atopic dermatitis. Family history was negative. A biopsy of the nodular lesions was performed, and the findings confirmed the diagnosis of dermatofibromas.ConclusionWe describe a patient with Ehlers–Danlos Syndrome who presented with multiple dermatofibromas. To our knowledge, this combination of findings is a previously unreported occurrence.

Comparison of different peritoneal dialysis catheters on complication and catheter survival: A network meta-analysis of randomised controlled trials.

This network meta-analysis (NMA) aimed to compare the clinical advantage of four commonly used peritoneal dialysis catheters (PDCs) including the Swan neck segment with straight tip (Swan neck + S), Tenckhoff segment with straight tip (Tenckhoff + S), Swan neck segment with coiled tip (Swan neck + C) and Tenckhoff segment with coiled tip (Tenckhoff + C). Randomised clinical trials were searched from PubMed, Embase, the Cochrane Register of clinical trials, China National Knowledge Infrastructure (CNKI) and ChinaInfo from their inception until July 31, 2022. Meta-analysis was performed using Stata 14.0 and RevMan 5.3.5 software to evaluate the four commonly used PDCs. Seventeen studies involved 1578 participants were included. NMA showed that compared with Swan neck + C, Swan neck + S significantly reduced catheter tip migration (OR 0.47 95% CI 0.22-0.99). Tenckhoff + S was more effective in reducing catheter dysfunction (OR 0.42, 95% CI 0.23-0.79), catheter tip migration with dysfunction (OR 0.19, 95% CI 0.05-0.78) and catheter removal (OR 0.56, 95% CI 0.34-0.93) which were consistent with the pairwise meta-analysis. According to the surface under the cumulative ranking curve, Swan neck + S emerged as the best PDC in the reduction of catheter tip migration (83.3%), followed by Tenckhoff + S (79.4%). Moreover, Tenckhoff + S (86.5%, 76.3%) and Swan neck + S (72.3, 86.9%) ranked as the first and second PDC for 1 and 2-year technique survival which was significantly higher than those of the other two PDCs. Our NMA showed Swan neck + S and Tenckhoff + S tended to be more efficacious than Swan neck + C and Tenckhoff + C in lowering the mechanical dysfunction and prolonging the technique survival, which may contribute to better clinical decisions. More randomised controlled trials with larger scales and higher quality are needed in order to obtain more credible evidence.

Dorsal capsule release and lateral band translocation for a stiff swan neck deformity without articular involvement.

The treatment for proximal interphalangeal joint (PIP) stiffness in extension requires extensor tenolysis, concomitant procedures to restore flexion, and intensive therapy. A stiff swan neck deformity without articular involvement is rare and the treatment is always challenging. Six patients with stiff swan neck deformities were operated between 2016 and 2023, and the outcome was analyzed retrospectively. A dorsal capsule release and radial lateral band translocation volar to the PIP joint axis were done. This translocation was maintained by a sling formed by the flexor digitorum superficialis and the free margins of the accessory collateral ligament. The range of movements in the PIP joint, visual analog scale (VAS), and functional outcomes were analyzed by the Michigan Hand Outcome Questionnaire (MHOQ) score. The mean follow-up was 49.5months (range 48-52months). The mean preoperative PIP joint extension was 8 (range 5-10) degrees of extension), and the mean preoperative PIP joint flexion was 0. All patients improved after the surgery and the mean flexion of the PIP joint at follow-up was 95 degrees; extension was 1 degree (range 0-5 degrees). The mean Michigan Hand Outcomes Questionnaire (MHOQ) score was 92 (range 90-95) and the VAS was 0. Dorsal capsule contracture release and lateral band translocation to the volar axis of the PIP joint seem to be the possibilities for correcting stiff swan neck deformity. IV, retrospective case study.

Fixation of Mallet Fractures Using a Modified Hook Plate Technique: A Prospective Case Series of 17 Patients.

Objective Various modalities have been suggested to manage mallet fractures; however, inappropriate treatment can lead to extension lag, a swan neck deformity, or arthritis of the distal interphalangeal joint (DIPJ). The current study aimed to evaluate the results (functional, radiological, and complications) of open reduction and internal fixation (ORIF) of mallet fractures using low-cost hook plates fabricated from low-profile titanium mini plates. Methods A prospective case series of 17 consecutive patients (average age of 32.3 years) with mallet fractures (six were Wehbe Type IB and 11 were Wehbe Type IIB). Eleven (64.7%) were males. The affected hand was dominant in all patients, and the affected digit was the index in 6 (35.3%), the ring in 5 (29.4%), the small in 3 (17.65%), and the middle in 3 (17.65%) patients. The same fellowship-trained hand surgeon performed all surgeries. Results The average operative time was 37.65 minutes. After an average follow-up of 10.94 months (range 6-27), the average DIPJ motion was 50° ° (range 20°-70°), the extensor lag was noted in 4 (23.5%) patients, and complications were reported in 6 (35.29%) patients. According to Crawford criteria, 6 (35.3%) patients achieved excellent results, 7 (41.2%) achieved good results, and 4 (23.5%) achieved fair results. Conclusion The modified hook plate technique for fixation of mallet fractures is a beneficial, economical, yet demanding technique that adequately provides stable fixation to allow early DIPJ motion with acceptable functional outcomes.

Surgical Management of Swan Neck Deformity Following Mallet Finger Injury: A Review of 25 Patients Over 20 Years.

Swan neck deformity develops as a sequela of chronic mallet finger. Surgical management can include soft tissue reconstruction or distal interphalangeal joint (DIPJ) fusion. Studies examining the incidence and management of posttraumatic swan neck deformity following mallet fracture are limited. A retrospective, single-institution review of patients undergoing surgical management of swan neck deformity following a traumatic mallet finger from 2000 to 2021 was performed. Patients with preexisting rheumatoid arthritis were excluded. Injury, preoperative clinical, and surgical characteristics were recorded along with postoperative outcomes and complications. Twenty-five patients were identified who had surgical intervention for swan neck deformity. Sixty-four percent of mallet fingers were chronic. Median time to development of mallet finger was 2 months. Twelve (48%) mallet fingers were Doyle class I, 6 (24%) were class III, and 7 (28%) were class IVB. Forty percent of injuries failed nonoperative splinting trials. Sixteen (64%) underwent primary DIPJ arthrodesis, 8 (32%) underwent DIPJ pinning, and 1 underwent open reduction and internal fixation of mallet fracture. The complication rate was 50% overall, and 33% of surgeries experienced major complications. The overall reoperation rate was 33%. Proximal interphalangeal joint hyperextension improved by 11° on average. Median follow-up was 61.2 months. The development of symptomatic swan neck deformity following traumatic mallet finger injury is rare. All patients warrant an attempt at nonsurgical management. Attempts at surgical correction had a high rate of complications, and DIPJ fusion appeared to provide the most reliable solution.

Implementation of Vocal Training Methods from the Stanislavski System in the Kanti Becakap

This vocal training method research is an interpretation of Stanislavski's acting method. This study aims to formulate vocal training methods for actors based on the Stanislavski system. The application of this method is carried out in the Kanti Becakap (Art Community). The material object of this research is "The System" by Stanislavski which is contained in two books, An Actor's Prepares (Translation of Asrul Sani, 1980) and the book Building A Character (Translation of Gramedia Popular Library, 2008). The research method used is a qualitative method with an analytic descriptive approach. The data collection technique used was literature study and the data analysis technique used was inductive analysis. The results of the formulation of the vocal training method from the stanislavski system consist of eight training methods, Vocal Relaxation, Articulation Clarity, Vocal Volume, Musical Dialogue, Swan Neck Intonation, Possibility of Pauses, Accentuation Rules and Instinctive Rhythms. The eight formulations of the vocal training method can be divided into two exercises, namely vocal preparation and dialogue preparation.

#6578 ACUTE KIDNEY INJURY IN PATIENTS WITH VENTRICULAR SEPTAL RUPTURE: A SINGLE CENTER STUDY

Abstract Background and Aims Ventricular septal rupture (VSR) is an infrequent but dreaded complication of acute myocardial infarction(AMI). Acute kidney injury(AKI) is one of the major determinants of morbidity and mortality in these patients. Renal replacement therapy (RRT) is, in this set of patients of high-risk nature and can be prolonged. Focused data on the management of AKI in patients with VSR from developing countries is scarce. We present a large cohort of patients presenting with VSR from a tertiary care Centre in South India, evaluating the incidence of AKI, RRT, and short-term outcomes in this cohort. Method Observational study of all adult patients diagnosed with VSR following AMI over 5 years in a single centre in Chennai, India. Demographic characteristics, co-morbidities,clinical and laboratory,Serial renal function tests and urine output was noted. eGFR was calculated using the CKD-EPI formula.AKI definition and staging -KDIGO clinical Practice Guidelines. Data analysis was done using the IBM SPSS version 24. P-value less than 0.05 is used to indicate statistical significance. Results During the study period, 3024 patients presented to our hospital with acute coronary syndrome (ACS) and seventy patients presented with VSR (2.3%). Of these, forty-seven (67.1%) developed AKI. A nephrology consult was obtained for thirty-three (70%) patients. Older age, higher total count and lower systolic blood pressure were significantly associated with the occurrence of AKI. The mortality in the AKI group was significantly higher (63.8%). VSR closure was done in 12.7% and 21.7% of the AKI and non-AKI groups respectively. Surgical VSR repair was done in 61.7% and 60.8% of the patients with and without AKI respectively. Most of the patients (26, 55.3%) presented with KDIGO stage 3 AKI and all were oliguric. 10 and 11 patients were staged into KDIGO stages 1 and 2 respectively. 26 patients with Stage 3 AKI, only 14 (29.7%%) of them received nephrology consult.. RRT was initiated in fifteen patients (31.9%). The indications for RRT were oliguria, pulmonary oedema, metabolic acidosis, and worsening electrolyte disturbance.Acute peritoneal dialysis was initiated in 11 patients (73.3%) using a 43cm swan neck double cuffed tunnelled Tenckhoff peritoneal dialysis catheter placed at the bedside. Percutaneous peritoneal dialysis catheter insertion by a nephrologist was done in and the rest was inserted by open laparotomy technique by a trained general surgeon. All 11 were initiated on urgent low volume supine exchanges. Of these ten patients had manual exchanges done by a trained peritoneal dialysis nurse and one patient was put on automated peritoneal dialysis. The average volume per dwell was 500 ml±250 ml which was gradually increased if there was no leak. The total average peritoneal dialysis volume per day was 10L±2 L. The strength of bags (1.36%, 2.25%, 3.86%) dextrose was determined based on volume status and patients’ hemodynamics. No patient had a leak or peritoneal dialysis-related peritonitis. All patients’ peritoneal dialysis catheter was immobilized with a tight abdominal dressing. One patient continued continuous ambulatory peritoneal dialysis at home as there was no recovery of renal function and was lost to follow up. Sustained low-efficiency dialysis was performed on four patients. Duration of Sustained low-efficiency dialysis ranged from 6-8 hours with average blood flows of 150 ml/min and average fluid removal between 1.5-3L. Unfractionated heparin was used in three patients, and one was heparin free saline dialysis. Discharge eGFR in the AKI group was significantly lower as compared to the non-AKI group. (38 vs 104ml/min/1.73m2, p<0.001). Follow up was done on 14 at 3 months, The mean eGFR was 57.8ml/min/1.73 m2 when compared to 81.8 ml/min/1.73 m2. Conclusion The incidence of AKI is high and is associated with a high rate of mortality in patients with VSR. Peritoneal dialysis is a safe and effective option for those patients requiring RRT. Follow up of AKI patients at three months did not show a significant decline in renal function

Flexor Digitorum Superficialis Excision for Trigger Finger - A Systematic Literature Review.

Background: Division of one or more slips of the flexor digitorum superficialis (FDS) tendon has been posited as an effective surgical modality for advanced or recurrent trigger finger. This may be an effective approach among patients with diabetes or rheumatoid arthritis, or in those with fixed flexion deformities who have poor outcomes from A1 pulley release alone. However, there is limited evidence regarding the effectiveness of this procedure. The role of this study was to systematically review the evidence on functional outcomes and safety of partial or complete FDS resection in the management of trigger finger. Methods: A systematic review was performed according to PRISMA guidelines. PubMed, Cochrane CENTRAL and Ovid Medline databases were electronically queried from their inception until February 2022. English language papers were included if they reported original data on postoperative outcomes and complications following resection of one or more slips of FDS for adult trigger finger. Results: Seven articles were eligible for inclusion, encompassing 420 fingers in 290 patients. All included studies were retrospective. Isolated ulnar slip FDS resection was the most described surgery. Mean postoperative fixed flexion deformity at the proximal interphalangeal joint was 6.0° compared to 31.5° preoperatively, and the proportion of patients with fixed flexion deformity reduced by 58%. Mean postoperative total active motion was 228.7°. Recurrence was seen in 4.7% of digits, and complications occurred in 11.2% of cases. No post-surgical ulnar drift or swan neck deformities were observed. Conclusions: FDS resection for long-standing trigger finger, or in diabetic or rheumatoid populations, is an effective and safe technique with low rates of recurrence. Prospective and comparative studies of this technique would be beneficial. Level of Evidence: Level III (Therapeutic).

Analisis Sanitasi Dasar Wilayah Pesisir Dusun Talaga Ratu

Coastal communities are a group of people who live together inhabiting coastal areas and then form and have a distinctive culture related to their dependence on the use of coastal resources. Basic sanitation is a minimum environmental health requirement that every family must have to meet their daily needs. The scope of basic sanitation is the provision of clean water, disposal of household waste, provision of healthy latrines and clean water facilities. The purpose of this research is to identify basic sanitation in Waitasi Hamlet. The type of research method used is descriptive observation research. Based on the results, it can be concluded that clean water facilities with clean water supply facilities in the Waitasi Hamlet community which have their own, odorless, colorless, tasteless as much as 1 4 KK (93.3%). facilities for the availability of clean water that are not their own, odorless, colorless, tasteless as much as 1 family (6.7%). Family latrine facilities in the Waitasi hamlet community have not met the requirements for providing family latrines that are not in the form of a goose neck and have a septic tank of 10 families (66.7%). for latrines that are not swan neck, and have a lid, channeled to the river/kolam are 2 families (13.7%) and for latrines with a goose neck saptic tank it is 1 household (6.7%). Waste water disposal facilities in the Dusun Waitasi community do not meet the SPAL requirements and are channeled into open sewers as many as 6 people (40.0%), who have impregnated and do not pollute water sources (distance to water source >10 meters) as many as 6 people (40.0) , and 3 people who have SPAL and have closed sewers (City Channels) for further processing (20.0%). Most of the waste disposal facilities in the Dusun Waitasi community do not meet the requirements, namely 11 families (73.3%). people do not have waste disposal facilities and tend to use plastic bags, sacks and boxes for temporary disposal and then throw them to the beach and rivers. there are 4 families (36.7) that have garbage disposal facilities but are not watertight.

Rhupus – a combination of systemic lupus erythematosus and rheumatoid arthritis as a separate disease phenotype (a clinical case)

Rhupus is a rare combination of systemic lupus erythematosus (SLE) and rheumatoid arthritis, one of the characteristic features of which is the development of erosive polyarthritis on the background of the main immunological signs of SLE. The article presents a clinical observation in which, along with the typical immunological picture of SLE, the patient was diagnosed with erosive polyarthritis with “swan neck” type deformities of the hand joints, which required administration of anti-B-cell therapy.

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

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

Design, Manufacturing, and Trial of a 3D Printed Customized Finger Splint for Patients with Rheumatoid Arthritis

Rheumatoid arthritis has become one of the most common inflammatory diseases and plays a major role in the disability of the population affected by it. The prevalence of finger deformities in the upper extremity caused by rheumatoid arthritis is increasing day by day, especially in low and middle-income countries such as India. For the management of these finger deformities, the splinting options are either customized or prefabricated. The performance and success of finger splinting depend on several factors, including precision, aesthetics, patient acceptance, comfort, the convenience of usage, effects, price, and side effects. However, to date, customized splints are high-cost and usually fabricated by conventional production techniques, which dominantly work on approximation. This study focused on the development of a novel finger splint through computational optimization and 3D printing for the management of boutonniere and swan neck deformity caused by rheumatoid arthritis. Twenty subjects with finger deformities were recruited, and the performance of the 3D-printed splint was characterized. The results were assessed using the nine-hole peg test and QUEST 2.0, which showed positive effects of the splint, including achievement of corrected joint positions, finger dexterity, and comfort. Such a low-cost and effective splint, with further acceptability testing, is anticipated to be a better line of conservative management for patients affected by rheumatoid arthritis.

CONGENITAL SWAN NECK DEFORMITY: A CASE REPORT AND REVIEW OF LITERATURE

Many theories have been suggested for the etiology of congenital swan neck deformity. The one main theory is that there is a lack of anatomical balance of the extrinsic and intrinsic muscles of the finger that is affected. Also, due to the imbalance between the flexors and extensors, flexion at the proximal interphalangeal joint results. As the patient gets older, there is increased lag in the extensors leading to worse flexion deformity, and this is mainly an aesthetic rather than a purely functional problem.A seven-month-old female infant presented with a hand deformity (congenital swan neck deformity on the fifth finger) that started appearing spontaneously and insidiouslywhen the infant was six months old. Operations for this type of deformity can range from skin plasties, artholysis, tenotomies, tendon transfers, and osteotomies to arthrodesis.Postoperative care consists of a splint, in which the duration in which it is kept is based on the technique used.

Reconstructive Surgery of Ulnar Claw Hand in Leprosy Patients by Lasso Procedure

Leprosy, Hansen's disease caused by mycobacterium leprae, is widely known. Though there has been a substantial achievement in recent years given eliminating the disease, the deformity caused by the disease needs to be managed by reconstructive surgery. The ulnar nerve being superficial, is the most common nerve affected. When affected, the muscles innervated by the nerve begin to weaken, leading to a disparity between the strong extrinsic muscles and the weakened intrinsic muscles and is characterized clinically by metacarpophalangeal joint hyperextension and flexion of the proximal and distal interphalangeal joint. Doing reconstructive surgery on these patients will help them carry out day-to-day activities and reduce social awkwardness. Corrective surgeries like modified Stiles-Bunnell transfer, extensor carpi radialis graft, Zancolli lasso procedure, and palmaris longus tail graft are known to us. Out of all, the Zancolli lasso procedure was chosen for operating on all our cases because all other surgeries need high precision with proper training and proper post-operative physiotherapy. The study aims to evaluate the functional outcome of patients with leprotic ulnar claw hand operated with the Zancolli lasso procedure. Objectives assessed were deformity correction, grip strength, and range of motion. During the last two years, ten patients with ulnar claw hands came to Sree Balaji Medical College and Hospital, Chennai. They were operated on with the Zancolli Lasso procedure with adequate results. The zancolli procedure is easy to do and can be done in small centers, which restores finger flexion and doesn’t harm other superficialis tendons, thus preventing swan neck deformity of the fingers.

Swan neck deformity: a review of its causes and treatment options

Swan neck deformity is characterized by hyperextension of the proximal interphalangeal joint and limited extension of the distal interphalangeal joint, showing the shape of a swan’s neck. The deformity can occur either acutely or chronically. A common acute cause of this deformity is trauma, and a common chronic cause is a secondary deformity due to rheumatoid arthritis. The treatment of swan neck deformity tends to depend on the knowledge and experience of the physician because the number of cases that hand surgeons can experience is limited, and there are no clear guidelines on treatment options. This review introduces the known causes of swan neck deformity and its treatment options. For swan neck deformity, the cause of the deformity, the elapsed time, the stage of the deformity, the biomechanical relationship between adjacent joints, and the functional limitations and needs of the patients must be considered when determining the treatment method. Based on these considerations, an appropriate choice should be made between nonsurgical and surgical treatment. The patients should receive a full explanation before treatment that an optimal outcome is not always guaranteed. The treatment process requires full understanding and cooperation from the patient.

Pitfalls and suggestions for the treatment of open, comminuted fractures of the middle phalanx using custom-made dynamic external fixators: a retrospective case series

Background: The proximal interphalangeal joint (PIPJ) is a synovial joint prone to injury encompassing a wide spectrum of severity. In the setting of complicated injuries, dynamic external traction systems are considered to be the optimal treatment modality with numerous different Kirschner-wire configurations combined with rubber bands, springs, pulleys, or hinges being described. However, many of these pose significant technical challenges for the surgeon or are unwieldy to the patient emphasizing the need for simple, easy to construct, and well-tolerated modifications, which are equally effective in reducing the fracture and allowing early motion. Methods: The authors retrospectively analyzed prospectively collected data of 12 patients with open complex PIPJ fracture dislocations treated with a custom-made external fixator based on the one that was originally suggested by Suzuki et al. All patients were men with an average age of 55.1 yr (23 to 81). Injured digits involved four index, five middle, and three ring fingers. Results: The mean follow-up was 54.36 mo, and all patients healed without a second operation and returned to their jobs and preinjury level of activity. The average active range of motion of the PIPJ was 75.16±3.18 degrees, DIPJ was 69.33±14.7 degrees, and MCPJ was 88.75±1.97 degrees. Mean Quick Disabilities of Arm, Shoulder, and Hand (DASH)-Japan Society for Surgery of the Hand (JSSH) score at the final examination was 4.33±1.38 (range 2.3 to 6.8). The authors recorded five complications involving two rubber bands breaking, one pin-track infection, one rubber band-axial traction pin malposition, and one swan neck deformity, which were treated accordingly. Conclusions: One of the most crucial factors affecting outcome in this kind of injury is the appearance of the digit and functional results. None of the participants in this series had any complaint about the appearance of their fingers in the final examination, and 10 out of 12 judged the cosmetic result as very good. To the authors' knowledge, this report is one of the few that describes the functional outcome of pins and rubbers traction system (PRTS) application in complex fracture and fractures-dislocations with severe comminution of the middle phalanx and not only fractures related to the PIP joint. Level of Evidence: Level V.

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

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

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.

Striatal Hand Deformities in Parkinson's Disease: Hand Surgical Perspectives.

The knowledge about striatal hand deformities (SHD) in Parkinson's disease (PD), has recently increased but need more attention due to their early impact on dexterity. The focus of clinical studies has been on the staging of SHD severity and neurological features. However, a hand surgical perspective has not been considered. Our purpose was to examine SHD in patients with PD using hand surgical assessment methods and the recommended staging of SHD. In this observational study, a specialist in neurological physiotherapy examined 100 consecutive PD patients and identified 35 with suspected SHD, who were then examined by two hand surgeons. Their hands were clinically evaluated for severity of SHD, according to a previous proposed staging, focusing on metacarpophalangeal (MCP) joint flexion, presence of intrinsic and extrinsic tightness, as well as other hand deformities. Three kinds of deformities were identified among 35 included patients: surgical diagnoses unrelated to PD (n=5), SHD (n=23), and PD related hand deformities with increased extrinsic tightness (n=10); three of these 10 patients had also contralateral SHD, thus are included in SHD group. In addition to previously described MCP joint flexion, swan neck deformity and z-thumb deformity, we found in most hands finger "clefting," abduction of the little finger and/or an increased intrinsic tightness, indicating pathology of intrinsic muscles of the hand involved in SHD. SHD diagnosed with a modified staging method, including features of intrinsic and extrinsic hand deformities, should be considered in PD to implement early and more accurate treatment.

Patient-Reported Outcomes 1 Year After Proximal Interphalangeal Joint Arthroplasty for Osteoarthritis

Implant survival, range of motion, and complications of proximal interphalangeal joint arthroplasty have been reported often, but patient-reported outcomes are less frequently described. This study evaluated patients' experiences during the first year after proximal interphalangeal joint arthroplasty, measured with the Michigan Hand Outcomes Questionnaire (MHQ). The primary focus was the reduction of patient-reported pain after proximal interphalangeal joint implant placement and the percentage of patients who considered this reduction clinically relevant, indicated by the minimal clinically important difference (MCID). Data were collected prospectively; 98 patients completed the MHQ before and at 3 and 12 months after surgery. Our primary outcome was the change in the pain score. An increase of 24 points or more was considered a clinically important difference. Secondary outcomes included changes in MHQ total and subscale scores and MCIDs, range of motion (ROM), patient satisfaction with the outcome of the surgery, and complications. The pain score improved significantly, from 42 (95% confidence interval, 38-46) at baseline to 65 (95% confidence interval, 60-69) at 12 months after surgery. The MCID was reached by 50% (n = 49) of patients. The ROM did not improve, reoperations occurred in 13% (n= 13) of patients, and swan neck deformities only occurred among surface replacement implants. Although most patients undergoing arthroplasty for osteoarthritis experienced significantly less pain after surgery, the pain reduction was considered clinically relevant in only 50% (n= 49) of patients. Patients with high MHQ pain scores before surgery are at risk for postoperative pain reduction that will not be clinically relevant. Likewise, the other subscales of the MHQ improved after surgery, but reached a clinically relevant improvement in only 46% (n = 45) to 63% (n = 62) of patients. This knowledge can be used during preoperative consultation to improve shared decision making. Prognostic IV.