Swan Neck Research Articles

Palmar fracture dislocation of the proximal interphalangeal joint

Palmar fracture dislocation of the proximal interphalangeal joint is uncommon. Thirteen patients treated for this injury were retrospectively reviewed. There were 9 acute injuries. Seven were treated by closed reduction and percutaneous pin fixation and 2 were treated by open reduction and internal fixation. The 4 chronic injuries (more than 1 month after injury) were treated with open reduction and soft tissue reconstruction. The length of follow-up averaged 55 months. Eight patients were free from pain. Postoperative proximal interphalangeal motion averaged 91 for the acute injuries and 70 degrees for the chronic injuries. Follow-up radiographic findings were notable for an increased height of the middle phalangeal base in 6 patients, articular irregularity in 4, and residual subluxation in 2; however, these changes did not correlate with the clinical results. Complications included loss of reduction in 1 patient, progressive swan neck deformity in 1, and development of an average 25 degrees extension lag of the distal interphalangeal joint in 5.

Swan Neck Presternal Peritoneal Dialysis Catheter: Five-Year Experience in Children

To reduce the incidence of exit-site infection (ESI) a new peritoneal dialysis (PD) catheter, the Swan neck presternal catheter (SNPC), composed of abdominal and presternal parts joined by a titanium connector, with the exit site located on the chest wall, was designed. A prospective study was undertaken to estimate the usefulness of the SNPC for continuous ambulatory peritoneal dialysis (CAPD) in children. University Children's Hospital, Medical Academy, Warsaw, Poland. From December 1991 to June 1997, 11 SNPCs were implanted in 10 children for the following reasons: recurrent ESI in 3, the presence of ureterocutaneostomies in 3, obesity in 3, the use of diapers in 2, young age in 1, and fecal incontinence in 1. More than one indication was present in some patients. In 7 patients the SNPC was the first PD catheter inserted. In all children the presternal catheter was implanted surgically by the modification of the technique described by Twardowski et al. The observation period ranged from 1-60 months. The rate of ESI was 1/162 patient-months. The major complication was trauma of the exit site (4 times in 3 of 10 patients). In spite of leaving an extra length of the catheter in the entire subcutaneous tunnel at the time of implantation, the two parts of the SNPC became disconnected in 2 children (after 7 and 33 months respectively). Our results achieved with the SNPC in children are very good. The presternal catheter reduces the risk of ESI. However, the chest localization of the exit site does not help to prevent trauma in children. This type of PD catheter should be reserved for patients with specific indications.

外傷性ｓｗａｎ ｎｅｃｋ変形に対する治療経験

Thompson's surgical procedure was carried out on 4 cases of post traumatic swan neck deformity. The mean time from injury to surgery was 88 months, and that following surgery was 26 months, ranging from 8 months to 6 years. Reconstruction of the oblique retinacular ligament was performed with the palmalis longus tencion used as a free tendon graft.In all the cases, the swan neck deformity was corrected. The mean extension of the PIP joint was 36 degrees before surgery, improving to -4 degrees ranging from -12 to 0 degrees during follow up. The mean extension lag of the DIP joint was 32 degrees, improving to -5 degrees ranging from -21 to 0 degrees during follow-up.Thompson's procedure is useful for correcting such post traumatic swan neck deformity.

Post-Laminectomy Swan Neck Deformity in Adults - Report of 20 Cases

A retrospective study of anterior cervical fusion in post-laminectomy swan-neck deformity was carried out, the objective being to observe the effect of anterior interbody fusion on the post-laminectomy swan-neck deformity. Independent segmental interbody fusion procedure was more effective than that of the multi-joint single graft fusion in correcting the deformed cervical spine. However, there was more loss of correction as well as a slightly higher fusion failure in the former procedure than the latter.

Lateral Band Rerouting in the Treatment of Swan Neck Deformities Due to Cerebral Palsy

Lateral Band Rerouting in the Treatment of Swan Neck Deformities Due to Cerebral Palsy

P-4-466 - Multi-level anterior cervical arthrodesis and instrumentation: Outcome analysis

Occipito-cervical(OC) fusion is often practiced for congenital atlanto-axial dislocation (CAAD) and basilar invagination (BI) with claims of good long term outcome. Little has been discussed about the delayed complications following fusing occipital squama to cervical spine (OC fusion). We have described and analyzed delayed complications with OC fusion in our patients that helps us understand the underlying dynamics and biomechanics.Twenty seven patients of CAAD and BI underwent OC fusion (between 2008 and 11) after transoral odontoidectomy or direct posterior reduction with OC distraction. OC fusion was achieved using either sublaminar wiring or with precurved rods and screws or contoured loop. One patient was referred after OC fusion with contoured loop and wires with additional C1 laminectomy. The outcome (> 12 months) and delayed complications in these patients were analyzed.Five types of delayed complications were noticed in 6 of the 28 patients who underwent OC fusion. Five of 6 patients were adults. Vertical redislocation with posterior midline fusion (n = 2), adjacent level angular listhesis (n = 1) and swan neck deformity (n = 1) was seen in cases of OC fusion with sublaminar wires alone. Progressive C1 dislocation was seen in the lone patient who was referred after OC fusion with loop and wires. Vertical and angular dislocation was seen in 1 patient of OC fusion with precurved rod and screws.Progressive redislocation and adjacent level dislocation are delayed complications seen after OC2 fusion. These complications are more often seen in adults, especially with sublaminar wiring/semi rigid OC fixation.

Complications Associated with the Use of the Swan Neck Presternal Catheter: A Case Report

Complications Associated with the Use of the Swan Neck Presternal Catheter: A Case Report

Dynamic swan neck deformity in a patient with Ehlers-Danlos syndrome

A patient with type I Ehlers–Danlos syndrome with a congenital hand deformity described as a “dynamic swan neck deformity” is presented and causes of the deformity are discussed.

Hemoperitoneum in Peritoneal Dialysis Secondary to Retroperitoneal Hematoma

Editor: Hemoperitoneum is an unusual complication in patients undergoing CAPD (1). In most cases it has a benign course. Two milliliters of blood can dye the peritoneal effluent an intense red. The most frequent cause is endometriosis. However, other gynecological, hematological, tumoral, and abdominal sources can cause hemoperitoneum. Polycystic kidney disease, peritonitis, pancreatitis, cholecystitis, and extracorporeal lithotripsy are other possibilities. Rarely, hemoperitoneum is associated with rupture of the spleen (2) or iliopsoas spontaneous hematoma (3). We present a case of hemoperitoneum consequent to retroperitoneal hematoma after manipulating a double-lumen femoral catheter for hemodialysis. This 44-year-old woman with systemic lupus erythematosus and end-stage renal disease has been on hemodialysis for the last three years. Because of thrombosis of every possible vascular access site, it was decided to change her to peritoneal dialysis. A left Swan neck Missouri peritoneal catheter was placed by surgical technique without complication. A peritoneal lavage at the seventh and fourteenth day was clear. The patient continued on hemodialysis through a doublelumen femoral catheter on the right side. We waited four weeks before standard CAPD was begun. Seventeen days after placement of the peritoneal catheter, during a hemodialysis session, her femoral catheter was changed through a guide wire because of poor flow. Suddenly, she developed severe pain in the right lumbar fossa, right hemiabdomen, and acute anemia and hypovolemic shock occurred. The femoral catheter was removed, and she received intravenous fluids and transfusion of six packed red blood cells, achieving hematologic and hemodynamic stabilization. No surgery was required. A computed tomography scan of the abdomen showed retroperitoneal hematoma involving the right anterior and posterior pararenal space and right iliopsoas muscle. Twenty-four hours later, nightly intermittent peritoneal dialysis was begun. The first peritoneal effluent was very bloody. After continuous peritoneal lavage with 1-L exchanges at room temperature over two hours, the dialysate became clear. One year later, the patient continues on continuous cycling peritoneal dialysis without any problems. To our knowledge, this cause of hemoperitoneum has not been reported before. Therefore, we believe that retroperitoneal hematoma secondary to hemodialysis with a femoral catheter may be listed in the causes of hemoperitoneum in peritoneal dialysis. F. Fernandez Giron F. Hermosilla Sanchez M. Paralle Alcalde J. Gonzalez Martinez

FINGER DEFORMITIES IN RHEUMATOID ARTHRITIS

Swan neck and boutonniere deformities describe the two most common afflictions of the interphalangeal joints attributable to rheumatoid arthritis. Two separate classifications have been described, with an emphasis on practical treatment. The complications that can occur are very significant and the decision to perform reconstructive surgery in these patients must be made with full consideration of the patient's disease process, careful functional evaluation of the patient, specific adjacent joint involvement, and the overall treatment plan for improving the patient's function. The timing of hand, foot, and large joint surgery is complex and requires excellent communication among the patient and all the treating specialists, including the primary internist, rheumatologist, orthopaedic surgeon, and hand surgeon. The care for these patients is served best by a coordinated team approach.

Electromyographic and subjective evaluation of hand tools: The example of masons' trowels

The objective of this study was to evaluate an ergonomically designed handle of a mason's trowel in comparison with two standard types, both with a round cross-section of the handle and either a straight neck or a swan's neck. All the tools were equipped with the same blade. Job-specific dynamic and static working elements were performed by 10 subjects in a laboratory. Under well-controlled conditions, physiological cost associated with mixing and throwing of mortar onto a vertical wall, translatory carrying and depositing of sand on a horizontal wall, rotatory scooping movements (supination and pronation of the forearm) with and without an external load of the trowel, and static holding of the tool in different working postures were measured. Electromyographic activity (EA) of the biceps brachii, pronator teres, flexor digitorum, and extensor carpi ulnaris was registered continuously and summed up during all of the test sessions lasting 30 or 45 s, each. All data were standardized by means of maximum EA resulting from preceding job-specific maximum voluntary contractions. Before and after the working sessions, which lasted about 4 h for each subject, the ergonomic quality of the handles had to be rated by means of a questionnaire with 9 items on a bipolar 4-step scale. In accordance with the hypothesis that the ergonomically designed handle should enable a specific relief of the strain in the grip musculature and the ulnar deviation muscles, significantly lower EA values were measured with this model during most of the test phases. But the effect was much less in scale than was expected from the subjective assessment before the tests. Also, subjective rating data after the working sessions differed clearly between the 3 handles mostly corresponding with the pretest assessment.

Surgical Principles and Planning for the Rheumatoid Hand and Wrist

Each surgical procedure available for the rheumatoid hand has a score card. The most indicated and necessary procedures include: extensor tenosynovectomy and Darrach for the impending or already ruptured extensor tendons; flexor tenosynovectomy and carpal tunnel release for the patient with impaired median nerve function; stabilization of the deformed unstable thumb with MP or IP arthrodesis; and flexor tenosynovectomy in the palm and finger of a motivated patient with significant disparity between active and passive motion. Relative indications for surgery include arthrodesis for the unstable wrist; MP arthroplasty for the fixed MP volar and ulnar subluxation with inability to open the hand; synovectomy for the occasional patient with painful boggy synovitis of the MP or PIP joint; and reconstruction of the fixed swan neck deformity with relatively good PIP joints. Both MP and PIP joints can and should be operated on at the same time. Extensive wrist surgery, that is, tenosynovectomy and Darrach or arthrodesis, should not be performed at the same time as MP arthroplasty. Try to do the "winner operations" first.

Comparisons of the Swan Neck and Tenckhoff Catheters

Comparisons of the Swan Neck and Tenckhoff Catheters

Comparisons of the Swan Neck and Tenckhoff Catheters: Response to Twardowski Et Al

Comparisons of the Swan Neck and Tenckhoff Catheters: Response to Twardowski Et Al

Comparisons of the Swan Neck and Tenckhoff Catheters: Response to Twardowski Et Al

Comparisons of the Swan Neck and Tenckhoff Catheters: Response to Twardowski Et Al

A Prospective Randomized Comparison of the Swan Neck, Coiled, and Straight Tenckhoff Catheters in Patients on Capd

Our objective was to study the impact of peritoneal catheter configuration on continuous ambulatory peritoneal dialysis (CAPD)-related infections, mechanical complications, and patient dropout in a prospective randomized trial. Forty consecutive patients who were commencing CAPD were randomized to receive either a double-cuff, Swan neck coiled catheter or a double-cuff, straight Tenckhoff catheter, implanted by surgical technique. There was no significant difference in the peritonitis rate between the two groups. There was a lower rate of exit-site infection in the Swan neck group compared to the straight catheter group (0.29 vs 0.60 episodes/patient-year, p < 0.05). Catheter-tip migration occurred in 3 patients with the straight catheters compared to one patient with the Swan neck catheter. No patient had to discontinue CAPD because of mechanical complications. The number of CAPD patient dropouts was not significantly different between the two groups. The Swan neck configuration resulted in a significant reduction in the rate of exit-site infections. The coiled component of the catheter may lead to fewer episodes of catheter-tip migration. However, catheter configuration did not influence the number of technique failures.

Four-year experience with swan neck presternal peritoneal dialysis catheter

The swan neck presternal catheter is composed of two flexible (silicon rubber) tubes joined by a titanium connector at the time of implantation. The exit site is located in the presternal or parasternal area. The catheter located on the chest was designed to reduce the incidence of exit site infections compared with peritoneal dialysis catheters with abdominal exit sites. From August 1991 to May 1995, 24 swan neck presternal catheters have been implanted in 24 patients for the following reasons: obesity nine patients, ostomies three patients, a suprapubic catheter one patient, previous problems with abdominal catheters two patients, desire to use a bathtub five patients, need to use a whirlpool one patient, need to wear sweatpants with an elastic waistband one patient, and body image two patients. In the same period, 47 abdominal swan neck catheters were implanted in 44 patients who preferred catheters with the exit on the abdomen. Presternal catheters tended to perform better regarding exit and tunnel infections, even though they were implanted in several patients in whom regular catheters with the exit on the abdomen would be difficult or impossible to implant. Two-year survival probability of presternal catheters was 0.88 ± 0.14 (±SE). Recurrent/refractory peritonitis was the only reason of catheter failure. The differences in results between presternal and abdominal catheters were statistically insignificant; only the use of antibiotics to treat exit site infection was significantly higher with abdominal catheters. Patient acceptance of the exit position was good; at least seven patients preferred presternal catheter for psychological or body image reasons. We conclude that the swan neck presternal catheters provide excellent results comparable to those achieved with swan neck abdominal catheters. The catheter seems suitable for any patient commencing peritoneal dialysis and is particularly useful in extremely obese patients (body mass index >40 kg/m 2) and those with ostomies. The catheter exit location in the chest may be preferred by some patients, both men and women, for psychological or body image reasons. No specific contraindications to the presternal catheter implantation have been identified.

SYNOVECTOMY, JOINT RELEASE AND LATERAL BAND TRANSLOCATION FOR STIFF SWAN NECK DEFORMITY

This paper presents the results of surgery on 36 fingers, in 15 patients with swan neck deformity treated by synovectomy, joint release and lateral band translocation. Overall, the range of motion postoperatively was 56 degrees and the arc was transposed to a more functional position (centre of arc of motion at 12 degrees preoperatively versus 42 degrees postoperatively). Even the more severe Type 5 deformity as well as those fingers with evidence of degenerative change, derived lasting benefit from the procedure, both in terms of range and arc of motion. This technique of treating stiff swan neck deformity is an effective means of obtaining a greater and more functional range of motion and maintaining it in the medium term.

Obstructive Fibrin Clot in the Peritoneal Catheter

Editar: We read with interest the observation reported by Twardowski and Pasley (1), and we wish to report a similar case, in which the shape of the clot is even more evocative. A 65-year-old woman had a Swan neck continuous ambulatory peritoneal dialysis (CAPD) catheter surgically implanted (right transrectal) on 2 August 1994. Her underlying renal disease was hypertension and noninsulindependent diabetes, the evolution of which has been speeded up by infectious episodes of urolithiasis and dehydration with rhabdomyolysis. Following implantation, the catheter was rinsed until the dialysate was bloodfree; then a stopper was put onto the titanium connector after injection of 2 mL (5000 U/mL) heparin. The patient left the department on the third day and returned on the tenth day for a check of the catheter position by x-ray and its pattern. The abdominal x-ray radiograph showed the catheter tip placed in the Douglas cul-de-sac. However, there was a two-way obstruction. An energetic suction aspirated a long fibrin clot which moulded perfectly the catheter lumen, particularly the side orifices ofits distal portion (Figure 1). Peritoneal dialysis was initiated, but on 8 September 1994 a new obstruction occurred. She was treated successfully by intraperitoneal infusion of 75 000 U urokinase in 40 mL isotonic saline solution, contact during 60 min, then rinsed with 2 L isotonic dialysate. She remained on CAPD until June 1995 without further episodes of catheter clotting. This observation has many features in common with those of Twardowski and Pasley: clotting occurred in the absence of any infection, on a catheter recently implanted without any difficulty, the use of which had been delayed; the clot was easily aspirated with a syringe, and the molding was perfect. Other maneuvers are sometimes necessary in case of obstruction, including the classical use of fibrinolytics or even resorting to mechanical intervention (2).

Survival on Chronic Peritoneal Dialysis: Have Results Improved in the 1990s?

One hundred and seventy patients were treated with home peritoneal dialysis (PD) in our unit between 1986 and 1994. During this time lapse, several technical improvements were included in our practice. Among others there were: Swan neck permanent catheters, Y-systems, and automated home PD (APD). We reviewed our experience, to assess if these improvements had any impact on patient and technique survival, comparing patients who started PD between 1986 and 1989 (group A), with those who started PD between 1990 and 1994 (group B). Both groups had a comparable basal comorbidity, except for a higher proportion of elderly patients in group B (mean age 48 vs 58 years, p < 0.01). The incidence of peritonitis was lower in group B, while there were no differences in the rates of catheter-related infection or hospital admission. Also, there were no significant differences in patients or technique survival. The increasing presence of elderly patients in our PD unit was, apparently, determinant for the evolution of patient survival. On the other side, technical improvements had a marginal impact on technique survival. A good general PD survival in both groups, with few patients changing to hemodialysis (HD), may explain the lack of significant differences. In addition, peritonitis and inadequate PD/ultrafiltration (UF) were replaced by abdominal surgical events and social reasons as the main causes for PD failure in the second phase of the study.