Toe Proximal Interphalangeal Joint Research Articles

Stack versus Te technique for central slip reconstruction during vascularized toe proximal interphalangeal joint transfer.

Significant extension deficit is a common problem after a vascularized toe proximal interphalangeal joint transfer. One of the main causes related to extensor lag is central slip deficiency of the donor toes. In our clinical practice, we performed both the Stack and Te technique to reconstruct central slip function during a joint transfer. The aim of this study was to compare the long-term outcomes of vascularized joint transfers between these two techniques. From May 2009 to October 2021, 38 digits in 36 patients (28 men and 8 women) underwent free vascularized toe joint transfer requiring central slip reconstruction. Eight and 30 digits were reconstructed with the Stack and Te technique, respectively. The median length of follow-up was 19 months (range, 5 to 78 months). The overall median extension lag was 20±20 degrees and the flexion was 80±20 degrees. There were no significant differences in extension lag (25±29 vs. 20±15 degrees, p = 0.281), flexion (75±10 vs. 85±20 degrees, p = 0.13), and range of motion (53±23 vs. 63±15 degrees, p = 0.076) of the joints between the Stack and Te techniques after the transfers. From the limited number of cases, both the Stack and Te techniques provided similar outcomes in correcting extension lag in vascularized joint transfers. The Te technique is a simplified and effective method for central slip reconstruction, while caution is advised when using the Stack technique due to potential complications.Clinical question/level of evidence: Therapeutic, IV.

Vascularized Toe Proximal Interphalangeal Joint Transfer in Posttraumatic Fingers: Analysis of Prognostic Factors for Suboptimal Outcomes.

Posttraumatic finger osteoarthritis of the proximal interphalangeal joint (PIPJ) is a difficult problem. Over the past decade, we have reported several methods for improving the outcomes of vascularized toe joint transfer (VJT). In this study, we focused on determining poor prognostic factors which lead to a suboptimal outcome. A consecutive series of patients with posttraumatic osteoarthritis of the PIPJ who received VJT between January 2008 and January 2021 were enrolled in this study. The senior surgeon (Y.-T.L.) performed the surgery in all cases. In this retrospective study, we reexamine the initial trauma-related soft tissue and bony structure injuries of the recipient finger, to assess the baseline tissue quality before VJT. The injuries were classified into five major categories according to their anatomic region. The functional outcome parameters (including range of motion, percentage of use, and extensor lag of the transferred PIPJ) were collected. Univariate and multivariate linear regression analyses were performed using the generalized estimated equation model to identify the correlation between the injury category involved and functional outcome. A total of 59 digits were enrolled. Our results revealed that the fingers with previous vascular injury that received revascularization procedures had relatively suboptimal functional outcomes. These fingers had a significantly lower percentage of use both before (β = -0.222, P = 0.006) and after (β = -0.177, P = 0.006) receiving secondary procedures to improve functional outcome. Patients with prior revascularization surgery were associated with a poor functional outcome after VJT.

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.

Nonvascularized Toe Joint Transfers to the Hand in Young Children: Technique Revisited.

Small joint reconstruction of the hand poses a significant challenge, especially in children where both functional motion and preservation of the epiphysis are desired. Auto-transplantation of whole joints is the only way to reconstruct a functional joint that maintains growth potential. Historically, nonvascularized toe-to-finger joint transfer has been criticized for high rates of avascular necrosis and joint dissolution, while vascularized transfers seemingly resulted in increased durability of the joint space and epiphysis. However, certain populations remain poor candidates for microvascular reconstruction, such as those with congenital deformities or sequelae from trauma or infection. In our case series, we demonstrate that a simplified nonvascularized surgical technique and careful patient selection can produce stable, functional joints. Nonvascularized toe-to-finger joint transfer was performed in 3 children between the ages of 4 and 6. Reconstructed joints included 2 proximal interphalangeal (PIP) joints and 1 metacarpophalangeal (MCP) joint. Donor grafts consisted of second toe PIP joints harvested en bloc to include the epiphysis of the middle phalanx, collateral ligaments, volar plate, and a diamond-shaped island of extensor tendon with its central slip attachment. Follow-up ranged from 7 to 29 months. Each patient demonstrated functional improvements in joint motion and stability. Postoperative radiographs confirmed adequate joint alignment and persistence of the joint spaces. Epiphyseal closure was observed in 1 patient as early as 25 months postoperatively. Nonvascularized joint transfer should remain a practical consideration for small joint reconstruction of the hand in certain pediatric patients.

Simultaneous Stiles-Bunnell Tendon Transfer Enhances Intrinsic Function of Second-Toe Transplantations.

Therapeutic, IV.

Stabilization of Proximal Interphalangeal Arthrodesis of Lesser Toes Using K-wires vs. Implants

Category: Lesser Toes Introduction/Purpose: Lesser toe proximal interphalangeal (PIP) joint arthrodesis is one of the most common foot and ankle elective operative procedures. Currently, the most common method for fixation of the PIP joints is utilization of intramedullary Kirschner wires (K-wires). Implantation of K-wires have been shown to be associated with a fair number of complications including hardware failure, loosening, bending, mal-union, non-union, wire migration, and infection. These complications have led to the development of intramedullary devices for fixation. Our hypothesis was that the memo-metal X-fuse PIP joint arthrodesis implant (Stryker, Kalamazoo MI) would provide a stronger and stiffer arthrodesis than Kirschner wire fixation. Methods: Six matched fresh frozen cadaveric second toe pairs were used in the study. Six PIP joints were prepared and fixed with K-wires and the six contralateral PIP joints were prepared and fixed with the X-fuse system. All specimens were then potted and fixed to a custom jig. Specimens were then cyclically loaded with extension bending force of the PIP joint mimicking natural upward bending force in walking using 2 N step increases of force with 10 cycles per step. Failure was defined as 4 mm of actuator displacement. Load to failure was then assessed. Paired t-test was utilized for statistical analysis. Results: The average force at failure (defined as 4 mm of displacement) for the Kirschner wire was 93.3 N (SD 25.8) which was significantly greater than the average for the X-fuse system, 65.0 N (SD 13.8). P-value was 0.0053. Failure of the K-wire resulted from bending of the K-wire itself or breaching of cortical bone. Failure of the X-fuse typically resulted from implant pullout. Conclusion: Contrary to our hypothesis, K-wires provided a stiffer and stronger construct than the X-fuse system. Successful bony fusion is the clinical outcome of interest, and this cadaver study was used to assess stability of the fusion site at time zero after surgery. Limitations of this study include a relatively small sample size.

The impact of transferred vascularized toe joint length on motion arc of reconstructed finger proximal interphalangeal joints: a cadaveric study.

Vascularized toe joint transfer for finger proximal interphalangeal joint reconstruction can result in sub-optimal arc of motion and extension lag due to inappropriate intercalated bony segment length. We investigated the impact of intercalated segment length on passive arc of motion and extension lag of the reconstructed proximal interphalangeal joint. Cadaveric intercalated joint grafts were harvested from lesser toes and transferred to cadaveric fingers. The pre-determined finger proximal interphalangeal joint defect size was 2 cm. Three different intercalated segment lengths were inserted and resulting proximal interphalangeal joint arc of motion and extension lag were measured. The average arc of motion of finger proximal interphalangeal joints was 81° and 54° for toe proximal interphalangeal joints. Long intercalated segments had an average arc of motion of 30° with 32° extension lag. Equal-length intercalated segments had an average 49° arc of motion with 15° extension lag. Short intercalated segments had an average arc of motion of 71° with 8° extension lag. Shorter intercalated segments provide the greatest reduction in extension lag.

Reconstruction of combined thumb amputation at the metacarpal base level and index amputation at the metacarpal level with pollicization and bilateral double toe composite transfer

This study aimed to describe the technique and report our experience with the reconstruction of combined proximal thumb amputations at the metacarpal base level and index finger amputation at the metacarpal level with pollicization and bilateral double toe composite transfer. The technique consists of pollicization of the remnant index ray. Then a contralateral composite medial great toe pulp and vascularized second toe proximal interphalangeal joint flap are harvested to reconstruct the metacarpophalangeal joint of the thumb. Subsequently, an ipsilateral composite great toe wrap-around and second toe proximal interphalangeal joint flap are harvested to reconstruct the thumb interphalangeal joint and the distal thumb. A neurotized superthin anterolateral thigh flap is used to reconstruct the ipsilateral toe defect, while the bone defects of the bilateral second toes are reconstructed with corticocancellous iliac crest bone grafts. Between 2010 and 2014, eight patients underwent reconstruction. Four patients could be recalled for follow-up, with a mean duration of 22 months. All flaps survived. The contour and length of the reconstructed thumbs was similar to the contralateral one. The mean Michigan hand outcomes questionnaire score was 80.5. The mean disabilities of the arm, shoulder and hand score was 7.5. The mean foot and ankle disability index score was 94.2. Reconstruction of thumb amputations at the metacarpal base level with pollicization and double toe composite transfer results in excellent contour and functional outcome, with a natural-appearing thumb. In addition, all toes are preserved. Therapeutic, Level IV.

A Midterm Review of Lesser Toe Arthrodesis With an Intramedullary Implant

Therapeutic, Level IV: Case series.

Customizing Extensor Reconstruction in Vascularized Toe Joint Transfers to Finger Proximal Interphalangeal Joints: A Strategic Approach for Correcting Extensor Lag.

Vascularized toe proximal interphalangeal joint transfer allows the restoration of damaged joints. However, extensor lag and poor arc of motion have been reported. The authors present their outcomes of treatment according to a novel reconstructive algorithm that addresses extensor lag and allows for consistent results postoperatively. Vascularized toe joint transfers were performed in a consecutive series of 26 digits in 25 patients. The average age was 30.5 years, with 14 right and 12 left hands. Reconstructed digits included eight index, 10 middle, and eight ring fingers. Simultaneous extensor reconstructions were performed and eight were centralization of lateral bands, five were direct extensor digitorum longus-to-extensor digitorum communis repairs, and 13 were central slip reconstructions. The average length of follow-up was 16.7 months. The average extension lag was 17.9 degrees. The arc of motion was 57.7 degrees (81.7 percent functional use of pretransfer toe proximal interphalangeal joint arc of motion). There was no significant difference in the reconstructed proximal interphalangeal joint arc of motion for the handedness (p = 0.23), recipient digits (p = 0.37), or surgical experience in vascularized toe joint transfer (p = 0.25). The outcomes of different techniques of extensor mechanism reconstruction were similar in terms of extensor lag, arc of motion, and reconstructed finger arc of motion compared with the pretransfer toe proximal interphalangeal joint arc of motion. With this treatment algorithm, consistent outcomes can be produced with minimal extensor lag and maximum use of potential toe proximal interphalangeal joint arc of motion. Therapeutic, IV.

Application of regulating pre- and post-load of the blood vessel in small joint transplantation

Objective To explore the clinical application of regulating the pre- and post-load of the blood vessel in small joint transplantation. Methods Four cases of metacarpophalangeal joint defects and 2 cases of proximal interphalangeal joint defects were treated with free transplantation of the second toe metatarsophalangeal joint and proximal interphalangeal joint, respectively. The conventional end-to-end anastomosis of perforators was modified to collateral anastomosis, end-to-side anastomosis, and inset anastomosis. The pressure within the free tissue was balanced by the regulation of the arterial perfusion volume and venous return flow. Results All 6 transplants of small joint free transplantation survived. Tenolysis was done in 3 cases 3 months postoperatively. All the cases were follow-up for 3 to 16 months, the average being 6 months. Range of motion of the metacarpophalangeal joint was 75° to 85°of flexion and -10° to 0° of dorsiflexion: 4.5 points based on the upper limb functional assessment criteria issued by the Chinese Hand Surgery Society. Range of motion of the interphalangeal joint was 65° to 75°of flexion and -15°to 0° of dorsiflexion: 3.1 points. The appearance of the fingers was satisfactory, while the thumb opposition function was good. Conclusion Regulating the pre- and post-load of the blood vessel can improve the survival rate of small joint free transplantation. Key words: Finger joint; Treatment outcome; Pre- and post-load of blood vessels; Toe joint transplantation

A Treatment Algorithm for Correcting Extensor Lag in Vascularized Toe Proximal Interphalangeal Joint to Finger Transfers

Introduction: To improve the arc of motion (AOM) and reduce the extension lag of vascularized toe proximal interphalangeal joint (PIPJ) transfers, simultaneous reconstruction of the extensor mechanism as part of the transfer has been mentioned in our preliminary report. According to diverse tendon conditions of the recipient fingers and donor toes, we rationalize 3 procedures used to reconstruct the extensor mechanism in vascularized joint transfers (VJTs). These include (1) centralization of lateral tendons when intrinsic hand muscles are non-functional, (2) central slip reconstruction when type I toes* are encountered, and (3) direct extensor digitorum longus (EDL)-to-extensor digitorum communis (EDC) repair for type II toes*. In this study, we evaluate the outcomes of VJTs reconstructed using these techniques and propose an updated treatment algorithm based on our findings. Materials and Methods: VJT was performed in a consecutive series of 26 digits in 25 patients (20 males and 5 females). The average age was 30.5 years. There were 14 right hands (dominant) and 12 left hands. Reconstructed digits included 8 index, 10 middle, and 8 ring fingers. Techniques of simultaneous extensor reconstruction included 8 centralization of lateral bands, 5 direct EDL-to-EDC repairs, and 13 central slip reconstructions. Similar protocol of postoperative rehabilitation was applied to all the patients. Results: The patients were followed up for an average of 16.7 months. The overall AOM and extension lag of the reconstructed PIPJ were 57.7° and 17.9° (81.7% functional usage of pretransferred toe PIPJ AOM), respectively. No significant difference in the results was found between the handedness ( P = .23) and between different recipient fingers ( P = .37). Comparing the outcomes of different extensor reconstructions, the extension lag after centralization, direct EDL-to-EDC repair, and central slip reconstruction were 19.4°, 13°, and 18.8° ( P = .42), respectively; The PIPJ AOM was 54.4°, 55°, and 60.8° ( P = .42); the final finger PIPJ AOM compared to the pretransferred toe PIPJ AOM was 76.3%, 79.7%, and 85.9% ( P = .34). Discussion: Due to the varied recipient finger conditions, no single technique is suitable for every scenario. Careful evaluation of recipient finger and toe tendons is required to perform the most appropriate extensor reconstruction. Using our treatment algorithm, consistent outcomes can be produced with reduced extensor lag and maximum usage of potential toe PIPJ AOM. As such, customized extensor mechanism reconstruction is important to improve the outcomes of vascularized toe PIPJ transfers. *In our clinical observations, the majority (>86%) of second toes do not have a strong, definite insertion of central slip at the base of middle phalanx (type I). On the contrary, less than 14% of second toes do have.

Comparison Between Different Techniques of Central Slip Reconstruction for Correcting Extensor Lag in Vascularized Toe Proximal Interphalangeal Joint Transfers

Objective: From our previous study, deficiency of the central slip was identified in more than 86% of the lesser toes. This was correlated with the extension lag of proximal interphalangeal joint (PIPJ) after vascularized joint transfers (VJT). Subsequently, we demonstrated our clinical experiences that extension lag associated with poor central slip formation in the toe can be corrected using central slip reconstruction with the Stack method. The Stack procedure involves the dorsal passing of a distally based flexor digitorum superficialis (FDS) slip through the middle phalangeal base. To drill an extra hole along with extensive manipulation of periosteum can increase the risk of damage to the perfusion of the transferred joint. As such, we present a novel, simple, and effective technique to correct extensor lag during VJT and compared it with our prior VJT with the Stack method. Methods: In our new technique, the lack of a central slip in type I toes can be corrected by anchoring the lateral bands to the middle phalanx of the transferred PIPJ. When transferring a PIPJ of the second toe for the reconstruction of PIPJ defect in a finger, osteosynthesis is first performed passing cerclage wire through 2 holes drilled through the distal and proximal ends of the joint complex. Re-creation of the extensor insertion to the middle phalanx is performed by anchoring the lateral bands down to bone with sutures. Tenorrhaphy of extensor digitorum longus (EDL) to central extensor of the finger at zone IV is performed utilizing Pulvertaft weaving. After the surgery, this group of patients followed the same rehabilitation protocol as those with the Stack method. The arc of motion of the PIPJ was measured in the latest clinics. Results: The use of this novel technique in our institution has seen equivalent results in range of motion when compared with the use of Stack’s technique (61.0 ± 19.6° vs. 54.4 ± 11.8°) in the reconstruction of PIPJs using VJTs. This technique is also safe and quick to perform when compared with our prior adopted method in central slip reconstruction, and no injury to neurovascular structures have been seen in our institution. The anchored lateral bands sufficiently enhances the axial pull of the extensor mechanism and corrects the inherent extensor lag of the type I toe joints. Only by correcting this inherent extensor lag can we maximize the full potential range of motion of the toe PIPJ. Conclusions: Our method achieves similar outcomes to the Stack procedure, but has the advantage of minimizing addition bone drilling and soft tissue manipulation, hence making the procedure markedly easier to perform.

Reconstruction of thumb II-III degree defect by big toe wrap-around flap combined with second toe proximal interphalangeal joint

To investigate the reconstruction of thumb II-III degree defect by big toe wrap-around flap combined with second toe proximal interphalangeal joint. Between May 2004 to July 2012, 25 cases with thumbs II-III degree defects were treated. The ipsilateral big toe wrap-around flap combined with second toe proximal interphalangeal joint was designed to reconstruct the thumb defects based on the thumb size on the healthy side. The distal end of hallux was covered by flap at tibial side. The wound at the fibula side was covered by skin graft and flap. The bone defect at the second toe was filled with remnant hallux or iliac bone. All the 25 reconstructed thumbs survived completely. The patients were followed up for 6-26 months without any joint degeneration. According to the finger reconstruction functional criterion publicized by China Medical Association, the finger function was assessed as excellent in 10 case, good in 11 cases, poor in 4 cases. Joint necrosis happened in 2 cases and bone malunion in 2 cases. The 4 cases received dead bone debridement and iliac bone graft. No malfunction occurred in the donor site. Our surgical method is a currently effective way to reconstruct II-III degree thumb defects. Satisfactory functional and cosmetic results can be achieved both in donor site and recipient site.

Salvage of a Lesser Toe Osteomyelitis when Complicated by a Broken Screw: A Case Study

Orthopedic screw removal has proven itself to be a challenge. Access to a Screw Removal Set (TM Synthes) is essential. But what options are available when it cannot remove a broken screw in a lesser toe on a background of osteomyelitis of a lesser toe? A young healthy patient had undergone a 2nd and 3rd toe proximal interphalangeal joint (PIPJ) and distal interphalangeal joint (DIPJ) fusion using a cannulated dual threaded compression screw in 2006. She had had a successful fusion but eight years later, she developed osteomyelitis in the 2nd toe. An attempt was made to manage this conservatively with antibiotic therapy but a further flair up occurred following treatment. At surgery, the screw head broke while trying to remove it leaving just the smooth shaft of the screw, deep within the proximal phalanx. The Screw Removal Set was not useful and it was removed by making a gutter dorsally.

Improving the Extensor Lag and Range of Motion following Free Vascularized Joint Transfer to the Proximal Interphalangeal Joint

Free vascularized joint transfer for reconstructing the posttraumatic proximal interphalangeal joint has enjoyed limited popularity because of the low range of motion typically achieved after transfer. One of the commonest complaints is the significant extensor lag. Part 2 of this two-part study is focused on the clinical outcomes following a more anatomical approach to extensor tendon reconstruction. Nine patients (eight male and one female), with a mean age of 31.7 years, underwent free vascularized joint transfer for posttraumatic proximal interphalangeal joint injuries using the second toe proximal interphalangeal joint. In Part 1, two arrangements of the central slip mechanism were found: type I with an attenuated and type II with a distinct central slip. An algorithm was constructed using this information: in a type I toe with sufficient recipient lateral bands, a centralization procedure was carried out; and when the lateral bands were insufficient, a modified Stack procedure was carried out. In type II toe joints, a tight repair of the corresponding extensor tendons was performed. Four patients underwent centralization procedures, two underwent a modified Stack procedure, and three underwent tight extensor repair. At 23.4 months, the average extensor lag was 18.3 degrees. A total range of motion of 53.9 degrees (mean flexion, 72.2 degrees) was achieved that approximated 81.1 percent of the pretransfer passive range of motion at the toe proximal interphalangeal joint. This preliminary result demonstrates that much improved range of motion can be achieved by reducing the extensor lag using an anatomical reconstruction that takes into account the recipient finger and toe joint anatomy. Therapeutic, IV.

Improving the Extensor Lag and Range of Motion following Free Vascularized Joint Transfer to the Proximal Interphalangeal Joint

Extension lag is a common occurrence following free vascularized joint transfer reconstruction of the proximal interphalangeal joint, thus limiting the range of motion that is achievable. In this Part 1 study, the anatomical and biomechanical arrangements of the toe proximal interphalangeal joint extensor mechanism were investigated. Twelve second toes from 12 fresh cadavers were dissected for examination of the extensor mechanism. Similar observations were performed in nine clinical cases. A total of 21 toes were therefore examined with dynamic and static testing. In 17 toes, the central tendon attenuated before inserting onto the middle phalangeal base (type I). In four toes, a thicker tendinous insertion analogous to a central slip was identified (type II). In type I toes, traction of the extensor digitorum brevis and digitorum longus did not correct the extensor lag. The extension lag decreased when the metatarsophalangeal joint was flexed passively or when both extrinsic and intrinsic tendons were pulled simultaneously. In type II toes, a full extension of the proximal interphalangeal joint was achieved when the extensor tendons were pulled with or without pulling the intrinsic tendons. In both types of toes, there was an increase in the extension lag caused by dorsal bowstringing when separated from the extensor sling. The lesser toe proximal interphalangeal joint adopts a naturally flexed posture for evolutionary reasons, with corresponding adaptations in extensor mechanism arrangements. The most significant limiting factor to full extension could be the presence of an attenuated central slip in the majority of toes.

Simultaneous Reconstruction of Extensor Mechanism in the Free Transfer of Vascularized Proximal Interphalangeal Joint

From a recent systemic review, vascularized toe proximal interphalangeal joint (PIPJ) transfer achieved an average arc of motion (AOM) of merely 37 degrees for finger PIPJ reconstruction. Despite the technical refinement over the past 3 decades, the resulting active motion of the reconstructed joint remains unpredictable and often fraught with extension lag. The technique for vascularized toe PIPJ transfer at our institute has evolved over the years to its current state, with simultaneous extensor mechanism reconstruction being a major component. During the transfer, the quality of extensor tendons on the recipient finger and donor toe are carefully evaluated. If the central slip of finger extensor is destroyed but the quality of lateral bands is adequate, centralization of lateral bands overlying the transferred PIPJ is performed. If there is acceptable central slip remnant at the proximal phalanx level, modified Stack procedure is performed for central slip reconstruction while leaving the lateral bands in continuity. If both lateral bands are poor, modified Stack procedure is performed unless the central tendon of the toe is strong enough to extend the PIPJ. From November 2008 to October 2010, 7 joints were transferred with this modified technique. The average follow-up was 18.2 months. The average active AOM of the transferred PIPJ was 56.4 degrees. The average extension lag of the toe PIPJ was 10.7 and 16.4 degrees before and after the transfer, respectively. Simultaneous reconstruction of extensor mechanism decreases the extension lag without sacrificing AOM of the transferred PIPJ.

Comparison of Third Toe Joint Cartilage Thickness to That of the Finger Proximal Interphalangeal (PIP) Joint to Determine Suitability for Transplantation in PIP Joint Reconstruction

To compare the cartilage thickness of the third toe joints to the finger proximal interphalangeal (PIP) joints to assess the appropriateness of using third toe osteochondral grafts for finger PIP joint reconstruction. A laser scanner was used to construct 3-dimensional computer models of 6 matched cadaver right third toe PIP joints, condyles of the third toe middle phalanx, and finger PIP joints with and without cartilage. Cartilage distribution patterns were computed and analyzed for each surface. The cartilage thickness of both sides of the third toe PIP joint and the third toe middle phalanx condyles were compared to the PIP joint of the fingers. A total of 18 third toe and 48 finger joint surfaces were analyzed. For the third toe middle phalanx condyles, the mean thickness was 0.20 ± 0.09 mm with a maximum of 0.52 ± 0.18 mm, and a coefficient of variation (CV%; a measure of uniformity of cartilage distribution) of 62. For the third toe proximal phalanx condyles, the mean cartilage thickness was 0.26 ± 0.10 mm with a maximum thickness of 0.56 ± 0.14 mm and a CV% of 44. The mean thickness, maximum thickness, and CV% of the finger proximal phalanx condyles was 0.43 ± 0.11 mm, 0.79 ± 0.16 mm, and 31, respectively. For the third toe middle phalanx base, the mean thickness was 0.28 ± 0.06 mm with a maximum of 0.47 ± 0.09 mm and a CV% of 34, compared to the finger middle phalanx base mean of 0.40 ± 0.12 mm with a maximum of 0.67 ± 0.14 mm and a CV% of 27. There were significant differences in cartilage thickness between the third toe and the fingers in this study. However, fewer differences were observed with the third toe middle phalanx base cartilage thickness than with the third toe condyles in comparison to the fingers.

Repair of proximal interphalangeal joint (finger) defects using the second toe proximal interphalangeal joint with skin flaps

Objective To discuss the clinical efficaey of repairing proximal interphalangeal (PIP) joint (finger) defects by transferring the second toe PIP joint with mlni-flaps. Methods PIP joint transfer from the second toe with vascular anastomosis was used to repair 28 PIP joint (finger) defects in 23 cases, among which 18 were total joint transfer and 10 were semi-joint transfer. Results All 28 transphnts in 23 cases survived. Primary postoperative healing was achieved, without the occurrence of infection and osteomyelitis. All grafted joints clinically healed within 4 to 8 weeks. The bone healing time was 6 to 10 weeks. The duration of postoperative follow up was 5 to 16 months with an average of 9 months. Degeneration of grafted joints was absent. Palmar joint dislocation was found in one case with seml-joint transfer involving two and a half fingers, which was sueccssfully corrected by arthroplasty. The postoperative range of motion if the transferred PIP joint was 35° to 90°, with an average of 65°. According to joint movement TAM/TAF criteria, outcomes of this series were graded as excellent in 10 grafted fingers, satisfactory in 14 fingers, average in 2 fingers and poor in 2 fingers. Overall excellent and good rate was 86%. Conclusion Repair of PIP joint(finger) defects using PIP joint transfer from the second toe enables favorable functional recovery and joint movement that meets daily needs, providing satisfying functional improvement of the joints. Key words: Hand joints; Wounds and injuries; Tissue tramplantafion; Microsurgery