Arthrodesis of the equine proximal interphalangeal joint: a biomechanical comparison of 3-Hole 4.5 mm locking compression plate and 3-hole 4.5 mm narrow dynamic compression plate, with two transarticular 5.5 mm cortex screws

Objectives To compare the biomechanical characteristics of 2 arthrodesis techniques for the equine proximal interphalangeal joint (PIP) using either a 3-hole 4.5 mm locking compression plate (LCP) or 3-hole 4.5 mm narrow dynamic compression plate (DCP), both with 2 transarticular 5.5 mm cortex screws. Study Design Experimental. Sample Population Cadaveric adult equine forelimbs (*n=6 pairs). Methods For each forelimb pair, 1 limb was randomly assigned to 1 of 2 treatment groups and the contralateral limb by default to the other treatment group. Construct stiffness, gap formation across the PIP joint, and rotation about the PIP joint were determined for each construct before cyclic axial loading and after each of four, 5000 cycle loading regimens. After the 20,000 cycle axial loading regimen, each construct was loaded to failure. Results There were no significant differences in construct stiffness, gap formation, or sagittal plane rotation between the LCP and DCP treatment groups at any of the measured time points. Conclusion Biomechanically, fixation of the equine PIP joint with a 3-hole 4.5 mm LCP is equivalent to fixation with a 3-hole 4.5 mm narrow DCP under the test conditions used.

Resection of the flexor digitorum superficialis for trigger finger with proximal interphalangeal joint positional contracture

Open release of the Al pulley is a widely known procedure for the treatment of trigger finger. However, a subset of patients present trigger finger with a positional contracture of the proximal interphalangeal joint. These patients usually have a long history of trigger finger or have already undergone one surgery to treat trigger finger. In both instances, surgical intervention with only transection of the Al pulley is ineffective. In this study, 36 patients (39 fingers) were treated by resection of the flexor digitorum superficialis after section of the Al pulley (mean age: 63 y). We performed a retrospective review with a mean follow up of 30 months. The mean pre-operative extension deficit of the proximal interphalangeal articulation was 24 degrees, and 28 of the 39 affected fingers achieved filli extension following the surgical intervention. All of the resected tendons had histological damage. This technique is a useful treatment for selected patients whose trigger finger is associated with a positional contracture.

Bilateral Dorsal Subluxation of the Proximal Interphalangeal Joint of the Hind Limb in a Mare: Case Report

Subluxation of the proximal interphalangeal joint is a rare and little studied condition in horses. We describe the case of a 12-year-old mare with bilateral dorsal subluxation of the proximal interphalangeal joint of the hind feet. Tenectomy of the medial digital flexor was performed in both limbs, and the patient showed signs of recovery within 14 days. Goniometry of the proximal interphalangeal joints 10 months after surgery showed diminution of 5° for the proximal interphalangeal axis of the left hind limb. However, no change was found for the joint angle of the right limb. Even so, the patient's gait and radiographic results were normal, and clinical abnormalities such as joint clicking and swelling were no longer observed. © 2013 Elsevier Inc.

Traumatische chronische Instabilität des proximalen Tibiofibulargelenkes [Traumatic chronic instability of the proximal tibiofibular joint]

The rare condition of chronic instability of the proximal tibiofibular joint can be of traumatic or idiopathic origin and can lead to secondary arthritis. After conservative treatment for 6 months and persistent pain, operative treatment should be considered. We present a case of traumatic instability, ligament reconstruction with a part of the biceps femoris tendon, and postoperative return to full and painless sport activities.

Vascularized Bone Grafts for Upper Limb Reconstruction: Defects at the Distal Radius, Wrist, and Hand

Vascularized bone grafts have been successfully applied for the reconstruction of bone defects at the forearm, distal radius, carpus, and hand. Vascularized bone grafts are most commonly used in revision cases in which other approaches have failed. Vascularized bone grafts can be obtained from a variety of donor sites, including the fibula, the iliac crest, the distal radius (corticocancellous segments and vascularized periosteum), the metacarpals and metatarsals, and the medial femoral condyle (corticoperiosteal flaps). Their vascularity is preserved as either pedicled autografts or free flaps to carry the optimum biological potential to enhance union. The grafts can also be transferred as composite tissue flaps to reconstruct compound tissue defects. Selection of the most appropriate donor flap site is multifactorial. Considerations include size matching between donor and defect, the structural characteristics of the graft, the mechanical demands of the defect, proximity to the donor area, the need for an anastomosis, the duration of the procedure, and the donor site morbidity. This article focuses on defects of the distal radius, the wrist, and the hand. (J Hand Surg 2010;35A:1710-1718. (C) 2010 Published by Elsevier Inc. on behalf of the American Society for Surgery of the Hand.)

The Role of Kinaesthetic Motor Imagery in Promoting Activation of the Lumbrical Muscles in the Hemiparetic Hand: a Randomised Controlled Study

The objective of the investigation who gave as result this work was to investigate the effectiveness of kinaesthetic motor imagery in the activation of the hemiplegic hand muscles following stroke. The experiment consisted of two random groups. Movements were measured after treatment. The participants were ten patients with hemiplegic hands (men who mean age was 74.4 years; mean time since stroke 3.05 months). All patients received three sessions of physical treatment based on an identical treatment protocol. Five patients were randomly assigned to an experimental group practising kinaesthetic motor imagery of a grasp using the 'lumbrical action' (experimental group). The others five (control group) followed a relaxation script. All the patients were then asked to grasp an object using the 'lumbrical action'. The grasps were recorded using an optoelectronic motion capture system. The magnitude of the extension of the index finger and the correlation of the angular displacement of the proximal phalangeal joints and the metacarpophalangeal joints were calculated. The movement time for the whole grip was calculated. The experimental group demonstrated higher extension in the index finger (p = < 0.01) and they had a higher correlation coefficient (0.99) than the control group (0.77) for the displacement of the proximal interphalangeal joint and the metacarpophalangeal joints. The movement time for the experimental group was faster, although the difference was not significant.

Variações goniométricas metatarsofalângica e interfalângicas e medidas do casco do membro pélvico de equinos submetidos à tenectomia do flexor digital medial (flexor longo do halux)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Extra-articular fractures of the proximal phalanges of the fingers: a comparison of 2 methods of functional, conservative treatment

For nonsurgical treatment of fractures of the proximal phalanges of the triphalangeal fingers, different dynamic casts have been described. The main principle behind these casts is advancement and tightening of the extensor hood, caused by a combination of blocking the metacarpophalangeal joints in flexion and actively flexing the proximal interphalangeal joints. In contrast to established treatment protocols using functional forearm casts, the Lucerne cast allows for free mobilization of the wrist joint. The purpose of the current multicenter study was to compare the results of conservative, functional treatment using 2 different methods, either a forearm cast or a Lucerne cast.

Measuring finger joint cartilage by ultrasound as a promising alternative to conventional radiograph imaging

OBJECTIVE: To evaluate the reliability and validity of a novel ultrasound (US) imaging method to measure metacarpophalangeal (MCP) and proximal interphalangeal (PIP) finger joint cartilage. METHODS: We examined 48 patients with rheumatoid arthritis (RA), 18 patients with osteoarthritis (OA), 24 patients with unclassified arthritis of the finger joints, and 34 healthy volunteers. The proximal cartilage layer of MCP and PIP joints for fingers 2-5 was bilaterally visualized from a posterior view, with joints in approximately 90 degrees flexion. Cartilage thickness was measured with integrated tools on static images. External validity was assessed by measuring radiologic joint space width (JSW) and a numeric joint space narrowing (JSN) score in patients with RA. RESULTS: Precise measurement was possible for 97.5% of MCP and 94.2% of PIP joints. Intraclass correlation coefficients for bilateral total joint US scores were 0.844 (95% confidence interval [95% CI] 0.648-0.935) for interobserver comparisons and 0.928 (95% CI 0.826-0.971) for intraobserver comparisons (using different US devices). The US score correlated with JSN for both hands (adjusted R(2) = 0.513, P < 0.001) and JSW of the same finger joints (adjusted R(2) = 0.635, P < 0.001). Reduced cartilage shown by US allowed discrimination of early symptomatic OA versus early RA and healthy joints. In patients with RA, US scores correlated with duration of treatment-resistant, progressive RA. CONCLUSION: The US method of direct visualization and quantification of cartilage in MCP and PIP joints is objective, reliable, valid, and can be useful for diagnostic purposes in patients with arthritis.

Sensitivity to Change of the Ultrasound synovitis SONAR Score in RA Patients: Results of the Scqm Cohort

Background/Purpose: Since the end of 2009, an ultrasound scoring call SONAR has been implemented for RA patients as a routine tool in the SCQM registry (Swiss Clinical Quality Management registry for rheumatic diseases). A cross-sectional evaluation of patients with active disease and clinical remission according to the DAS28ESR and the novel ACR/EULAR remission criteria from 2010 clearly indicated a good correlational external validity of synovial pathologies with clinical disease activity in RA (2012 EULAR meeting. Objective: of this study was to evaluate the sensitivity to change of B-mode and Power-Doppler scores in a longitudinal perspective along with the changes in DAS28ESR in two consecutive visits among the patients included in the SCQM registry Methods: All patients who had at least two SONAR scores and simultaneous DAS28ESR evaluations between December 2009 and June 2012 were included in this study. The data came from 20 different operators working mostly in hospitals but also in private practices, who had received a previous teaching over 3 days in a reference center. The SONAR score includes a semi-quantitative B mode and Power-Doppler evaluation of 22 joints from 0 to 3, maximum 66 points for each score. The selection of these 22 joints was done in analogy to a 28 joint count and further restricted to joint regions with published standard ultrasound images. Both elbows and wrist joints were dynamically scanned from the dorsal and the knee joints from a longitudinal suprapatellar view in flexion and in joint extension. The bilateral evaluation of the second to fifth metacarpophalangeal and proximal interphalangeal joints was done from a palmar view in full extension, and the Power-Doppler scoring from a dorsal view with hand and finger position in best relaxation. Results: From the 657 RA patients with at least one score performed, 128 RA patients with 2 or more consultations of DAS28ESR, and a complete SONAR data set could be included. The mean (SD) time between the two evaluations was 9.6 months (54). The mean (SD) DAS28ESR was: 3.5 (1.3) at the first visit and was significantly lower (mean 3.0, SD.2.0, p:_0.0001) at the second visit. The mean (SD) of the total B mode was 12 (9.5) at baseline and 9.6 (7.6) at follow-up (p_0.0004). The Power-Doppler score at entry was 2.9 (5.7) and 1.9 (3.6), at the second visit, p _0.0001. The Pearson r correlation between change in DAS28ESR and the B mode was 0.44 (95% CI: 0.29, 0.57, p_ 0.0001),and 0.35 (95% CI: 0.16, 0.50, p _ 0.0002) for the Power-Doppler score,. Clinical relevant change in DAS (_1.1) was associated with a change of total B mode score _3 in 23/32 patients and a change a Doppler score _0.5 in 19/26. Conclusion: This study confirms that the SONAR score is sensitive to change and provides a complementary method of assessing RA disease activity to the DAS that could be very useful in daily practice.

Luxação aguda isolada da articulação tibiofibular proximal

A luxação traumática isolada da articulação tibiofibular proximal é rara. Esta lesão pode não ser reconhecida ou diagnosticada no atendimento inicial. A ausência de suspeita clínica pode causar problemas para o diagnóstico. O diagnóstico necessita de história precisa do mecanismo e sintomas da lesão, avaliação clínica e radiográfica adequada de ambos joelhos. Casos não reconhecidos são fonte de alterações crônicas. O tratamento é feito por redução fechada e imobilização ou, em casos irredutíveis ou instáveis, redução aberta com fixação interna temporária. Um caso raro de luxação tibiofibular proximal isolada em um jogador de basquetebol é relatado para ilustrar essa lesão.

Estudo morfológico e radiológico sobre a comunicação entre a articulação interfalangeana distal e a bolsa do osso navicular em eqüinos (Equus caballus, L., 1758)

Objetivou-se neste estudo verificar radiográfica e morfologicamente a existência de comunicação entre a bolsa do osso navicular (BN) e a articulação interfalangeana distal (AID), estabelecendo sua freqüência, sua forma e identificação das estruturas anatômicas envolvidas no processo. Para tanto, foram utilizados membros torácicos e pélvicos de 16 animais vivos, sendo 8 animais jovens e 8 animais adultos. Contraste iodado era injetado na BN dos membros direitos e na AID dos membros esquerdos. em seguida, realizavam-se radiografias em projeções látero-medial ou médio-lateral, dorsopalmar ou dorsoplantar, para a constatação de possível comunicação entre as estruturas em questão, que, posteriormente, seriam identificadas por meio da técnica de dissecação. Não foram observadas comunicações entre as estruturas em questão ou qualquer outra na porção distal dos membros, porém, em dois membros torácicos, constataram-se variações morfológicas nas extremidades laterais da BN, caracterizadas por projeções que se estendiam até o terço proximal da falange média, sendo mais pronunciada na face lateral que na medial.

Estudo morfológico e radiológico sobre a comunicação entre a articulação interfalangeana distal e a bolsa do osso navicular em peças anatômicas de eqüinos (Equus caballus, L. 1758)

Objetivou-se neste estudo verificar anatômica e radiograficamente a existência de comunicação entre a bolsa do osso navicular (BN) e a articulação interfalangeana distal (AID), estabelecendo sua freqüência e forma e identificando as estruturas anatômicas envolvidas no processo. Desta forma, foram utilizadas 140 peças anatômicas de membros torácicos e pélvicos de eqüinos. Com o auxílio de fluoroscópio, foi injetada uma mistura de contraste iodado, Neoprene látex e corante na BN dos membros direito e na AID dos membros esquerdos, com subseqüentes exposições radiográficas. Constatadas comunicações, identificavam-se as estruturas e os locais envolvidos, mediante técnica de dissecação. Verificou-se, em duas observações, comunicação entre a BN e a AID, após injeção de contraste iodado, látex e corante na bolsa do osso navicular, sendo um no membro torácico direito (MTD) e outro no membro pélvico direito (MPD). Comunicação entre a AID e a bainha do tendão do músculo flexor profundo do dedo (BTMFPD) ocorreu em uma peça, pertencente ao membro torácico esquerdo (MTE). Comunicação entre a BN e a BTMFPD foi observada na peça de um membro torácico direito. Variações morfológicas nas extremidades laterais da BN, constituindo projeções que se estendiam até o terço proximal da falange média, sendo mais pronunciada na face lateral do que na medial, ocorreram em cinco membros. Mediante a administração de contraste iodado, látex e corante na AID, nenhuma comunicação foi observada entre a AID e a BN.

Tenotomia do músculo flexor digital superficial e desmotomia acessória em equinos: goniometria radiometacarpiana, metacarpofalângica e interfalângica

The purpose of this study was to investigate the effects of the superficial digital tenotomy and the superior check ligament desmotomy on the radio-metacarpal, metacarpophalangeal, proximal and distal interphalangeal angles in horses. Under general anesthesia the superficial digital flexor tenotomy and superior check ligament desmotomy were performed, respectively, on the right and left forelimbs in nine horses. Before surgery and on 15th, 30th, and 60th postoperative days the radio-metacarpal, metacarpophalangeal, and proximal and distal interphalangeal angles were measured by radiographic examination. Tenotomy decreased significantly the metacarpophalangeal angle (mean ± standard deviation: preoperative – 140.7º ± 6.85; 60th day – 128.2º ± 5.93) and increased the distal interphalangeal angle (mean ± standard deviation: preoperative – 172.6 ± 1.87; 60th day – 167.6 ± 1.36). Desmotomy decreased the proximal interphalangeal angle (mean ± standard deviation: preoperative – 180.2º ± 5.43; 60th day- 197.3º ± 8.29). These surgical procedures did not change the radio-metacarpal angle. The superficial digital flexor tenotomy and the superior check ligament desmotomy cause different and significant changes in joint angles distal to the carpus.