[Flexion contracture of the middle phalangeal finger joint. Solution of the skin loss].
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Phalangeal fractures have up to now always been treated using a conservative static form of splint. Open reduction and stabilisation is preferred in the case of injuries with severe displacement, shortening, open fractures and joint involvement. In this study, we have shown the results of 86 proximal phalangeal fractures that were treated with "dynamic splinting". In the "intrinsic plus" position a dorsopalmar plaster splint is affixed in combination with a Bedford double finger stall, splinting the injured finger securely to its neighbour. Clinical and X-ray results were evaluated. Oblique, rotational and transverse fractures can be reduced and treated showing good results with dynamic splinting. Bending fractures cannot always be treated with this method. Especially basal fractures with dorsal comminution can be problematic. Comminuted fractures can only be treated with dynamic splinting if they have been primarily adequately reduced. Intraarticular condylar fractures have to be treated surgically. Our results have also shown that the fingers still are freely mobile even when the bone has not healed in an anatomical position.
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The use of dynamic traction splintage is established in the treatment of complex intra-articular phalangeal fractures. Several different systems have been used and we report our experience with one of these, the Pins and Rubber Traction System. A cohort of 14 patients with complex intra-articular fractures at the base of the middle phalanges of the fingers were treated and assessed prospectively over a 2.5-year period (mean, 20 months; range, 7-28 months). The mean active range of motion regained, at the proximal interphalangeal joint, was 74 degrees (range, 0-100 degrees ). The mean total active motion of the injured digit was 196 degrees (range, 40-275 degrees ). Refinements in the regime are suggested as a result of this investigation.
Complete dorsal dislocation of the metacarpal phalangeal joint almost always requires an open reduction. This case report presents an unusual set of circumstances allowing a closed reduction to be performed. The metacarpal-phalangeal joint of the patients' little finger was reduced before the carpal-metacarpal joint, followed by placement of percutaneous Kirschner wires.
OBJECTIVES--To follow up 102 patients with vibration induced white finger (VWF). METHODS--102 subjects with VWF were reexamined one to 13 years after the condition had first been diagnosed. Information about symptoms, occupation, vibration exposure, smoking habits, age, and the prevalence of other diseases was present in the medical records from the first examination and was collected by a questionnaire and an interview at the second examination. The decrease in systolic blood pressure in a finger during cold provocation (FSP%) was measured in the same finger at both examinations. RESULTS--At the second examination, 22% stated that the frequency of attacks had decreased. The improvement was most frequent in subjects with little or no exposure to vibration during the previous two years, in non-smokers, and in subjects without other circulatory diseases than VWF. 32% stated that the frequency of attacks had increased. The aggravation was most notable in smokers and subjects who also had circulatory diseases other than VWF. The number of finger phalanges that blanched on cooling averaged 15.8 at the first examination and 14.4 at the second examination. Working with high vibration hand held tools during the previous two years was related to an aggravation, with more finger phalanges affected at the second examination. Presence of other circulatory diseases had the same effect. In non-smokers the number of affected finger phalanges had decreased at the second examination. The FSP% had increased (improvement) in 43%, decreased (aggravation) in 12%, and was unchanged in 45%. The increase in FSP% was more pronounced in the older than in the younger subjects. The decrease of FSP% was more frequent among the younger subjects and subjects with a short follow up. CONCLUSION--As the FSP% in nearly half of the subjects had improved, it is concluded that VWF has a good prognosis in patients with mainly moderate to severe VWF after one to 13 years of observation. The improvement in FSP%, however, was not reflected in the subjective experience of the development of attacks of VWF. Continued work with high vibration hand held tools, smoking, other circulatory diseases, and low age at the time of diagnosis had an unfavourable influence on the prognosis.
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Trigger finger is commonly secondary to stenosing tenosynovitis. Space occupying lesions in the tendon bed, although uncommon, may prevent smooth tendon gliding. These include lipoma, anomalous muscle insertions, tumours of the tendon sheath and haemangiomas. We describe a patient who had triggering of the left middle finger at the proximal interphalangeal joint due to an exostosis blocking the flexor tendons gliding. Removal of the exostosis relieved the problem. The clinician must be aware that there are other causes for triggering. These may be identified with pertinent findings in the history and physical examination.
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Following our previous study about mobility of the three-phalangeal fingers we have measured flexion in the interphalangeal (IPP) and metacarpophalangeal (MPP) thumb joints as well as thumb opposition (hyperadduction) in university students (52 males and 49 females), seniors (30 males and 30 females) and pianists (21 males and 31 females). In the student control group we did not find difference between males and females or right and left hand, unlike in the previous study of three-phalangeal fingers. The MPP has greater flexion variability than the IPP joint. We have recorded greater limitation in all measured movements in seniors, in the thumb opposition significantly greater in males than in females. Pianists, on the other hand, always show greater thumb opposition, while greater flexion was significant only in the MPP joint in males. We did not record a difference between right and left hand in seniors or pianists.
Two unrelated patients, a 4-year-old boy and a 2 1/2-year-old girl, presented with a similar pattern of abnormalities. Both had severe mental retardation, macrocephaly, absence of the corpus callosum, unusual facial appearance, duplication of hallucal phalanges, postaxial hexadactyly of finger phalanges, and 2/3-syndactyly of toes. The boy also had postaxial hexadactyly of toe phalanges, inguinal hernias and umbilical hernia, and growth retardation. We suspect a common cause of this apparently "new" syndrome, most likely a gene mutation.
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