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The article contains data of using carbon implants of syntactic foam to replace marginal defects of bone tissue of finger phalanges and metacarpal bones after excision of enchondromas. Sixteen clinical observations are reported.
After X-radiation of pregnant rats on the 10th day of pregnancy, in 50% of the fetuses studied subtotal aplasia of the tibial bone anlage and decreasing number of the metatarsus and finger phalanges anlages are observed. Radiation on the 11th day of embryogenesis does not result in anomaly formation of the thoracic and pelvic extremities. After radiation on the 12th day of embryogenesis, the most specific anomaly of the pelvic extremity is phocomelia. The thoracic extremity skeleton lesions are revealed as an ulnar type of distal ectromelia, or axial ectromelia. After radiation on the 13th--14th day, hypoplasia of the bone anlages, that make zeugopodium, autopodium, is observed. After radiation on the 13th day, a partial or total aplasia of the fibular bone anlage can take place. In all the fetuses a sharp decrease in number of the hand and foot bone anlages is observed; it is connected with a total aplasia of some of them and with fusion of the others. A specific feature for radiation lesions of the extremity skeleton is that the oppositely situated anlages of the bones do not separate from each other. This results from certain disturbances in the joint interzone formation at early stages of embryogenesis and from underdevelopment of the joint cleft. Qualitatively different radiation anomalies of the extremity skeleton development are formed as consequence of disturbances in morphogenetic processes of determination: migration, proliferation, morphogenetic cell death and differentiation.
The authors describe a case of an inborn contracture of the superficial flexors of the three-phalangeal fingers in a 15-year-old girl and treatment of the condition. For clinical purposes a classification on congenital deformities in the proximal part of the flexor complex was proposed in which the described case is included. The classification was derived from the ontogenetic development of flexor tendons. There are three types of deformities: S1--the muscular belly of the superficial flexor of the fingers is only in the palm; S2--the muscle is attached to the area between the wrist and medial epicondyle; S3--the palmaris longus of the fingers is on the medial epicondyle, however the m. palmaris longus is lacking; Pl-1 the superficial flexor exists only in the form of a proximal muscular belly of varying length; Pl-2--the palmaris longus is on the wrist and the insertion tendon may be thinner than on the contralateral side. The described contracture deformity was classified as type S2.
Two cases of proximal phalangeal fracture following finger wrestling are described. The mechanism of the injury is discussed.
Thirty-three patients with avulsion fractures from the base of the proximal phalanges were treated during a 6-year period. All eight fractures treated conservatively failed to unite and subsequently required surgery. The remaining 25 patients were treated with primary internal fixation using a single lag screw through a palmar approach. Surgery gave excellent results in all cases and all patients achieved a full range of movement within 3 weeks.
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An unconstrained surface metacarpophalangeal joint replacement was developed with metal metacarpal and polyethylene phalangeal components, fixed by uncemented finned polyethylene plugs which allowed some metacarpal component motion. Clinical and radiological results in 13 joints in eight patients are presented after 5 years. One infection required revision at 3 months. There were no further complications. At final review there were no implant failures. Two of 13 joints showed lucency around the phalangeal component and one showed 2mm subsidence of the metacarpal component. No other adverse radiological features were observed. Seven patients had no pain and one had minor discomfort. Joint movement had improved from an arc of 27 degrees to 60 degrees and disability, assessed using the P.E.M. questionnaire, had improved from 77% to 9%.
Subcutaneous "pocketing" is proposed as a simple and convenient method to nourish a denuded, replanted end of a finger, when the amputation is between the lunule and the DIP joint. The investigation of a laboratory model is presented, and our initial clinical experience is reported.
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