PURPOSE OF THE STUDY: Osteoarthritis (OA) of the joints of the hand is one of the most common musculoskeletal disorders in the elderly population. It is a complex, degenerative disease affecting all components of the joint. Surgical treatment is indicated when conservative therapy fails. The ultimate solution is arthrodesis of the distal interphalangeal (DIP) joint. Various methods of arthrodesis have been described, ranging from the use of K-wires or compression screw to different types of intra-articular (intramedullary) implants. The aim of this study is to evaluate the surgical outcomes of arthrodesis of the distal interphalangeal (DIP) joint of the fingers using intramedullary implants. MATERIAL AND METHODS: Since 2011, arthrodesis of the distal interphalangeal joint using an intramedullary implant has been performed at our department 97 times in total, in 59 patients. 9 patients (15 cases of arthrodesis) were excluded from the study group due to their failure to complete the questionnaire, 1 female patient died. In the final group, 82 cases of arthrodesis in 49 patients (47 women, 2 men) were evaluated. In 72% of cases, the surgery was performed on the dominant hand. The mean age at the time of surgery was 58 years (median 59 years). The patients were indicated for surgery after the failure of all conservative treatment options. In addition to radiographs, also the hand function and pain were assessed based on the preand postoperative DASH score questionnaires. RESULTS: The surgical outcomes for all implants are satisfactory. In all 82 patients, the surgical wounds healed per primam. In one case, implant extraction was performed due to infection. Another complication was an unhealed fusion and formation of a non-union with minimum pathological mobility (the patient is satisfied with the outcome). In three patients, a fracture at the base of the distal phalanx was observed on postoperative radiographs, which fully healed within 3 months after surgery. The mean DASH score decreased from 41.95 preoperatively to 14.93 postoperatively. The mean time to healing of the arthrodesis observed on radiographs was 9.1 weeks. DISCUSSION: Currently, there are many different types of arthrodesis of the distal interphalangeal joint of the hand. Each method has its pros and cons. Arthrodesis using an intramedullary implant has the advantages of the older methods while minimizing postoperative complications. Our results are comparable to those reported in the foreign literature. CONCLUSIONS: Based on the evaluated outcomes, arthrodesis of the distal interphalangeal joint using an intramedullary implant can be considered valid. It definitely deserves to be included in the portfolio of surgical treatment of osteoarthritis of the DIP joints of the hand. According to our observation, the differences between various types of implants are minimal and their outcomes are comparable to those reported in foreign publications. The pain relief, restored finger function and fusion rate are comparable to, if not better than, those achieved by the older surgical methods. The advantage of this method is mainly easier implantation, fewer complications, and the possibility of implantation without the use of an X-ray image intensifier, which ultimately reduces the cost of surgery. The main disadvantage is the higher purchase price of the implant. KEY WORDS: osteoarthritis, distal interphalangeal joint, arthrodesis.
- MeSH
- artrodéza * metody přístrojové vybavení MeSH
- kloub prstu ruky * chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- osteoartróza * chirurgie MeSH
- radiografie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
OBJECTIVE: The aim of the present study was to illustrate the (potential) diagnostic role of high resolution US images in assessing the elementary lesions of dactylitis. METHODS: Using high-frequency US machines/probes, we matched the micro-anatomical cadaveric architecture of the digit with multiple sonographic findings of dactylitis. High-sensitive color/power Doppler assessments have also been performed to evaluate the digital microvasculature. DISCUSSION: Modern US equipment/features guarantee prompt and in-depth B-mode and color/power Doppler imaging of tiny anatomical structures of the digit which are usually not properly visible with standard US machines. More specifically, hypervascularization of the digital subcutaneous tissue, fibrous pulleys of flexor tendons, dorsal synovial pads as well as pathological changes of the distal entheseal anchorage network can be accurately detected. CONCLUSION: In clinical practice, high-end US equipment can be used to accurately assess the digits in patients with dactylitis. This way, simple and convenient sonographic diagnosis of different elementary lesions can be timely established.
OBJECTIVES: The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system. METHODS: The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis. RESULTS: 32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39-0.71) and intraobserver reliability good to excellent (κ 0.80-0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes). CONCLUSIONS: We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated.
- MeSH
- delfská metoda MeSH
- dospělí MeSH
- entezopatie diagnostické zobrazování MeSH
- kloub prstu ruky * diagnostické zobrazování patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mrtvola MeSH
- odchylka pozorovatele MeSH
- prsty ruky diagnostické zobrazování patologie MeSH
- psoriatická artritida * diagnostické zobrazování MeSH
- reprodukovatelnost výsledků MeSH
- senioři MeSH
- studie proveditelnosti MeSH
- stupeň závažnosti nemoci * MeSH
- synovitida diagnostické zobrazování patologie MeSH
- tenosynovitida diagnostické zobrazování MeSH
- ultrasonografie * metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- validační studie MeSH
Pachydermodaktylie (PDD) je vzácná benigní dermatóza charakterizovaná asymptomatickým progredujícím zbytněním periartikulární měkké tkáně, především laterálních částí proximálních interfalangeálních (PIP) kloubů. Nejčastěji bývají symetricky postiženy II.–IV. prst, postižení I. a V. prstu je vzácné. Periartikulární tkáň prstů nohou není zasažena nikdy. Postihuje především mladé muže, nejčastěji adolescenty, s poměrem zastoupení muži : ženy 3,9 : 1. Zduření PIP kloubů se vyvíjí asymptomaticky po několik let s následnou stabilizací stavu. Správná diagnóza PDD předchází zbytečnému vyšetřování pacienta a nevhodně zvolené, často imunosupresivní léčbě. Autoři uvádějí případ 21letého muže s 6 let trvajícím, neprogredujícím postižením, jeho diferenciální diagnózu a přehled současné literatury.
Pachydermodactyly (PDD) is a rare, benign dermatosis characterized by asymptomatic, progressive swelling of the periarticular soft tissue mainly of the lateral parts of the second through fourth PIP joints. The thumb is usually spared. The periarticular tissue of the toes is never affected. It mainly affects young men, most often adolescents, with a male : female ratio of 3.9 : 1. Swelling of the PIP joints develops asymptomatically for several years with subsequent stabilization of the condition. Correct diagnosis of PDD prevents unnecessary examination of the patient and inappropriately chosen often immunosuppressive treatment. The authors present the case of a 21year-old man with non-progressive infliction lasting 6 years, its differential diagnosis and a review of the current literature.
- Klíčová slova
- pachydermodaktylie,
- MeSH
- dermatózy ruky * diagnóza etiologie klasifikace patologie MeSH
- diferenciální diagnóza MeSH
- histologické techniky MeSH
- hyperplazie diagnóza etiologie klasifikace patologie MeSH
- kloub prstu ruky * patologie MeSH
- kůže patologie MeSH
- lidé MeSH
- mladý dospělý MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
The best treatment for mallet fingers is still a matter of debate. Numerous splints with different designs to keep the distal interphalangeal (DIP) joint in extension have been described in literature. The outcomes of splint treatment are generally good with occasional reports of minor skin complications. Percutaneous Kirschner-wire pinning of the DIP joint for closed tendinous mallet finger represents a alternative treatment modality that reliably immobilises the joint and does not need much patient compliance or use of an external splint. We report a rare but devastating complication of percutaneous pinning of the DIP joint for closed tendinous mallet finger. Level of Evidence: Level V (Therapeutic).
PURPOSE OF THE STUDY Arthrodesis of interphalangeal joints of the hand is a method used to treat conditions associated with joint destruction, instability and pain. Our study aims to evaluate the outcomes of the treatment of sequelae of septic arthritis of interphalangeal joints by arthrodesis with external fixation. This topic is hardly covered in literature. Moreover, it compares the outcomes of application of this method in diabetic patients and non-diabetic population. MATERIAL AND METHODS Arthrodesis by means of Stellbrink external fixator was performed in 17 patients who had suffered septic arthritis of interphalangeal joints of the hand. The following parameters were followed in patients in our group: age, sex, etiology of disease, smoking, diabetes, affected fingers and joints of the hand, side, microbial culture finding, wound healing, postoperative ATB therapy and its duration, radiographic signs of the union of arthrodesis and potential complications. RESULTS The group included 8 men and 9 women. The mean age was 66.2 years. 5 patients in the group were diabetic. In 16 patients the wound healed per primam, in 1 case per secundam. The average duration of postoperative ATB therapy was 4.3 weeks. The X-ray showed the union of fused articular surfaces at 6.9 weeks on average. Complications occurred in 3 patients, namely 1 case of secondary wound healing, 1 case of nail bed damage and 1 case of flexor tenosynovitis of the operated finger. The arthrodesis was successfully healed in all the patients and a no difference was detected between diabetic and nondiabetic patients. DISCUSSION When arthrodesis of interphalangeal joints of the hand is performed using an external fixator, the metal material is introduced outside the area of inflammation, or the field potentially at risk of infection, therefore this method is predetermined for surgeries in the terrain changed by inflammation or potentially at risk of inflammation. Compared to the other methods such as arthrodesis by inserting K-wires intramedullary, there is no risk of migration of the metal material and the associated soft tissue irritation. CONCLUSIONS Our study confirms the safety and efficiency of arthrodesis of interphalangeal joints of the hand by means of an external fixator in treating the sequelae of septic arthritis. The union of arthrodesis with no complications was observed even in all the diabetic patients. Ranking among the main advantages of this method are the easy care for the surgical wound, achievement of easy and firm fixation with the possibility to apply an external fixator outside the area of the original infection. Key words:arthrodesis, external fixator, septic arthritis, interphalangeal joint.
- MeSH
- artrodéza přístrojové vybavení metody MeSH
- externí fixátory MeSH
- infekční artritida komplikace chirurgie MeSH
- kloub prstu ruky chirurgie MeSH
- komplikace diabetu komplikace MeSH
- kostní dráty MeSH
- lidé MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- antiflogistika nesteroidní aplikace a dávkování MeSH
- antirevmatika aplikace a dávkování MeSH
- aplikace lokální MeSH
- chondroitinsulfáty terapeutické užití MeSH
- kloub prstu ruky patologie účinky léků MeSH
- klouby ruky diagnostické zobrazování patologie účinky léků MeSH
- lidé MeSH
- osteoartróza * diagnostické zobrazování farmakoterapie klasifikace MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
INTRODUCTION: Fractures of the base of the middle phalanx of the hand include the entire spectrum of injuries. They can be divided into fractures of the volar part of the base of the phalanx at the place where the metacarpophalangeal volar plate is attached, fractures of the dorsal part of the base of the phalanx at the insertion point of the central extensor band, or complex fractures of the pilon. The paper presents case reports that point to possible errors in diagnosis and treatment. Furthermore, an overview of current therapeutical concepts is presented. DISCUSSION: The treatment method is based on the evaluation of the stability of the proximal interphalangeal joint. Stable injuries are treated conservatively, unstable fractures require surgical treatment. For conservative treatment, functional therapy is preferred. Possibilities of treatment of unstable injuries include open reduction and osteosynthesis, closed reduction and stabilization by dynamic external fixation, or more advanced methods of reconstruction, such as volar plate arthroplasty and hemi-hamate arthroplasty. CONCLUSION: Quality diagnostics, surgeon‘s erudition and material equipment are essential for successful treatment. Despite proper treatment, full functional recovery is usually not achieved. The aim of therapy is the patient´s functional and painless finger.
- MeSH
- artroplastika prstů metody MeSH
- chybná diagnóza MeSH
- chybná zdravotní péče MeSH
- interní fixátory MeSH
- kloub prstu ruky chirurgie diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- poranění prstů ruky * diagnostické zobrazování MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
ÚVOD: Zlomeniny baze středního článku prstů ruky zahrnují celé spektrum poranění. Lze je rozdělit na zlomeniny volární části baze článku v místě, kde se upíná volární ploténka, zlomeniny dorzální části baze článku v místě úponu centrálního pruhu extenzoru, případně komplexní zlomeniny pilonu. V práci jsou prezentovány kazuistiky, které poukazují na možné chyby při diagnostice a léčbě. Dále je podán přehled současných přístupů k terapii. DISKUZE: Způsob léčby se odvíjí od zhodnocení stability proximálního interfalangeálního kloubu. Stabilní poranění léčíme konzervativně, nestabilní zlomeniny vyžadují operační řešení. Při konzervativní terapii je preferována funkční léčba. Mezi možnosti ošetření nestabilních poranění patří otevřená repozice a osteosyntéza, zavřená repozice a stabilizace dynamickou zevní fixací, případně pokročilejší metody rekonstrukce, kam se řadí artroplastika volární ploténkou a hemi-hamátní artroplastika. ZÁVĚR: Kvalitní diagnostika, erudice chirurga a materiální vybavení je nezbytné pro úspěšnou léčbu. I přes správný léčebný postup nebývá dosaženo plné obnovy funkce. Cílem terapie je funkční a nebolestivý prst.
- MeSH
- artroplastika prstů metody MeSH
- chybná diagnóza MeSH
- chybná zdravotní péče MeSH
- interní fixátory MeSH
- kloub prstu ruky chirurgie diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- poranění prstů ruky * diagnostické zobrazování MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- Klíčová slova
- Boutonnierova deformita,
- MeSH
- časné pohybování MeSH
- chronická nemoc MeSH
- deformity ruky * chirurgie klasifikace patofyziologie rehabilitace MeSH
- dospělí MeSH
- fraktury ulny * chirurgie komplikace terapie MeSH
- kloub prstu ruky chirurgie patofyziologie MeSH
- konzervativní terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- olecranon * diagnostické zobrazování patofyziologie MeSH
- poranění prstů ruky etiologie chirurgie patofyziologie MeSH
- prospektivní studie MeSH
- randomizované kontrolované studie jako téma MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- souhrny MeSH
- srovnávací studie MeSH
