Abstract
Introduction
Finger proximal interphalangeal joint (PIP) reconstruction after the destruction of parts of the joint remains challenging. Surgical techniques include implant arthroplasty, arthrodesis, free vascularized joint transfer, and non-vascularized bone and joint transfer. This study analyzes our experience after non-vascularized transfer in terms of range of motion, postoperative rehabilitation, and patient satisfaction.
Materials and methods
Between 2009 and 2014, ten patients underwent non-vascularized partial joint transfer for PIP joint reconstruction. One of them was lost to follow-up. Included patients had osteochondral partial joint transplants of 25–50% of the toes (n = 4) and the hand (n = 5). Range of motion (ROM), grip-, and pinch-strength were measured at the last follow-up control and compared to the healthy side. Patients were asked to score the pain at rest/ on load on a visual scale (VAS: 0 = no pain; 10 = excruciating pain). Satisfaction self-assessment was evaluated by asking the patients to grade their postoperative result as excellent, very good, good or poor.
Results
Mean follow-up period was 4.0 years (range 1.2–7.9 years). Mean PIP joint flexion was 93 ± 26° at the last follow-up control. Mean grip- and pinch-strength of the operated side at the last control were, respectively, 43 ± 18 kg and 8 ± 5 kg, close to the healthy side values (45 ± 15 kg and 9 ± 4 kg). Mean pain at rest/on load measured on a visual scale was, respectively, 0.3 ± 1 and 1.8 ± 2. Eight patients (89%) rated their operation as excellent, and one as poor.
Conclusion
In this study, non-vascularized partial joint transfer provides a mobile and stable PIP joint 4 years after reconstruction. The surgical technique presented herein is complex depending on additional injuries but results in great patient satisfaction.
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References
Khan W, Agarwal M, Muir L (2004) Management of intra-articular fractures of the proximal interphalangeal joint by internal fixation and bone grafting. Arch Orthop Trauma Surg 124:688–691
Yamagami N, Yamamoto S, Tsujimoto Y, Uchio Y (2013) Osteochondral autograft transplantation for malunited intra-articular fracture of the proximal interphalangeal joint: a case report. Arch Orthop Trauma Surg 133:135–139
Tekkis PP, Kessaris N, Gavalas M, Mani GV (2001) The role of mini-fragment screw fixation in volar dislocations of the proximal interphalangeal joint. Arch Orthop Trauma Surg 121:121–122
Caggiano NM, Harper CM, Rozental TD (2018) Management of proximal interphalangeal joint fracture dislocations. Hand Clin 34:149–165
Unglaub F, Langer MF, Hahn P, Müller LP, Ahrens C, Spies CK (2016) Fractures of the proximal interphalangeal joint: Diagnostic and operative therapy options. Unfallchirurg 119:133–143
Strohl AB, Teplitsky SL, Gandhi SD, Kane PM, Osterman AL (2017) Dorsal versus lateral plate fixation of finger proximal phalangeal fractures: a retrospective study. Arch Orthop Trauma Surg 137:567–572
Park JH, Park GW, Choi IC, Kwon YW, Park JW (2019) Dorsal transosseous reduction and locking plate fixation for articular depressed middle phalangeal base fracture. Arch Orthop Trauma Surg 139:141–145
Quadlbauer S, Pezzei C, Hintringer W, Hausner T, Leixnering M (2019) Percutaneous treatment of unstable fractures of the base of the middle phalanx : Technique according to Hintringer and Ender. Oper Orthop Traumatol Epub Jul 25.
Wagner ER, Luo TD, Houdek MT, Kor DJ, Moran SL, Rizzo M (2015) Revision proximal interphalangeal arthroplasty: an outcome analysis of 75 consecutive cases. J Hand Surg [Am] 40:1949–1955
Moran SL, Rizzo M (2018) Medium-term outcomes with pyrocarbon proximal interphalangeal arthroplasty: a study of 170 consecutive arthroplasties. J Hand Surg [Am] 43:797–805
Squitieri L, Chung KC (2008) A systematic review of outcomes and complications of vascularized toe joint transfer, silicone arthroplasty, and PyroCarbon arthroplasty for posttraumatic joint reconstruction of the finger. Plast Reconstr Surg 121:1697
Bravo CJ, Rizzo M, Hormel KB (2007) Pyrolytic carbon proximal interphalangeal joint arthroplasty: results with minimum two-year follow-up evaluation. J Hand Surg [Am] 32:1–5
Schindele SF, Altwegg A, Hensler S (2017) Surface replacement of proximal interphalangeal joints using CapFlex-PIP. Oper Orthop Traumatol 29:86–96
Rijnja JP, Kouwenberg PPGM, Ray S, Walbeehm ET (2017) Robert Mathys Finger prosthesis of the proximal interphalangeal joint: a retrospective case series of 19 joints in 17 patients. Arch Orthop Trauma Surg 137:1155–1160
Hohendorff B, Zhang W, Burkhart KJ, Müller LP, Ries C (2015) Insertion of the Ascension PyroCarbon PIP total joint in 152 human cadaver fingers: analysis of implant positions and malpositions. Arch Orthop Trauma Surg 135:283–290
Schindele SF, Sprecher CM, Milz S, Hensler S (2016) Osteointegration of a modular metal-polyethylene surface gliding finger implant: a case report. Arch Orthop Trauma Surg 136:1331–1335
Newman EA, Orbay MC, Nunez FA Jr, Nunez F Sr (2018) Minimally invasive proximal interphalangeal joint arthrodesis using headless screw: surgical technique. Tech Hand Up Extrem Surg 22:39–42
Hohendorff B, Franke J, Spies CK, Müller LP, Ries C (2017) Arthrodesis of the proximal interphalangeal joint of fingers with tension band wire. Oper Orthop Traumatol 29:385–394
Millrose M, Zach A, Kim S, Güthoff C, Eisenschenk A, Vonderlind HC (2019) Biomechanical comparison of the proximal interphalangeal joint arthrodesis using a compression wire. Arch Orthop Trauma Surg 139:577–581
Spies CK, Hohendorff B, Löw S, Müller LP, Oppermann J, Hahn P, Unglaub F (2017) Arthrodesis of the distal interphalangeal joint using the headless compression screw. Oper Orthop Traumatol 29:374–384
Capo JT, Hastings H Jr, Choung E, Kinchelow T, Rossy W, Steinberg B (2008) Hemicondylar hamate replacement arthroplasty for proximal interphalangeal joint fracture dislocations: an assessment of graft suitability. J Hand Surg 33A:733–739
Tyser AR, Tsai MA, Parks BG, Means KR Jr (2015) Biomechanical characteristics of hemi-hamate reconstruction versus volar plate arthroplasty in the treatment of dorsal fracture dislocations of the proximal interphalangeal joint. J Hand Surg [Am] 40:329–332
Pillukat T, Kalb K, Fuhrmann R, Windolf J, van Schoonhoven J (2018) Reconstruction of the middle phalangeal base of the finger using an osteocartilaginous autograft from the hamate. Oper Orthop Traumatol Epub Sep 14.
Kuzu İM, Kayan RB, Öztürk K, Güneren E (2018) Functional improvement with free vascularized toe-to-hand proximal interphalangeal (PIP) joint transfer. Plast Reconstr Surg Glob Open 6:e1775
Chen HY, Lin YT, Lo S, Hsu CC, Lin CH, Wei FC (2014) Vascularised toe proximal interphalangeal joint transfer in posttraumatic finger joint reconstruction: the effect of skin paddle design on extensor lag. J Plast Reconstr Aesthet Surg 67:56–62
Calfee RP, Kiefhaber TR, Sommerkamp TG, Stern PJ (2009) Hemi-hamate arthroplasty provides functional reconstruction of acute and chronic proximal interphalangeal fracture-dislocations. J Hand Surg Am 34:1232–1241
Williams RM, Kiefhaber TR, Sommerkamp TG, Stern PJ (2003) Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft. J Hand Surg 28A:856–865
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Leclère, F.M., Haug, L., Meier, R. et al. Non-vascularized partial joint transfer for Finger Proximal Interphalangeal joint reconstruction: a series of 9 patients. Arch Orthop Trauma Surg 140, 139–144 (2020). https://doi.org/10.1007/s00402-019-03301-9
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DOI: https://doi.org/10.1007/s00402-019-03301-9