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Query: UMLS:C0003090 (arthrodesis)
 8,374 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The pathogenesis and the anatomic causes for the swan neck deformity are reviewed. Many different soft tissue operations can succeed in preventing catastrophic loss of function if the deformity is treated while still in stage 1 or 2. In the later stages (3 and 4) restoration of finger is often not possible as a result of joint stiffness and irreversible joint changes. In this case, arthroplasty and arthrodesis should be considered.
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PMID:[Treatment of the swan neck deformity]. 55 50

Reconstructive hand surgery is an established, proved, and effective method to correct deformities and increase function in rheumatoid patients. As more experience has been gathered, the indications for both arthrodesis and arthroplasty have been better established, and a better approach to reconstructive hand surgery has developed. In this discussion we have evaluated in detail the surgical treatment indicated for wrist, metacarpophalangeal joint, and thumb deformities. The treatment of swan-neck deformities and boutonniere deformities is discussed in other sections in this volume.
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PMID:Reconstructive surgery in the rheumatoid hand. 116 Dec 66

The authors report the appearance of a swan-neck deformity few months after arthrodesis of the distal interphalangeal joint. The pathomechanics, prevention and treatment of the established deformity are discussed.
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PMID:A complication of distal interphalangeal joint arthrodesis. 126 96

Most rheumatoid patients will present with one or more thumb deformities at some stage of their clinical history. The goal of treatment is restoration and maintenance of stable and painless motion. Treatment is based on the type and stage of the deformity. The boutonniere thumb is the most common deformity. Metacarpophalangeal arthrodesis is preferred for isolated metacarpophalangeal involvement. For advanced cases in a low-demand patient, metacarpophalangeal arthroplasty with interphalangeal arthrodesis is performed. In the higher demand hand with an uninvolved carpometacarpal joint, arthrodesis of both metacarpophalangeal and interphalangeal joints may be considered. The less common swan neck is approached by treating the carpometacarpal joint with a hemiarthroplasty or a total resection with capsulodesis or arthrodesis of the metacarpophalangeal joint. Adduction contracture is treated by Z-plasty of the skin of the first web space and release of the adductor aponeurosis. Gamekeeper's deformity is treated with reconstruction of the ulnar collateral ligament. Arthrodesis is recommended for those patients with articular erosion of the metacarpophalangeal joint. Flexor pollicis longus and extensor pollicis longus tendon ruptures are common in rheumatoid patients. Extensor pollicis longus ruptures are usually treated with EIP transfer or observation. Flexor pollicis longus ruptures are more disabling and usually require a tendon transfer, tendon graft, or an interphalangeal joint fusion in patients with radiographic destruction of that joint.
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PMID:Reconstruction of the rheumatoid thumb. 157 17

Between 1974 and 1986 a total of 123 patients with a spastic or spastic athetotic paresis of the upper limb underwent surgery. The interval between surgery and follow-up examination was between one and 13 years. There were 73 cases of hemiparesis and 50 dipareses or tetrapareses due to perinatal cerebral paresis and 35 cases due to a variety of causes. The patients were aged between 6 and 58 years, the majority between 8 and 28 years. All contractures in the arm and hand region were treated at a single sitting. The sole exception to this was surgery for swan-neck deformity of the long fingers. In none of the cases was a wrist arthrodesis indicated. As regards the elimination of the previously existing malpositions, some of which were severe, and the cosmetic outcome, the results were good in all cases. The postoperative reduction was also preserved through the subsequent years, until completion of growth. Also, the difference in growth between flexors and extensors had no detectable negative influence on the long-term results of surgery. Only in a few isolated cases was limited revisional surgery necessary to improve the result as regards extension in the elbow joint and the posture of the wrist joint, which it had not been possible to treat satisfactorily at the first sitting. Two patients with a pronounced athetotic component manifested unsatisfactory results in several respects, or overcorrection of extension in the wrist joint: special caution is called for here. As far as necessary, corresponding corrective surgery was performed simultaneously on the lower limbs.
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PMID:[Results of hand surgery operations in spastic-athetotic paresis]. 321 63

Ninety-two fingers with rheumatoid swan-neck deformity were treated with dorsal capsulotomy and lateral band mobilization. An initial increase of 55 degrees of motion into flexion was noted, but this proximal interphalangeal motion deteriorated over time. Of 15 fingers followed at 3 and 12 months, there was a mean loss of 17 degrees of the early postoperative flexion. Nineteen fingers with rheumatoid boutonniere deformity were treated with central slip reconstruction. The results were unpredictable, with only modest improvement in the proximal interphalangeal extension, which deteriorated over time. The authors now recommend arthrodesis for most severe rheumatoid boutonniere deformities.
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PMID:Soft tissue reconstruction for rheumatoid swan-neck and boutonniere deformities: long-term results. 829 59

Each surgical procedure available for the rheumatoid hand has a score card. The most indicated and necessary procedures include: extensor tenosynovectomy and Darrach for the impending or already ruptured extensor tendons; flexor tenosynovectomy and carpal tunnel release for the patient with impaired median nerve function; stabilization of the deformed unstable thumb with MP or IP arthrodesis; and flexor tenosynovectomy in the palm and finger of a motivated patient with significant disparity between active and passive motion. Relative indications for surgery include arthrodesis for the unstable wrist; MP arthroplasty for the fixed MP volar and ulnar subluxation with inability to open the hand; synovectomy for the occasional patient with painful boggy synovitis of the MP or PIP joint; and reconstruction of the fixed swan neck deformity with relatively good PIP joints. Both MP and PIP joints can and should be operated on at the same time. Extensive wrist surgery, that is, tenosynovectomy and Darrach or arthrodesis, should not be performed at the same time as MP arthroplasty. Try to do the "winner operations" first.
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PMID:Surgical principles and planning for the rheumatoid hand and wrist. 882 79

The hand (wrist and fingers) is one of the regions most frequently affected by rheumatic arthritis (RA). The nature of the alterations involved means it is possible to interpret the clinical picture as RA even from the external appearance. Obviously the functional handicap affects activities of daily living, and the insult to the patient's aesthetic sensibilities imposes an additional, psychological, burden. A generally satisfactory limitation of damage can only be expected from professionals who work well together as a team. The ability to devise a therapy plan with the right priorities is the mark of those who have mastered the art of surgery for rheumatic conditions. Operative treatment presupposes failure of a conservative therapy carried out according to modern views. In addition to operations on the affected joints, operations on the tendons of the hand are also highly significant in terms of function. The interventions that can be performed on the joints embrace synovectomies, arthroplasties and arthrodeses. In the last 20 years the absolute number of joint synovectomies has fallen, since at least in treatment of the early stages radiosynoviorthesis has become increasingly important, especially for the metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints. Operative synovectomy is now considered when radiosynoviorthesis fails or in more advanced stages (Larsen 3) and when reconstruction procedures (especially on the tendons) are necessary. The chances are also better with open synovectomy (with or without resection of the head of the ulna) at the wrist. The results of synovectomy are not so impressive from the radiological aspect as from the clinical viewpoint, since as a result of the removal or attenuation of pain the function is often improved to the status of more than 10 years before and valuable time is thus gained. When the destruction is too far advanced arthroplasty is considered, especially for the MP joints but increasingly also for the PIP joints. Arthrodesis is a still highly valuable procedure for the wrist, since there is no really satisfactory artificial joint. An arthroplasty can only be successful if the tendons are intact. Tenosynovectomy and repair of ruptures have a good prognosis if appropriate techniques are used. The correction of such typical deformities of the fingers as buttonhole and swan neck deformity requires some of the technically more demanding operations.
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PMID:[The rheumatic hand]. 958 24

The replacement of finger joints, especially of the proximal interphalangeal joint (PIP), remains an unsolved problem. Long-term results of conventional reconstructive procedures as well as previously available artificial joint implants have been disappointing. In a controlled study, 12 PIP-joints were replaced by a new type of total endoprosthesis as an alternative to joint fusion. The cementless prosthesis is unhinged and consists of metal joint surfaces. After a follow-up of 18 months, implantation of this metal prosthesis resulted in almost complete pain relief and an active range of movement of 58 degrees. The absolute gain in mobility, however, was only 6 degrees. A swan-neck deformity was found in nine out of 12 cases but corrective surgery was not required. The proximal half of the implant had to be exchanged in two cases due to loosening. All patients were satisfied with the result. The disparity between subjective acceptance by the patients, who clearly prefer joint replacement to fusion, and objective results demonstrates the necessity for further development in this field. The type of prosthesis used in this study seems to be a useful baseline tool which could be turned into a ingenious PIP-joint replacement by further development aiming at reduced abrasion, increased initial stability, a more individual configuration, to name just a few goals.
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PMID:[Experiences with the alloplastic joint prosthesis of the interphalangeal joint]. 1076 29

Silicone implant arthroplasty (SIA) has been an effective alternative in the treatment of arthritic conditions of the proximal interphalangeal (PIP) joints since its introduction into surgical practice in the early 1960s. Patients with post-traumatic, degenerative, and rheumatoid arthritis all may be candidates for PIP joint SIA. The indications for SIA of the PIP joint include pain, limited joint mobility, and angular deformity of the joint with underlying articular destruction. Contraindications include ankylosis of the joint due to bony or soft-tissue restrictions, infection, inadequate soft-tissue support for coverage, absence of flexor and/or extensor tendon function, and considerable periarticular bone loss in the proximal and middle phalanges. Proximal interphalangeal joint SIA can be accomplished by dorsal, volar, or midaxial approaches. The dorsal approach has the advantages of relative technical ease, excellent visibility of the articular surfaces for preparation of the implant canals, access to the extensor mechanism for correction of central slip abnormalities, and preservation of the collateral ligaments. The surgical technique is outlined and includes handling of the extensor mechanism and central slip attachment, mobilization of the collateral ligaments, joint surface resection, preparation of the bony canals, implant sizing, implant insertion, and repair of the soft tissues. Pearls and pitfalls of the technique are outlined. Early postoperative mobilization with hand therapy is essential but must include protection of the repaired extensor apparatus. Complications include bony changes, implant failure, recurrent angular deviation or swan-neck deformity, particulate synovitis, and rarely, infection. Complications related to implant failure are most often managed with implant replacement or arthrodesis; those related to poor mobility, angular deformity and tendon imbalance, pain, or infection are managed by arthrodesis. Although SIA of the PIP joint has a relatively high degree of success when measured both subjectively and objectively, careful patient selection is important for achieving desirable results.
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PMID:The dorsal approach to silicone implant arthroplasty of the proximal interphalangeal joint. 1760 76


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