Finger Joint ; diagnostic imaging ; pathology ; Humans ; Joint Dislocations ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Radiography

BACKGROUND/AIMS: To examine the correlation between radiological joint damage and serological parameters in early rheumatoid arthritis (RA). METHODS: This retrospective study reviewed the records of 216 patients diagnosed with RA and classified them according to disease duration: group 1, < or = 24 months; group 2, > 24 months; and group 3, all patients combined. The extent of joint damage was assessed from plain radiographs using a modified version of the Larsen method and compared among groups. RESULTS: The mean radiographic joint damage score was significantly higher in patients who had established RA (10.1 points) compared with those who had early RA. In group 1, the inflammatory parameters, erythrocyte sedimentation rate, and C-reactive protein were positively correlated with the joint damage score, but rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody were not. A subgroup analysis revealed that the anti-CCP positive patients in groups 1 and 2 had greater joint damage scores than did the anti-CCP negative patients, but no difference in RF was observed between subgroups. Anti-CCP positivity was not significantly correlated with joint damage sores in group 3. CONCLUSIONS: Anti-CCP positivity was significantly correlated with more severe joint damage at diagnosis. A correlation was observed between the radiological joint damage score and inflammatory parameters in early and established RA, indicating that anti-CCP can serve as a diagnostic tool and predict structural joint damage. These findings suggest anti-CCP positive patients should receive aggressive therapeutic intervention.
Adult ; Arthritis, Rheumatoid/*immunology/*radiography ; Autoantibodies/*blood ; *Biological Markers ; Early Diagnosis ; Female ; Finger Joint/radiography ; Humans ; Male ; Metacarpophalangeal Joint/radiography ; Middle Aged ; Peptides, Cyclic/*immunology ; Retrospective Studies ; Severity of Illness Index ; Wrist Joint/radiography

BACKGROUND: Symphalangism is a rare congenital difference characterized by ankylosis of interphalangeal (IP) joints of the fingers and toes. In adults, there were several attempts to restore the stiff joints into mobile ones, but these treatment options resulted in poor outcomes and could not be applied to growing children. Here, we report our experiences on surgical treatment for children who had symphalangism of the hand. METHODS: We treated 36 joints in 17 children with symphalangism of the hand using dorsal capsulotomy and collateral ligament release. The diagnoses were based on history, physical examination, and simple radiographs. Affected fingers were classified according to our grading system. Simple compressive dressing was applied using Coban after surgery. Passive range of motion (ROM) exercise was started on day one or 2 postoperative, with the help of a hand therapist and patients' parents. The patients were prescribed passive ROM exercises for at least 2 hours a day over a period of 6 months. RESULTS: A single surgeon operated on 30 proximal IP joints, 3 distal IP joints, and 3 IP joints of the thumb. Twenty six joints were classified as grade I, and 10 as grade II. The ROM of affected joints, which was 7.8 +/- 8.1 (mean +/- SD) degrees preoperatively, increased to 46.8 +/- 18.6 degrees at final follow-up. The final ROM was significantly better in grade I joints, especially when the children had operations at ages 24 months or younger. CONCLUSIONS: Symphalangism of the hand in children, can be restored into a mobile joint by release of the collateral ligament, a dorsal capsulotomy, and postoperative physical therapy.
Age Factors ; Ankylosis/radiography/surgery ; Child ; Child, Preschool ; Female ; Finger Joint/abnormalities/radiography/surgery ; Humans ; Infant ; Joint Diseases/classification/*congenital/radiography/surgery ; Ligaments/surgery ; Male ; Orthopedic Procedures/methods ; Physical Examination ; *Range of Motion, Articular ; Statistics, Nonparametric ; Treatment Outcome

BACKGROUND: Symphalangism is a rare congenital difference characterized by ankylosis of interphalangeal (IP) joints of the fingers and toes. In adults, there were several attempts to restore the stiff joints into mobile ones, but these treatment options resulted in poor outcomes and could not be applied to growing children. Here, we report our experiences on surgical treatment for children who had symphalangism of the hand. METHODS: We treated 36 joints in 17 children with symphalangism of the hand using dorsal capsulotomy and collateral ligament release. The diagnoses were based on history, physical examination, and simple radiographs. Affected fingers were classified according to our grading system. Simple compressive dressing was applied using Coban after surgery. Passive range of motion (ROM) exercise was started on day one or 2 postoperative, with the help of a hand therapist and patients' parents. The patients were prescribed passive ROM exercises for at least 2 hours a day over a period of 6 months. RESULTS: A single surgeon operated on 30 proximal IP joints, 3 distal IP joints, and 3 IP joints of the thumb. Twenty six joints were classified as grade I, and 10 as grade II. The ROM of affected joints, which was 7.8 +/- 8.1 (mean +/- SD) degrees preoperatively, increased to 46.8 +/- 18.6 degrees at final follow-up. The final ROM was significantly better in grade I joints, especially when the children had operations at ages 24 months or younger. CONCLUSIONS: Symphalangism of the hand in children, can be restored into a mobile joint by release of the collateral ligament, a dorsal capsulotomy, and postoperative physical therapy.
Age Factors ; Ankylosis/radiography/surgery ; Child ; Child, Preschool ; Female ; Finger Joint/abnormalities/radiography/surgery ; Humans ; Infant ; Joint Diseases/classification/*congenital/radiography/surgery ; Ligaments/surgery ; Male ; Orthopedic Procedures/methods ; Physical Examination ; *Range of Motion, Articular ; Statistics, Nonparametric ; Treatment Outcome

BACKGROUND: To evaluate the efficacy of intramedullary K-wire fixation and interosseous wiring in the arthrodesis of the distal interphalangeal (DIP) joint with description of surgical procedure. METHODS: We retrospectively analyzed 9 cases (7 women and 2 men) of DIP joint arthrodesis. The average age of patients was 44.2 years (range, 21 to 71 years) and the mean follow-up period was 19.6 months. Joint union was evaluated on the follow-up radiographs together with postoperative complications. RESULTS: All cases achieved radiologic union of the arthrodesis site. There was no surgical complication except for one case of skin irritation by the interosseous wire knot which was removed during the follow-up period. CONCLUSIONS: Intramedullary K-wire fixation and interosseous wiring could be an alternative procedure of arthrodesis in the DIP joint.
Adult ; Aged ; Arthritis/*surgery ; Arthrodesis/*methods ; Bone Wires ; Female ; Finger Joint/radiography/*surgery ; Hand Deformities, Acquired/*surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult