1.Classification and Surgical Treatment of Symphalangism in Interphalangeal Joints of the Hand.
Clinics in Orthopedic Surgery 2012;4(1):58-65
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
2.Classification and Surgical Treatment of Symphalangism in Interphalangeal Joints of the Hand.
Clinics in Orthopedic Surgery 2012;4(1):58-65
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
3.The Result of Revision Total Hip Arthroplasty in Patients with Metallosis Following a Catastrophic Failure of a Polyethylene Liner.
Hong Suk KWAK ; Jeong Joon YOO ; Young Kyun LEE ; Kyung Hoi KOO ; Kang Sup YOON ; Hee Joong KIM
Clinics in Orthopedic Surgery 2015;7(1):46-53
BACKGROUND: Wear cannot be completely prevented after total hip arthroplasty. If severe polyethylene (PE) liner wear develops, the so-called catastrophic failure occurs and metallosis develops. We postulated that longevity of the new implant may be affected after revision surgery for metallosis following a catastrophic failure of a PE liner due to the substantial amount of PE wear particles and infiltration of the metal particles in this catastrophic condition. METHODS: Twenty-three hips of 23 patients were identified because they showed metallosis during revision total hip arthroplasties performed in Seoul National University Hospital between January 1996 and August 2004. They were followed for at least 6.5 years after the index revision total hip arthroplasty. The clinical and radiological results of revision total hip arthroplasties in these patients were evaluated. RESULTS: The median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the final follow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cup loosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and loosening as the end points, the 15-year survival rates were 28.2% and 56.0%, respectively. CONCLUSIONS: The survival rate of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a PE liner was low.
Adolescent
;
Adult
;
*Arthroplasty, Replacement, Hip
;
Biocompatible Materials
;
Female
;
Hip Joint/radiography/surgery
;
Hip Prosthesis/*adverse effects
;
Humans
;
Joint Diseases/radiography/*surgery
;
Male
;
Metals/adverse effects
;
Metals, Heavy/*poisoning
;
Middle Aged
;
Osteolysis/etiology/surgery
;
Poisoning/etiology/*surgery
;
Polyethylene/adverse effects
;
Prosthesis Design
;
*Prosthesis Failure/etiology
;
Reoperation
;
Young Adult