• PNF and Movement
• /
• v.21 no.2
• /
• pp.171-183
• /
• 2023

Purpose: The purpose of this study was to compare universal goniometry (UG), which is commonly used in clinical practice to measure the range of motion (ROM) of finger joints with a wearable soft sensor glove, and to analyze the reliability to determine its usefulness. Methods: Ten healthy adults (6 males, 4 females) participated in this study. The metacarpophalangeal joint (MCP), interphalangeal joint (IP), and proximal interphalangeal joint (PIP) of both hands were measured using UG and Mollisen HAND soft sensor gloves during active flexion, according to the American Society for Hand Therapists' measurement criteria. Measurements were taken in triplicate and averaged. The mean and standard deviation of the two methods were calculated, and the 95% limits of agreement (LOA) of the measurements were calculated using the intraclass correlation coefficient (ICC) and Bland-Altman plot to examine the reliability and discrepancies between the measurements. Results: The results of the mean values of the flexion angles for the active range of motion (AROM) of the finger joints showed large angular differences in the finger joints, except for the MCP of the thumb. In the inter-rater reliability analysis according to the measurement method, the ICC (2, 1) value showed a low level close to 0, and the mean difference by the Bland-Altman plot showed a value greater than 0, showing a pattern of discrepancy. The 95% LOA had a wide range of differences. Conclusion: This study is a preliminary study investigating the usefulness of the soft sensor glove, and the reliability analysis showed a low level of reliability and inconsistency. However, if future studies can overcome the limitations of this study and the technical problems of the soft sensor glove in the development stage, it is suggested that the measurement instrument can show more accurate measurement and higher reliability when measuring ROM with UG.

• Archives of Plastic Surgery
• /
• v.45 no.4
• /
• pp.363-366
• /
• 2018

Background Camptodactyly refers to permanent flexion contracture at the proximal interphalangeal joint. Most cases are limited to fifth-finger involvement. Although common, the treatment of camptodactyly is controversial. Many published studies have emphasized conservative treatment, while others have described surgical procedures. The problem with this deformity is that it presents in several forms, which means that there is no single model for effective treatment. The aim of this paper is to present the difficulties encountered with this condition and the management thereof on an individual basis. Methods This is a case series of 14 patients (nine males, five females) who underwent surgical treatment. The results were classified using the method from Mayo Clinic as excellent, good, fair, and poor. Results Fourteen patients with 15 fingers underwent surgery, and the results achieved were as follows: excellent, 0; good, 1; fair, 6; poor, 8. The treatment of camptodactyly still remains controversial, and hence proper planning individualized to each patient is needed to achieve the maximal improvement with realistic goals. Conclusions Although we performed individualised surgery, our careful follow-up was not able to identify any method as superior over another with respect to gain in extension and loss of flexion. We therefore propose that the extensor mechanism should not be disturbed during surgery to treat camptodactyly cases.

• Journal of Korean Foot and Ankle Society
• /
• v.28 no.2
• /
• pp.71-74
• /
• 2024

This report presents a unique case of checkrein deformities in both halluces following isolated intramuscular sarcoidosis, a rare occurrence given the infrequent musculoskeletal involvement in sarcoidosis. Typically resulting from flexor hallucis longus tendon entrapment by scar tissue post-trauma, the checkrein deformity reported in this paper presented with unusual metatarsophalangeal joint flexion and interphalangeal joint extension during ankle dorsiflexion. A 49-year-old woman with a history of intramuscular sarcoidosis presented with a great toe deformity and discomfort while wearing shoes, leading to a diagnosis of dynamic deformity, possibly attributed to tendon tethering by sarcoidosis. Surgical treatments, including abductor hallucis muscle intratendinous tenotomy, flexor hallucis longus Z-plasty lengthening, Weil osteotomy, and Kirschner wire fixation, significantly improved the functional scores and patient discomfort. This report underscores the importance of recognizing dynamic deformities and the potential for rare diseases, such as sarcoidosis, to cause such conditions, highlighting the need for careful diagnosis and tailored surgical intervention for atypical checkrein deformities.

• Archives of Hand and Microsurgery
• /
• v.23 no.4
• /
• pp.248-253
• /
• 2018

Purpose: The purpose of this study was to evaluate the clinical results of anatomic reduction of bony mallet finger using modified-intrafocal pinning technique. Methods: From March 2014 to October 2017, 18 patients with bony mallet finger were treated with modified-intrafocal pinning technique. Kirschner-wire was used to directly reduction the bony fragment, and extension block pinning and distal interphalangeal joint fixation were additionally performed to minimize the loss of reduction. Postoperative pain, range of motion, and radiological evaluation were performed. Duration of bone healing, functional recovery and complication rate were evaluated and Crawford's criteria was used to determine functional outcome after surgery. Results: Bone union was achieved in all cases after a postoperative mean of 6 weeks (5-7 weeks). An average of $2.8^{\circ}$ ($0^{\circ}-10^{\circ}$) extension loss occurred in all patients. All patients showed satisfactory joint congruency and reformation of the joint surface, the mean flexion angle of the distal interphalangeal joint at the final follow-up was $72.2^{\circ}$ ($70^{\circ}-75^{\circ}$). According to Crawford's classification, 12 patients (66.7%) were excellent and 6 patients (33.3%) were good. Conclusion: Modified-intrafocal pinning technique is a method of obtaining anatomical bone healing by directly reduction and fixation of the bony fragment. Combined with other conventional percutaneous pinning procedures, it is expected that good results can be obtained if applied to appropriate indications.

• Clinical and Experimental Pediatrics
• /
• v.57 no.6
• /
• pp.292-296
• /
• 2014

The deletion of the distal long arm of chromosome 1 is associated with a characteristic facial appearance and a pattern of associated malformations. Characteristic manifestations include a round face with prominent 'cupid's bow' and downturned corners of the mouth, thin vermilion borders of lips, a long upper lip with a smooth philtrum, a short and broad nose, epicanthal folds, apparently low-set ears, micrognathia, microcephaly, abnormal hands and feet, variable cardiac or genital anomalies, moderate to severe mental retardation, and growth retardation. Using fluorescent in situ hybridization (FISH) analysis to map precisely the deletion, we present a case of chromosome 1q44 deletion with craniofacial characteristics, multiple congenital anomalies, and growth and psychomotor retardation. In comparison with other reported cases of 1q43-44 deletion, the subject does not show hydrocephalus, seizure, syn- or polydactyly of hands, and a urogenital anomaly. However, an arachnoid cyst, pinpoint dimple on the midline of the forehead, a right-sided supernumerary nipple and auricular pit, polydactyly of the right foot, adducted thumb, and flexion restriction of the proximal interphalangeal joint with a simian line in both hands were observed additionally.

• Archives of Plastic Surgery
• /
• v.37 no.2
• /
• pp.187-190
• /
• 2010

Purpose: Pediatric trigger thumb is a condition of flexion deformity of the interphalangeal (IP) joint. The known surgical treatment is the release of the flexor pollicis longus by transection of the A1 pulley. We report two cases of pediatric trigger thumb that were resolved by releasing of additional pulley as well as A1 pulley. Methods: From March 2006 to April 2008, a total of 10 children with trigger thumb were operated. In two cases, transection of only the A1 pulley was insufficient to relieve the triggering. When more distally dissection, we found an additional pulley. After release of the additional pulley, the full extension of IP joint is obtained. Results: There were no significant complications. In 8 cases, the trigger thumbs were resolved by transecting only the A1 pulley, does not extend beyond the base of the proximal phalanx. In one case, the additional pulley was found to be more distal to the A1 pulley. It was necessary to extend the release up to the half in the proximal phalangeal shaft. In other case, the additional pulley was immediately adjacent to the A1 pulley. Conclusion: In most cases of trigger thumb, division of just A1 pulley is sufficient to relieve the triggering. However, dividing the A1 pulley in two patients proved to be insufficient to relieve the flexed deformity. In these cases, we found that the additional pulley, different from previous known A1 pulley, had existed, which must be transected to allow full excursion of flexor pollicis longus.

• Archives of Reconstructive Microsurgery
• /
• v.14 no.2
• /
• pp.152-156
• /
• 2005

Purpose: We reconstructed the thumb with groin flap combined with secondary heterodigital neurovascular island flap and report our 6 cases. Materials and Methods: Between March 2003 and August 2004, 6 degloving thumbs or amputation of thumbs were reconstructed with groin flap combined with secondary heterodigital neurovascular island flap. There ware 4 men and 2 women, and mean age was 42.2 years. The following parameters were evaluated. Results: Recipient thumb was no limitation of apposition. but flexion contracture of interphalangeal joint was about 10 degree in two cases. Average grip power were 80% and average pinch power were 70% that of the normal thumb. The two point discrimination was average 10.5 mm and double sensibility in 2 cases. 2 patients have cold intolerance. Neuroma formation was not made. Cosmetic results as judged by patients were that 4 cases are good and 2 cases are fair. Conclusion: If massive skin defect after degloving thumb or amputation of thumb are present, we consider the numerous methods for reconstruction of thumb. This surgical procedure is good methods because of it's pliability, sensation, satisfactory functional results but major disadvantage are the staged operation and cosmetic effect of the absence of thumb nail.

• Journal of the Korean Orthopaedic Association
• /
• v.54 no.4
• /
• pp.353-360
• /
• 2019

Purpose: In the treatment of Dupuytren's contracture, the aim of optical treatment is to lower the recurrence rate and reduce complications. This paper reports the results of subtotal fasciectomy in Dupuytren's contracture, extending the excision of palmar fascial structures from the diseased to normal appearing adjacent fascial structure. Materials and Methods: From 2007 to 2017, 45 patients with Dupuytren's contracture treated by subtotal fasciectomy were reviewed retrospectively. The mean follow-up period was 45.9 months. Ninety-two digits were involved (index: 2, middle: 10, ring: 44, little: 36). The predisposing factors and affected joint were reviewed and the preoperative and postoperative contracture was measured. For clinical results, quick disabilities of the arm, shoulder, and hand (quick DASH) were used. Complications, including wound or skin problems, nerve injuries, hematoma, and complex regional pain syndrome, were assessed. Results: Preoperative flexion contracture was 43.2° in the proximal interphalangeal joint and 32.9° in the metacarpophalangeal joint. In nine cases, patients had residual contracture of 9.7° (range, 5°-20°) on average and if the total number of cases were included, the mean residual contracture was 2.3° on average. The quick DASH score at the 12 months follow-up was 12.4. The overall complication rate was 26.6%. Conclusion: Subtotal fasciectomy can be a good surgical treatment option for Dupuytren's contracture with a low recurrence and low complication rate compared to other open procedures.

• Archives of Plastic Surgery
• /
• v.37 no.5
• /
• pp.650-658
• /
• 2010

Purpose: In the case of repair for far distal parts of FDP (Flexor digitorum profundus) division, the method of either pull-out suture or fixation of tendon to the distal phalanx is preferred. In this paper, the results of a modified loop suture technique used for the complete division of FDP from both zone 1a and distal parts of zone 1b in Moiemen classification are presented. Methods: From July 2006 to July 2009, the modified loop suture technique was used for the 10 cases of FDP in complete division from zone 1a and distal parts of zone 1b, especially where insertion sites were less than 1 cm apart from a tendon of a stump. In a suture technique, a loop is applied to each distal and proximal parts of tendon respectively. Core suture of 2-strand and epitendinous suture are done with PDS 4-0. Out of 10 patients, the study was done on 6 patients who were available for the followup. The average age of the patients was 49.1 years (in the range from 26 to 67). 5 males and 1 female patients were involved in this study. There were 3 cases with zone 1a and distal parts of zone 1b. The average distance to the distal tendon end was 0.6 cm. There were 5 cases underwent microsurgical repair where both artery and nerve divided. One case of only tendon displacement was presented. The dorsal protective splint was kept for 5 weeks on average. The results of the following tests were measured: active & passive range of motion, grip strength test, key pinch and pulp pinch test. Results: The follow-up period on average was 11 months, in the range from 2 to 20 months. There was no case of re-rupture, but tenolysis was performed in 1 cases. In all 6 cases, the average active range of motion of distal interphalangeal joint was 50.8 degree. The grip strength (ipsilateral/contralateral) was measured as 88.7% and the pulp pinch test was 79.2% as those of contralateral side. Flexion contracture was presented in 2 cases (15 degree on average) and there was no quadrigia effect found. Conclusion: Despite short length of tendon from the insertion site in FDS rupture in zone 1a and distal parts of zone 1b, sufficient functional recovery could be expected with the tendon to tendon repair using the modified loop suture technique.

• Archives of Hand and Microsurgery
• /
• v.23 no.4
• /
• pp.239-247
• /
• 2018

Purpose: We investigated occurrence of reduction loss after extension block (EB) Kirschner wire fixation or additional interfragmentary fixation (AIF) and clinical results including extension lag of the distal interphalangeal joint for treating bony mallet finger. Methods: Forty-six patients were included with a mean follow-up of 28 months (range, 12-54 months). Twenty-seven patients were treated with EB K-wire fixation (Group A) while 19 patients were treated with AIF (Group B). We checked radiologic factors, such as amount of articular involvement, volar subluxation, mallet fragment angle, reduction loss, range of motion including extension lag, and functional outcomes using Crawford's criteria. Results: Reduction loss occurred in eight patients (17%). Differences in mean extension lag, age, preoperative volar subluxation and mallet fragment angle between patients with reduction loss and those with reduction maintaining were significant. However, there were no significant differences in gender, hand dominance, amount of articular involvement, AIF, or further flexion between reduction loss and reduction maintaining. As for patterns of displacement, there was a significant relationship between gap or step-off and extension lag. Using Crawford's evaluation criteria, functional outcomes were excellent in 31, good in 10, fair in 3, and poor in 2 patients. Conclusion: Reduction loss should be careful in older age, smaller mallet fragment angle and preoperative volar subluxation.