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The ultimate effectiveness of an arthroplasty is most accurately determined by a long-term review of the joints' function and freedom from pain. We examined 17 patients an average of 11.5 years (range, 4-26 years) following volar plate arthroplasty for a fracture-dislocation of the proximal interphalangeal joint. All surgeries were performed by the same surgeon. The average age was 36 years (range, 17-61 years). No patient complained of pain at rest or with activity. Patients having arthroplasty within 4 weeks of injury attained a total active range of motion of 85 degrees (50 degrees to 110 degrees ). Patients having arthroplasty more than 4 weeks after injury (average, 20 weeks) included several elderly women and averaged 61 degrees (30 degrees to 90 degrees ) total active range of motion. Four patients showed some degree of joint narrowing at the follow-up examination. This review suggests that volar plate arthroplasty continues to be of benefit on a long-term basis and provides satisfactory function and pain-free motion.

The presence of palpable thickening and maintenance of stability within weeks of total excision of the proximal interphalangeal (PIP) joint collateral ligaments is an established, although somewhat mysterious, phenomenon. To further investigate this postoperative thickening, magnetic resonance imaging (MRI) scans were obtained on 10 joints in 9 patients who had undergone total ligament excision for posttraumatic stiff PIP joints 3 months to 14 years earlier. Although the ultrastructure of these newly formed structures is yet unknown, their palpable consistency, MRI contour, distribution, and signal intensity suggest the formation of a new soft tissue structure, albeit scar, which has all the attributes of a collateral ligament. This MRI of a "neocollateral ligament" would help explain the consistent observation of complete joint stability within weeks following total excision of both PIP joint collateral ligaments. All patients from the 14-year span sampled were found to have a similar, consistent, linear low signal density structure crossing the joint margins and essentially identical to that of a normal collateral ligament.

This article discusses the volar plate arthroplasty utilized to resurface the proximal interphalangeal joint, for fracture subluxations involving the lower 60%. The procedure is effective when open reduction and internal fixation are not feasible because of excessive comminution or delay in treatment. The procedure has been used up to 2 years postinjury if certain conditions are met. The article also emphasizes the volar approach to the joint as an optimal exposure to fix these fractures.

The complete excision of scarred proximal interphalangeal collateral ligaments as the cornerstone of surgical treatment for proximal interphalangeal joint contractures was evaluated. Supplemental palmar plate distal release, extensor tenolysis, and flexor sheath release were performed as needed. Sixteen patients with primary proximal interphalangeal joint contractures treated by this method were reviewed with the use of preoperative data obtained from chart review and postoperative data from direct patient examination. The average range of motion increased from 38 degrees to 78 degrees. No patients had instability of the proximal interphalangeal joints on manual testing and x-ray examination. This radical surgical approach to contracted proximal interphalangeal joints is justified by the improved range of motion without instability.

Visualization of the scaphotrapezial joint during basal joint arthroplasty has been recommended to establish the stage of degeneration. This study attempts to clarify that recommendation and evaluate whether moderate wear of the joint precludes a good result of trapeziometacarpal hemiarthroplasty. To assess the need for inspection of the scaphotrapezial joint, x-ray films, tomograms, and operative findings in 23 cases of basal joint arthroplasty were reviewed. X-ray findings agreed with operative findings at the scaphotrapezial joint in only 76% of the cases. We also evaluated 18 thumbs in 15 patients who underwent interposition arthroplasty of the trapeziometacarpal joint and at surgery had moderate degenerative changes of the scaphotrapezial joint. The scaphotrapezial joints were left intact and the trapeziometacarpal joints were reconstructed. Follow-up averaged 8 years. In no case was there x-ray or symptomatic progression of the disease at the scaphotrapezial joint. Clinically, 78% were rated excellent, 17% good, and 5% fair.

Painful arthrosis of the basal joints of the thumb covers a spectrum of arthritic disease. The painful hypermobile thumb with articular cartilage preserved requires an entirely different type of treatment than does the similarly painful basal joint, which has stiffness and degeneration of more than one facet of the trapezium. By careful radiographic evaluation of the trapezial articulations, particularly in the lateral projection, a reasonable set of radiographic guidelines for staging of the degenerative process can be provided. One must be prepared to adjust this preoperative staging should direct inspection of the articular surfaces at surgery indicate more damage than perceived on the radiograph. Once the ultimate staging of the disease has been established, the means of treatment is considerably simplified and the multiple procedures that have been proposed for "basal joint arthritis" can be applied more accurately.

In 10 years 24 patients had a volar plate advancement arthroplasty for acute or chronic fracture dislocations of the proximal interphalangal joint. Seven were done within 6 weeks of injury, 17 at 6 weeks to 2 years following injury. Final ranges of motion averaged 95 degrees for the former and 78 degrees for the latter group. Radiographs frequently demonstrated a marked remodeling of the disrupted contour of the joint surface of the middle phalanx.

Improvement in range of motion and in strength of digital flexion and extension is reported in three diabetic subjects with the syndrome of limited joint mobility. Therapy was accomplished with sorbinil, an inhibitor of the enzyme aldose reductase, which inhibits the polyol pathway. We propose that reduction in collagen hydration secondary to reduced tissue content of polyols may participate in the clinical response.

Forty-six patients (fifty hands) had replacement of the trapezium by a silicone implant that incorporated a local tendon strip to stabilize the device. The patients had intractable pain due to degenerative changes of multiple facets of the trapezium. The over-all rate of subluxation and dislocation was 10 per cent. In all hands, pain-free improved movement resulted. The pinch strength approximated the normal, averaging six kilograms for women and eight kilograms for men.

An extra-articular ligament reconstruction to stabilize the thumb carpometacarpal (CMC) (basal) joint by routing a portion of the flexor carpi radialis (FCR) through the base of the thumb metacarpal has been performed on more than 100 patients since 1967. This study reviews the first 50 consecutive reconstructions with an average follow-up of 7 years. Intractable pain was the primary indication for surgery. Each joint was examined both pre and postoperatively and rated as a stage I through stage IV according to the radiographic appearance. Of the patients with zero or minimal articular changes (stages I and II), 95% achieved good or excellent results because of having little or no postoperative pain. Of the patients with moderate to advanced degenerative changes (stages III and IV), 74% achieved good or excellent results. All stage I cases and 82% of stage II cases were free of recognizable degeneration on follow-up radiographs up to 13 years postoperatively. These findings suggest that ligament reconstruction that is now recommended only for stage I or stage II disease will restore stability, reduce pain, and possibly even retard joint degeneration in a large proportion of patients with painful instability of the thumb CMC joint.

Thirteen patients had thumb metacarpophalangeal (MP) capsulodesis in conjunction with basal joint arthroplasty. The indication for capsulodesis was an MP hyperextension deformity of at least 30 degrees. The minimum follow-up period was 12 months, and the average follow-up was 39 months. Nine patients had an excellent result, three had a good result, and one patient had a result that was rated as fair. Ten patients had complete correction of the MP hyperextension deformity. The average increase in pinch strength was 50%. This procedure enhances the result of a basal point arthroplasty by improving the transmission of force along the thumb ray and by correcting the metacarpal collapse, which produces dorsal subluxation stress on the metacarpotrapezial joint.