Search

INTRODUCTION: Arthrodesis was for a long time the only surgical method used in the arthrosis of the proximal interphalangeal joint (PIPJ), until Swanson used the first silicone implant. This is not a total endoprosthesis, but a spacer, which is currently preferred to other surgical methods for PIPJ reconstruction. MATERIAL AND METHOD: A 41-year-old male patient with posttraumatic arthrosis of finger V of the right hand, following a metacarpal V fracture, osteosynthesized with a Kirschner pin and immobilized in an ABPD splint for 2 months. Operative technique: The incision was performed on the dorsal side of the digital ray V, on the old scar, with deep dissection and excision of cicatricial and adherent tissue. After penetrating into the PIPJ and evaluating the arthrosic lesions, the head of the proximal phalanx and the base of the middle phalanx were resected, after which the bone channels were prepared and the joint silicone implant no. 0 was introduced. This was fixed with four slowly resorbable sutures (Maxon 2.0), which were passed through the 2 bone ends and crossed above the implant, with three knots to avoid its dislocation, until the complete healing of the extensor aponeurosis. Then, the reconstruction of the dorsal extensor aponeurosis of the digital ray V was initiated, in order to increase PIPJ stability. Reconstruction was performed by taking a central strip from the proximal aponeurosis end and by placing it over the existing defect. After the introduction of a small drain into the implant chamber, hemostasis, lavage, skin suture and sterile dressing, immobilization with the ABPD splint in a neutral position was maintained for 3-4 weeks, with the passive mobilization of the finger at each dressing change. RESULTS: Control X-ray showed the presence of the interarticular space in which the implant was positioned. After the drain was removed at 72 hours and the dressing was changed, passive rehabilitation was started. After the ABPD splint was removed at 4 weeks, active rehabilitation was initiated with the help of a kinesiotherapist. In 2 weeks up to the present time, the patient achieved a PIPJ flexion of 40-45 degrees. CONCLUSIONS: 1. Silicone implant arthroplasty is an alternative to PIPJ arthrodesis. 2. Silicone implant is particularly indicated for the ulnar region (digital ray IV-V), which contributes through the maintenance of mobility to the performance of fine movements (prehension). 3. In Tg-Mures, such interventions are limited by the high implant costs and by the absence of a National Prosthetic Rehabilitation Program for this segment, approved by the Health Insurance House. [ABSTRACT FROM AUTHOR]

Objective: To assess, using statistical analysis, if and to what extent the final outcome of surgical treatment for burst fractures depends on operation type, fracture level and initial deformity severity., Methods: A database of 287 patients with single-vertebral-level thoracic and lumbar spine fractures analysed using simple and multiple linear regression analyses models. The dependent variable was last follow-up (LFU) kyphotic angle and the predictor variables were operation type [anterior approach (AA), posterior short-segment fixation (PSSF) and posterior monosegmental fixation (PMF)], fracture level (T11-L1, L2-L3 and L4-L5) and preoperative kyphotic angle. The models were applied on either the whole sample or on the operation type subgroups., Results: In simple linear regression analysis models, fracture level accounted for 32% and 18% of the variation in LFU kyphotic angle in the AA and PMF subgroups, respectively. In the multiple linear regression models for the same subgroups, up to 40% of the variation in LFU kyphotic angle was accounted for by fracture level. Surgical treatment, as predictor variable, indicated that patients treated by PSSF developed a post-surgical kyphotic angle 8.51° more severe than those treated by AA. However, the model accounted for only 2% of the variation in LFU kyphotic angle. Simple linear regressions performed on each subgroup with preoperative kyphotic angle as the independent variable revealed that the variable accounted for 15% (PSSF subgroup), 17% (AA subgroup) and 34% (PMF subgroup) of the variation in LFU kyphotic angle., Conclusion: All valid regression models displayed modest explanatory power, suggesting that factors other than those taken into consideration are involved.