Distraction correction of chronic flexion contractures of PIP joint: comparison between two distraction rates. 2007

Shirzad Houshian, and Chandrasekar Chikkamuniyappa
Department of Orthopaedics, Upper Limb Unit, University Hospital Lewisham, London, UK. shirzad.houshian@uhl.nhs.uk

OBJECTIVE The surgical correction of chronic flexion contractures of the proximal interphalangeal (PIP) joints is quite challenging because the extensive soft-tissue surgery needed is demanding, and the results often are discouraging. Gradual joint distraction recently was shown to be effective in the correction of PIP joint contractures. We performed this study to determine the optimum rate and amount of daily distraction and the optimum duration for which the external fixator should be left in situ after correction. This study compared 2 groups of patients with different distraction rates: one group with 0.5 mm/day and the other group with 1.0 mm/day. We also compared and evaluated the results of external fixation removal at 1 week versus 2 weeks after full correction. METHODS The Mini-Orthofix external fixator was used to correct post-traumatic PIP joint contractures in 10 consecutive patients divided into 2 groups. Group 1 consisted of 5 patients who had 0.5 mm of joint distraction per day until full correction followed by an in situ external fixator for 2 weeks. Group 2 consisted of 5 patients who had 1 mm of joint distraction per day until full correction followed by an in situ external fixator for only 1 week. The 2 groups were compared and statistically analyzed. RESULTS At the 1-year follow-up evaluation there were no statistically significant differences between the 2 groups. The mean range of motion gained was 64 degrees in group 1 and 66 degrees in group 2. There were no recurrences. CONCLUSIONS We concluded that 1 mm of joint distraction per day followed by an in situ external fixator for 1 week may be safe and effective for the correction of chronic post-traumatic contractures of the PIP joint; however, similar studies on a larger group may be necessary before this technique could be recommended universally. METHODS Therapeutic I.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D002908 Chronic Disease Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care (Dictionary of Health Services Management, 2d ed). For epidemiological studies chronic disease often includes HEART DISEASES; STROKE; CANCER; and diabetes (DIABETES MELLITUS, TYPE 2). Chronic Condition,Chronic Illness,Chronically Ill,Chronic Conditions,Chronic Diseases,Chronic Illnesses,Condition, Chronic,Disease, Chronic,Illness, Chronic
D003286 Contracture Prolonged shortening of the muscle or other soft tissue around a joint, preventing movement of the joint. Contractures
D004204 Joint Dislocations Displacement of bones from their normal positions at a joint. Inferior Dislocation,Joint Subluxations,Luxatio Erecta,Dislocation, Joint,Dislocations, Joint,Inferior Dislocations,Joint Dislocation,Joint Subluxation,Subluxation, Joint,Subluxations, Joint
D005260 Female Females
D005384 Finger Joint The articulation between the head of one phalanx and the base of the one distal to it, in each finger. Interphalangeal Joint of Hand,Interphalangeal Joint of Finger,Finger Interphalangeal Joint,Finger Interphalangeal Joints,Finger Joints,Hand Interphalangeal Joint,Hand Interphalangeal Joints,Joint, Finger,Joints, Finger
D005500 Follow-Up Studies Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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