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Bone and soft tissue loss of the proximal interphalangeal joint of the long fingers. Emergency treatment with a Swanson implant: prospective study of ten patients with a mean 2.7-year follow-up - 27/03/08

Doi : RCOE-05-2006-92-3-0035-1040-101019-200519775 

L. Obert [1],

P. Clappaz [1],

C. Hampel [1],

N. Blanchet [1],

D. Lepage [1],

J. Pauchot [1],

P. Garbuio [1],

Y. Tropet [1]

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Resumen

Perte de substance ostéo-articulaire de l'IPP des doigts longs : traitement en urgence par implant de Swanson. Étude prospective de 10 cas avec 2,7 ans de recul moyen

Les traumatismes de l'articulation inter-phalangienne proximale (IPP) avec perte de substance ostéo-articulaire, plus ou moins associée à une perte de substance tendineuse et cutanée font discuter l'arthrodèse, parfois l'amputation même sur un doigt vascularisé.

Treize patients ont bénéficié d'une reconstruction en un temps de l'IPP. Dix patients, 16 implants, ont pu être revus avec un recul moyen de 2,7 ans (1-6). Aucune infection n'a été observée. Aucune arthrodèse ou amputation n'a été demandée en secondaire. Après 1 an, l'amplitude de flexion maximale était atteinte. En moyenne, la flexion active atteignait 41,8° (20-80). Deux implants étaient fracturés sans perte fonctionnelle au recul de 6 ans. Dans ces lésions tangentielles de la face dorsale de l'IPP, le travail du bois en loisir est responsable de la majorité des accidents. La mise en place en urgence d'implant type Swanson a permis si la reconstruction tégumentaire et tendineuse est effectuée, d'éviter l'amputation et d'obtenir une flexion utile, supérieure à 50°chez 5 patients (7 articulations inter-phalangiennes).

Abstract

Purpose of the study

Injury of the proximal interphalangeal joint (PIP) with loss of bone and soft tissue (joint surface, tendon, skin cover) can compromise finger vascularization. Fusion or amputation is often proposed. We report our experience with another solution, emergency implantation of the Swanson implant.

Material and methods

Thirteen patients, with a mean age of 47.4 years (range, 18-76 years), underwent emergency surgery between 1997 and 2003. In 12 patients, the finger injury occurred when working with wood. For ten of the 13 patients, the injury occurred during recreational activity. The index was involved when only one ray was injured. The thumb was spared in all patients. Joint tissue was lost in all patients. The head of the distal phalanx was injured in all cases, creating a situation incompatible with fusion without loss of finger length. All patients underwent emergency surgery for complete reconstruction of the PIP joint with a Swanson implant, tendon reconstruction or suture, and skin cover performed during the same procedure.

Results

Ten patients, 16 implants, were reviewed at a mean of 2.7 years (range, 1-6 years). Mean flexion reached 41.8° (range, 20°-80°). Maximal amplitude of flexion was achieved at 1 year and remained unchanged thereafter. There were no cases of infection or secondary amputation. Two implant fractures were noted with no functional impact at 6 years. There were four cases of instability.

Discussion

Most publications in the literature report composite blast or firearm injuries. Ours appears to be the first series involving injuries occurring during woodworking activity. Most of the lesions caused by the circular saw were tangential, damaging the dorsal aspect of several PIP joints. Classically, it would be logical to propose arthrodesis if the bone and cartilage loss is not excessive, but with the loss of joint motion provided by implants. Like Nagle, we propose emergency implantation of a Swanson prosthesis if soft tissue and tendon reconstruction can be achieved, avoiding amputation.

Conclusion

Although the technique is relatively simple, implantation of a Swanson prosthesis implies certain prerequisites, particularly ligament repair and correct alignment. Oversized implants appear to be better. We did not have to perform any secondary arthrodesis.


Mots clés : Articulation inter-phalangienne proximale , fracture , implant de Swanson , arthrodèse

Keywords: Proximal interphalangeal joint , fracture , Swanson implant , arthrodesis


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© 2006 Elsevier Masson SAS. Tous droits réservés.
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Vol 92 - N° 3

P. 234-241 - mai 2006 Regresar al número

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