[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 mean 2.7 year follow-up].
OBJECTIVE
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.


METHODS
Thirteen patients, mean age 47.4 years (range 18-76) underwent emergency surgery between 1997 and 2003. In twelve patients, the finger injury occurred when working with wood. For ten of the thirteen 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 P1 was injured in all cases creating a situation incompatible with fusion without loss of finger length. All patients underwent an emergency surgery for complete reconstruction of the PIP joint with Swanson implant, tendon reconstruction or suture, and skin cover performed during the same procedure.


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


CONCLUSIONS
Most reports in the literature concern composite blast or firearm injuries. Ours appears to be the first series involving injuries occurring while working with wood. 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. 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.
Obert
L
L
Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique Reconstructrice et Assistance Main, CHU Jean-Minjoz, Besançon. lobert@chu-besancom.fr
Clappaz
P
P
Hampel
C
C
Blanchet
N
N
Lepage
D
D
Pauchot
J
J
Garbuio
P
P
Tropet
Y
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D019643:Arthroplasty, Replacement / Q000379:methods*; D062109:Dermatologic Surgical Procedures; D004630:Emergencies; D005383:Finger Injuries / Q000601:surgery*; D005384:Finger Joint / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011475:Prosthesis Failure; D016059:Range of Motion, Articular / Q000502:physiology; D019651:Plastic Surgery Procedures; D012867:Skin / Q000293:injuries; D013536:Suture Techniques; D013708:Tendon Injuries / Q000601:surgery