title: Predictors of Proximal Interphalangeal Joint Flexion Contracture After Homodigital Island Flap.
abstract: OBJECTIVE
  To identify independent predictors of postoperative proximal interphalangeal (PIP) joint contracture after direct-flow homodigital island flap transfer.
  
  
  METHODS
  Forty-four fingertip amputations in 39 patients treated with oblique triangular flaps were evaluated at a minimum of 1 year after surgery. Five variables were examined: patient age, injured finger, mechanism of injury, flap advancement distance, and time required for wound healing. Univariate and multivariate linear regression analyses were performed to identify the extent to which these variables affected the flexion contracture of the PIP joint.
  
  
  RESULTS
  The average reduction in the passive extension angle of the PIP joint was 16° at final follow-up. Univariate analysis indicated significant correlations of PIP joint flexion contracture with age, injured finger, and time for wound healing, but no significant correlation with the distance the flap was advanced. Multivariate analysis indicated that the age and duration of wound healing were independent predictors of the flexion contracture of the PIP joint.
  
  
  CONCLUSIONS
  Elderly people and cases with delayed wound healing are at risk for postoperative PIP joint contracture after homodigital flap transfer. Intervention with early hand therapy and orthotics may be useful in elderly patients with delayed wound healing.
  
  
  METHODS
  Prognostic II.
authors.affiliation: Department of Orthopaedic Surgery, Takita Hospital, Nara, Japan.
authors.forename: Akito
authors.initials: A
authors.lastname: Nakanishi
authors.affiliation: Department of Hand Surgery, Nara Medical University, Nara, Japan. Electronic address: omokawa@gaia.eonet.ne.jp.
authors.forename: Shohei
authors.initials: S
authors.lastname: Omokawa
authors.affiliation: Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Iida
authors.affiliation: Department of Orthopaedic Surgery, Takita Hospital, Nara, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kaji
authors.affiliation: Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan.
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000673:Amputation, Traumatic / Q000601:surgery*; D003286:Contracture / Q000453:epidemiology*; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Homodigital island flap; advancement flap; flexion contracture; predictor; proximal interphalangeal joint