Search

Purpose: To evaluate the outcomes (range of motion, function, and pain relief) of the volar approach to proximal interphalangeal (PIP) joint surface replacement arthroplasty (SRA) in active, high-demand patients. Methods: A single surgeon performed PIP SRA in 6 joints using a volar approach. Patients with posttraumatic arthritis or osteoarthritis of the PIP joint were included. Range of motion, postoperative key pinch and grip strength, and Disabilities of the Arm, Shoulder, and Hand questionnaire data were collected. Complications, component integration, and use of cement were noted. Average follow-up was 35 months (range, 12–66 mo). Results: Total arc of motion averaged 33° before surgery and improved significantly in all patients, for an average postoperative arc of motion of 60°. Grip strength averaged 30 kg in the affected hand and 35 kg in the contralateral hand after surgery. Postoperative key pinch strength averaged 6 and 7 kg in ipsilateral and contralateral hands, respectively. The average Disabilities of the Arm, Shoulder, and Hand score after surgery was 14. No coronal plane deformity or postural deformity was observed. Good component integration and stability were observed in all 5 cemented joints. The only noncemented joint demonstrated progressive subsidence of both components. Conclusions: The volar approach to PIP SRA can result in excellent range of motion, function, and pain relief with minimal complications in active patients with osteoarthritis or posttraumatic arthritis. The volar approach offers the advantages of maintaining the integrity of the extensor mechanism and allowing early postoperative motion. This case series demonstrates compelling data for a prospective, randomized study comparing dorsal and volar approaches to PIP SRA in patients with osteoarthritis and posttraumatic arthritis. Type of study/level of evidence: Therapeutic IV. [Copyright &y& Elsevier]

Objectives: To design a new assessment of dental anxiety for 5-year-old children that takes less than five minutes to complete, for use in primary care or community settings, that requires minimal training for assessment administrator and has favourable psychometric properties. Setting Primary schools in Cheshire, UK.Method: Two studies were conducted. The first study required a sample of 31 five-year-old children to rank order five diagrammatic picture cards denoting emotions of very happy to very sad, including a neutral emotion card. The second study invited children to post 12 gender-matched pictures of children receiving dental advice, examination and treatment procedures in a dental surgery into four post boxes arranged in rank order and labelled clearly, with the face pictures in the rank order confirmed in study 1 (omitting the neutral choice option).Results: In study 1, consistent rank ordering was obtained with four faces (very happy-happy-sad-very sad). Neutral point was omitted due to inconsistent ranking. Study 2 children responded enthusiastically to instructions of new assessment and fully completed the test. A good association was demonstrated between the new measure and the 'gold standard' projective measure picture test of Klinberg'. Reliability of measure was moderate. Conclusions: This new assessment appeared to assess dental anxiety in young children without causing apparent distress in respondents and warrants further testing to determine additional measurement properties. [ABSTRACT FROM AUTHOR]