Contracture of the Proximal Interphalangeal Joint in Dupuytren’s Disease

1991 ◽  
Vol 16 (4) ◽  
pp. 446-448 ◽  
Author(s):  
J. G. ANDREW
Keyword(s):  
Anatomical Study ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Corrective Surgery ◽  
Collateral Ligaments ◽  
Flexion Deformity ◽  
Dupuytren's Disease ◽  
Secondary Damage ◽  
Fixed Flexion Deformity

The correction of fixed flexion deformity at the P.I.P. joint in Dupuytren’s disease is often difficult. This paper reports an anatomical study of this joint in fingers amputated because of this condition. All the joints would extend fully after release of the accessory collateral ligaments and volar plate. Lateral and dorsal structures showed severe secondary damage and it is suggested that these changes may explain the poor results of corrective surgery to this joint in Dupuytren’s disease.

Proximal Interphalangeal Joint Release in Dupuytren’s Disease of the Little Finger

2004 ◽  
Vol 29 (1) ◽  
pp. 15-17 ◽  
Author(s):  
J. F. S. RITCHIE ◽  
K. M. VENU ◽  
K. PILLAI ◽  
D. H. YANNI
Keyword(s):  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Flexion Deformity ◽  
Dupuytren's Disease ◽  
Sequential Release ◽  
Full Correction ◽  
A Prospective Study ◽  
Fixed Flexion Deformity ◽  
Little Finger

We present a prospective study, with 3-year follow-up, of the role and outcome of fasciectomy plus sequential surgical release of structures of the proximal interphalangeal joint in Dupuytren’s contracture of the little finger. Our treatment programme involves fasciectomy for all patients followed by sequential release of the accessory collateral ligament and volar plate as necessary. Of the 19 fingers in the study, eight achieved a full correction by fasciectomy alone, and in these cases there was a fixed flexion deformity of 6° at 3 months and 8° at 3 years. The remaining 11 fingers (initial mean deformity 70° flexion) were left with a fixed flexion deformity of 42° after fasciectomy which reduced to 7° with capsuloligamentous release. This increased to 26° at 3 months but then remained relatively stable, increasing only to 29° at 3 years. In our experience sequential proximal interphalangeal joint release has led to consistently good results with few complications in the correction of severe Dupuytren’s disease of the little finger.

Angular correction related to excision of specific cords in fasciectomy for Dupuytren’s disease

2013 ◽  
Vol 39 (5) ◽  
pp. 472-476 ◽  
Author(s):  
R. W. Trickett ◽  
R. Savage ◽  
A. J. Logan
Keyword(s):  
Joint Angle ◽  
Metacarpophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Flexion Deformity ◽  
Collateral Ligament ◽  
Dupuytren's Disease ◽  
Lateral Cord ◽  
Angular Correction

Named cords were excised sequentially at fasciectomy for Dupuytren’s disease and the resultant correction in the joint angle was measured intra-operatively in 99 fingers. Eighty-two metacarpophalangeal and 59 proximal interphalangeal joints were affected. At the metacarpophalangeal joint, excision of the central cord resulted in 82% correction in 69 joints, and spiral/lateral cord excision resulted in an additional 12% correction in 10 joints. At the proximal interphalangeal joint, excision of the central cord resulted in 44% correction in 36 joints, spiral/lateral cord excision resulted in an additional 19% correction in 16 joints, and retrovascular cord excision resulted in a further 23% correction in 27 joints. Subsequent division of the accessory collateral ligament resulted in a further 14% correction in 14 joints. Larger pre-operative angles of the proximal interphalangeal joint were associated with a retrovascular cord, and larger combined angles were associated with an increasing number of pathological structures involved. The data explain the complexity of surgery at the proximal interphalangeal joint, where four structures are implicated in causing flexion deformity.

Nonoperative treatment of PIPJ flexion contractures associated with Dupuytren’s disease

2011 ◽  
Vol 37 (8) ◽  
pp. 722-727 ◽  
Author(s):  
J. Larocerie-Salgado ◽  
J. Davidson
Keyword(s):  
Soft Tissue ◽  
Nonoperative Treatment ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Patient Dissatisfaction ◽  
Flexion Contractures ◽  
Alternative Treatment Option ◽  
Soft Tissue Mobilization

Post-surgical outcomes in patients with Dupuytren’s disease causing flexion contractures of the proximal interphalangeal joint can be inconsistent and are often associated with protracted rehabilitation, reduced flexion, recurrence of the contracture, and patient dissatisfaction. An alternative treatment option, comprised of splinting and soft tissue mobilization techniques, was introduced to stabilize early contractures of the proximal interphalangeal joint in the hopes of delaying or obviating surgery. Over the course of approximately 12.6 months (±7.8), thirteen patients were followed at the hand clinic at Hotel Dieu Hospital in Kingston. One patient was unable to complete the course of therapy. Of the remaining patients, analysis showed significant improvement in active proximal interphalangeal joint extension of approximately 14.6° (SD: ±5.1°; range: 5–25°) over the course of the treatment ( p < .05). Nighttime static extension splinting and soft tissue mobilization techniques appear to delay and possibly prevent the need for surgery in individuals with flexion contractures of the proximal interphalangeal joint due to Dupuytren’s disease.

The Proximal Interphalangeal Joint in Dupuytren’s Disease

1985 ◽  
Vol 10 (3) ◽  
pp. 358-364
Author(s):  
M. A. TONKIN ◽  
F. D. BURKE ◽  
J. P. W. VARIAN
Keyword(s):  
Surgical Approach ◽  
Proximal Phalanx ◽  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Joint Contracture ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Average Percentage ◽  
Percentage Improvement

In one hundred patients with Dupuytren’s disease, one hundred and fifty-four operations were performed. The average pre-operative proximal interphalangeal joint contracture was 42° and the average percentage improvement in proximal interphalangeal joint extension at post­operative review was 41%. Fourteen amputations were performed (9.1%). The primary deformity is caused by disease involvement of the palmar fascial structures. Secondary changes may prevent correction of the deformity despite excision of the contracted fascia. The anatomy of the joint is reviewed together with the primary and secondary mechanisms of joint contracture in Dupuytren's disease. Arthrodesis, osteotomy of the proximal phalanx and joint replacement are considered as alternatives to amputation when a systematic surgical approach fails to correct the flexion contracture.

Predicting the Outcome of Surgery for the Proximal Interphalangeal Joint in Dupuytren’s Disease

2007 ◽  
Vol 32 (2) ◽  
pp. 240-245 ◽  
Author(s):  
Alok Misra ◽  
Abhilash Jain ◽  
Reza Ghazanfar ◽  
Terrencia Johnston ◽  
Jagdeep Nanchahal
Keyword(s):  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Outcome Of Surgery

Capsular Tissues of the Proximal Interphalangeal Joint: Normal Composition and Effects of Dupuytren’s Disease and Rheumatoid Arthritis

1993 ◽  
Vol 18 (3) ◽  
pp. 371-376 ◽  
Author(s):  
M. BENJAMIN ◽  
J. R. RALPHS ◽  
M. SHIBU ◽  
M. IRWIN
Keyword(s):  
Rheumatoid Arthritis ◽  
Type Ii Collagen ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Volar Plate ◽  
Dupuytren's Disease ◽  
Extracellular Matrix Components ◽  
Central Slip ◽  
Normal Composition

Three fibrocartilages associated with the proximal interphalangeal joint are described—at the attachment of the central slip to bone, within the slip where it passes over the joint, and the volar plate. Material was obtained at surgery following trauma, Dupuytren’s disease and rheumatoid arthritis. The fibrocartilages were structurally distinct and immunolabelled differently with monoclonal antibodies to extracellular matrix components. All fibrocartilages from normal and Dupuytren’s fingers contained chondroitin and keratan sulphate. Type II collagen was present in all attachment zones, although there was little in rheumatoid fingers. It was also present in the dorsal hood of some normal fingers, but not in pathological specimens or the volar plate. The results show that the fibrocartilages are dynamic tissues whose composition varies according to function and use, and changes in disease.

Hammer Toe Correction Using an Absorbable Intramedullary Pin

2007 ◽  
Vol 28 (8) ◽  
pp. 916-920 ◽  
Author(s):  
Kurt F. Konkel ◽  
Andrea G. Menger ◽  
Sharon Ann Retzlaff
Keyword(s):  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Foot Deformities ◽  
Flexion Deformity ◽  
Hammer Toe ◽  
Intramedullary Canal ◽  
Pin Track ◽  
Fixed Flexion Deformity

Background: Fixed flexion deformity of the proximal interphalangeal joint with or without hyperextension of the metatarsophalangeal joint is one of the most common foot deformities. Many operative options have been recommended. Complaints after operative procedures include a too straight toe, floating toe, painful toe recurvatum, mallet toe, pin track infection, broken hardware, and the necessity of removing hardware. A proximal interphalangeal joint arthrodesis for hammertoe deformity using a 2-mm absorbable pin for internal fixation is described. Methods: The results of 48 toe arthrodeses in 35 patients were reviewed. Followup ranged from 16 to 58 (average 38.5) months. Results: The procedure is simple and safe for the correction of painful rigid hammertoe deformities. Patient satisfaction was high, complications were minimal, and followup required no pin management or removal. Conclusions: This procedure can be used for hammer toe deformities requiring surgery when the metatarsophalangeal joint is stable, the skin is not compromised, and the intramedullary canal of the proximal phalanx is 2.0 mm or less. It also has been useful in stabilizing hammertoe correction when there are severe pre-existing metal allergies.

Outcome of arthrodesis for severe recurrent proximal interphalangeal joint contractures in Dupuytren’s disease

2020 ◽  
pp. 175319342096030
Author(s):  
Alexander M. Bolt ◽  
Henk Giele ◽  
Ian S. H. McNab ◽  
Michelle Spiteri
Keyword(s):  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dupuytren’S Disease ◽  
Salvage Procedure ◽  
Long Term Outcomes ◽  
Level Of Evidence ◽  
Dupuytren's Disease ◽  
Joint Contractures ◽  
Patient Demographics

We report long-term outcomes of proximal interphalangeal joint arthrodesis for treatment of severe recurrent joint contractures secondary to Dupuytren’s disease. The patients had at least two previous procedures for Dupuytren’s contracture that involved the same joint, before undergoing joint fusion. Patient demographics, satisfaction, functional outcome, complications, revision and re-operation rates are reported. Eleven patients were included with a mean age of 64 years (range 53–73). The mean proximal interphalangeal joint contracture at presentation was 102° (range 80°–120°). None required revision surgery at a mean of 8 years and 9 months (range 9–199 months). All patients were able to perform their activities of daily living and would recommend this operation to family and friends. This series shows that proximal interphalangeal joint arthrodesis combined with needle fasciotomy or segmental fasciectomy provides a satisfactory salvage procedure in cases of severe recurrent Dupuytren’s disease. Level of evidence: IV

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