Non—Traumatic Flexion Deformity of the Proximal Interphalangeal Joint—Its Pathogenesis and Treatment

HAND ◽  
1983 ◽  
Vol os-15 (1) ◽  
pp. 25-34 ◽  
Author(s):  
Takayuki Miura
Keyword(s):  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Middle Phalanx ◽  
Flexion Deformity ◽  
Splint Therapy ◽  
Extensor Apparatus ◽  
Long Time ◽  
Dynamic Splint ◽  
Flexor Digitorum ◽  
Flexion And Extension

The pathogenesis of camptodactyly may be the lack of equilibrium between the flexion and extension forces. The imbalance must be a result of palmar translocation of lateral slips of the extensor apparatus due to anchoring of the middle phalanx in the flexed position by fibrous substrata, abnormal shortening of the flexor digitorum superficialis or abnormal insertion of the lumbricals. It is reasonable therefore to start dynamic splint therapy as early as possible and carry on for a long time. Long-standing malposition of the extensor lateral slips possibly introduced contracture of periarticular tissues and the transverse retinacular ligament, making treatment more difficult. For those patients resistant to dynamic splint therapy, a surgical procedure is necessary. Surgical procedures are discussed.

TREATMENT OF CONGENITAL SWAN NECK DEFORMITY WITH DYNAMIC TENODESIS OF PROXIMAL INTERPHALANGEAL JOINT

2001 ◽  
Vol 26 (2) ◽  
pp. 165-167 ◽  
Author(s):  
V. SMRÈKA ◽  
I. DYLEVSKÝ
Keyword(s):  
Tendon Transfer ◽  
Tendon Graft ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Flexor Digitorum Superficialis ◽  
Middle Phalanx ◽  
Flexor Digitorum ◽  
Swan Neck Deformity

Congenital swan neck deformities in seven fingers of two patients were treated by transfer of the flexor digitorum superficialis tendon to a tendon graft which was attached the extensor aponeurosis over the middle phalanx. The tendon transfer is protected for at least 2 months by a modified Murphy splint.

Trigger Finger Treatment by Ulnar Superficialis Slip Resection (U.S.S.R.)

2004 ◽  
Vol 29 (4) ◽  
pp. 368-373 ◽  
Author(s):  
D. LE VIET ◽  
I. TSIONOS ◽  
M. BOULOUEDNINE ◽  
D. HANNOUCHE
Keyword(s):  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Trigger Finger ◽  
Flexion Deformity ◽  
Full Extension ◽  
History Of ◽  
Flexor Digitorum ◽  
Fixed Flexion Deformity ◽  
A1 Pulley

Surgical release of the A1 pulley for treatment of trigger finger normally produces excellent results. However, in patients with long-standing disease, there may be a persistent fixed flexion deformity of the proximal interphalangeal joint. This is sometimes due to a degenerative thickening of the flexor tendons and may be treated by resection of the ulnar slip of flexor digitorum superficialis tendon. One hundred seventy-two patients (228 fingers) who had undergone this procedure were reviewed at a mean follow-up of 66 months. Mean pre-operative fixed flexion deformity of the proximal interphalangeal joint was 33°. All but eight fingers were improved by surgery and there was an average gain of 26° in passive extension (7° residual fixed flexion deformity) of the proximal interphalangeal joint. Full extension was attained in 141 of the 228 fingers, and in all 101 fingers with a pre-operative loss of passive extension of 30° or less. This technique is indicated for patients with loss of passive extension in the proximal interphalangeal joint and a long history of triggering.

Fractures of the Phalanges: Results of Internal Fixation Using 1.5mm and 2mm A. O. Screws

1987 ◽  
Vol 12 (1) ◽  
pp. 28-33
Author(s):  
D. J. FORD ◽  
S. EL-HADIDI ◽  
P. G. LUNN ◽  
F. D. BURKE
Keyword(s):  
Internal Fixation ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Active Movement ◽  
Flexion Deformity ◽  
The Mean ◽  
Condylar Fractures ◽  
Phalangeal Fractures ◽  
Mean Time

Thirty-six patients were treated for 38 phalangeal fractures using 1.5 mm and 2 mm A. O. screws. Plates were not used in the fingers. Oblique fractures of the condyles, shafts or bases of the proximal or middle phalanges were treated by internal fixation because of instability, displacement or rotation. 40% of fractures had associated skin wounds, were comminuted or had damage to the extensor mechanism. The mean duration of post-operative immobilization was 9 days and the mean time off work was 6 weeks. Total active movement in the involved ray was 220 degrees or greater in 24 cases, 180 degrees to 215 degrees in eight cases, and less than 180 degrees in two patients at follow up. The patients were reviewed between three and 54 months after treatment and the mean duration of follow up was 24 months. The most frequent complication was 10 degrees to 30 degrees of flexion deformity of the proximal interphalangeal joint after internal fixation of condylar fractures. Results were satisfactory in 90% of cases.

A novel technique for proximal interphalangeal joint fracture-dislocations: the second toe middle phalanx osteochondral graft

2021 ◽  
pp. 175319342110292
Author(s):  
Danielle Nizzero ◽  
Nicholas Tang ◽  
James Leong
Keyword(s):  
Range Of Motion ◽  
Surgical Techniques ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Middle Phalanx ◽  
Joint Fracture ◽  
Acute Injuries ◽  
Fracture Dislocations ◽  
Chronic Injuries ◽  
Second Toe

Many different surgical techniques have been used to treat unstable dorsal proximal interphalangeal joint fracture-dislocations. The authors have used the base of the middle phalanx of the second toe base as an alternative autograft to treat this type of injury. This retrospective study assessed the clinical outcomes of this procedure in 11 patients. Range of motion, grip strength, Disability of the Arm, Shoulder and Hand score and donor site morbidity were assessed at regular intervals postoperatively. Nine patients had acute injuries and two had chronic injuries. The mean range of motion in the proximal interphalangeal joint at final review was 65° for patients with acute injuries and 41° for patients with chronic injuries. Other outcomes were satisfactory and there were no complications. Level of evidence: IV

scholarly journals Infiltration of synovitis into the flexor tendon: a case report

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052093618
Author(s):  
Qianjun Jin ◽  
Haiying Zhou ◽  
Hui Lu
Keyword(s):  
Flexor Tendon ◽  
Surgical Excision ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Flexion Angle ◽  
Flexor Digitorum Profundus ◽  
Normal Tendon ◽  
Active Flexion ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

Synovitis is a type of aseptic inflammation that occurs within joints or surrounding tendons. No previous reports have described a hypertrophic synovium eroding the tendon sheath and manifesting as synovitis within the flexor tendon. We herein report a case involving a 10-year-old girl who presented to our hospital with a 1-month history of a swollen mass and progressive inability to completely flex her left index finger. The active flexion angle of the proximal interphalangeal joint was limited to 85°. A longitudinal incision of the flexor digitorum profundus tendon was surgically performed. The synovium inside and outside the flexor digitorum profundus tendon was completely removed. After the surgical excision, normal tendon gliding returned without recurrence by the 1-year follow-up. The active flexion angle of the proximal interphalangeal joint improved to 100°. To the best of our knowledge, this is the first case of synovitis affecting the flexor tendon and leading to limited flexion of a finger. The manifestation of a double ring sign on magnetic resonance imaging is quite characteristic. Early diagnosis and monitoring of the hyperproliferation and invasiveness of the synovial tissue are required. Surgical excision can be a simple and effective tool when necessary.

Volar Plate Arthroplasty for Closed Proximal Interphalangeal Joint Injuries

1992 ◽  
Vol 17 (4) ◽  
pp. 422-428 ◽  
Author(s):  
G. DURHAM-SMITH ◽  
G. M. MCCARTEN
Keyword(s):  
Patient Satisfaction ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Volar Plate ◽  
Middle Phalanx ◽  
Satisfaction Rate ◽  
Joint Injuries ◽  
Original Procedure ◽  
Patient Satisfaction Rate

The anatomy and histology of the volar plate at the proximal interphalangeal joint and the mechanism of fracture/subluxation of the base of the middle phalanx in closed proximal interphalangeal joint injuries is reviewed. Our current technique of repair for these injuries and its evolution from Eaton’s original procedure is described. The results of 71 cases of volar plate arthroplasty performed over a five-year period for fracture/subluxations of the proximal interphalangeal joints are presented with follow-up ranging from six months to four years. 62 (87%) patients achieved a stable pain-free joint with a range of motion from 5° to 95° within two months. Complications were uncommon and correctable with an overall eventual patient satisfaction rate of 94%.

Morphology of the proximal and middle phalanx of fingers with regard to the Ascension PyroCarbon PIP total joint

2014 ◽  
Vol 39 (6) ◽  
pp. 596-603 ◽  
Author(s):  
C. Ries ◽  
W. Zhang ◽  
K. J. Burkhart ◽  
W. F. Neiss ◽  
L. P. Müller ◽  
...  
Keyword(s):  
Potential Risk ◽  
Proximal Phalanx ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Critical Examination ◽  
Middle Phalanx ◽  
Bone Morphology ◽  
Component Size ◽  
Base Insertion

The Ascension PyroCarbon prosthesis has been used in proximal interphalangeal joint osteoarthritis. The dimensions of the intramedullary distal metadiaphyseal canal (isthmus) of the proximal phalanx and the base of the middle phalanx of cadaver fingers were investigated radiographically ( n = 304) and macroscopically ( n = 152). In up to 30% of the phalanges, the isthmus was smaller than the stem of the smallest proximal component size. The distal component head was always smaller than the middle phalanx base. Insertion and success of the Ascension PyroCarbon prosthesis is strongly dependent on bone morphology. A critical examination of the isthmus in radiographs is recommended in planning. If the isthmus is clearly smaller than the smallest proximal component, insertion of the prosthesis could be inadvisable. A clear mismatch between the distal component and the middle phalanx base should be avoided due to the potential risk for late subsidence and failure of the prosthesis.

Treatment of unstable proximal interphalangeal joint fractures with hemi-hamate osteochondral autografts

2016 ◽  
Vol 42 (2) ◽  
pp. 188-193 ◽  
Author(s):  
M. Burnier ◽  
T. Awada ◽  
F. Marin Braun ◽  
P. Rostoucher ◽  
M. Ninou ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Articular Surface ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Pinch Strength ◽  
Middle Phalanx ◽  
Level Of Evidence ◽  
Active Flexion ◽  
The Mean

The primary aim of this study was to assess the clinical and radiological results after hemi-hamate resurfacing arthroplasty in patients with acute or chronic unstable fractures of the base of the middle phalanx and to describe technical features that can facilitate the surgical procedure. Hemi-hamate arthroplasties were done in 19 patients (mean age 39 years) with an isolated fracture at the base of the middle phalanx that involved more than 40% of the articular surface. We assessed ten chronic cases (treated >6 weeks after fracture) and nine acute ones (<6 weeks) at a mean of 24 months. Pain scores, QuickDASH scores, grip strengths, range of motion and radiological findings were recorded at follow-up. At follow-up, the mean active flexion at the proximal interphalangeal joint was to 83° with a mean fixed flexion of 17° (active range of motion 66°). The mean active distal interphalangeal motion was 41°. The mean visual analogue scale score was 1.1. The mean QuickDASH score was 11. The mean pinch strength was 82% of the opposite side. Radiographs revealed one partial graft lysis. Level of evidence: IV

The extensor tendon splitting approach to the proximal interphalangeal joint: do we need to reinsert the central slip?

2009 ◽  
Vol 35 (3) ◽  
pp. 188-191 ◽  
Author(s):  
A. M. Afifi ◽  
A. Richards ◽  
A. Medoro ◽  
D. Mercer ◽  
M. Moneim
Keyword(s):  
Extensor Tendon ◽  
Proximal Interphalangeal Joint ◽  
Joint Arthroplasty ◽  
Interphalangeal Joint ◽  
Middle Phalanx ◽  
Dorsal Approach ◽  
Pip Joint ◽  
Central Slip ◽  
Extensor Lag

Current approaches to the proximal interphalangeal (PIP) joint have potential complications and limitations. We present a dorsal approach that involves splitting the extensor tendon in the midline, detaching the insertion of the central slip and repairing the extensor tendon without reinserting the tendon into the base of the middle phalanx. A retrospective review of 16 digits that had the approach for a PIP joint arthroplasty with a mean follow up of 23 months found a postoperative PIP active ROM of 61° (range 25–90°). Fourteen digits had no extensor lag, while two digits had an extensor lag of 20° and 25°. This modified approach is fast and simple and does not cause an extensor lag.

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