Dorsally Displaced Epiphyseal Fracture of the Phalangeal Base

1996 ◽  
Vol 21 (1) ◽  
pp. 136-138 ◽  
Author(s):  
H. HASHIZUME ◽  
K. NISHIDA ◽  
D. MIZUMOTO ◽  
H. TAKAGOSHI ◽  
H. INOUE
Keyword(s):  
Articular Surface ◽  
Extensor Tendon ◽  
Type I ◽  
Collateral Ligaments ◽  
Middle Phalanx ◽  
Epiphyseal Fracture ◽  
Diagnostic Difficulties ◽  
Pip Joint ◽  
Central Slip ◽  
Salter Harris

A dorsally displaced epiphyseal fracture of the middle phalanx (Salter–Harris Type I) is described. The epiphyseal fragments were attached to the central slip of the extensor tendon and collateral ligaments. The articular surface of the PIP joint was intact and smooth. The epiphysis was reduced and fixed without cutting the central slip or the collateral ligaments 8 months after injury. This kind of fracture can occur in the PIP and DIP joints, and presents special diagnostic difficulties. Open reduction is evidently necessary to correct the displacement.

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.

Irreducible Volar Rotatory Subluxation of the Proximal Interphalangeal Joint of the Finger

2018 ◽  
Vol 23 (01) ◽  
pp. 111-115
Author(s):  
Masahiko Tohyama ◽  
Sadahiko Konishi
Keyword(s):  
Proximal Interphalangeal Joint ◽  
Lateral View ◽  
Interphalangeal Joint ◽  
Collateral Ligaments ◽  
Middle Phalanx ◽  
Collateral Ligament ◽  
Pip Joint ◽  
Central Slip ◽  
Rotatory Subluxation ◽  
Careful Physical Examination

We describe 4 cases of irreducible volar rotatory subluxation of the proximal interphalangeal (PIP) joint of the finger that required open reduction. All of the patients had radiographically proven (in lateral-view radiographs) volar rotatory subluxation of the PIP joint, without fracture. The causes of irreducibility were interposition of the lateral band about the condyle of the middle phalanx in 2 cases, interposition of the collateral ligament in 1 case, and scarring of the injured central slip in 1 case. Rupture of the collateral ligament of one side was found in all cases. Acceptable results were provided with all cases after restoration of the collateral ligaments and the damaged parts. Accurate early diagnosis by careful physical examination and obtaining true lateral radiographs of the PIP joint is important.

The anatomy and function of Cleland’s ligaments

2013 ◽  
Vol 39 (5) ◽  
pp. 482-490 ◽  
Author(s):  
R. L. Zwanenburg ◽  
P. M. N. Werker ◽  
D. A. McGrouther
Keyword(s):  
Proximal Phalanx ◽  
Extensor Tendon ◽  
Tendon Sheath ◽  
Lateral Side ◽  
Middle Phalanx ◽  
John Cleland ◽  
Pip Joint ◽  
Fresh Frozen ◽  
The Individual ◽  
And Function

The cutaneous ligaments of the digits have been recognized by anatomists for several centuries, but the best known description is that of John Cleland. Subsequent varying descriptions of their morphology have resulted in the surgical community having an imprecise view of their structure and dynamic function. We micro-dissected 24 fresh frozen fingers to analyze the individual components of Cleland’s ligamentous system. Arising from the proximal interphalangeal (PIP) joint, proximal, and sometimes middle phalanx, we found strong ligaments that ran proximally (PIP-P) and distally (PIP-D). On each side of each finger there was a PIP-P ligament present, which passed obliquely from the lateral side of the proximal and sometimes middle phalanx towards its insertion into the skin at the level of the proximal phalanx. The distal (PIP-D) ligaments were found to pass obliquely distally on the radial and ulnar aspects of the digit towards cutaneous insertions around the middle phalanx. A similar arrangement exists more distally with fibres originating from the DIP joint and middle phalanx (the DIP-P pass obliquely proximally, and the DIP-D, distally). Each individual PIP ligament consisted of three different layers originating from fibres overlying the flexor tendon sheath, periosteum or joint capsule, and extensor expansion. Ligaments arising at the DIP joint had two layers equivalent to the anterior two layers of the proximal ligaments. Cleland’s ligaments act as skin anchors maintaining the skin in a fixed relationship to the underlying skeleton during motion and functional tasks. They also prevent the skin from ‘bagging’, protect the neurovascular bundle, and create a gliding path for the lateral slips of the extensor tendon.

Cartilage and extensor tendon defects after headless compression screw fixation of phalangeal and metacarpal fractures

2020 ◽  
Vol 45 (6) ◽  
pp. 601-607
Author(s):  
Lukas Urbanschitz ◽  
Manuel Dreu ◽  
Julia Wagner ◽  
Reinhard Kaufmann ◽  
Julian M. Jeserschek ◽  
...  
Keyword(s):  
Articular Surface ◽  
Extensor Tendon ◽  
Tendon Injury ◽  
Defect Size ◽  
Tendon Injuries ◽  
Joint Surface ◽  
Open Approach ◽  
Middle Phalanx ◽  
Screw Insertion ◽  
Extensor Tendon Injuries

Osteosynthesis of metacarpal and phalangeal fractures with headless compression screws leads to a defect in the articular surface and possibly damage to the extensor tendons. This study aimed to quantify the articular surface defect and extensor tendon injuries after implant placement in cadaveric hands. Defect size was assessed with computed tomography. Extensor tendon injuries were assessed by direct visualization and measurement after dissection. In the middle phalanx, the defect size in relation to the joint surface was significantly smaller after anterograde screw placement when compared with retrograde placement. Also, a mini-open approach was found to cause significantly less tendon injury than a percutaneous approach, but there was no difference in tendon damage between retrograde and antegrade screw insertion into the middle phalanx.

scholarly journals Salter-Harris type II fracture of the middle phalanx with concomitant central slip injury in an 11 years old: a case report

2020 ◽  
Vol 6 (5) ◽  
pp. 1130
Author(s):  
Devan O. Higginbotham ◽  
Andrew G. Tsai
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Proximal Interphalangeal Joint ◽  
Open Reduction Internal Fixation ◽  
Interphalangeal Joint ◽  
Clinical Indication ◽  
Type Ii ◽  
Middle Phalanx ◽  
Central Slip ◽  
Salter Harris

<p>An 11-year-old male sustained an irreducible, completely displaced epiphyseal fracture of the proximal interphalangeal joint (PIPJ) of the middle finger with an associated central slip injury. Central slip injuries occurring in conjunction with Salter-Harris type II middle phalanx fracture are rare entities, with no previously documented case. Our patient underwent open reduction, internal fixation through crossed-pins to achieve reduction and fixation. He was then splinted in extension for six weeks to allow healing of the central slip injury. At 1-year follow-up, the patient had full range-of-motion with no clinical indication of physeal disruption or growth arrest of the repaired digit. We demonstrate a case in which ephiphyseal fractures of the proximal interphalangeal joint with a concomitant central slip injury can safely be treated with open reduction internal fixation combined with a period of immobilization. We characterize a surgical method of reduction and fixation with splinted immobilization and describe lessons learned from this previously unreported case.</p>

Treatment of Distal Tibial Epiphyseal fracture Salter-Harris Type I & II

1999 ◽  
Vol 12 (4) ◽  
pp. 1065 ◽  
Author(s):  
Sung Ho Hahn ◽  
Bo Kyu Yang ◽  
Seung Rim Yi ◽  
Sung Hwan Yoo
Keyword(s):  
Type I ◽  
Epiphyseal Fracture ◽  
Salter Harris ◽  
Tibial Epiphyseal

The Dorsal Plate of the Proximal Interphalangeal Joint

1990 ◽  
Vol 15 (1) ◽  
pp. 68-73
Author(s):  
P. G. SLATTERY
Keyword(s):  
Knee Joint ◽  
Articular Surface ◽  
Extensor Tendon ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Dorsal Plate ◽  
Palmar Plate ◽  
Constant Structure ◽  
Central Slip

There exists on the articular surface of the central slip of the extensor tendon slip overlying the P.I.P. joint a constant structure which is morphologically similar to the patella of the knee joint and histologically similar to the fibro-cartilaginous palmar plate of the P.I.P. joint. It has been termed the dorsal plate. A study of 70 fingers, including 30 examined under magnification and 20 examined histologically, confirmed its constant presence and structure. Its functions appear to include stabilisation of the central extensor tendon and participation in stabilisation of the proximal interphalangeal joint.

The By-Pass Extensor Tendon Transfer

1995 ◽  
Vol 20 (3) ◽  
pp. 392-397 ◽  
Author(s):  
C. OBERLIN ◽  
A. ATCHABAYAN ◽  
A. SALON ◽  
A. BHATIA ◽  
J. M. OVIEVE
Keyword(s):  
Tendon Transfer ◽  
Extensor Tendon ◽  
Tendon Graft ◽  
Middle Phalanx ◽  
Extensor Apparatus ◽  
Pip Joint ◽  
Substance Loss ◽  
Active Mobilization

A salvage technique for the treatment of substance loss of the extensor apparatus with some special features is presented. It uses the extensor indicis muscle prolonged with a tendon graft. The tendon is directly attached to the middle phalanx. After surgery, the wrist is immobilized in extension, allowing immediate active mobilization of the PIP joint. The results in five patients are satisfactory.

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