Volar transfer of the lateral band with transverse retinacular ligament is effective for the correction of swan-neck deformity caused by volar plate injury of the PIP joint

2019 ◽  
Vol 4 (1) ◽  
pp. 152-155
Author(s):  
Masahiro Sato ◽  
Taku Suzuki ◽  
Takuji Iwamoto ◽  
Noboru Matsumura ◽  
Hiroo Kimura ◽  
...  
Keyword(s):  
Volar Plate ◽  
Lateral Band ◽  
Pip Joint ◽  
Swan Neck Deformity

Anatomical Basis for Arthroscopy of the Proximal Interphalangeal Joints

2018 ◽  
Vol 23 (03) ◽  
pp. 342-346 ◽  
Author(s):  
Hideki Okamoto ◽  
Isato Sekiya ◽  
Jun Mizutani ◽  
Nobuyuki Watanabe ◽  
Takanobu Otsuka
Keyword(s):  
Proximal Phalanx ◽  
Ring Finger ◽  
Invasive Technique ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Lateral Band ◽  
Dorsal Edge ◽  
Anatomical Basis ◽  
Pip Joint ◽  
The Right

Background: Arthroscopy is a widely used minimally invasive technique. Nevertheless, no report describes the arthroscopic anatomy of the proximal interphalangeal (PIP) joint for portal creation. To facilitate arthroscopy, this study elucidated the anatomy of the lateral bands of the extensor mechanism and collateral ligaments of PIP joints. Methods: A total of 39 fingers from the right hands of 10 cadavers (4 males, 6 females) were evaluated in this study. We defined the extension line from the proximal interphalangeal volar crease as the C-line. We also defined an imaginary line along the distal edge of the proximal phalanx, which is parallel to the C-line, as the J-line. The distance between J-line and C-line was measured. On the C-line and J-line, we measured the following: from the dorsal skin to the lateral edge of the lateral band (LB), the dorsal edge of the collateral ligament (CL) and from the lateral band and the collateral ligament (D), the width of the finger (W). The finger half-width (M) was measured on the J-line. Comparison between the digits and comparison between radial and ulnar distance were measured and statistical analysis was performed. Results: All PIP joint spaces were distal from the C-line, except for one ring finger. The average distances between the J-line and C-line were 1.8–3.2 mm. On the C-line, only 11 cases (14.1%) showed an interval between the lateral bands and the collateral ligaments, but, on the J-line 72, cases (92.3%) had such an interval. The interval was located 1.6–2.9 mm in a dorsal direction from the midlateral on the J-line. Conclusions: Portal creation at the J-line is safer than at the C-line. This study revealed that safe portals for arthroscopy of the PIP joint are 2 mm dorsal to the midlateral line of the finger on the J-line.

Correction of Swan Neck Deformity in Rheumatoid Arthritis Using a New Lateral Extensor Band Technique

2008 ◽  
Vol 33 (6) ◽  
pp. 712-716 ◽  
Author(s):  
M. SIROTAKOVA ◽  
A. FIGUS ◽  
P. JARRETT ◽  
A. MISHRA ◽  
D. ELLIOT
Keyword(s):  
Flexor Digitorum Superficialis ◽  
Palmar Plate ◽  
Pip Joint ◽  
Distal Interphalangeal ◽  
Distally Based ◽  
Student’S T ◽  
Flexor Digitorum ◽  
Swan Neck Deformity ◽  
Student’S T Test

Swan neck deformity is a progressive and disabling condition that commonly affects rheumatoid arthritic hands. During a 4-year period, 101 fingers in 43 patients had this deformity corrected using a new procedure combining the distally based extensor lateral band technique described by Littler and the flexor digitorum superficialis (FDS)-palmar plate pulley introduced by Zancolli. The ranges of motion of the metacarpophalangeal, proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints were assessed pre-operatively and 12 months after surgery. An average PIP joint hyperextension of −13.3° was converted to +13.4°. The ranges of motion of the proximal and DIP joints were significantly different (Student’s t-test). No patient suffered recurrence of the deformity during an average follow-up of 20 months. This new technique improves some unappealing aspects of previous techniques and provides a stable and reliable correction of swan neck deformity.

Development of an In Vitro Swan Neck Deformity Biomechanical Model

Hand ◽  
2020 ◽  
pp. 155894472096673
Author(s):  
Mohammad M. Haddara ◽  
Stacy Fan ◽  
Bogdan A. Matache ◽  
Shrikant J. Chinchalkar ◽  
Louis M. Ferreira ◽  
...  
Keyword(s):  
In Vitro Model ◽  
Volar Plate ◽  
Strong Positive Correlation ◽  
Mallet Finger ◽  
Active Motion ◽  
Motion Simulator ◽  
Flexion Extension ◽  
Vitro Model ◽  
Swan Neck Deformity

Background: Injury to the finger’s extensor mechanism is a common cause of swan neck deformity (SND). Progression of extensor and flexor tendon imbalance negatively affects laxity of the volar plate, resulting in the inhibition of proper finger motion. The complexity of finger anatomy, however, makes understanding the pathomechanics of these deformities challenging. Therefore, development of an SND model is imperative to understand its influence on finger biomechanics and to provide an in vitro model to evaluate the various treatment options. Methods: The index, middle, and ring fingers from 8 cadaveric specimens were used in an in vitro active motion simulator to replicate finger flexion/extension. An SND model was developed through sectioning of the terminal extensor tendon at the distal insertion (creating a mallet finger) and transverse retinacular ligament (TRL). A strain gauge inserted under the volar plate measured laxity of the plate, and electromagnetic trackers recorded proximal interphalangeal joint (PIPJ) angles. Results: Strain in the volar plate increased progressively with creation of the mallet and SND conditions ( P = .015). Although not statistically significant, the mallet finger condition accounted for 26% of the increase, whereas sectioning of the TRL accounted for 74% ( P = .031). As predicted, PIPJ hyperextension was not detectable by joint angle measurement; however, the PIPJ angle had a strong positive correlation with volar plate strain ( R2 = 1.0, P < .001). Conclusion: Volar plate strain measurement, in an in vitro model, can detect an induced SND. Moreover, as a surrogate for PIPJ hyperextension, volar plate strain may be useful to evaluate the time-zero effectiveness of various surgical interventions.

Long-term Results of Lateral Band Translocation for the Correction of Swan Neck Deformity in Cerebral Palsy

2010 ◽  
Vol 30 (1) ◽  
pp. 67-70 ◽  
Author(s):  
Marije de Bruin ◽  
Daphne C. van Vliet ◽  
Mark J. Smeulders ◽  
Mick Kreulen
Keyword(s):  
Cerebral Palsy ◽  
Long Term Results ◽  
Lateral Band ◽  
Swan Neck Deformity

scholarly journals Simultaneous Central Slip and Volar Plate Injuries at PIP Joint: A Novel Therapeutic Approach

2021 ◽  
Vol 9 (11) ◽  
pp. e3923
Author(s):  
Ahmed S. Alotaibi ◽  
Felwa A. AlMarshad ◽  
Abdullah M. Alzahrani ◽  
Mohanad O. Hossein ◽  
Attiya Ijaz ◽  
...  
Keyword(s):  
Therapeutic Approach ◽  
Volar Plate ◽  
Pip Joint ◽  
Central Slip ◽  
Novel Therapeutic

scholarly journals Results of Dynamic Claw Correction in Ulnar nerve Palsy

2013 ◽  
Vol 3 (1) ◽  
pp. 13-18
Author(s):  
D Biswas ◽  
MA Kalam ◽  
A Roy ◽  
FR Aolad
Keyword(s):  
Plastic Surgery ◽  
Ulnar Nerve ◽  
Nerve Palsy ◽  
Hand Function ◽  
Lesion Group ◽  
Common Procedure ◽  
Ulnar Nerve Palsy ◽  
Normal Hand ◽  
Pip Joint ◽  
Swan Neck Deformity

Normal hand function is a balance between the extrinsic-intrinsic and extensor-flexor group of musculature. Although individually the intrinsics are very small muscles, collectively they contribute about 50% of grip strength. Total 19 patents with claw deformity were corrected by 4 different techniques. 11 claws were due to high ulnar nerve palsy and 8 were due to low palsy. Result was excellent in 9 (47.36%), good in 7(36.84%), fair in 2(10.52%) and poor in 1(05.26%) patient. Zancolli’s Lasso was the most common procedure used for correction of claw deformity. 1(05.26%) patient developed swan neck deformity treated by FDS 4 tail procedure of low lesion group and final result was fair, another 1 (05.26%) patient developed contracture of the PIP joint. Though exact biomechanical correction of claw is complicated yet function of the hand can be improved with different techniques of tendon transfer.DOI: http://dx.doi.org/10.3329/bdjps.v3i1.15000 Bangladesh Journal of Plastic Surgery 2012, 3(1): 13-18

A Flexor Digitorum Superficialis Tenodesis Technique for Surgical Treatment of Finger PIP Joint Volar Plate Chronic Avulsion

2019 ◽  
Vol 24 (02) ◽  
pp. 195-201
Author(s):  
L. Rocchi ◽  
G. Merendi ◽  
L. Mingarelli ◽  
F. Mancino ◽  
A. Merolli
Keyword(s):  
Range Of Motion ◽  
Proximal Phalanx ◽  
Volar Plate ◽  
Flexor Digitorum Superficialis ◽  
Joint Stability ◽  
Bone Anchor ◽  
Active Motion ◽  
Pip Joint ◽  
Post Traumatic ◽  
Flexor Digitorum

Background: Chronic, post-traumatic, avulsion of the proximal interphalangeal (PIP) joint volar plate represents a disabling lesion. The purpose of this report is to describe a flexor digitorum superficialis (FDS) tenodesis using a mini-bone anchor inserted into the proximal phalanx, and its clinical outcome. Methods: 15 patients with chronic post-traumatic hyperextension instability of the PIP joint were treated surgically. From the first post-operative day patients were invited to start an early gradual joint active motion, wearing an extension block splint. Forty days after surgery, clinical evaluations were carried out, including: joint stability, pain and range of motion (ROM). The use of a circumferential splint was recommended for two further months, avoiding strenuous manual activities. The range of motion, time lost at work and the functional results were recorded six months after surgery. Results: At last follow up, 7 of the 13 reviewed patients presented an excellent functional recovery, with complete resolution of pain and stability with attainment of ROM comparable to the contralateral finger. The others 6 patients obtained good results, with remission of the functional impairment and pain, with either residual hyperextension or flexion contracture. There was one case of recurrence consecutively to a premature traumatic work-related activity. Conclusions: The FDS tenodesis via a bone anchor, combined with early active PIP joint protected motion, was shown in this study to be effective and reliable.

Pin Insertion to the Interosseous Hood Minimize the Finger Motion Restriction for the Proximal Phalangeal Percutaneous Fixation: A Cadaveric Study

2020 ◽  
Vol 25 (02) ◽  
pp. 177-183
Author(s):  
Akira Ikumi ◽  
Toshikazu Tanaka ◽  
Yusuke Matsuura ◽  
Kazuki Kuniyoshi ◽  
Takane Suzuki ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Insertion Point ◽  
Lateral Band ◽  
Significant Difference ◽  
Flexion Extension ◽  
Before And After ◽  
Pip Joint ◽  
Fresh Frozen ◽  
Joint Flexion ◽  
Finger Motion

Background: The purpose of this study was to identify the optimal pin insertion point to minimize finger motion restriction for proximal phalangeal fixation in cadaver models. Methods: We used 16 fingers from three fresh-frozen cadavers (age, 82–86 years). Each finger was dissected at the level of the carpometacarpal joint and fixated to a custom-built range of motion (ROM)-measuring apparatus after skin removal. The pin was inserted into the bone through four gliding soft tissues: the interosseous hood, dorsal capsule, lateral band, and sagittal band. Then, each tendon was pulled by a prescribed weight in three finger positions (flexion, extension, and intrinsic plus position). Changes in the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) angles were measured before and after pinning. We compared the differences between the insertion points using the Tukey-Kramer post hoc test. Results: Placement of pins into the sagittal band significantly restricted MCP joint flexion, while placement into the dorsal capsule and lateral band significantly restricted PIP joint flexion. Only placement into the interosseous hood showed no significant difference in joint angles between the three finger positions compared to pre-pin insertion. There were no significant effects on MCP, PIP, and DIP joint extension. Conclusions: The ROM of the MCP joint was obstructed due to pinning in most areas of insertion. However, pin insertion to the interosseous hood did not obstruct the finger flexion ROM compared to that of other gliding soft tissues; therefore, we believe that the interosseous hood may be a suitable pin insertion point for proximal phalangeal fixation.

A Conservative Approach for Proximal Interphalangeal Joint Arthroplasty

2001 ◽  
Vol 26 (3) ◽  
pp. 235-237 ◽  
Author(s):  
N. R. FAHMY ◽  
A. LAVENDER ◽  
C. BREW
Keyword(s):  
Proximal Phalanx ◽  
Proximal Interphalangeal Joint ◽  
Joint Arthroplasty ◽  
Interphalangeal Joint ◽  
Extensor Mechanism ◽  
Conservative Approach ◽  
Lateral Band ◽  
Pip Joint ◽  
Central Slip

Access to the proximal interphalangeal joint of the finger for arthroplasty is difficult without detaching its stabilizers or dividing the tendons that cross it, which then require repair and slow rehabilitation. We describe a method that conserves both, so facilitating post-operative rehabilitation. A C-shaped incision is made on the dorsum of the finger. The lateral bands of the extensor expansion are separated from the central slip proximally to the extensor hood. They are then retracted to expose the condyles of the proximal phalanx, which are excised. The PIP joint is then dislocated between the central slip and a lateral band allowing the remainder of the head to be excised. The middle and proximal phalanges are then prepared to accept the prosthesis. The prosthesis is then inserted and the joint is reduced. The lateral bands of the extensor mechanism are sutured back to the central slip before the skin is closed.

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