Dorsal and Volar Surgical Approaches to the Metacarpophalangeal Joint: A Comparative Anatomic Study

2017 ◽  
Vol 22 (03) ◽  
pp. 297-302
Author(s):  
Eitan Melamed ◽  
Nicholas Calotta ◽  
Ricardo Bello ◽  
Richard M Hinds ◽  
John T Capo ◽  
...  
Keyword(s):  
Surface Area ◽  
Articular Surface ◽  
Insertion Site ◽  
Proximal Phalanx ◽  
Extensor Tendon ◽  
Joint Surface ◽  
Surgical Approaches ◽  
Collateral Ligament ◽  
Volar Approach ◽  
A1 Pulley

Background: We compared 3 surgical approaches to the MP joint: a dorsal extensor tendon–splitting approach, a dorsal extensor tendon–reflecting parasagittal approach, and the volar A1 pulley approach. We quantitatively compared each of these approaches by measuring the amount of articular cartilage exposed on the base of the proximal phalanx. We hypothesize that visualization of the articular cartilage of the proximal phalangeal base is enhanced with the volar approach. Methods: The MP joints of the 32 available digits were randomly assigned to 1 of 3 surgical approaches: extensor tendon splitting (A), extensor tendon reflecting (B), or volar approach (C). After each approach, the visible articular surface of the base of the proximal phalanx was stained with methylene blue. The MP joints were then disarticulated, and the proximal phalanges were digitally mapped using a 3-dimensional digitizer. Three-dimensional computer software was used to analyze and calculate the dyed exposed surface area and total surface area of each specimen. Results: The mean % exposed joint surface area for the dorsal extensor splitting, dorsal extensor reflecting and volar approaches were 62%, 67% (over the dorsal side of the proximal phalanx) and 54% (over the volar side of the proximal phalanx), respectively. Multiple linear regression showed statistical significance for a smaller percentage of articular surface area exposed with the volar approach. However, this was not clinically significant. A significant association was found between location in the small finger and greater % exposed joint surface, compared to approaches in the index finger. In all volar approach specimens, the collateral insertion site was visible, but not in the dorsal approach specimens. Conclusions: Knowledge of the limits of each exposure is essential for planning the most appropriate surgical approach. The A1 pulley approach provided greater access to the volar 50% of the joint and collateral ligament insertion without violating the extensor mechanism. The amount of joint surface visualized through all 3 approaches was not significantly different. However, based on the accessibility to the collateral ligament insertion site among three different approaches, we recommend the volar A1 pulley approach for treatment of avulsion fractures of the base of the proximal phalanx. For other injuries of the MP joint, including the intra-articular proximal phalanx base fractures, and metacarpal head fractures, the dorsal approaches are still indicated.

scholarly journals Evaluating the Subtalar Joint in Tibiotalocalcaneal Nail

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0040
Author(s):  
Megan Reilly ◽  
Kurosh Darvish ◽  
Soroush Assari ◽  
John Cole ◽  
Tyler Wilps ◽  
...  
Keyword(s):  
Surface Area ◽  
Subtalar Joint ◽  
Articular Surface ◽  
Joint Surface ◽  
Central Dome ◽  
Below The Knee ◽  
Joint Surfaces ◽  
Circular Surface ◽  
The Mean ◽  
Pass Through

Category: Hindfoot Introduction/Purpose: In tibiotalocalcaneal nails for arthrodesis, the path of the nail through the subtalar joint has not been well documented. Ideally, the defect caused by reaming and the nail does not pass through the joint surface so that the amount of bony contact between the talus and calcaneus is maintained in order to optimize fusion. Our hypothesis is that the TTC nail does not destroy a significant amount contact area between the talus and calcaneus. However, using larger diameter nails (which are inherently stronger) will have more of an effect on the contact surface. Methods: Five cadaveric below the knee specimens were obtained. The ankle was disarticulated on each specimen. Subsequently, a guidepin was drilled from the central dome of the talus down to the calcaneus. The 11 mm reamer was then passed over the guidepin through the calcaneus to simulate retrograde reaming of a TTC nail. Then, the subtalar joint was dissected open and the articular surface was documented in comparison with the area that was reamed out. Measurements were then made, using software that calculated two dimensional surface area to determine the percentage of actual subtalar joint area that was reamed out. The mean percentage of articular area that was removed with the reamer was then calculated. Results: Among the five specimens, in the calcaneus, the mean total articular area was 599mm2±113 and the mean drilled articular area was 21mm2±16. The percentage of the calcaneal articular surface that was removed with the reamer was 3.4%±1.9. In the talus, the mean total articular area was 782mm2±130 and the mean drilled articular area was 39mm2±18. The percentage of the talar articular surface that was removed with the reamer was 5.0%±2.3. Additionally, an 11 mm reamer makes a circular surface area of 95mm2, and the statistics above indicate that a significant portion of the reamed area is nonarticular, within the calcaneal sulcus or the talar sulcus. Conclusion: In a tibiotalocalcaneal nail the subtalar joint is typically incompletely visualized, however this anatomic study demonstrates that the 11 mm reamer eliminates about 3.4% of the calcaneal articular surface and about 5% of the talar articular surface. Therefore, the majority of the articular surface is left intact, which is ideal in optimizing arthrodesis outcomes. Furthermore, this study could extrapolate the effects of a larger nail on the availability of joint surface. It could also be used to argue for cartilage stripping of the affected joint surfaces in arthrodesis preparation, because the majority of the articular surface is, in fact, left intact.

Measuring Visualized Joint Surface in Hallux Metatarsophalangeal Arthroscopy

2018 ◽  
Vol 39 (8) ◽  
pp. 978-983
Author(s):  
Michael Hull ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
R. Frank Henn ◽  
Rebecca A. Cerrato
Keyword(s):  
Clinical Practice ◽  
Clinical Relevance ◽  
Articular Surface ◽  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Lateral View ◽  
Joint Surface ◽  
Foot And Ankle ◽  
Kirschner Wires

Background: Arthroscopy has been increasingly used to evaluate small joints in the foot and ankle. In the hallux metatarsophalangeal (MTP) joint, little data exist evaluating the efficacy of arthroscopy to visualize the articular surface. The goal of this cadaveric study was to determine how much articular surface of the MTP joint could be visualized during joint arthroscopy. Methods: Ten fresh cadaveric foot specimens were evaluated using standard arthroscopy techniques. The edges of the visualized joint surface were marked with curettes and Kirschner wires; the joints were then surgically exposed and imaged. The visualized surface area was measured using ImageJ® software. Results: On the distal 2-dimensional projection of the joint surface, an average 57.5% (range, 49.6%-65.3%) of the metatarsal head and 100% (range, 100%-100%) of the proximal phalanx base were visualized. From a lateral view of the metatarsal head, an average 72 degrees (range, 65-80 degrees) was visualized out of an average total articular arc of 199 degrees (range, 192-206 degrees), for an average 36.5% (range, 32.2%-40.8%) of the articular arc. Conclusion: Complete visualization of the proximal phalanx base was obtained. Incomplete metatarsal head visualization was obtained, but this is limited by technique limitations that may not reflect clinical practice. Clinical Relevance: This information helps to validate the utility of arthrosocpy at the hallux metatarsophalangeal joint.

scholarly journals Tethering the Extensor Apparatus Limits PIP Flexion Following K-wire Placement for Pinning Extra-articular Fractures at the Base of the Proximal Phalanx

Hand ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. 433-437 ◽  
Author(s):  
Yaron Sela ◽  
Caitlin Peterson ◽  
Mark E. Baratz
Keyword(s):  
Insertion Site ◽  
Proximal Phalanx ◽  
Extensor Tendon ◽  
Metacarpophalangeal Joint ◽  
Minimally Invasive Surgical ◽  
Articular Fractures ◽  
Pip Joint ◽  
Joint Flexion ◽  
The Mean ◽  
K Wires

Background: Closed reduction with percutaneous Kirschner wires (K-wires) is the most minimally invasive surgical option for stabilizing phalanx fractures. This study examines the effect of K-wire placement on proximal interphalangeal (PIP) joint motion. Methods: PIP joint flexion was measured in the digits of 4 fresh-frozen cadaver hands after placing a suture loop through the flexor tendons and placing tension on the flexors via a mechanical scale. The load necessary to flex the PIP joint to 90° or to maximum flexion was recorded. The load was removed and K-wires were inserted in 3 locations about the metacarpophalangeal joint (MPJ): through the extensor tendon and across the MPJ, adjacent to the extensor tendon insertion site and across the MPJ, and through the sagittal band and into the base of the proximal phalanx (P1). The load on the tendons was reapplied, and angles of PIP joint flexion were recorded for each of the 3 conditions. Results: The mean angle of PIP joint flexion prior to K-wire insertion was 87°, and the mean load applied was 241 g. The angles of flexion were 53° when the K-wire was placed through the extensor tendon, 70° when the K-wire was placed adjacent to the tendon, and 75° when the K-wire was placed into the base of P1 by going through the sagittal band, midway between the volar plate and the extensor tendon. Conclusions: K-wires placed remote from the extensor tendon create less of an immediate tether to PIP joint flexion than those placed through or adjacent to the extensor tendon.

scholarly journals PEDIATRIC ELBOW COLLATERAL AND ANNULAR LIGAMENT ANATOMY: A CT-BASED CADAVERIC STUDY

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0026
Author(s):  
Tyler J. Stavinoha ◽  
Peter C. Cannamela ◽  
Theodore J. Ganley ◽  
Kevin G. Shea
Keyword(s):  
Sports Medicine ◽  
Articular Surface ◽  
Ulnar Collateral Ligament ◽  
Longitudinal Axis ◽  
Joint Surface ◽  
Annular Ligament ◽  
Collateral Ligament ◽  
Reconstructive Procedures ◽  
Lateral Epicondyle ◽  
The Sublime

Background: The medial and lateral ligamentous complexes of the elbow provide static restraint to the elbow and serve as important components of posteromedial and posterolateral rotatory instability. Many collateral ligament and medial epicondylar injuries require surgical repair in those with open physes. Little is known about the anatomy of the pediatric elbow and the relationship between these ligaments and physes. Purpose: To evaluate the anterior bundle of the medial collateral ligament complex, lateral ulnar collateral ligament, annular ligament, and relationships to the joint surfaces and physes. Methods: Two cadaveric elbows from a 3 year-old donor were dissected. Collateral and annular ligaments were isolated and left intact at their osseous attachment. Pins were placed at the origins and insertions and CT scans were used to establish precise anatomic relationships. All dissections and measurements were performed by a single orthopedic surgeon with specialization in pediatric sports medicine. Results: The MUCL origin was a mean 4.10 mm distal and anterior to the medial epicondyle, 10.09 mm from the distal humeral articular surface, and 9.01 mm distal to the medial physis. The distal insertion of the MUCL spanned a mean 3.09 mm and was posterior and medial to the sublime tubercle. In the longitudinal axis, the MUCL insertion footprint spanned the tubercle. The origin was a mean 1.20 mm proximal to the sublime tubercle and the distal extent averaged 2.53 mm distal to the tubercle. The center of the MUCL insertional footprint was 0.38 mm distal to the tubercle. The center of the MUCL was 3.87 mm from the olecranon articular surface. The annular ligament had consistent medial and lateral attachments to the ulna. Distance from the annular ligament attachments to the tip of the coronoid averaged 4.6 mm (4.46 & 4.74 lateral and medial for left; 4.80 & 5.27 lateral and medial for right). The LUCL origin was distal and anterior to the lateral epicondyle. It was 3.43 mm from the lateral epicondyle, 7.51 mm from the articular surface and 0.74 mm distal to the physis. Conclusions: This study is the first to describe anatomy of the elbow collateral and annular ligaments in pediatric cadaveric specimens, through a reliable, CT-based identification method. Knowledge of the precise ligamentous attachments and relationships to the physis and to the joint surface is important for reconstructive procedures. A better understanding of these relationships may assist with surgical planning that preserves adjacent physeal growth regions.

scholarly journals Measuring Visualized Joint Surface in Hallux Metatarsophalangeal Arthroscopy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Michael Hull ◽  
John T. Campbell ◽  
Rebecca Cerrato ◽  
Clifford Jeng ◽  
R. Frank Henn
Keyword(s):  
Articular Surface ◽  
Proximal Phalanx ◽  
Metatarsal Head ◽  
Lateral View ◽  
Joint Surface ◽  
Foot And Ankle ◽  
Kirschner Wires ◽  
Diagnostic Confidence ◽  
Joint Surfaces ◽  
Small Joint

Category: Arthroscopy, Midfoot/Forefoot Introduction/Purpose: Arthroscopy has been increasingly utilized to evaluate small joints in the foot and ankle. In the hallux metatarsophalangeal (MTP) joint, little data exist evaluating the efficacy of arthroscopy to visualize the articular surface. The goal of this cadaveric study was to determine how much articular surface of the MTP joint could be visualized. Methods: Ten (10) fresh cadaveric foot specimens were evaluated using standard arthroscopy techniques. Arthrosocopy was performed with gravity distraction utilizing a 1.9 mm 30° arthroscope and small joint instruments. The edges of the visualized joint surface were marked with curettes and Kirschner wires; the joints were then surgically exposed and imaged. The percentage of cartilage visualized (visualized / total cartilage x 100%) was measured using ImageJ® software. Measurements include surface area visualized on axial imaging as well as arc visualized on lateral imaging Results: On the distal 2-dimensional projection of the joint surface, an average 57.5% (49.6 – 65.3) of the metatarsal head and 100% (100-100) of the proximal phalanx base were visualized. From a lateral view of the metatarsal head, an average 72° (65-80) was visualized out of an average total articular arc of 199° (192-206), for an average 36.5% (32.2 – 40.8) of the articular arc. Conclusion: The results suggest that hallux MTP arthroscopy visualizes a sizable portion of the joint surfaces. However, incomplete visualization could potentially miss a hallux metatarsophalangeal lesion. Further imaging preoperatively may improve diagnostic confidence.

Scaphotrapezoid Assessment during Thumb Carpometacarpal Arthroplasty: A Cadaveric Study

2021 ◽  
Author(s):  
Brianna R. Fram ◽  
Bryan Hozack ◽  
Asif M. Ilyas ◽  
Christopher Jones ◽  
Michael Rivlin
Keyword(s):  
Surface Area ◽  
Articular Surface ◽  
Total Surface Area ◽  
High Rate ◽  
Joint Surface ◽  
Level Of Evidence ◽  
Large Variability ◽  
Thumb Carpometacarpal ◽  
Intraoperative Visualization ◽  
Cmc Joint

Abstract Background Due to limited sensitivity of radiographs for scaphotrapeziotrapezoid (STT) arthritis and the high rate of concurrence between thumb carpometacarpal (CMC) and STT arthritis, intraoperative visualization of the STT joint is recommended during CMC arthroplasty. Purpose We quantified the percentage of trapezoid facet of the scaphotrapezoid (ST) joint that could be visualized during this approach, and compared it to the degree of preoperative radiographic STT arthritis. Methods We performed dorsal surgical approach to the thumb CMC joint after obtaining fluoroscopic anteroposterior, lateral, and oblique wrist radiographs of 11 cadaver wrists. After trapeziectomy, the ST joint was inspected and the visualized portion of the trapezoid articulation marked with an electrocautery. The trapezoid was removed, photographed, and the marked articular surface area and total surface area were independently measured by two authors using an image analysis software. The radiographs were analyzed for the presence of STT arthritis. Results The mean visualized trapezoid surface area during standard approach for CMC arthroplasty was 60.3% (standard deviation: 24.6%). The visualized percentage ranged widely from 16.7 to 96.5%. There was no significant correlation between degree of radiographic arthritis and visualized percentage of the joint (p = 0.77). Conclusions: On average, 60% of the trapezoid joint surface was visualized during routine approach to the thumb CMC joint, but with very large variability. Direct visualization of the joint did not correlate with the degree of radiographic STT arthritis. Clinical Relevance A combination of clinical examination, pre- and intraoperative radiographs, and intraoperative visualization should be utilized to assess for STT osteoarthritis and determine the need for surgical treatment. Level of Evidence This is a Cadaveric Research Article.

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 Anatomy of the Intermetatarsal Facets of the Fourth and Fifth Metatarsals

2021 ◽  
Vol 6 (1) ◽  
pp. 247301142097570
Author(s):  
Mossub Qatu ◽  
George Borrelli ◽  
Christopher Traynor ◽  
Joseph Weistroffer ◽  
James Jastifer
Keyword(s):  
Articular Cartilage ◽  
Digital Imaging ◽  
Articular Surface ◽  
Implant Design ◽  
Joint Surface ◽  
Fracture Classification ◽  
Articular Damage ◽  
Metatarsal Fracture ◽  
Metatarsal Fractures ◽  
The Mean

Background: The intermetatarsal joint between the fourth and fifth metatarsals (4-5 IM) is important in defining fifth metatarsal fractures. The purpose of the current study was to quantify this joint in order to determine the mean cartilage area, the percentage of the articulation that is cartilage, and to give the clinician data to help understand the joint anatomy as it relates to fifth metatarsal fracture classification. Methods: Twenty cadaver 4-5 IM joints were dissected. Digital images were taken and the articular cartilage was quantified by calibrated digital imaging software. Results: For the lateral fourth proximal intermetatarsal articulation, the mean area of articulation was 188 ± 49 mm2, with 49% of the area composed of articular cartilage. The shape of the articular cartilage had 3 variations: triangular, oval, and square. A triangular variant was the most common (80%, 16 of 20 specimens). For the medial fifth proximal intermetatarsal articulation, the mean area of articulation was 143 ± 30 mm2, with 48% of the joint surface being composed of articular cartilage. The shape of the articular surface was oval or triangular. An oval variant was the most common (75%, 15 of 20 specimens). Conclusion: This study supports the notion that the 4-5 IM joint is not completely articular and has both fibrous and cartilaginous components. Clinical Relevance: The clinical significance of this study is that it quantifies the articular surface area and shape. This information may be useful in understanding fifth metatarsal fracture extension into the articular surface and to inform implant design and also help guide surgeons intraoperatively in order to minimize articular damage.

Correction of Fixed Hammertoe Deformity with Resection of the Head of the Proximal Phalanx and Extensor Tendon Tenodesis

1995 ◽  
Vol 16 (7) ◽  
pp. 449-451 ◽  
Author(s):  
Shahan K. Sarrafian
Keyword(s):  
Proximal Phalanx ◽  
Extensor Tendon ◽  
Surgical Correction ◽  
Wire Fixation

A method of surgical correction of a fixed hammertoe deformity is presented. It incorporates the resection of the head of the proximal phalanx with an extensor tendon tenodesis to the dorsum of the proximal phalanx. The controlled tension in the extensor tendon provides the necessary stability. It alleviates the use of K-wire fixation.

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