Simultaneous Volar Dislocation of Distal Interphalangeal Joint and Volar Fracture-Subluxation of Proximal Interphalangeal Joint of Little Finger: A New Mechanism of Injury

2016 ◽  
Vol 21 (03) ◽  
pp. 422-424
Author(s):  
Kamran Mozaffarian ◽  
Abdollah Bayatpour ◽  
Amir Reza Vosoughi
Keyword(s):  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Mechanism Of Injury ◽  
Full Extension ◽  
Joint Fracture ◽  
Pip Joint ◽  
Distal Interphalangeal ◽  
Full Flexion ◽  
Loss Of Motion ◽  
Little Finger

Simultaneous volar dislocation of distal interphalangeal (DIP) joint and volar fracture-subluxation of proximal interphalangeal (PIP) joint of the same finger has not been reported yet. A 19-year-old man was referred due to pain on the deformed left little finger after a ball injury. Radiographs showed volar dislocation of the DIP joint and dorsal lip fracture of the middle phalanx with volar subluxation of PIP joint of the little finger. This case was unique in terms of the mechanism of injury which was hyperflexion type in two adjacent joints of the same finger. The patient was treated by closed reduction of DIP joint dislocation and open reduction and internal fixation of the PIP joint fracture-subluxation and application of dorsal external fixator due to instability. Finally, full flexion of the PIP joint and full extension of the DIP joint were obtained but with 10 degree extension lag at the PIP joint and DIP joint flexion ranging from 0 degree to 30 degrees. Some loss of motion in small joints of the fingers after hyperflexion injuries should be expected.

Open Reduction and Internal Fixation for Dorsal Fracture-dislocation of the Proximal Interphalangeal Joint

2020 ◽  
Vol 52 (01) ◽  
pp. 18-24
Author(s):  
Jun-Ku Lee ◽  
Yoon Seok Kim ◽  
Jin-Hyun Lee ◽  
Gyu-Chol Jang ◽  
Soo-Hong Han
Keyword(s):  
Range Of Motion ◽  
Screw Fixation ◽  
Plate Fixation ◽  
Interphalangeal Joint ◽  
Distal Interphalangeal Joint ◽  
Joint Fracture ◽  
Plate Group ◽  
Pip Joint ◽  
Distal Interphalangeal ◽  
Screw Group

Abstract Purpose The purpose of this study was to investigate and compare the clinical and radiological results of ORIF with inter-fragment screw or buttress plate fixation of acute PIP joint fracture dorsal dislocation. Patients and Methods Between January 2007 to December 2016, nineteen patients – 14 men and 5 women with an average age of 40.9 (19 to 64) years – were included in this study; 9 patients underwent small sized interfragmentary screw fixation and 10 patients underwent small buttress plating. The average follow-up period was 45.1 (13 to 78) months. Clinical assessment included measurement of range of motion (ROM) of the proximal and distal interphalangeal joint (PIP, DIP), grip and pinch strength, and pain with use of the Visual Analog Scale (VAS). At the postoperative X-ray, articular step off, gap, and degree of dorsal subluxation was measured, and maintenance of the reduction, fracture union, and the presence of degenerative changes were assessed. Results All patients achieved solid unions without instability. The overall average range of motion of PIP joint were from 9° to 85° (10–83° in the screw group, 8–87° in the plate group without significant difference). However, the screw group (average: 53°) presented more flexion in the distal interphalangeal joint than the plate group (average: 34°). Plate fixation can cause limited DIP flexion. Six of the ten patients from the plate group, underwent implant removal and two of these patients required PIP joint arthrolysis due to the PIP flexion contracture of more than 30°. Three of the nine patients in screw group underwent implant removal and two of the three patients required PIP joint arthrolysis. Conclusion Mini plate and screw fixation of acute PIP joint fracture dorsal dislocation can achieve comparable favorable clinical and radiographic outcomes through stable fixation and early range of motion exercise. Screw fixation, if possible, is probably preferable to plate fixation because of better DIP joint ROM and lower incidence of hardware removal. If there is a need for plate fixation the use of a short plate is recommended to avoid joint stiffness.

TREATMENT OF CHRONIC POST-TRAUMATIC HYPEREXTENSION DEFORMITY OF PROXIMAL INTERPHALANGEAL JOINT USING THE SUTURE ANCHOR: A CASE REPORT

Hand Surgery ◽  
2007 ◽  
Vol 12 (01) ◽  
pp. 47-49 ◽  
Author(s):  
Yasuo Onishi ◽  
Hiroyuki Fujioka ◽  
Minoru Doita
Keyword(s):  
Suture Anchor ◽  
Proximal Phalanx ◽  
Attachment Site ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Suture Anchors ◽  
Acceptable Result ◽  
Pip Joint ◽  
Post Traumatic ◽  
Little Finger

We present a case of chronic post-traumatic hyperextension of the PIP joint of the little finger. The volar plate was reattached at the original attachment site of the proximal phalanx using two suture anchors and tenodesis of the radial half slip of the FDS tendon was added. An acceptable result was obtained.

SUBCUTANEOUS RUPTURE OF THE FLEXOR TENDON OF THE LITTLE FINGER ASSOCIATED WITH ANOMALOUS FLEXOR DIGITORUM SUPERFICIALIS

Hand Surgery ◽  
2007 ◽  
Vol 12 (02) ◽  
pp. 87-90
Author(s):  
Hiroya Senda ◽  
Hidenori Muro
Keyword(s):  
Flexor Tendon ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Flexor Digitorum Superficialis ◽  
Anomalous Muscle ◽  
Distal Interphalangeal ◽  
Hook Of Hamate ◽  
Flexor Digitorum ◽  
A1 Pulley ◽  
Little Finger

A 59-year-old man suffered from subcutaneous rupture of the flexor tendon of the little finger associated with fracture of the hook of hamate. He could not flex his little finger completely at the distal interphalangeal joint, but incomplete flexion of the proximal interphalangeal joint was possible. Surgical exploration revealed anomaly of the flexor digitorum superficialis of the little finger, as it originated from the palmar aspect of the carpal ligament, and a small portion of the muscle belly was traversed toward the A1 pulley over the profundus tendon and then it ran into the A1 pulley as a normal superficialis tendon. The flexor digitorum superficialis of the little finger is well known to show variations, but our case is extremely rare, and furthermore there are no reports in the available literatures about the function of this anomalous muscle.

Arthrodesis of Little Finger Distal Interphalangeal Joint in Flexion to Regain Sporting Ability

2017 ◽  
Vol 22 (01) ◽  
pp. 83-87
Author(s):  
S.M. Beecher ◽  
D.E. O’Briain ◽  
J.P. Ng ◽  
E. Murphy ◽  
M.E. O’Sullivan
Keyword(s):  
Grip Strength ◽  
Hand Function ◽  
Interphalangeal Joint ◽  
Bony Union ◽  
Posttraumatic Arthritis ◽  
Distal Interphalangeal Joint ◽  
Full Extension ◽  
Distal Interphalangeal ◽  
Post Traumatic ◽  
Little Finger

Background: Finger injuries are common in the sport of hurling. Injury to the little finger distal interphalangeal joint (DIPJ) often occurs when a high dropping ball impacts on the outstretched finger. The little finger contributes to approximately 15% of grip strength. Injury therefore results in reduced grip strength and may impair the ability of players to grip or catch a ball. Methods: Six elite hurlers with post-traumatic arthritis of their non-dominant little finger DIPJ underwent arthrodesis in 30 degrees of flexion. Kirchner wires were inserted for up to 8 weeks to achieve fusion of the joint. Patients were evaluated after recovery using a dynamometer to assess grip strength, the DASH questionnaire and a sport specific questionnaire. Results: All arthrodeses achieved bony union without complication. All patients reported a resolution of their pain and recovery in their ability to catch & retain a ball. Measurements of grip strengths were comparable between hands. DASH scores improved by up to 47 points. All scores were less than 5 at final follow-up. Conclusions: Grip strength decreases when fingers are immobilized in full extension. In sports that require catching or gripping a ball or a bat, arthrodesis of the DIP joint in flexion can improve grip strength and hand function. Fusion in 30 degrees of flexion for hurlers results in restoration of function and resolution of pain. Little finger DIPJ arthrodesis is a valid method of treating posttraumatic arthritis in ball and bat sports.

Post-Reduction Stability of the Proximal Interphalangeal Joint after Dorsal Fracture Dislocation—A Cadaveric Study

2016 ◽  
Vol 21 (03) ◽  
pp. 382-387 ◽  
Author(s):  
Andre Eu-Jin Cheah ◽  
Tun-Lin Foo ◽  
Janice Chin-Yi Liao ◽  
Min He ◽  
Alphonsus Khin-Sze Chong
Keyword(s):  
Traction Force ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocation ◽  
Treatment Modalities ◽  
Full Extension ◽  
Early Motion ◽  
Fracture Dislocations ◽  
Reduction Stability ◽  
The One

Background: Proximal interphalangeal joint (PIPJ) dorsal fracture dislocations (DFD) are challenging injuries. Treatment aims to achieve stability of the PIPJ after reduction so that early motion can be initiated. We studied how increasing articular destruction would affect post reduction stability and investigate the amount of traction and PIPJ flexion needed to maintain the reduction. Methods: Increasing amounts (20%, 40% and 60%) of damage to the volar lip of the middle phalanx in cadaveric specimens were created to represent PIPJ DFD that were stable, of tenuous stability and frankly unstable. Traction forces and PIPJ flexion needed to maintain the reduction were then measured. Results: The PIPJ DFD with 20% damage were stable and did not subluxe while the one with 40% articular involvement was stable after reduction. For unstable the PIPJ with 60% involvement, the more the PIPJ was flexed, the less traction force was needed to hold the joint in reduction. For PIPJ flexion of 20 degrees, a minimum 4.4N of force is needed to maintain reduction while PIPJ flexion of 10 degrees required a minimum 5.0N of force. No amount of force could maintain PIPJ reduction if traction was performed in full extension. Conclusions: In our model, PIPJ DFD with less than 30% articular damage are stable while those with 30% to 50% of involvement have tenuous stability. For the unstable PIPJ DFD, traction obviates the need for excessive flexion of the PIPJ to maintain joint reduction. This information should be considered in treatment modalities for PIPJ DFD, as well in the design of external traction devices for the treatment of PIPJ DFD.

Results of Vascularized Joint Transfers from the Foot

1997 ◽  
Vol 22 (4) ◽  
pp. 492-498 ◽  
Author(s):  
G. DAUTEL ◽  
M. MERLE
Keyword(s):  
Joint Space ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Indications For Surgery ◽  
Pip Joint ◽  
Prosthetic Implant ◽  
Metatarsophalangeal Joints ◽  
Second Toe ◽  
The Average Range

We report our results in ten cases of vascularized joint transfer to reconstruct the proximal interphalangeal joint (five cases) or metacarpophalangeal joints (five cases). Donor sites were the proximal interphalangeal or the metatarsophalangeal joints of the second toe. Indications for surgery were the need to reconstruct both the growth plate and joint space in children or the impossibility of a conventional prosthetic implant. The average range of motion was 44° for the PIP joint and 53° for the MP joint at a mean follow-up of 22.7 months.

Volar plating versus external fixation for unstable dorsal fracture-dislocations of the proximal interphalangeal joint

2021 ◽  
pp. 175319342110593
Author(s):  
Atsuhiko Murayama ◽  
Kentaro Watanabe ◽  
Hideyuki Ota ◽  
Shigeru Kurimoto ◽  
Hitoshi Hirata
Keyword(s):  
External Fixation ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Volar Plating ◽  
Distal Interphalangeal Joint ◽  
Active Flexion ◽  
Plate Group ◽  
Fracture Dislocations ◽  
Distal Interphalangeal

We retrospectively compared the results of volar plating and dynamic external fixation for acute unstable dorsal fracture-dislocations of the proximal interphalangeal joint with a depressed fragment. We treated 31 patients (31 fingers), 12 with volar buttress plating and 19 with dynamic external fixation. Follow-up averaged 35 and 40 months in the two groups, with a minimal 6-month follow-up. Average active flexion of the proximal interphalangeal joint was 95° after plate fixation and 87° after external fixation, with an active extension lag of –6° and –9°, respectively. Active flexion at the distal interphalangeal joint averaged 67° in the plate group and 58° in the external fixation group, with active extension lags of 0° and –5°, respectively. We conclude that both methods can obtain a good range of motion at the proximal interphalangeal joint. A limitation of the extension of the distal interphalangeal joint occurred with dynamic external fixation but not with volar buttress plating. Level of evidence: IV

An Unusual Dorsal Fracture–Dislocation of the Proximal Interphalangeal Joint

2007 ◽  
Vol 32 (2) ◽  
pp. 193-194 ◽  
Author(s):  
K. OTANI ◽  
K. FUKUDA ◽  
C. HAMANISHI
Keyword(s):  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Volar Plate ◽  
Fracture Dislocation ◽  
Unusual Variant ◽  
Full Flexion

A case of dorsal fracture–dislocation of the proximal interphalangeal joint in which the volar plate had been pulled from its distal attachment without bony or cartilaginous attachments and the lip of the volar plate had also been detached separately and was obstructing full flexion of the joint is presented. A tentative mechanism of causation of this unusual variant of a common injury is suggested.

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

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