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.

scholarly journals Results of tension band wiring in intra-articular collateral ligament avulsion fractures of the phalanx

2018 ◽  
Vol 6 (2) ◽  
pp. 74-77
Author(s):  
Rajeev Raj Manandhar ◽  
Shishir Lakhey ◽  
Umash Karki
Keyword(s):  
Functional Outcome ◽  
Soft Tissues ◽  
Proximal Phalanx ◽  
Ring Finger ◽  
Ulnar Collateral Ligament ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Collateral Ligament ◽  
Avulsion Fractures ◽  
Radial Collateral Ligament

Background: Avulsion fractures of the base of proximal phalanx associated with ulnar or radial collateral ligament instability are relatively rare. The small size of the fragment and strong deforming pull of the attached soft tissues make the process of reduction and maintenance difficult.Objective: The purpose of this study was to assess the functional outcome of tension band wiring in intra-articular avulsion fractures of the base of the proximal phalanx.Methodology: A prospective study was performed on ten patients with intra-articular collateral ligament avulsion fractures of the proximal phalanx (Jupiter’s classification Type III). A tension band construct was performed using a dorsal approach. The functional outcome was assessed at six months with the quick Disability of Arm, Shoulder and Hand score.Results: The mean age of the patients was 25.8 years (Mean ± SD: 25.80). Six avulsion fractures were of the ulnar collateral ligament of the proximal phalanx of the index finger, one involved the radial collateral ligament of the ring finger and three, the radial collateral ligament of the little finger suggesting an abduction injury. All fractures had united at three months. Eight patients were graded as excellent and two as good. All patients were satisfied with the surgery and the functional outcome of the injured digit. There were no perioperative complications.Conclusion: The functional outcome of tension band wiring in intra-articular collateral ligament avulsion fractures of the base of the proximal phalanx was good to excellent.

OSTEOCHONDROMA PREVENTING CLOSED REDUCTION OF A PROXIMAL INTERPHALANGEAL DISLOCATION OF THE LITTLE FINGER

Hand Surgery ◽  
1998 ◽  
Vol 03 (02) ◽  
pp. 297-302
Author(s):  
K. Horiuchi ◽  
K. Yamauchi ◽  
M. Tanaka
Keyword(s):  
Case Report ◽  
Closed Reduction ◽  
Proximal Phalanx ◽  
Complete Recovery ◽  
Daily Activities ◽  
Joint Function ◽  
Collateral Ligament ◽  
Pip Joint ◽  
Little Finger

We present a case of a 21-year-old male patient who developed an osteochondroma at the neck of the proximal phalanx of the left little finger, which interfered with reduction of a dorsally dislocated PIP joint. This is the first such case report in the literature. At the time of surgery, we excised the osteochondroma and reconstructed the collateral ligament that produced locking of the PIP joint. This treatment brought a quick and essentially complete recovery of the PIP joint function. At 3 years follow-up in the affected digit, the patient has no limitations in daily activities.

The Treatment of Chronic Flexion Contractures of the Proximal Interphalangeal Joint

1995 ◽  
Vol 20 (3) ◽  
pp. 385-389 ◽  
Author(s):  
G. ABBIATI ◽  
G. DELARIA ◽  
E. SAPORITI ◽  
M. PETROLATI ◽  
C. TREMOLADA
Keyword(s):  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Extension Deficit ◽  
Flexion Contractures ◽  
Complete Extension ◽  
Pip Joint ◽  
Surgical Release

A method of treatment of chronic flexion contractures of the PIP joint is presented, with the results obtained in 19 patients treated between 1989 and 1992 after a follow-up of from 6 to 53 months. The flexion contractures, with an extension deficit which ranged between 70 and 90°, had been present for a period of between 2 months and 24 years. Our treatment program involves the surgical release of the unreducible PIP joint followed by the use of static and/or dynamic splints. Surgery is performed using a midlateral approach; the accessory collateral ligament and the flexor sheath are incised and, after the volar plate and check-rein ligaments have been excised, forced hyperextension is applied. The main collateral ligaments are carefully spared and freed from the condyle if there are any remaining adhesions. In our 19 patients, complete extension of the finger was achieved in 11 cases (57.9%); in the remaining 8 cases (42.1%) the residual extension deficit ranges from 10 to 15°. In our experience this combined surgical and rehabilitative approach had led to consistently good results with minimal complications.

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.

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.

Free Vascularized Joint Transfer from Toes for Finger Reconstruction in a 2-Year-Old Child with Good Functional Recovery

2021 ◽  
Author(s):  
Jyoshid R. Balan
Keyword(s):  
Road Traffic ◽  
Ring Finger ◽  
Middle Finger ◽  
Tissue Loss ◽  
Soft Tissue Reconstruction ◽  
Middle Phalanx ◽  
Pip Joint ◽  
Tissue Reconstruction ◽  
Distal Interphalangeal ◽  
The Right

AbstractA 2-year-old male child sustained injury to middle and ring fingers of the right hand following a road traffic accident. He had mutilated fingers with loss of middle phalanx along with proximal interphalangeal (PIP) joint, distal interphalangeal joint of middle finger, and loss of part of middle phalanx and PIP joint of the ring finger. There was dorsal tissue loss of both the fingers. With staged reconstructive strategy, we could salvage the fingers. In the initial part, the soft tissue reconstruction was done using pedicled groin flap. In the later stage, free PIP joint transfer from the second toes of both feet was used to reconstruct the bone and PIP joint of the ring and middle finger. A year following the joint transfer, the child had good functional outcome.

Collateral Ligament Reconstruction of the Unstable Metatarsophalangeal Joint: An in Vitro Study

Foot & Ankle ◽  
1992 ◽  
Vol 13 (7) ◽  
pp. 391-395 ◽  
Author(s):  
Jonathan T. Deland ◽  
Mark Sobel ◽  
Steven P. Arnoczky ◽  
Francesca M. Thompson
Keyword(s):  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
In Vitro Study ◽  
Metatarsal Head ◽  
Anatomic Reconstruction ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Toe Deformity ◽  
Metatarsophalangeal Joints

Anatomic reconstruction of the collateral ligaments of the lesser metatarsophalangeal joints is proposed for certain cases of metatarsophalangeal instability. The suggested reconstruction involves replication of the attachments of the collateral ligaments. As an example of such a reconstruction, the interosseous tendon was used in this study as a graft for anatomic replacement of the collateral ligaments. The tendon was left attached distally where its attachments include the volar plate and proximal phalanx, thereby resembling the distal attachment of the collateral ligament. The proximal portion of the tendon was inserted into the metatarsal head, replicating the attachment of the collateral ligament at that location. Preliminary testing of such a reconstruction shows that it can re-establish stability caused by loss of the collateral ligaments. Such a procedure may be applicable in select cases of crossover toe deformity and straight vertical instability.

VERTICAL LOCKING OF THE METACARPOPHALANGEAL JOINT OF THE THUMB

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 279-284 ◽  
Author(s):  
Kosuke Tajima ◽  
Takashi Sasaki ◽  
Kazuyoshi Yamanaka
Keyword(s):  
Proximal Phalanx ◽  
Metacarpophalangeal Joint ◽  
Vertical Position ◽  
Collateral Ligament ◽  
X Ray ◽  
First Case ◽  
The Right ◽  
Flexion Force

Locking of the metacarpophalangeal (MP) joint of the fingers, though reported infrequently, is not rare in the literature. We will report two rare cases of the MP joint of the thumb locked in 90° of flexion (vertical locking). The first case is a 21-year-old man, punched on his right thumb by his friend, who arrived with his thumb fixed in a flexed position. The X-ray images of the right thumb showed the proximal phalanx subluxation in the palmer side in a vertical position. The second case is a 35-year-old woman with her right thumb accidentally caught in the chain of a key-holder. The locking was easily reduced without anaesthesia in both cases. We assume the mechanism was that the flexion force on the MP joint led to subluxation and the locking occurred due to the tension of the collateral ligament caused by the volar prominence of the radial condyle.

3D kinematics of the interphalangeal joints in the forelimb of walking and trotting horses

2007 ◽  
Vol 20 (01) ◽  
pp. 01-07 ◽  
Author(s):  
D. H. Sha ◽  
J. A. Stick ◽  
P. Robinson ◽  
H. M. Clayton
Keyword(s):  
Significant Contribution ◽  
Soft Tissues ◽  
External Rotation ◽  
Imaging Techniques ◽  
Proximal Phalanx ◽  
Middle Phalanx ◽  
Coordinate Systems ◽  
Flexion Extension ◽  
Pip Joint ◽  
The Right

SummaryThe objective was to measure 3D rotations of the distal (DIP) and proximal (PIP) interphalangeal joints at walk and trot. 3D trajectories of markers fixed to the proximal phalanx, middle phalanx and the hoof wall of the right forelimb of four sound horses were recorded at 120 Hz. Joint kinematics were calculated in terms of anatomically-based joint coordinate systems between the bone segments. Ranges of motion were similar at walk and trot. Values for the DIP joint were: flexion/extension: 46 ± 3° at walk, 47 ± 4° at trot; internal/ external rotation: 5 ± 1° at walk, 6 ± 3° at trot; and adduction/abduction: 5 ± 2° at walk, 5 ± 3° at trot. Within each gait, kinematic profiles at the DIP joint were similar between horses with the exception of adduction/abduction during breakover, which may vary depending on the direction of hoof rotation over the toe. Knowledge of the types and amounts of motion at the DIP joint will be useful in understanding the aetiology and treatment of injuries to the soft tissues, which are being recognized more frequently through the use of sensitive imaging techniques. Ranges of motion for the PIP joint were: flexion/extension: 13 ± 4° at walk, 14 ± 4° at trot; adduction/abduction: 3 ± 1° at walk, 3 ± 1° at trot; and internal/external rotation: 3 ± 1° at walk, 4 ± 1° at trot. The PIP joint made a significant contribution to flexion/extension of the digit. During surgical arthrodesis, the angle of fusion may be important since loss of PIP joint extension in late stance is likely to be accommodated by increased extension of the DIP joint.

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