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 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.

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.

Rotatory subluxation of the proximal interphalangeal joint: an easily missed diagnosis

2021 ◽  
Vol 14 (1) ◽  
pp. e237402
Author(s):  
Angelos Assiotis ◽  
Christopher Jenkins ◽  
Rouin Amirfeyz
Keyword(s):  
Index Finger ◽  
Joint Space ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Collateral Ligament ◽  
Acute Setting ◽  
Central Slip ◽  
Rotatory Subluxation ◽  
Missed Diagnosis ◽  
Initial Delay

We present a case of volar rotatory subluxation of index finger proximal interphalangeal joint (PIPJ) following a skiing accident. The injury was initially perceived to be a central slip rupture and treatment was directed as such. After the initial delay in the diagnosis, the patient underwent surgery during which his radial collateral ligament was found to be avulsed from the proximal origin, the radial lateral band palmarly subluxed and was interposed in the joint space. This structure was also adhered to the uninjured volar plate.PIPJ volar rotatory subluxation could be readily missed in the acute setting. Without surgery, the functional outcome could be mediocre and to the patient’s detriment.

Area of cartilage accessible to curettage for subsequent arthrodesis of the equine proximal interphalangeal joint

2013 ◽  
Vol 26 (06) ◽  
pp. 489-492 ◽  
Author(s):  
S. Berchtold ◽  
J. M. Kuemmerle
Keyword(s):  
Articular Cartilage ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Joint Disease ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Contralateral Limb ◽  
Conventional Procedure ◽  
Articular Cartilage Surface ◽  
The Difference

SummaryThis study compared the areas of cartilage accessible for curettage in arthrodesis of the equine proximal interphalangeal joint using the conventional and collateral ligament sparing approaches. For this purpose, forelimbs and hindlimbs of six equine cadavers without radiographic evidence of proximal interphalangeal joint disease were used. One limb of each pair of limbs was randomly assigned to a dissection using a standard approach to the proximal interphalangeal joint including transection of the collateral ligaments, while each contralateral limb was exposed using the same approach but leaving the collateral ligaments intact. Hohmann retractors and Spratt curettes were then used to remove as much articular cartilage as possible. Finally, proximal interphalangeal joints were photographed and image analysis was performed.Using the collateral ligament sparing procedure, the mean percentage of articular cartilage surface removed (41.2%) was significantly less than using the conventional procedure (79.6%) (p <0.01). The difference between forelimbs and hindlimbs was not significant.

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.

Three-dimensional analysis of the palmar plate and collateral ligaments at the proximal interphalangeal joint

2013 ◽  
Vol 39 (4) ◽  
pp. 391-397 ◽  
Author(s):  
S. W. J. Lee ◽  
Z. Y. Ng ◽  
Q. A. Fogg
Keyword(s):  
Virtual Environment ◽  
Dimensional Analysis ◽  
Three Dimensional ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Collateral Ligaments ◽  
Middle Phalanx ◽  
Palmar Plate ◽  
3D Virtual Environment

The purpose of this study was to analyze the palmar plate complex at the proximal interphalangeal joint using a three-dimensional (3D) technique, which makes it easier to understand the dimensions of structures and their relationship to the adjacent components. This method allows individual elements to be removed virtually, facilitating clearer observation of each component. Sixteen cadaveric specimens were dissected and reconstructed in a 3D virtual environment. The palmar plate is made up of a distal, fibrous portion and a proximal, membranous portion, which anchors distally on the base of the middle phalanx and is continuous with the bilateral check-rein ligaments proximally. The accessory collateral ligaments and the A3 pulley suspend the palmar plate laterally.

scholarly journals Complete Avulsion of the Extensor Mechanism of a Finger with Simultaneous Dislocation of the Proximal Interphalangeal Joint

2009 ◽  
Vol 3 (1) ◽  
pp. 75-77 ◽  
Author(s):  
K.C Xarchas ◽  
K Tilkeridis ◽  
G Kitsikidou ◽  
S.I Pelekas ◽  
D.A Verettas
Keyword(s):  
Ulnar Collateral Ligament ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Extensor Mechanism ◽  
Collateral Ligament ◽  
Rare Injury ◽  
Single Finger ◽  
Extensor Apparatus ◽  
Pip Joint ◽  
Mechanism Operative

We report a rare case of open dislocation of the proximal interphalangeal (PIP) joint, associated with simultaneous avulsion of the central band and distal insertion of the extensor mechanism, rapture of the proximal volar plate, and rapture of the ulnar collateral ligament of the PIP joint. Although isolated IP joint injuries are common, they rarely occur simultaneously in a single finger. Even more rarely are they accompanied by a complete avulsion of the extensor mechanism. Operative restoration of the injured structures is a necessity in order to achieve a good functional outcome. An initial forceful flexion of the finger resulting to rapture of the extensor apparatus and then followed by finger hyperextension and PIP joint dislocation is our perception of the possible mechanism of this extremely rare injury.

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>

Change in the collateral and accessory collateral ligament lengths of the proximal interphalangeal joint using cadaveric model three-dimensional laser scanning

2015 ◽  
Vol 41 (4) ◽  
pp. 380-385
Author(s):  
S. S. Sandhu ◽  
S. Dreckmann ◽  
P. A. Binhammer
Keyword(s):  
Laser Scanning ◽  
Index Finger ◽  
Three Dimensional ◽  
Middle Finger ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Ligament Length ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Level Of Evidence

The purpose of this study was to assess the lengths of the index and middle finger proximal interphalangeal joint ligaments and determine the relative changes in the collateral and accessory collateral ligament lengths at 0°, 45° and 90° flexion. We generated three-dimensional scans of 16 finger (eight index and eight middle) proximal interphalangeal joints to assess relative changes in ligament length. Significant changes were found between 45°–90° and 0°–90° for the ulnar collateral ligament of the index finger and both collateral ligaments of the middle finger between 45°–90° and 0°–90°. No significant changes in length were found for the radial collateral ligament of the index finger or the accessory collateral ligaments of the index and middle fingers. Overall, it was found that the collateral ligament length changed significantly, but there was no significant change in the accessory collateral ligaments. Type of study/level of evidence: Therapeutic IV

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.

Sign in / Sign up

Export Citation Format

Share Document