Peg and Dowel Fusion of the Proximal Interphalangeal Joint

Foot & Ankle ◽  
1980 ◽  
Vol 1 (2) ◽  
pp. 90-94 ◽  
Author(s):  
Franklin G. Alvine ◽  
Kevin L. Garvin
Keyword(s):  
Flexor Tendon ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Fusion Rate ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Office Practice

The clawtoe or hammertoe deformity is frequently encountered in office practice. The etiology of this condition remains obscure, although intrinsic atrophy or imbalance was suspected as early as 1863 by Duchenne. Arthrodesing the proximal interphalangeal joint converts the more powerful flexor tendon to a flexor of the metatarsophalangeal joint, thereby alleviating pressure on the metatarsal head and distributing the weight more evenly on the forefoot. Arthrodesing is accomplished by the peg and dowel method, with the fourth toe presenting the most technical difficulties. An extensor tenotomy or dorsal capsulotomy of the metatarsophalangeal joint is frequently necessary to realign the toe with the corresponding metatarsal ray. A collodian dressing is used to immobilize the toe for a period of 4 to 6 weeks, with a fusion rate of 97% in 73 toes. All patients were contacted, with 87% responding favorably and stating that they had relief of their pain and were able to resume wearing normal footwear.

scholarly journals Minimally invasive management of dorsiflexion contracture at the metatarsophalangeal joint and plantarflexion contracture at the proximal interphalangeal joint of the fifth toe

2011 ◽  
Vol 1 (2) ◽  
pp. 27
Author(s):  
Mariano De Prado ◽  
Pedro-Luis Ripoll ◽  
Pau Golanó ◽  
Javier Vaquero ◽  
Nicola Maffulli
Keyword(s):  
Minimally Invasive ◽  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Invasive Technique ◽  
Wedge Osteotomy ◽  
Invasive Approach ◽  
Fifth Toe ◽  
Toe Deformity

Several surgical options have been described to manage persistent dorsiflexion contracture at the metatarsophalangeal joint and plantarflexion contracture at the proximal interphalangeal joint of the fifth toe. We describe a minimally invasive technique for the management of this deformity. We perform a plantar closing wedge osteotomy of the 5th toe at the base of its proximal phalanx associated with a lateral condylectomy of the head of the proximal phalanx and at the base of the middle phalanx. Lastly, a complete tenotomy of the deep and superficial flexor tendons and of the tendon of the extensor digitorum longus is undertaken. Correction of cock-up fifth toe deformity is achieved using a minimally invasive approach.

scholarly journals Infiltration of synovitis into the flexor tendon: a case report

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052093618
Author(s):  
Qianjun Jin ◽  
Haiying Zhou ◽  
Hui Lu
Keyword(s):  
Flexor Tendon ◽  
Surgical Excision ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Flexion Angle ◽  
Flexor Digitorum Profundus ◽  
Normal Tendon ◽  
Active Flexion ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

Synovitis is a type of aseptic inflammation that occurs within joints or surrounding tendons. No previous reports have described a hypertrophic synovium eroding the tendon sheath and manifesting as synovitis within the flexor tendon. We herein report a case involving a 10-year-old girl who presented to our hospital with a 1-month history of a swollen mass and progressive inability to completely flex her left index finger. The active flexion angle of the proximal interphalangeal joint was limited to 85°. A longitudinal incision of the flexor digitorum profundus tendon was surgically performed. The synovium inside and outside the flexor digitorum profundus tendon was completely removed. After the surgical excision, normal tendon gliding returned without recurrence by the 1-year follow-up. The active flexion angle of the proximal interphalangeal joint improved to 100°. To the best of our knowledge, this is the first case of synovitis affecting the flexor tendon and leading to limited flexion of a finger. The manifestation of a double ring sign on magnetic resonance imaging is quite characteristic. Early diagnosis and monitoring of the hyperproliferation and invasiveness of the synovial tissue are required. Surgical excision can be a simple and effective tool when necessary.

The influence of the equine proximal interphalangeal joint on flexor tendon strain

2006 ◽  
Vol 39 ◽  
pp. S492 ◽  
Author(s):  
S.E.M. Lawson ◽  
H. Château ◽  
P. Pourcelot ◽  
J.-M. Denoix ◽  
N. Crevier-Denoix
Keyword(s):  
Flexor Tendon ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Tendon Strain

Definitions of Hammer Toe and Claw Toe

2009 ◽  
Vol 99 (3) ◽  
pp. 194-197 ◽  
Author(s):  
Joost C.M. Schrier ◽  
Cees C.P.M. Verheyen ◽  
Jan Willem Louwerens
Keyword(s):  
Metatarsophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Clear Definition ◽  
Literature Study ◽  
Claw Toe ◽  
Hammer Toe ◽  
Single Criterion ◽  
Pubmed Database ◽  
Definition Of

Background: Lesser toe surgery is among the most conducted interventions in general orthopedic practice. However, the definitions of hammer toe and claw toe are not uniform. The objective of this literature study is to propose clear definitions for these deformities to establish unambiguous communication. Methods: A literature search was performed in the PubMed database (May 2006). Of 81 eligible articles, 42 that stated a clear definition of hammer toe or claw toe were selected. Results: In all 35 articles in which hammer toe was clearly defined, flexion in the proximal interphalangeal joint was part of the definition. Seventeen articles (49%) defined hammer toe as a combination of metatarsophalangeal extension and proximal interphalangeal flexion. Thirteen articles showed flexion of the proximal interphalangeal joint as the single criterion. Twenty-three articles with a clear definition of claw toe were selected. Twenty-one articles (91%) showed metatarsophalangeal extension as part of the claw toe deformity. Twelve articles (52%) regarded metatarsophalangeal extension and flexion of the proximal interphalangeal and distal interphalangeal joints as the essential characteristics. Seven articles described a claw toe as metatarsophalangeal extension with flexion in the proximal interphalangeal joint. Conclusions: There are variations in the definitions of lesser toe deformities in the literature. We propose that extension of the metatarsophalangeal joint is the discriminating factor and essential characteristic for claw toe. Claw toe and hammer toe should be characterized by flexion in the proximal interphalangeal joint, which is the single criterion for a hammer toe. The flexibility of these joints could be a basic factor in discriminating between these deformities. The development of these deformities should be regarded as a continuum in the same pathophysiologic process. (J Am Podiatr Med Assoc 99(3): 194–197, 2009)

Resistive testing in a patient with suspected zone I flexor tendon injury

Hand Therapy ◽  
2009 ◽  
Vol 14 (3) ◽  
pp. 83-85
Author(s):  
Gangatharam Sudhagar ◽  
Monique Leblanc
Keyword(s):  
Occupational Therapy ◽  
Flexor Tendon ◽  
Tendon Injury ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Distal Interphalangeal Joint ◽  
Hand Surgeon ◽  
Flexor Tendon Injury ◽  
Distal Interphalangeal

Lacerations are the major cause of flexor tendon injury in zone I and they are most commonly missed due to incomplete examinations. We report a case of lacerated flexor tendon injury in Zone I closed without explorations and which was referred to occupational therapy with the diagnosis of stiff hand. The patient received therapy for his stiff hand following which he could flex the distal interphalangeal joint (DIP) on blocking the proximal interphalangeal joint but failed to flex his DIP joint on making a composite fist. With resistive testing the patient failed to initiate resistance on flexion. The patient was referred back to the hand surgeon and subsquently diagnosed with a flexor tendon injury.

Hammer Toe Correction Using an Absorbable Intramedullary Pin

2007 ◽  
Vol 28 (8) ◽  
pp. 916-920 ◽  
Author(s):  
Kurt F. Konkel ◽  
Andrea G. Menger ◽  
Sharon Ann Retzlaff
Keyword(s):  
Proximal Phalanx ◽  
Metatarsophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Foot Deformities ◽  
Flexion Deformity ◽  
Hammer Toe ◽  
Intramedullary Canal ◽  
Pin Track ◽  
Fixed Flexion Deformity

Background: Fixed flexion deformity of the proximal interphalangeal joint with or without hyperextension of the metatarsophalangeal joint is one of the most common foot deformities. Many operative options have been recommended. Complaints after operative procedures include a too straight toe, floating toe, painful toe recurvatum, mallet toe, pin track infection, broken hardware, and the necessity of removing hardware. A proximal interphalangeal joint arthrodesis for hammertoe deformity using a 2-mm absorbable pin for internal fixation is described. Methods: The results of 48 toe arthrodeses in 35 patients were reviewed. Followup ranged from 16 to 58 (average 38.5) months. Results: The procedure is simple and safe for the correction of painful rigid hammertoe deformities. Patient satisfaction was high, complications were minimal, and followup required no pin management or removal. Conclusions: This procedure can be used for hammer toe deformities requiring surgery when the metatarsophalangeal joint is stable, the skin is not compromised, and the intramedullary canal of the proximal phalanx is 2.0 mm or less. It also has been useful in stabilizing hammertoe correction when there are severe pre-existing metal allergies.

The outcomes of zone 1 flexor tendon injuries treated using micro bone suture anchors

2013 ◽  
Vol 38 (9) ◽  
pp. 973-978 ◽  
Author(s):  
S. Huq ◽  
S. George ◽  
D. E. Boyce
Keyword(s):  
Range Of Motion ◽  
Flexor Tendon ◽  
Proximal Interphalangeal Joint ◽  
Tendon Injuries ◽  
Interphalangeal Joint ◽  
Distal Interphalangeal Joint ◽  
Flexor Tendon Injuries ◽  
Distal Interphalangeal ◽  
Bone Anchors ◽  
The Mean

This article evaluates the outcome of 42 consecutive zone 1 flexor tendon injuries treated by using micro bone anchors during the period 2003–2008. Patients were rehabilitated using the modified Belfast Regime. The range of motion at the distal interphalangeal joint was assessed using Moiemen’s classification. A total of 56% of patients achieved excellent or good results for range of motion at the distal interphalangeal joint and 23% had a poor outcome. The mean distal interphalangeal joint and proximal interphalangeal joint range of motion were 48° and 96°, respectively. A total of 94% of patients returned back to work by 12 weeks. One patient sustained a tendon rupture and one developed osteomyelitis. The mean QuickDASH score was 13.5 and 81% of patients were satisfied with their outcomes. This is the largest clinical study on the use of bone anchors for zone 1 tendon injuries. Our study demonstrated a low rate of complications and outcomes that compare favourably with other published techniques.

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.

Flexor Tendon Repair in Zone 2 Using A Six-Strand ‘Figure of Eight’ Suture

2009 ◽  
Vol 34 (3) ◽  
pp. 322-328 ◽  
Author(s):  
M. M. AL-QATTAN ◽  
T. M. AL-TURAIKI
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Prospective Clinical Study ◽  
Flexor Tendon Repair ◽  
Active Range Of Motion ◽  
The Mean ◽  
Repair Techniques

The tensile strength of three different flexor tendon repair techniques were tested in vitro: the modified Kessler technique (a two-strand repair), two ‘figure of eight’ sutures (a four-strand repair) and three ‘figure of eight’ sutures (a six-strand repair). The mean breaking forces for the three techniques were 48.0 N, 73.1 N and 93.3 N, respectively, and the differences were highly significant ( p < 0.0001). In a prospective clinical study, a total of 45 patients (50 fingers) with clean-cut complete lacerations of both flexor tendons in zone 2 were included. The protocol used the three ‘figure of eight’ suture techniques for (profundus only) tendon repair, ‘venting’ of the pulleys, and post-operative immediate active range of motion that ensured full active extension of the proximal interphalangeal joint. One repair (2%) ruptured. In the remaining 49 repairs, the result was considered excellent in 39 (78%) and good in 10 (20%) using the Strickland and Glogovac grading system.

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