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.

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 Kirschner Wire Fixation for Immobilization of the Thenar Flap in an Uncooperative Pediatric Patient: A Case Report

2020 ◽  
Vol 25 (4) ◽  
pp. 287-291
Author(s):  
Hyokyung Yoo ◽  
Yunghoon Kim ◽  
Sung Tack Kwon ◽  
Byung Jun Kim
Keyword(s):  
Pediatric Patients ◽  
Kirschner Wire ◽  
Proximal Phalanx ◽  
Ring Finger ◽  
Soft Tissue Reconstruction ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Tissue Reconstruction ◽  
Two Stages ◽  
Fingertip Reconstruction

Thenar flap is a commonly used operational method in fingertip reconstruction. It should be maintained for two to three weeks before flap division until the neovascularization is established from the fingertip to the flap. However, immobilization between two stages of operation is challenging especially in uncooperative pediatric patients. A 47-month-old female with a ring fingertip amputation underwent soft tissue reconstruction with thenar flap. Two days postoperatively, the flap’s proximal margin was found disrupted. Flap revision was performed, followed by applying a trans-phalangeal Kirschner wire (K-wire) between the thumb proximal phalanx and ring finger middle phalanx. The flap was successfully divided two weeks after the original operation. The result was aesthetically pleasing, and no complication was observed, including dehiscence, necrosis, limitation of range of motion, and visible scar of the pinning sites. In conclusion, K-wire fixation is a safe and effective method to immobilize thenar flap in uncooperative pediatric patients.

Range of Motion Following Extensor Tendon Splitting vs. Tendon Sparing Approaches for Plate Osteosynthesis of Proximal Phalangeal Fractures – A Systematic Review and Meta-Analysis

2020 ◽  
Vol 25 (04) ◽  
pp. 462-468
Author(s):  
Brahman S. Sivakumar ◽  
Vincent VG. An ◽  
Kevin Phan ◽  
David J. Graham ◽  
James Ledgard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Proximal Phalanx ◽  
Extensor Tendon ◽  
Preliminary Evidence ◽  
Active Motion ◽  
Total Active Motion ◽  
Randomised Controlled

Background: Several approaches to plate fixation of the proximal phalanx have been proposed, such as the dorsal extensor splitting approach and the lateral or dorso-lateral extensor sparing approach, which aims to minimise invasiveness to promote native extensor tendon glide. This study aimed to meta-analyse the outcomes of these two approaches. Methods: A systematic review of electronic databases was undertaken, and the outcomes of comparative studies meta-analysed. Results: Three studies were included for meta-analysis. Total active motion (TAM) was significantly greater in the extensor sparing group compared to the extensor splitting (Mean difference 8.52 degrees, 95%CI 0.8–16.36, p = 0.03). Conclusions: This study demonstrates that there is preliminary evidence favouring the use of extensor sparing approaches when fixing proximal phalanxes – however, this result requires validation with randomised controlled trials.

Open Reduction and Cerclage Wire Fixation for Long Oblique/Spiral Fractures of the Proximal Phalanx of the Fingers

2008 ◽  
Vol 33 (2) ◽  
pp. 170-173 ◽  
Author(s):  
M. M. AL-QATTAN ◽  
K. AL-ZAHRANI
Keyword(s):  
Open Reduction ◽  
Full Range ◽  
Proximal Phalanx ◽  
Pain Syndrome ◽  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Active Motion ◽  
Cerclage Wire ◽  
Wire Fixation ◽  
Total Active Motion

Fifteen cases of long oblique/spiral fractures of the shaft of the proximal phalanx of the fingers treated by open reduction, cerclage wire fixation and immediate postoperative mobilisation were studied prospectively. Twelve patients presented early (within 24 hour of injury) and the remaining three cases were treated initially elsewhere by closed reduction and percutaneous oblique K-wire fixation with failure of the fixation. The latter three patients presented to our clinic late (10–14 days after injury). Following internal fixation with cerclage wires, no cases of infection, complex regional pain syndrome (CRPS) Type 1, fracture re-displacement, wire migration or extrusion were noted. One patient complained of a palpable wire which was removed 4 months after surgery. All fractures united and all patients returned to work at a mean of 8 (range 7–11) weeks after surgery. Twelve patients obtained a full range of motion (total active motion–TAM = 260°) and the remaining three patients had a mild (5–15°) flexion contracture of the proximal interphalangeal joint. Cerclage wire fixation is an acceptable technique of fixation for these fractures.

scholarly journals Plantar Plate Reconstruction for Stage IV Plantar Plate Tear Using Flexor Tendon Tenodesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0039 ◽  
Author(s):  
Megan Reilly ◽  
Kurosh Darvish ◽  
Soroush Assari ◽  
John Cole ◽  
Eric Gokcen
Keyword(s):  
Flexor Tendon ◽  
Force Measurement ◽  
Proximal Phalanx ◽  
Measurement Instrument ◽  
Stage Iv ◽  
Extensor Tendon ◽  
Plantar Plate ◽  
Alternative Treatment Option ◽  
Stage 4 ◽  
Plate Reconstruction

Category: Lesser Toes Introduction/Purpose: Outcomes of the surgical treatment of dislocated lesser toes have improved significantly over the past few years due to the development of techniques to repair plantar plate tears through a dorsal incision. However, treatment of stage 4 tears with no reparable plantar plate can be challenging. The current treatment involves flexor to extensor tendon transfer, requiring multiple incisions and surgical time. An alternative approach is presented, using the same modern techniques of plantar plate repair, but reconstructing the plantar plate using a flexor tendon tenodesis to the plantar base of the proximal phalanx. Methods: Four fresh frozen cadaver foot and ankle specimens were used to determine the stability of this new technique. A simulated Lachman’s test was performed on the 2nd, 3 rd, and 4th metatarsophalangeal joints utilizing a force measurement instrument with displacement control on specimens with an intact plantar plate, an excised plantar plate, and following a flexor tenodesis reconstruction. Results: The intact plantar plate force was 9.0+2.6kN for 2 mm displacement, and following excision of the plantar plate, the force reduced to 1.3+0.4kN. The flexor tenodesis reconstruction improved the force to 6.0+1.9kN. Conclusion: Plantar plate reconstruction with a flexor tenodesis to the proximal phalanx resulted in stability equal to 53% of the intact plantar plate, for the shear displacements between 2 to 6 mm. This procedure may be an alternative treatment option in patients with Stage 4 irreparable plantar plate tears.

Tendon Interposition In A Juxta-Epiphyseal Fracture Of The Proximal Phalanx

1998 ◽  
Vol 23 (4) ◽  
pp. 558-559 ◽  
Author(s):  
E. L. FREEDMAN ◽  
R. A. VANDER GRIEND ◽  
P. C. DELL
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Proximal Phalanx ◽  
Extensor Tendon ◽  
Epiphyseal Fracture ◽  
Epiphyseal Fractures ◽  
Tendon Interposition ◽  
Type Of Fracture

Juxta-epiphyseal fractures of the proximal phalanx are relatively common. A case report and literature review calls attention to the possibility of entrapment of either a flexor or extensor tendon in this type of fracture.

One-Step Surgical Correction of Transverse and Anteroposterior Maxillary Deficiencies Using Wire Fixation. A New Approach and Long-Term Stability

2017 ◽  
Vol 75 (7) ◽  
pp. 1498-1513
Author(s):  
Max Domingues Pereira ◽  
Vivian Farfel ◽  
Gabriela Pereira Ribeiro Prado ◽  
Lydia Masako Ferreira
Keyword(s):  
Surgical Correction ◽  
New Approach ◽  
Term Stability ◽  
Long Term Stability ◽  
Wire Fixation ◽  
One Step

Juxta-Epiphyseal Fractures of the Base of the Proximal Phalanx of the Fingers in Children and Adolescents

2002 ◽  
Vol 27 (1) ◽  
pp. 24-30 ◽  
Author(s):  
M. M. AL-QATTAN
Keyword(s):  
Children And Adolescents ◽  
Closed Reduction ◽  
Kirschner Wire ◽  
Proximal Phalanx ◽  
Fracture Site ◽  
Pattern Of Injury ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Epiphyseal Fractures

A series of 34 juxta-epiphyseal fractures of the base of the proximal phalanx of the fingers of children and adolescents are presented. The pattern of injury appeared identical in all these fractures, with a lateral angulation force separating a small triangular metaphyseal fragment from the base of the phalanx on the side of angulation and the fracture line then continuing through the metaphysis, 1–2mm distal to the growth plate. Fractures were classified into two types according to the degree of displacement. Type 1 fractures ( n=18) were mildly displaced and were all successfully treated with closed reduction and splinting. Type 2 fractures ( n=16) were severely displaced and problems with obtaining an adequate reduction and long-term residual deformities were encountered. One patient with a severely displaced fracture required open reduction and Kirschner-wire fixation because of flexor tendon entrapment at the fracture site. Another five cases required Kirschner-wire fixation after closed manipulation in order to maintain the reduction. The remaining 10 patients with Type 2 fractures were treated by closed reduction and splinting, and two patients healed with malunion causing a “pseudo-claw” deformity.

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