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.

Trans-metacarpal Screw Fixation for Extra-articular Proximal Phalangeal Base Fractures

2017 ◽  
Vol 22 (01) ◽  
pp. 35-38 ◽  
Author(s):  
Eichi Itadera ◽  
Takahiro Yamazaki
Keyword(s):  
Screw Fixation ◽  
Proximal Phalanx ◽  
Metacarpophalangeal Joint ◽  
Fixation Method ◽  
Compression Screw ◽  
Metacarpal Head ◽  
Headless Compression Screw ◽  
Articular Fractures ◽  
Intramedullary Canal ◽  
Cannulated Drill

We developed a new internal fixation method for extra-articular fractures at the base of the proximal phalanx using a headless compression screw to achieve rigid fracture fixation through a relatively easy technique. With the metacarpophalangeal joint of the involved finger flexed, a smooth guide-pin is inserted into the intramedullary canal of the proximal phalanx through the metacarpal head and metacarpophalangeal joint. Insertion tunnels are made over the guide-pin using a cannulated drill. Then, a headless cannulated screw is placed into the proximal phalanx. All of five fractures treated by this procedure obtained satisfactory results.

scholarly journals Extension Mechanism of the Proximal Interphalangeal Joint of the Human Phalanx: A Cadaveric Biomechanical Study

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Junho Park ◽  
Chang-Hun Lee ◽  
Youngjin Choi ◽  
Il-Han Joo ◽  
Kwang-Hyun Lee ◽  
...  
Keyword(s):  
Joint Angle ◽  
Proximal Interphalangeal Joint ◽  
Biomechanical Study ◽  
Regression Analyses ◽  
Absolute Value ◽  
Extension Mechanism ◽  
Fresh Cadaver ◽  
Pip Joint ◽  
Joint Flexion ◽  
The Mean

Our purpose was to compare the contributions of these two systems to assess PIP joint extension in fresh cadaver models. Nine middle fingers of fresh cadavers were used. The PIP joint angle was measured while an extension load was applied on the extensor tendons. Specimens on which extension load was applied on the extrinsic extensors were classified as the extrinsic group, and those on which extension load was applied on the intrinsic extensors were classified as the intrinsic group. Linear regression analyses were performed to obtain regression equation and the extension load-PIP joint angle curve. The mean of slope of the curve was compared between the two groups using paired t-test. The same experiments were done for the metacarpophalangeal (MP) joint in 0° and 60° flexion to evaluate the effect of MP joint flexion on PIP joint extension. The mean slope of the extension load-PIP joint angle curve of the extrinsic group was significantly greater than that of the intrinsic group. With the MP joint in 0° flexion, the mean slope of the extrinsic and intrinsic groups was -0.148 and -0.117, respectively (greater absolute value means greater slope, p=0.01). With the MP joint in 60° flexion, the mean slopes were -0.147 and -0.104, respectively (p=0.015). The contribution of the intrinsic extensor for PIP joint extension shows decreasing trends with MP joint flexion. The extrinsic extensors have greater contribution for PIP joint extension compared with the intrinsic extensors.

Anterior Tenoarthrolysis for Severe Flexion Contracture of the Fingers (The “Tata” Operation): A Review of 50 Cases

2007 ◽  
Vol 32 (2) ◽  
pp. 224-229 ◽  
Author(s):  
P. LOREA ◽  
J. MEDINA HENRIQUEZ ◽  
R. NAVARRO ◽  
P. LEGAILLARD ◽  
G. FOUCHER
Keyword(s):  
Flexion Contracture ◽  
Salvage Procedure ◽  
Extension Deficit ◽  
Salvage Operation ◽  
Active Range Of Motion ◽  
Pip Joint ◽  
Distal Interphalangeal ◽  
Joint Flexion ◽  
The Mean

The “hook finger”, with both proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint flexion contractures, often after multiple previous operations, is difficult to treat. This paper reports the results of 50 fingers in 49 patients in which the TATA (Téno-Arthrolyse Totale Antérieure) salvage procedure, described by Saffar in 1978, was carried out. Thirty-seven of 50 (74%) of these fingers had had at least one previous operation, most on the flexor apparatus. The mean PIP and DIP extension deficit pre-operatively was 133° with a mean PIP lag of extension of 83°. With a mean follow-up of 7.8 years, 45 fingers were improved, five were not and none was worsened. The mean PIP and DIP extension deficit postoperatively was 47°, with a mean PIP lack of extension of 31°. The overall gain in extension deficit of both joints was 86° and of the PIP was 52°. One PIP joint developed septic arthritis immediately after surgery. The benefit of this salvage operation is mainly in the change of the active range of motion to a more functional arc.

Arthroplasty of the Proximal Interphalangeal Joint Using Costal Cartilage Grafts

1992 ◽  
Vol 17 (5) ◽  
pp. 583-585 ◽  
Author(s):  
T. HASEGAWA ◽  
Y. YAMANO
Keyword(s):  
Costal Cartilage ◽  
Proximal Phalanx ◽  
Functional Results ◽  
Clinical Results ◽  
Proximal Interphalangeal Joint ◽  
Range Of Movement ◽  
Cartilage Grafts ◽  
Articular Fractures ◽  
Pip Joint ◽  
Bony Ankylosis

Seven intra-articular fractures in five patients with partial bone loss at the PIP joint were reconstructed using a graft of costal cartilage. In all cases there were total or partial cartilagenous defects of the proximal phalangeal side of the joint. Early treatment of two joints, using only costal cartilage grafts, resulted in bony ankylosis due to necrosis of the grafted cartilage. In five joints the grafted cartilage included osseous portions using the costo-osteochondral junction, leading to an average range of movement of 64° with satisfactory clinical results. The technique is a useful alternative to other forms of arthroplasty or arthrodesis, and can provide satisfactory functional results when there is a partial defect of the head of the proximal phalanx.

The anatomy and function of Cleland’s ligaments

2013 ◽  
Vol 39 (5) ◽  
pp. 482-490 ◽  
Author(s):  
R. L. Zwanenburg ◽  
P. M. N. Werker ◽  
D. A. McGrouther
Keyword(s):  
Proximal Phalanx ◽  
Extensor Tendon ◽  
Tendon Sheath ◽  
Lateral Side ◽  
Middle Phalanx ◽  
John Cleland ◽  
Pip Joint ◽  
Fresh Frozen ◽  
The Individual ◽  
And Function

The cutaneous ligaments of the digits have been recognized by anatomists for several centuries, but the best known description is that of John Cleland. Subsequent varying descriptions of their morphology have resulted in the surgical community having an imprecise view of their structure and dynamic function. We micro-dissected 24 fresh frozen fingers to analyze the individual components of Cleland’s ligamentous system. Arising from the proximal interphalangeal (PIP) joint, proximal, and sometimes middle phalanx, we found strong ligaments that ran proximally (PIP-P) and distally (PIP-D). On each side of each finger there was a PIP-P ligament present, which passed obliquely from the lateral side of the proximal and sometimes middle phalanx towards its insertion into the skin at the level of the proximal phalanx. The distal (PIP-D) ligaments were found to pass obliquely distally on the radial and ulnar aspects of the digit towards cutaneous insertions around the middle phalanx. A similar arrangement exists more distally with fibres originating from the DIP joint and middle phalanx (the DIP-P pass obliquely proximally, and the DIP-D, distally). Each individual PIP ligament consisted of three different layers originating from fibres overlying the flexor tendon sheath, periosteum or joint capsule, and extensor expansion. Ligaments arising at the DIP joint had two layers equivalent to the anterior two layers of the proximal ligaments. Cleland’s ligaments act as skin anchors maintaining the skin in a fixed relationship to the underlying skeleton during motion and functional tasks. They also prevent the skin from ‘bagging’, protect the neurovascular bundle, and create a gliding path for the lateral slips of the extensor tendon.

Displaced unstable transverse fractures of the shaft of the proximal phalanx of the fingers in industrial workers: reduction and K-wire fixation leaving the metacarpophalangeal and proximal interphalangeal joints free

2011 ◽  
Vol 36 (7) ◽  
pp. 577-583 ◽  
Author(s):  
Mohammad M. Al-Qattan
Keyword(s):  
Proximal Phalanx ◽  
Metacarpophalangeal Joint ◽  
Industrial Workers ◽  
Active Motion ◽  
Wire Fixation ◽  
Total Active Motion ◽  
K Wires ◽  
Pin Tract Infection ◽  
Transverse Fractures

A series of 35 adult male industrial workers with displaced unstable transverse fractures of the shaft of the proximal phalanx of the fingers were treated with reduction and K-wire fixation leaving the metacarpophalangeal and interphalangeal joints free to move immediately after surgery. At final follow-up, the total active motion score of the injured finger was graded as excellent, good, fair, or poor if it was greater than 240°, 220–240°, 180–219°, or less than 180°, respectively. Complications were also documented. The results were compared with our previously published series of these fractures treated with two other techniques: percutaneous K-wires immobilizing the metacarpophalangeal joint and open reduction and interosseous loop wire fixation. The final TAM scores in the current study were excellent in 43%, good in 29%, fair in 14% and poor in 14%. Four out of the 35 patients (11%) had minor pin tract infection. These results were significantly better than the results following percutaneous K-wire fixation immobilizing the metacarpophalangeal joint indicating that immediate mobilization of all joints has a significant effect on the outcome.

scholarly journals Radiographic Assessment of Diaphyseal Proximal Phalangeal Shortening Osteotomy for Correction of Hammertoe Deformity

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0015
Author(s):  
Gonzalo Bastias ◽  
Katherine Sage ◽  
Lew Schon
Keyword(s):  
Proximal Phalanx ◽  
Osteotomy Site ◽  
X Rays ◽  
Corrective Effect ◽  
Radiographic Measurements ◽  
Shortening Osteotomy ◽  
Significant Correction ◽  
Pip Joint ◽  
The Mean

Category: Lesser Toes Introduction/Purpose: Hammertoe deformities are a result of imbalance between static and dynamic stabilizers of the lesser toes. Flexor-to-extensor tendon transfer and PIP joint arthrodesis/arthroplasty are the gold standards of treatment. Tendon transfers are associated with stiffness, edema and recurrence. PIP arthrodesis/arthroplasty sacrifices the PIP joint producing loss of both motion and toe grip. Phalangeal sustraction osteotomies have been proposed for correcting these deformities by theoretically relaxing the surrounding soft tissue structures and correcting the hammertoe deformity at the PIP joint. We present the results of a new joint sparing procedure consisting on a Diaphyseal Proximal Phalangeal Shortening Osteotomy (DPPSO) with resection of a 3-4 mm cilindrical bone section. Methods: Retrospective study. Review of medical records of patients who underwent phalangeal shortening osteotomy for hammer toe correction from 2010 to 2016 by the senior author (L.S.). Patients with previous surgery on the toe were excluded of the study as well as patients with incomplete radiological follow-up. Demographic and comorbidities data were noted as well as postoperative complications and secondary procedures. We performed a radiographic analysis of preoperative and postoperative x-rays-Union was defined as the existence of brigding of at least 3 cortices on the osteotomy site. Preoperatively and 6 months follow up x-rays were additionally analyzed to obtain the following measurements (Figure 1): Frontal anatomic angle (medial) FAAm Lateral anatomic angle (plantar) LAAp Frontal proximal interphalangeal angle (medial) mFPIA Lateral interphalangeal angle (plantar) pLIPP Statistical analysis: t-test for paired samples to compare preoperative and postoperative angles. Results: Forty-five toes (31 patients) were included in the study. The mean age of the patients was 59,5 years and the mean follow-up was 27.9 months (range:12-52). Concomitant procedures were performed on 29 patients, most commonly Hallux Valgus correction. All patients evolved with radiographic union at an average 11,2 weeks. Two patients presented with delayed healing (15 and 19 weeks). Complications were present on 4 toes corresponding to Superficial infection (3 patients) and a symptomatic floating toe (1 patient). There were not recurrences in this group. Radiographic measurements showed no significant differences between the preoperative and postoperative mFFA (p:0,43), pLAA (p:0,239) and mFIA (p:0,239). In the other hand, the Plantar lateral interphalangeal angle (pLIA) that corresponds with the hammertoe deformity, was significantly corrected (p<0,05). Conclusion: DPPSO is a safe and reproducible procedure with a low rate of complications. This procedure has a corrective effect on the PIP joint on the sagittal plane, reducing significantly the plantar lateral interphalangeal angle and consequently the hammertoe deformity. There was no significant effect on the PIP joint on the coronal plane and neither on the anatomical axis of the proximal phalanx in the frontal and lateral planes, therefore not producing secondary deformities of the toe.The location of the osteotomy improves bone contact and anatomical alignment of the toe while obtaining a significant correction power of the deformity.

scholarly journals Intra-Articular Fracture of the Base of the First Metacarpal Bone: Treatment Through a Volar Approach

Hand ◽  
2017 ◽  
Vol 13 (1) ◽  
pp. 90-94 ◽  
Author(s):  
Violeta Levy ◽  
Marcelo Mazzola ◽  
Martín Gonzalez
Keyword(s):  
Grip Strength ◽  
Articular Surface ◽  
Visual Analog Scale Score ◽  
Metacarpophalangeal Joint ◽  
Metacarpal Bone ◽  
Volar Approach ◽  
Secondary Displacement ◽  
The Mean ◽  
K Wires

Background: Management of Bennett fractures has been controversial. Early reports supported closed reduction and casting with or without percutaneous pinning. Later, open reduction and internal fixation was advocated. The purpose of this article is to assess the surgical treatment using a direct volar approach. Methods: Between March 2008 and December 2014, 21 patients with intra-articular first metacarpal fractures displaced more than 1 mm were operated on using a direct volar approach. Fixation was done with micro-screws or K-wires, always placed from ulnar to radial during thumb supination. The articular step-off, secondary displacement incidence and consolidation rate time were measured. At final follow-up, we assessed the thumbs for range of motion, residual pain, and grip strength. Sensitive areas around the scar were evaluated. Mean follow-up was 8 months. Results: Anatomical reduction was achieved in all cases. One secondary displacement was registered. The mean distance between the tip of the thumb and the fifth metacarpophalangeal joint was less than 10 mm; reposition was complete. Mean palmar abduction was 63°. Grip strength averaged 84.6% of the opposite side. The mean visual analog scale score was 0. No sensory disturbances around the scar were recorded. Conclusions: The complete visualization of the first metacarpal articular surface is hard to accomplish from the dorsoradial aspect of the hand. The volar approach offers an excellent fracture exposure. It is possible to place the osteosynthesis in ulna-radial fashion from the smaller fragment achieving correct reduction and stabilization. In spite of the proximity to the radial and median nerve branches, we found no complications.

scholarly journals Ligamentoplasty with interposition of the proximal interphalangeal joint in the treatment of unicondylar osteochondral defects: a cadaveric feasibility study

2021 ◽  
Vol 48 (6) ◽  
pp. 635-640
Author(s):  
Jean-Charles Hery ◽  
Baptiste Picart ◽  
Mélanie Malherbe ◽  
Christophe Hulet ◽  
Aude Lombard
Keyword(s):  
Feasibility Study ◽  
Proximal Phalanx ◽  
Clinical Results ◽  
Proximal Interphalangeal Joint ◽  
Osteochondral Defects ◽  
Joint Stability ◽  
Significant Difference ◽  
Pip Joint ◽  
The Mean ◽  
A New Technique

Background Injuries to the proximal interphalangeal (PIP) joint are common and complex. However, the treatment of osteochondral defects of the head of the proximal phalanx has rarely been described. Herein, we propose a new technique for the management of unicondylar defects of the proximal phalanx that can restore joint amplitudes and provide PIP stability.Methods In this cadaveric feasibility study, unicondylar defects were generated using striking wedges and chisels. First, a transverse tunnel measuring 2 mm in diameter passing through the head of the proximal phalanx was made. A second tunnel at the base of the middle phalanx with the same diameter was then created. The hemitendon of the flexor carpi radialis graft was passed through each of these tunnels. The proximal end of the graft was interposed in the area with a loss of bone substance. The ligamentoplasty was then tensed and fixed by two anchors on the proximal phalanx. Joint amplitudes and frontal stability were measured preoperatively and postoperatively.Results There was no significant change in the joint’s range of motion: preoperatively, the mean mobility arcs were –2° to 113.80°, and they were –2° to 110° after the procedure (P=0.999). There was no significant difference in joint stability (P>0.05).Conclusions Ligamentoplasty with PIP interposition appears to be a possible solution for the management of unicondylar defects of the proximal phalanx. An evaluation of clinical results is planned in order to definitively confirm the validity of this procedure.

Clinical Outcomes of Ready-Made J-Shaped Nail Fixation for Unstable Metacarpal Fractures

2020 ◽  
Vol 25 (03) ◽  
pp. 276-280
Author(s):  
Eichi Itadera ◽  
Seiji Okamoto
Keyword(s):  
Range Of Motion ◽  
Clinical Outcomes ◽  
Insertion Site ◽  
Metacarpophalangeal Joint ◽  
Angular Deformity ◽  
Correction Loss ◽  
Metacarpal Fractures ◽  
Radiographic Outcomes ◽  
The Mean

Background: The purpose of this study was to report the clinical outcomes of ready-made J-shaped intramedullary nail fixation for unstable metacarpal fractures. Methods: A total of 25 unstable fractures from 24 patients were evaluated in this retrospective study, comprising 20 metacarpal neck and 5 metacarpal shaft fractures. The mean follow-up was 22 weeks. Functional outcomes were assessed based on the range of motion of the metacarpophalangeal joint. Radiographic outcomes were evaluated by four projections of the postoperative plain radiographs at the final follow-up, and then were rated as excellent if projections at the fracture site showed no correction loss or angular deformity greater than 10°. Surgery time and complications during the treatments were recorded for each case. Results: All 25 fractures obtained bony union. The mean range of motion of the metacarpophalangeal joint was 78° (range, 45°–90°). Radiographic outcomes were excellent in 24 (96%) of 25 fractures. Only one fracture had correction loss. The mean surgery time was 29 minutes (range, 14–61 minutes). Two cases had extensor tendon adhesion at the insertion site, which was easily released when the implant was removed. Conclusions: This study demonstrates that intramedullary fixation with a ready-made J-shaped nail is a reliable treatment option for unstable metacarpal fractures.

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