Volar A1 pulley sparing technique for fixation of avulsion fractures of the base of the proximal phalanx

2013 ◽  
Vol 48 (1) ◽  
pp. 56-58 ◽  
Author(s):  
Yasunori Kaneshiro ◽  
Noriaki Hidaka
Keyword(s):  
Proximal Phalanx ◽  
Avulsion Fractures ◽  
A1 Pulley

Volar A1 pulley approach for fixation of avulsion fractures of the base of the proximal phalanx

2001 ◽  
Vol 26 (4) ◽  
pp. 762-771 ◽  
Author(s):  
Kevin M. Kuhn ◽  
Khiem D. Dao ◽  
Alexander Y. Shin
Keyword(s):  
Proximal Phalanx ◽  
Avulsion Fractures ◽  
A1 Pulley

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.

Outcome of avulsion fractures of the ulnar base of the proximal phalanx of the thumb treated nonsurgically

1999 ◽  
Vol 24 (2) ◽  
pp. 275-282 ◽  
Author(s):  
Julian E. Kuz ◽  
Jeffrey B. Husband ◽  
Nancy Tokar ◽  
Scott A. McPherson
Keyword(s):  
Proximal Phalanx ◽  
Avulsion Fractures

scholarly journals Pediatric Trigger Finger due to Osteochondroma

Hand ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 99-105 ◽  
Author(s):  
Ricardo Kaempf de Oliveira ◽  
Pedro J. Delgado ◽  
João Guilherme Brochado Geist
Keyword(s):  
Proximal Phalanx ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Trigger Finger ◽  
Initial Visit ◽  
Initial Portion ◽  
A2 Pulley ◽  
Finger Motion ◽  
Bone Tumor Resection ◽  
A1 Pulley

Background: The trigger finger is characterized by the painful blocking of finger flexor tendons of the hand, while crossing the A1 pulley. It is a rare disease in children and, when present, is usually located in the thumb, and does not have any defined cause. Methods: We report 2 pediatric trigger finger cases affecting the long digits of the hand that were caused by an osteochondroma located at the proximal phalanx. Both children held the diagnosis of juvenile multiple osteochondromatosis. They had presented at the initial visit with a painful finger blocking. Surgical approach was decided with wide regional exposure, as compared with the trigger finger traditional surgical techniques, with the opening of the A1 pulley and the initial portion of the A2 pulley, along with bone tumor resection. Results: Patients evolved uneventfully, and recovered the affected finger motion. Conclusion: It is important to highlight that pediatric trigger finger is a distinct ailment from the adult trigger finger, and also in children is important to differentiate whenever the disease either affects the thumb or the long fingers. A secondary cause shall be sought whenever the long fingers are affected by a trigger finger.

The non-operative management of hand fractures

2014 ◽  
Vol 40 (1) ◽  
pp. 33-41 ◽  
Author(s):  
G. E. B. Giddins
Keyword(s):  
Operative Treatment ◽  
Current Knowledge ◽  
Proximal Phalanx ◽  
Operative Management ◽  
Metacarpophalangeal Joint ◽  
Level Of Evidence ◽  
Avulsion Fractures ◽  
Articular Fractures ◽  
Joint Fracture ◽  
Hand Fractures

Most hand fractures can be treated non-operatively. Some hand fractures, such as open injuries or markedly displaced intra-articular fractures, are almost always treated operatively. The treatment of many fractures, such as proximal interphalangeal joint fracture subluxations or spiral phalangeal fractures, is unclear. The aim of this review is to establish those injuries where the outcome of non-operative treatment is unlikely to be improved with surgery. This may help to prevent unnecessary surgery, concentrate work on finding the sub-groups that may benefit from surgery and to establish which injuries do so well with non-operative treatment that the only valuable clinical research in future will be large cohort studies of non-operative treatment or randomized controlled trials comparing operative and non-operative treatments. The relevant fractures are spiral metacarpal fractures, transverse metacarpal shaft and neck (boxer’s) fractures, base of proximal phalanx avulsion fractures, thumb metacarpophalangeal joint ulnar and radial collateral ligament injuries and bony mallet injuries. For the majority of these injuries, current knowledge suggests that the outcome of non-operative treatment cannot reliably be improved upon with surgery. Level of evidence IV

Dorsal and Volar Surgical Approaches to the Metacarpophalangeal Joint: A Comparative Anatomic Study

2017 ◽  
Vol 22 (03) ◽  
pp. 297-302
Author(s):  
Eitan Melamed ◽  
Nicholas Calotta ◽  
Ricardo Bello ◽  
Richard M Hinds ◽  
John T Capo ◽  
...  
Keyword(s):  
Surface Area ◽  
Articular Surface ◽  
Insertion Site ◽  
Proximal Phalanx ◽  
Extensor Tendon ◽  
Joint Surface ◽  
Surgical Approaches ◽  
Collateral Ligament ◽  
Volar Approach ◽  
A1 Pulley

Background: We compared 3 surgical approaches to the MP joint: a dorsal extensor tendon–splitting approach, a dorsal extensor tendon–reflecting parasagittal approach, and the volar A1 pulley approach. We quantitatively compared each of these approaches by measuring the amount of articular cartilage exposed on the base of the proximal phalanx. We hypothesize that visualization of the articular cartilage of the proximal phalangeal base is enhanced with the volar approach. Methods: The MP joints of the 32 available digits were randomly assigned to 1 of 3 surgical approaches: extensor tendon splitting (A), extensor tendon reflecting (B), or volar approach (C). After each approach, the visible articular surface of the base of the proximal phalanx was stained with methylene blue. The MP joints were then disarticulated, and the proximal phalanges were digitally mapped using a 3-dimensional digitizer. Three-dimensional computer software was used to analyze and calculate the dyed exposed surface area and total surface area of each specimen. Results: The mean % exposed joint surface area for the dorsal extensor splitting, dorsal extensor reflecting and volar approaches were 62%, 67% (over the dorsal side of the proximal phalanx) and 54% (over the volar side of the proximal phalanx), respectively. Multiple linear regression showed statistical significance for a smaller percentage of articular surface area exposed with the volar approach. However, this was not clinically significant. A significant association was found between location in the small finger and greater % exposed joint surface, compared to approaches in the index finger. In all volar approach specimens, the collateral insertion site was visible, but not in the dorsal approach specimens. Conclusions: Knowledge of the limits of each exposure is essential for planning the most appropriate surgical approach. The A1 pulley approach provided greater access to the volar 50% of the joint and collateral ligament insertion without violating the extensor mechanism. The amount of joint surface visualized through all 3 approaches was not significantly different. However, based on the accessibility to the collateral ligament insertion site among three different approaches, we recommend the volar A1 pulley approach for treatment of avulsion fractures of the base of the proximal phalanx. For other injuries of the MP joint, including the intra-articular proximal phalanx base fractures, and metacarpal head fractures, the dorsal approaches are still indicated.

scholarly journals Trigger finger due to phalangeal osteochondroma of an adult: A case report

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902096999
Author(s):  
Hoi Young Kwon ◽  
Hong Je Kang
Keyword(s):  
Pediatric Patients ◽  
Proximal Phalanx ◽  
Middle Finger ◽  
Trigger Finger ◽  
X Rays ◽  
Solitary Osteochondroma ◽  
Stenosing Tenosynovitis ◽  
Left Middle ◽  
A1 Pulley ◽  
Rule Out

Trigger finger is stenosing tenosynovitis that occurs in A1 pulley. It usually occurs idiopathically in patients’ 40s and 50s. On the other hand, pediatric trigger finger usually occurs before 8 years old in pediatric patients. Even though being rare, a tumor occurred in the soft tissue or bone near flexor tendons can cause a trigger finger. Trigger finger due to osteochondroma is very rare. Furthermore, most cases of trigger finger due to osteochondroma occur in pediatric patients with hereditary multiple osteochondromatosis (HMO). The authors report this case of a trigger finger caused by a solitary osteochondroma that occurred in the proximal portion of the proximal phalanx of the left middle finger, of a 21-year-old patient. The symptoms were relieved after excision of the osteochondroma. If a patient with unusual demographics visits, the cause of trigger finger may not be idiopathic. Evaluation methods such as x-rays and ultrasonography can be helpful to rule out other causes, such as tumors.

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