Proximal Interphalangeal Joint Arthrodesis with Tendon Transfer of the Flexor Digitorum Brevis

Correction of claw or hammer toe deformity can be achieved using various techniques, including proximal interphalangeal joint arthrodesis (PIPJA), flexor digitorum longus tendon transfer (FDLT), and flexor digitorum brevis transfer. PIPJA is the oldest technique, but is associated with significant complications (infection, fracture, delayed union, and nonunion). FDLT eliminates the deformity, but leads to loss of stability during gait. Flexor digitorum brevis tendon transfer (FDBT) seems to be the best surgical alternative, but it is a recent technique with still limited results. In this work, these three techniques have been analyzed by means of the finite-element method and a comparative analysis was done with the aim of extracting advantages and drawbacks. The results show that the best technique for reducing dorsal displacement of the proximal phalanx is PIPJA (2.28 mm versus 2.73 mm for FDLT, and 3.31 mm for FDBT). However, the best technique for reducing stresses on phalanges is FDLT or FDBT (a reduction of approximately 35% regarding the pathologic case versus the increase of 7% for the PIPJA in tensile stresses, and a reduction of approximately 40% versus 25% for the PIPJA in compression stresses). Moreover, the distribution of stresses in the entire phalanx is different for the PIPJA case. These facts could cause problems for patients, in particular, those with pain in the surgical toe.

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TREATMENT OF CONGENITAL SWAN NECK DEFORMITY WITH DYNAMIC TENODESIS OF PROXIMAL INTERPHALANGEAL JOINT

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2000.0498 ◽

2001 ◽

Vol 26 (2) ◽

pp. 165-167 ◽

Cited By ~ 6

Author(s):

V. SMRÈKA ◽

I. DYLEVSKÝ

Keyword(s):

Tendon Transfer ◽

Tendon Graft ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Flexor Digitorum Superficialis ◽

Middle Phalanx ◽

Flexor Digitorum ◽

Swan Neck Deformity

Congenital swan neck deformities in seven fingers of two patients were treated by transfer of the flexor digitorum superficialis tendon to a tendon graft which was attached the extensor aponeurosis over the middle phalanx. The tendon transfer is protected for at least 2 months by a modified Murphy splint.

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Hammer Toe Correction by Arthrodesis of the Proximal Interphalangeal Joint Using a Cortical Bone Allograft Pin

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-92-10-563 ◽

2002 ◽

Vol 92 (10) ◽

pp. 563-569 ◽

Cited By ~ 26

Author(s):

Stephen J. Miller

Keyword(s):

Internal Fixation ◽

Cortical Bone ◽

Tendon Transfer ◽

Bone Allograft ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Flexor Digitorum Longus ◽

Hammer Toe ◽

Freeze Dried ◽

Flexor Digitorum

In hammer toe correction by means of digital fusion, fixation so that the bone can unite while maintaining appropriate realignment can be a challenge. Metal fixation pins can be associated with many problems and potential complications. The author presents a method of rigid internal fixation using 2.4-mm-diameter pins fashioned out of freeze-dried allogeneic cortical bone. These devices avoid most of the risks of metal pins. Proximal interphalangeal joint arthrodesis using cortical bone pins was performed on 26 toes in 18 patients with very few complications. The author concludes that use of cortical bone pins can yield successful results in most cases. The outcomes of the fusions can be further enhanced by using flexor digitorum longus tendon transfer. (J Am Podiatr Med Assoc 92(10): 563-569, 2002)

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Technique of Dynamic Flexor Digitorum Superficialis Transfer to Lateral Bands for Proximal Interphalangeal Joint Deformity Correction in Severe Dupuytren Disease

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2017.11.010 ◽

2018 ◽

Vol 43 (2) ◽

pp. 192.e1-192.e6 ◽

Cited By ~ 1

Author(s):

Michael J. Schreck ◽

Hayden S. Holbrook ◽

L. Andrew Koman

Keyword(s):

Deformity Correction ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Flexor Digitorum Superficialis ◽

Joint Deformity ◽

Flexor Digitorum ◽

Dupuytren Disease

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Infiltration of synovitis into the flexor tendon: a case report

Journal of International Medical Research ◽

10.1177/0300060520936180 ◽

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.

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Non—Traumatic Flexion Deformity of the Proximal Interphalangeal Joint—Its Pathogenesis and Treatment

HAND ◽

10.1016/s0072-968x(83)80032-1 ◽

1983 ◽

Vol os-15 (1) ◽

pp. 25-34 ◽

Cited By ~ 17

Author(s):

Takayuki Miura

Keyword(s):

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Middle Phalanx ◽

Flexion Deformity ◽

Splint Therapy ◽

Extensor Apparatus ◽

Long Time ◽

Dynamic Splint ◽

Flexor Digitorum ◽

Flexion And Extension

The pathogenesis of camptodactyly may be the lack of equilibrium between the flexion and extension forces. The imbalance must be a result of palmar translocation of lateral slips of the extensor apparatus due to anchoring of the middle phalanx in the flexed position by fibrous substrata, abnormal shortening of the flexor digitorum superficialis or abnormal insertion of the lumbricals. It is reasonable therefore to start dynamic splint therapy as early as possible and carry on for a long time. Long-standing malposition of the extensor lateral slips possibly introduced contracture of periarticular tissues and the transverse retinacular ligament, making treatment more difficult. For those patients resistant to dynamic splint therapy, a surgical procedure is necessary. Surgical procedures are discussed.

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Finite-element simulation of flexor digitorum longus or flexor digitorum brevis tendon transfer for the treatment of claw toe deformity

Journal of Biomechanics ◽

10.1016/j.jbiomech.2009.04.031 ◽

2009 ◽

Vol 42 (11) ◽

pp. 1697-1704 ◽

Cited By ~ 26

Author(s):

Alberto García-González ◽

Javier Bayod ◽

Juan Carlos Prados-Frutos ◽

Marta Losa-Iglesias ◽

Kevin T. Jules ◽

...

Keyword(s):

Finite Element ◽

Finite Element Simulation ◽

Tendon Transfer ◽

Flexor Digitorum Longus ◽

Claw Toe ◽

Element Simulation ◽

Flexor Digitorum Brevis ◽

Flexor Digitorum ◽

Toe Deformity

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An Unusual Role of the Vinculum after Complete Laceration of the Flexor Tendons

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_87_90070-2 ◽

1987 ◽

Vol 12 (1) ◽

pp. 105-108

Author(s):

Y. SASAKI ◽

S. NOMURA

Keyword(s):

Clinical Diagnosis ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Flexor Digitorum Superficialis ◽

Flexor Tendons ◽

Full Flexion ◽

Flexor Digitorum ◽

Flexion Strength

Two cases are described with full flexion of the proximal interphalangeal joint produced by an intact short vinculum after complete laceration of both superficialis and profundus tendons. To establish the clinical diagnosis of complete flexor digitorum superficialis division, the necessity of examining the flexion strength of an injured finger is emphasized.

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Treatment of dynamic claw toe deformity flexor digitorum brevis tendon transfer to interosseous and lumbrical muscles: A literature survey

Foot and Ankle Surgery ◽

10.1016/j.fas.2012.04.005 ◽

2012 ◽

Vol 18 (4) ◽

pp. 229-232 ◽

Cited By ~ 6

Author(s):

C. Errichiello ◽

M. Marcarelli ◽

P.C. Pisani ◽

E. Parino

Keyword(s):

Tendon Transfer ◽

Literature Survey ◽

Claw Toe ◽

Flexor Digitorum Brevis ◽

Lumbrical Muscles ◽

Flexor Digitorum ◽

Toe Deformity

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Single Longitudinal Dorsal Incision Approach to Transfer the Flexor Digitorum Longus Tendon Between the Flexor Digitorum Brevis Hemitendons

Journal of the American Podiatric Medical Association ◽

10.7547/1030430 ◽

2013 ◽

Vol 103 (5) ◽

pp. 430-437 ◽

Cited By ~ 1

Author(s):

Ricardo Becerro de Bengoa Vallejo ◽

Marta Elena Losa Iglesias ◽

Miguel Fuentes Rodriguez ◽

Fermín Viejo Tirado

Keyword(s):

Proximal Phalanx ◽

Tendon Sheath ◽

Proximal Interphalangeal Joint ◽

Flexor Digitorum Longus ◽

Longus Tendon ◽

Longitudinal Incision ◽

Novel Approach ◽

Vascular Compromise ◽

Flexor Digitorum Brevis ◽

Flexor Digitorum

Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw and hammertoe deformities. The most common technique uses two cutaneous incisions, one plantar and another dorsal. We performed a cadaveric study to determine whether the flexor digitorum longus tendon could be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect through a unique single longitudinal central dorsal incision. The rationale for this novel approach was to minimize the risk of vascular compromise to the digit associated with the two-incision approach. Transposition of the flexor digitorum longus tendon was attempted in 120 toes of cadaveric feet (60 each second and third digits) through a central longitudinal dorsal incision. The flexor digitorum longus tendon segment was long enough to be successfully transposed between the flexor digitorum brevis hemitendons of the second and third toes in 100% of the cases using the central longitudinal dorsal incision approach, with a resection arthroplasty at the proximal interphalangeal joint. Transfer of the flexor digitorum longus tendon to the dorsum of the proximal phalanx can be performed for the correction of claw and hammertoe deformities in the second and third digits. The meticulous longitudinal incision of the flexor tendon sheath to expose the flexor digitorum brevis tendon and its longitudinal incision are essential to the successful transfer of the flexor digitorum longus tendon between the flexor digitorum brevis hemitendons. (J Am Podiatr Med Assoc 103(5): 430–437, 2013)

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