Clinical outcomes after mini-hook plate fixation for small avulsion fractures around the interphalangeal or metacarpophalangeal joints of the hand

Background Mini-hook plate has been described for the treatment of various small avulsion fragments in the hand. This retrospective study aimed to evaluate clinical outcomes after mini-hook plate fixation in patients with an avulsion fracture around the interphalangeal or metacarpophalangeal joints of the hand. Methods Nineteen patients with avulsion fractures around the interphalangeal or metacarpophalangeal joints of the hand were included in this study. Seven patients had a mallet fracture, and 12 patients had other phalangeal avulsion fractures including central slip, collateral ligament, volar plate, and flexor avulsion fractures. The osseous union and functional outcomes, including finger joint motion, joint stability, pinching strength, and the disabilities of the arm, shoulder, and hand score, were evaluated. Results The mean duration of follow-up was 33.8 months. All patients in mallet and other phalangeal avulsion fractures achieved osseous union between the avulsion fragment and phalangeal bone, and there was no joint subluxation. There were no significant differences in the disabilities of the arm, shoulder, and hand scores. However, the patients with mallet fracture have lower mean percentage values of the total active range of motion and pinching strength than other phalangeal avulsion fractures. We abandoned this procedure in mallet fractures because the early results after mini-hook plate fixation in mallet fractures appeared unfavorable. Conclusion These results suggest that the mini-hook plate fixation can provide sufficient stability and good clinical outcomes in those with phalangeal avulsion fractures. However, the outcomes for mallet fractures were not as good as those for other phalangeal avulsion fractures.

Treatment of the fresh central slip avulsion of the extensor tendon by bone tunnel-tendon suture: a prospective cohort study

Background The current evidence base for the management of central slip avulsions is limited from obtaining a best approach. The purpose of this study was to evaluate the clinical effect and feasibility of repairing the fresh central slip avulsion by bone tunnel-tendon suture. Methods Twenty-four cases of open and closed central slip avulsions were prospectively studied. They were treated by suturing the tendon to the pre-holed bone through two parallel bone tunnels. Follow-up was conducted at 1 month, 3 months, 6 months, 12 months and 18 months after the operation. Symptoms, degree of satisfaction with the appearance, complications, Crawford’s evaluation, DASH scores and the total active movement (TAM) were collected. Results The follow-up period was 6~18 months (mean 13 months). Finger function was assessed using the Crawford’s evaluation criteria: excellent in 12, good in 10, average in 2, with an excellent and good rate of 91.7%. DASH scores ranged from 37 to 47(mean 39). According to the Chinese Medical Association’s trial criteria for assessing the function of upper limbs, excellent, good and average cases were 9, 14 and 1 respectively. The range of motion gradually improved over time. Conclusions Good prognosis can be achieved through bone tunnel-tendon suture for the treatment of fresh central slip avulsion.

Rotatory subluxation of the proximal interphalangeal joint: an easily missed diagnosis

We present a case of volar rotatory subluxation of index finger proximal interphalangeal joint (PIPJ) following a skiing accident. The injury was initially perceived to be a central slip rupture and treatment was directed as such. After the initial delay in the diagnosis, the patient underwent surgery during which his radial collateral ligament was found to be avulsed from the proximal origin, the radial lateral band palmarly subluxed and was interposed in the joint space. This structure was also adhered to the uninjured volar plate.PIPJ volar rotatory subluxation could be readily missed in the acute setting. Without surgery, the functional outcome could be mediocre and to the patient’s detriment.

Boutonniere Deformity: A Review of Considerations before Treatment and Current Treatment Options

Central slip injury is a common occurrence in hand trauma. When the base of the middle phalanx, which is the contact part of the central tendon, is weakened or damaged, extension lag or restriction would be found in the proximal interphalangeal (PIP) joint and the distal interphalangeal joint becomes hyperextended, presenting buttonhole or boutonniere deformation. Buttonhole deformation has limited cases that a hand surgeon can experience, and there is still no clear guideline for treatment, so treatment tends to depend on the knowledge and experience of the treating doctor. In this review, the factors to be considered in determining the treatment of boutonniere deformity are discussed, and nonsurgical or surgical treatment is considered. Treatment of the PIP joint in boutonniere deformity is a difficult task. Understanding the cause of the deformity, the time point and the stage of deformity, the relationship to the biomechanical changes in adjacent joints, the patient’s functional limitations, and the condition of the joint will improve treatment decisions and outcomes. Based on these considerations, an appropriate treatment should be chosen among nonsurgical or surgical treatments. Various surgical options were introduced but none of method guarantee the optimal outcome. Sufficient understanding of deformity and sufficient consultation and cooperation with the patient regarding the treatment process, outcome, and rehabilitation are necessary.

Salter-Harris type II fracture of the middle phalanx with concomitant central slip injury in an 11 years old: a case report

<p>An 11-year-old male sustained an irreducible, completely displaced epiphyseal fracture of the proximal interphalangeal joint (PIPJ) of the middle finger with an associated central slip injury. Central slip injuries occurring in conjunction with Salter-Harris type II middle phalanx fracture are rare entities, with no previously documented case. Our patient underwent open reduction, internal fixation through crossed-pins to achieve reduction and fixation. He was then splinted in extension for six weeks to allow healing of the central slip injury. At 1-year follow-up, the patient had full range-of-motion with no clinical indication of physeal disruption or growth arrest of the repaired digit. We demonstrate a case in which ephiphyseal fractures of the proximal interphalangeal joint with a concomitant central slip injury can safely be treated with open reduction internal fixation combined with a period of immobilization. We characterize a surgical method of reduction and fixation with splinted immobilization and describe lessons learned from this previously unreported case.</p>

Vascularized tendon graft to the central slip using a finger fillet flap

Burn boutonniere deformity (BBD) treatment remains a challenge in reconstructive surgery. Severe hand defects after burn/trauma may be reconstructed with nonsalvageable or amputated tissue. The fillet flap (FF) is generally used as “spare parts” in the trauma algorithm for mangled extremities. This case study examines the use of a FF with concurrent repair of the adjacent finger extensor tendon with the amputated finger flexor tendon after burn injury. The goal is to provide adequate tissue coverage using a finger FF while concurrently reconstructing the central slip of the extensor tendon with the transposed flexor tendon from an adjacent nonfunctional digit. After reconstruction, no subluxation of the extensor tendon occurred with manipulation. Despite prolonged rehabilitation due to injuries, the surgical site healed appropriately. Single-stage FF reconstruction with vascularized tendon grafts should be considered in selected patients with BBD. This novel idea can be applied to the management of traumatized extremities.