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Caviglia D, Ciolli G, Fulchignoni C, Rocchi L. Chronic post-traumatic volar plate avulsions of the finger proximal interphalangeal joint: A literature review of different surgical techniques. Orthop Rev (Pavia) 2021; 13:9058. [PMID: 33953889 PMCID: PMC8077280 DOI: 10.4081/or.2021.9058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/15/2021] [Indexed: 11/26/2022] Open
Abstract
Avulsions of the volar plate of the finger proximal interphalangeal joint (PIPJ) following sprains are often undiagnosed in the acute setting. Therefore, the chronic outcomes of this injury are most frequently the object of study and treatment. Different techniques for volar plate chronic avulsion repair are described in the literature. The most used among these are mainly two: the direct suturing with or without the use of bone anchors and the tenodesis techniques with flexor digitalis superficialis (FDS). The aim of this systematic review is to determine outcomes and complications associated with these surgical treatments of post-traumatic volar plate avulsions without phalangeal fractures. An electronic literature research was carried out and pertinent articles were selected. Surgical techniques details, outcomes and complications for direct sutures and tenodesis technique are discussed. Outcomes (Range of motion and pain) seem to be comparable, whereas authors that use the direct suture technique describe more frequently PIPJ flexion contracture complication. From this review of the literature, authors believe that both techniques are available for the repair of chronic injuries of the volar plate of the PIPJ, although direct suturing can be considered as less reproducible.
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Affiliation(s)
- Daniele Caviglia
- Orthopaedics and Hand Surgery Unit, Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianluca Ciolli
- Orthopaedics and Hand Surgery Unit, Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Camillo Fulchignoni
- Orthopaedics and Hand Surgery Unit, Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo Rocchi
- Orthopaedics and Hand Surgery Unit, Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome; Università Cattolica del Sacro Cuore, Rome, Italy
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Abstract
Proximal interphalangeal joint injuries are one of the most common injuries of the hand. The severity of injury can vary from a minor sprain to a complex intra-articular fracture. Because of the complex anatomy of the joint, complications may occur even after an appropriate treatment. This article provides a comprehensive review on existing techniques to manage complications and imparts practical points to help prevent further complications after proximal interphalangeal joint injury.
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Affiliation(s)
- Sirichai Kamnerdnakta
- Department of Surgery, Section of Plastic Surgery, University of Michigan, NCRC, Building 18, G200, 2800 Plymouth Road, Ann Arbor, MI 48109, USA; Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 12th Floor, Siamintr Building, Bangkok-noi, Bangkok 10700, Thailand
| | - Helen E Huetteman
- Department of Surgery, Section of Plastic Surgery, University of Michigan, NCRC, Building 18, G200, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Kevin C Chung
- Section of Plastic Surgery, University of Michigan, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
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Swanstrom MM, Henn CM, Hearns KA, Carlson MG. Modified Sublimis Tenodesis: Surgical Technique for Treating Chronic Traumatic Proximal Interphalangeal Joint Hyperextension Instability. Tech Hand Up Extrem Surg 2016; 20:48-51. [PMID: 26807888 DOI: 10.1097/BTH.0000000000000114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many surgical techniques for treating chronic posttraumatic hyperextension instability of the proximal interphalangeal (PIP) joint involve exploration of the PIP joint, often leading to stiffness in an already traumatized joint. This article outlines the indications, contraindications, surgical technique, and postoperative management for a modified flexor digitorum sublimis tenodesis that utilizes 2 small incisions, a slip of flexor digitorum sublimis, a suture anchor, and temporary pinning of the PIP joint, while avoiding violation of the PIP capsule.
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Miyagi K, Riaz M. A transverse pull-through suture technique to repair volar plate avulsion for a chronic swan neck deformity. J Plast Reconstr Aesthet Surg 2016; 69:729-31. [PMID: 26876106 DOI: 10.1016/j.bjps.2016.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 01/24/2016] [Indexed: 11/21/2022]
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Ko JH, Kalainov DM, Hsu LP, Fang RC, Mastey RD. Double lateral band transfer for treatment of traumatic hyperextension instability of the proximal interphalangeal joint: a report of two cases. Hand (N Y) 2012; 7:108-13. [PMID: 23450120 DOI: 10.1007/s11552-011-9382-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Post-traumatic hyperextension instability of the proximal interphalangeal joint may lead to pain, difficulty with initiating finger flexion, and a swan-neck deformity. Most techniques to correct a traumatic hyperextension deformity of the proximal interphalangeal joint require a window in the flexor retinaculum, retraction of the flexor tendons, and manipulation of the joint capsule with a conceivable potential for joint stiffness, tendon adhesions, and tendon bowstringing. We describe an extra-articular lateral band transfer technique that utilizes strips of both lateral bands and preserves the functional integrity of the flexor tendon sheath.
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Deitch MA, Kiefhaber TR, Comisar BR, Stern PJ. Dorsal fracture dislocations of the proximal interphalangeal joint: surgical complications and long-term results. J Hand Surg Am 1999; 24:914-23. [PMID: 10509268 DOI: 10.1053/jhsu.1999.0914] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This retrospective study assessed the short-term complications and long-term subjective and objective results of operative treatment of acute unstable dorsal proximal interphalangeal joint dislocations treated by 2 methods: open reduction internal fixation and volar plate arthroplasty. Fifty-six patients were included in this study. Twenty-three (41%) were treated by volar plate arthroplasty and 33 (59%) were treated by open reduction internal fixation. Postoperative complications occurred in 10 patients (18%). The most frequent complication was redislocation, which occurred in 6 patients (volar plate arthroplasty, 3 patients; open reduction internal fixation, 3 patients) and necessitated salvage surgery in 4 of these 6 cases. In all 6 cases, the fracture of the base of the middle phalanx involved more than 50% of the articular surface. Twenty-four patients (43%) returned for long-term evaluation at an average follow-up period of 46 months (range, 13-125 months). Twenty of these 24 patients (83%) reported little or no pain despite a high incidence (96%) of posttraumatic degenerative changes. Eighteen (75%) reported no difficulty with work activities; 92% continued leisure activities with little or no modification. Proximal interphalangeal joint flexion contractures and extension lag at the distal interphalangeal joint were common. These data indicate that if reduction is maintained, patients may expect few functional deficits despite radiographic degenerative changes and loss of mobility.
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Affiliation(s)
- M A Deitch
- Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, OH, USA
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Morgan JP, Gordon DA, Klug MS, Perry PE, Barre PS. Dynamic digital traction for unstable comminuted intra-articular fracture-dislocations of the proximal interphalangeal joint. J Hand Surg Am 1995; 20:565-73. [PMID: 7594279 DOI: 10.1016/s0363-5023(05)80268-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Unstable intra-articular fracture-dislocations about the proximal interphalangeal joint present a formidable management dilemma. Fourteen patients with comminuted injuries of the proximal interphalangeal joint were treated with dynamic digital traction and followed for an average of 24 months. Dorsal fracture-dislocation and pilon-type injuries made up the majority of cases. Average proximal interphalangeal joint articular surface involvement was 80%. Immediate motion was instituted after traction application. The device was applied in the office with readily available materials. At final follow-up examination, active arc of motion averaged 89 degrees at the proximal interphalangeal joint and 95 degrees for patients sustaining isolated injuries. X-ray films revealed fracture union, joint remodeling, and preservation of joint space. Patient satisfaction was high, with return to previous levels of activity and excellent functional joint restoration. Dynamic digital traction is recommended for unstable proximal interphalangeal joint fractures with comminution, including those associated with subluxation or dislocation.
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Affiliation(s)
- J P Morgan
- Department of Orthopedic Surgery, Wright State University School of Medicine, Dayton, OH, USA
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Abstract
The "S" Quattro has proved its value in the treatment of acute displaced comminuted intraarticular phalangeal fracture dislocations. We have used the system to treat five cases of chronic fracture-dislocation or subluxation of the PIP joint. At an average follow-up period of 16.4 months, there was a mean increase in the range of movement of the injured joint by 75 degrees. We recommend this technique for selected cases.
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Abstract
The simple, percutaneous placement of a smooth pin into the head of the proximal phalanx creates an extension block, which prevents subluxation of the middle phalanx and allows early active flexion of the proximal interphalangeal joint. Three case reports involving this new treatment are presented along with a detailed description of the technique.
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Affiliation(s)
- S F Viegas
- Division of Orthopaedic Surgery, University of Texas Medical Branch, Galveston 77551
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Abstract
The anatomy and histology of the volar plate at the proximal interphalangeal joint and the mechanism of fracture/subluxation of the base of the middle phalanx in closed proximal interphalangeal joint injuries is reviewed. Our current technique of repair for these injuries and its evolution from Eaton's original procedure is described. The results of 71 cases of volar plate arthroplasty performed over a five-year period for fracture/subluxations of the proximal interphalangeal joints are presented with follow-up ranging from six months to four years. 62 (87%) patients achieved a stable pain-free joint with a range of motion from 5 degrees to 95 degrees within two months. Complications were uncommon and correctable with an overall eventual patient satisfaction rate of 94%.
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Abstract
We report the application and results of a technique of open reduction and rigid internal fixation of dorsal fracture/dislocation of the proximal interphalangeal joint with an interfragmentary screw in two cases. Articular congruity was restored, and the proximal interphalangeal joint was stabilized. This technique permitted immediate range-of-motion exercises. Excellent results were obtained in both cases. Previous descriptions have not detailed the indications, the surgical approach, or the results of this technique.
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Affiliation(s)
- A Green
- Department of Orthopaedics, Rhode Island Hospital/Brown University, Providence 02903
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Abstract
A new system has been designed to treat displaced comminuted intra-articular phalangeal fractures and 20 such fracture-dislocations were treated by it. Nineteen of the patients were satisfied at an average follow-up period of 13.6 months, with a mean total active motion of 226 degrees. The results are rewarding considering the gravity of the injuries.
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Abstract
Hyperextension injuries of the proximal interphalangeal joint have traditionally been immobilized in flexion. This may lead to a proximal interphalangeal flexion contracture of the joint. In an effort to prevent flexion contracture and to simultaneously avoid hyperextension laxity, we have immobilized these injuries in zero degrees of extension for 7 to 10 days. Immobilization is followed by buddy taping and active range of motion until 3 weeks after injury. Protective buddy taping is used until the 6-week point. We report our results using this treatment for only palmar plate avulsion fractures. We did not include proximal interphalangeal joint injuries associated with dorsal dislocation or major collateral ligament injury. Twenty-two of 45 patients were available for follow-up evaluation. Length of follow-up averaged 30 months (range, 6 to 36 months). A high percentage of patients had good or excellent results. In no patient did hyperextension laxity develop and in only one was there a flexion contracture. On the basis of these results, we recommend this treatment protocol for hyperextension injuries of the palmar plate of the proximal interphalangeal joint associated with small avulsion fractures.
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Affiliation(s)
- S J Incavo
- Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington 05405
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Abstract
The surgical anatomy and clinical course of the pure hyperextension injury of the proximal interphalangeal (PIP) joint is described based on observations in 12 patients coupled with 15 cases from the literature and vascular injection study of the volar plate. The conclusions are (1) virtually all pure hyperextension injuries produce a rupture of the volar plate at the distal end and (2) such a rupture, when not associated with a marginal metaphyseal avulsion fracture, is not easily diagnosed and is likely to eventuate in a chronic posttraumatic hyperextension deformity because relatively avascular injured tissue is insufficiently immobilized.
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