Clinical outcomes of operative repair of complete rupture of the proximal interphalangeal joint collateral ligament: Comparison with non-operative treatment

Proximal Interphalangeal Joint Congruity: A Biomechanical Study

BACKGROUND

Surgical approaches to the proximal interphalangeal (PIP) joint often require disruption of soft tissue stabilizers. Additionally, PIP joint injuries frequently result in soft tissue disruption. This study evaluates the necessity of repairing soft tissue stabilizers by assessing their role in maintaining native joint congruity.

METHODS

Eight specimens were used to evaluate congruity at 0° and 30° flexion when loaded with 2 N of valgus force. This was performed in the native joint and after sequential sectioning of the surrounding ligaments in order: volar plate (VP), radial collateral ligament (CL), and ulnar CL. The skin flap was sutured with the ligaments unrepaired and the load was reapplied. Radiographs were taken after each load and used to measure the joint line convergence angle (JLCA).

RESULTS

Mean JLCA increased in both degrees of flexion after ligaments were sectioned but was only significantly different from the native joint after the VP was disrupted along with 1 CL. Joint congruity improved following repair of the skin flap in both degrees of flexion but was not significant. Joints were more congruent in 30° flexion for all subgroups, but none were significantly different compared to 0° flexion.

CONCLUSIONS

Disruption of the VP is insufficient to significantly alter PIP joint congruity. While sectioning of both the VP and CLs resulted in a statistically significant change in joint congruity, mean JLCA demonstrated changes of minor clinical significance. The osseous anatomy of the phalanges imparts inherent stability that maintains a congruent joint despite loss of the soft tissue stabilizers.

Midterm clinical outcomes of collateral ligament repair of the thumb and lesser digits: a retrospective analysis of 35 cases

Background

Finger collateral ligament injuries are common, and conservative treatment usually works well. However, complete ruptures that lead to instability could cause painful disability. This study presents our clinical experience and a qualitative functional evaluation following the surgical repair of the thumb and proximal interphalangeal (PIP) joint collateral ligament ruptures.

Methods

Thirty-five patients (22 men and 13 women), diagnosed via a physical examination and magnetic resonance imaging (MRI) with a total collateral ligament rupture in the metacarpophalangeal thumb (16) and PIP joints of the lesser digits (19) and treated surgically, were evaluated retrospectively. The limited range of motion; functional score by Saetta; disabilities of the arm, shoulder, and hand (DASH) score; pre- and post-operative pain, deformity level; and post-operative ability to grip keys, buttons, and jars were measured. The significance of the change between the pre and post-operative visual analog scale for pain (VAS) scores were evaluated using the Wilcoxon signed-rank test. The difference between the lesser digits and thumb groups by patient age was evaluated using the Mann–Whitney-U test. All data, such as the mean, range, and standard deviation, were calculated using SPSS.

Results

The mean pre- and post-operative VAS scores were 4.8 (from 3 to 7) and 0.91 (0 to 4), respectively. The mean post-operative limitation in the range of motion was 9.78° (s = 14.47) for lesser digits and 6.87° (s = 12.29) for the thumb. According to Seatta et al., the final functional score was 62.5% excellent, 25% good, and 12.5% moderate for the thumb and 84.2% excellent, 10.5% good, and 5.3% poor for the lesser digits. The mean post-operative DASH score was 13.55 (SD: 8.77) for lesser digits and 14.22 (SD: 8.9) for the thumb. The mean contralateral (healthy) hand DASH score was 0.75 (SD: 1.05) for lesser digits and 0.75 (SD: 1.05) for the thumb. For the thumb and lesser digits, the z-scores were − 3.55 and − 3.787, respectively, and the progress of the VAS score was significant (p < 0.05).

Conclusion

After a 40-month follow-up for 35 acute, subacute, and chronic cases, the results suggest that direct and suture-anchor repairs are feasible, painless treatments associated with good finger function.

Collateral Ligament Reconstruction of a Distal Interphalangeal Joint with Chronic Instability: A Case Report

CASE

A 33-year-old man presented with a painful instability of the distal interphalangeal (DIP) joint of the little finger after recurrent sports-related traumatic injuries. Stress testing and radiography demonstrated the instability of the ulnar collateral ligament. We performed an ulnar collateral ligament reconstruction of the DIP joint using the palmaris longus tendon. One year after surgery, the patient reported a painless and stable DIP joint with good functional outcome.

CONCLUSION

This procedure could be a viable treatment option for active, high-demand patients experiencing chronic symptomatic instability of the DIP joint because of a longstanding tear of the collateral ligament.

Management of Finger Joint Dislocation and Fracture-Dislocations in Athletes

Although finger joint dislocations are generally thought of as benign by many athletes and assumed to be a sprain, these injuries represent a spectrum that includes disabling fracture-dislocations. Failure to recognize certain dislocations or fracture-dislocations may result in permanent deformity and loss of motion. Simple dislocations are frequently amenable to early return to play with protection; however, more complex injuries may require specialized splinting or surgery. Delay in diagnosis of unstable proximal interphalangeal fracture-dislocations may require reconstruction or fusion. Early diagnosis and appropriate treatment are essential to ensure optimal functional results.

Injuries Around the Proximal Interphalangeal Joint

Proximal interphalangeal joint (PIPJ) injuries are common and challenging to treat, involving a spectrum of conditions ranging from isolated ligamentous injuries to severe fracture dislocations. The main goal of treatment is to achieve a congruent, stable joint, which is key to achieving early range of motion and a favorable outcome. Injuries that do not compromise the stability of the joint may be treated nonsurgically, whereas those that render the joint unstable may be managed with one of many surgical strategies available. This article focuses on the current practices of treatment of injuries around the PIPJ.