不可闭合复位性的近侧指间关节脱位

目的 探讨不可闭合复位性的近侧指间关节脱位的创伤病理原因、治疗及预后。方法 对1991年5月至2002年10月期间,10例不可闭合复位性的近侧指间关节脱位的诊疗过程、随访结果进行回顾和分析。结果 术后随访4-32个月,近侧指间关节的平均主动活动范围:伸22°,屈71°。被动活动范围:伸18°,屈79°。2例分别于术后14、18个月发生创伤性关节炎;3例于随访时发现关节侧方不稳定;1例于术后6个月因指屈肌腱粘连行肌腱松解术。结论 严重的多向性或旋转性暴力损伤是不可闭合复位性的近侧指间关节脱位主要的致伤原因,它导致近侧指间关节周围的稳定结构复合损伤,其中1种或2种组织嵌入关节腔或羁绊指骨髁,造成闭合复位失败。虽然手术可以将脱位的近侧指间关节复位,但原始创伤严重、早期漏珍、术前反复暴力性闭合复位,手术复位不及时等因素仍可导致预后不良。     

Irreducible dorsal dislocations of the proximal interphalangeal joint

Dorsal dislocations of the proximal interphalangeal joint are common injuries, and reduction is usually obtained by manipulation. We describe four cases of dorsal dislocation in which attempts at reduction by manipulation were not successful. Three of these injuries were open and one was closed. At surgery, the main block to reduction in all cases was the palmar plate that had ruptured from its proximal attachment and was interposed between the joint surfaces.     

Irreducible volar dislocation of the proximal interphalangeal finger joint

Volar dislocation of the proximal interphalangeal finger joint is rare. The trauma that causes this injury consists in a rotation mechanism in almost all cases. It may be initially missed and diagnosed at a late sequel stage. Closed reduction should always be attempted first but this procedure may result in failure, necessitating a surgical intervention. In irreducible cases, the surgical investigation shows a longitudinal split which separates one of the lateral bands (ulnar or radial) from the central slip of the terminal extensor tendon. In addition, the lateral band is displaced to the volar aspect of the head of the first phalanx, and partially entrapped into the proximal interphalangeal joint, the head of the first phalanx being trapped between the central slip and the displaced lateral band. Surgical relocation of the displaced lateral band gives an immediate reduction of the dislocated joint. We present a case of irreducible dislocation of the proximal interphalangeal joint of the right index finger in a 42-year-old female patient who required a surgical treatment. We present the diagnostic, anatomic and therapeutic aspects of this rare injury, together with a review of the literature.     

Irreducible palmar dislocation of the proximal interphalangeal joint of the finger

Three patients with palmar dislocations of the proximal interphalangeal joints are described. The causes of irreducibility were the interposition of one lateral band about the condyle of the middle phalangeal head in two patients and the interposition of the central slip in one patient.     

Irreducible palmar dislocation of the proximal interphalangeal joint. A case report

Irreducible palmar dislocation of the proximal interphalangeal joint in which the central slip remains intact is a rare injury. A noose formed by the extensor mechanism traps the condyle of the proximal phalanx. The collateral ligament is avulsed and the volar plate is disrupted. Closed reduction was unsuccessful in this case. Open reduction achieved a good result.     

Irreducible palmar dislocation of the proximal interphalangeal joint with bilateral avulsion fractures

An unusual case of an irreducible anterior fracture dislocation of the proximal interphalangeal joint in a child with open epiphyses is described. Bilateral intraarticular avulsion fractures at the proximal attachment of the collateral ligaments were present, and the phalangeal head was locked through a tear in the central slip.     

Irreducible dislocation of the distal interphalangeal joint

A case of irreducible dislocation of the distal interphalangeal joint of the finger caused by entrapment of the deep flexor tendon is reported.     

Irreducible palmar dislocation of the distal interphalangeal joint

A case of a child with rare palmar dislocation of the ring finger distal interphalangeal joint requiring open reduction is presented and the literature discussed.     

Palmar dislocation of the proximal interphalangeal joint

Fifteen patients with palmar dislocations of the proximal interphalangeal (PIP) joint were reviewed 6 to 49 months after treatment (average 17.8 months). Disruption of the extensor mechanism, palmar plate, and one collateral ligament was found in all patients. The loss of static and dynamic joint support caused palmar subluxation, malrotation, and a boutonnière deformity. Two dislocations were irreducible, and three were associated with dorsal avulsion fractures from the middle phalanx. The serious nature of the injuries from this dislocation was initially unrecognized, and most patients were casually treated; delay from injury to referral averaged more than 11 weeks. Twelve of the 15 required surgery for joint reduction and tendon and ligament repair; three treated earlier were managed by closed reduction and percutaneous pinning. Joint alignment, comfort, and stability were restored, and all returned to full activities including heavy labor. However, a full range of PIP motion was not recovered in any case.     

Irreducible dorsal dislocation of the small finger distal interphalangeal joint: the importance of roentgenograms--case report

Irreducible dorsal dislocations of the distal interphalangeal joints of the fingers are uncommon injuries. They are almost always the result of an athletic injury. Although usually open, these can be subtle, closed injuries. Proper diagnosis requires clinical awareness and mandatory roentgenograms of all interphalangeal joint injuries.     

A case of dorsal dislocation of the proximal interphalangeal joint of the fourth toe

Dislocation of the interphalangeal joint of a toe is a rare injury, and when it does occur it usually involves the great toe. Dislocation of other toes without fracture is quite rare. We present here a case of dorsal dislocation of the proximal interphalangeal (PIP) joint which was reduced by manipulation.