Results of proximal interphalangeal joint release for flexion contractures: midlateral versus palmar incision

Forty-two patients (45 fingers) were retrospectively reviewed after operative release of flexion contractures of the proximal interphalangeal (PIP) joint. The release was accomplished through a palmar incision in 19 fingers, usually followed by skin coverage using a lateral transposition flap. A midlateral incision was used in 26 fingers. The 2 groups were comparably matched with respect to degree of contracture and demographic characteristics. Active range of motion (ROM) was measured before and after surgery. In the palmar incision group, preoperative median PIP joint ROM was 60 degrees to 90 degrees (extension/flexion) and 30 degrees to 90 degrees at the 3-year follow-up examination. In the midlateral incision group, preoperative median PIP joint ROM was 50 degrees to 90 degrees (extension/flexion) and 0 degrees to 90 degrees at the 1.5-year follow-up examination. The improvement in ROM was significantly better in the midlateral incision group than in the palmar incision group.     

Percutaneous accessory collateral ligament release in the treatment of proximal interphalangeal joint flexion contracture

A percutaneous release or capsulo-ligamentous proximal interphalangeal joint contracture is described, the indications are outlined and the advantage over open releases are discussed. The results of a small pilot study are reported which we feel are comparable to the results of open techniques. The procedure in itself, however, merely allows operative correction to be achieved. Its maintenance depends upon a stringent post-operative rehabilitation regime.     

近节指间关节严重屈曲挛缩畸形的显微外科治疗

目的探讨应用邻指皮瓣联合同指侧方带蒂皮瓣治疗手指近节指间关节严重屈曲挛缩畸形的临床疗效。方法 2008年10月-2011年2月,收治11例11指手指近节指间关节严重屈曲挛缩患者。男7例,女4例;年龄20～63岁,平均32.6岁。挤压伤及电锯伤7例,烧伤及爆炸伤3例,电击伤1例。指别:示指4例,中指2例,环指2例,小指3例。病程6～24个月,平均12.4个月。按照Stern等手指近节指间关节挛缩分型标准,均为Ⅲ型。术中切除瘢痕后,手指伸直掌侧皮肤软组织缺损范围3.0 cm×1.5 cm～5.0 cm×2.5 cm,均伴肌腱、神经、血管或指骨外露。采用大小为2.2 cm×1.8 cm～3.8 cm×2.5 cm的邻指皮瓣联合大小为1.5 cm×1.2 cm～2.5 cm×2.0 cm的患指侧方带蒂皮瓣移位修复,其中3例采用2个指侧方带蒂皮瓣。供区植皮或直接拉拢缝合。结果术后皮瓣及植皮均成活,创面Ⅰ期愈合。患者均获随访,随访时间6～18个月,平均11.3个月。患指外形恢复满意,皮瓣质地柔软,无明显色素沉着及瘢痕挛缩。患指均可完全伸直,患指主、被动屈伸活动恢复满意。末次随访时,近节指间关节最大伸直角度范围10～15°,按照中华医学会近节指间关节活动范围标准评定:优6例,良4例,可1例,优良率为90.9%。结论邻指皮瓣联合同指侧方带蒂皮瓣具有操作简便、修复面积大、术后外观及功能恢复满意的优点,是治疗手指近节指间关节严重屈曲挛缩畸形较理想方法之一。     

Denervation of the proximal interphalangeal joint: a realistic and simple procedure

Pain relief in osteoarthritis of the proximal interphalangeal joint is a difficult problem. Joint denervation, a technique yielding good reproducible results in wrist and first carpometacarpal joint osteoarthritis, is, at the proximal interphalangeal joint level, a good alternative to implant arthroplasty or arthrodesis. The surgical technique is simple and may be performed under local anesthesia. Results are satisfactory with about 80% pain relief.     

Congenital flexion deformities of the proximal interphalangeal joint in children: a subgroup of camptodactyly

Severe flexion contractures of the proximal interphalangeal joint that are present at birth affect both sexes equally, often involve several digits of the same hand, and show no predilection for the small finger make up a distinct subgroup of the deformity known as camptodactyly. In this series, 20 digits with such severe flexion contractures were treated surgically. In eight digits, the flexor digitorum superficialis tendon was lengthened with or without release of contracted palmar structures. There was no improvement in these digits. In the other 12 digits, the extensor mechanism was realigned and augmented by release or transfer of the flexor digitorum superficialis tendon. All 12 of these digits had good (n = 10) to fair (n = 2) improvement in active and passive extension while retaining adequate flexion, although 9 still had some residual flexion contracture. In this type of camptodactyly, extensor mechanism anomalies appear to be the primary lesion.     

Gradual joint distraction of post-traumatic flexion contracture of the proximal interphalangeal joint by a mini-external fixator

We present the outcome of the treatment of chronic post-traumatic contractures of the proximal interphalangeal joint by gradual distraction correction using an external fixator. A total of 30 consecutive patients with a mean age of 34 years (17 to 54) had distraction for a mean of 16 days (10 to 22). The fixator was removed after a mean of 29 days (16 to 40). Assessment at a mean of 34 months (18 to 54) after completion of treatment showed that the mean active range of movement had significantly increased by 63 degrees (30 degrees to 90 degrees ; p<0.001). The mean active extension gained was 47 degrees (30 degrees to 75 degrees ). Patients aged less than 40 years fared slightly better with a mean gain in active range of movement of 65 degrees (30 degrees to 90 degrees ) compared with those aged more than 40 years, who had a mean gain in active range of movement of 55 degrees (30 degrees to 70 degrees ) but the difference was not statistically significant (p=0.148). The use of joint distraction to correct chronic flexion contracture of the proximal interphalangeal joint is a minimally-invasive and effective method of treatment.     

Nonoperative treatment of fixed flexion deformity of the proximal interphalangeal joint.

Sixty-one stiff, stable proximal interphalangeal joints were treated by exercise and splinting. The average range of movement was 24 degrees to 67 degrees before treatment; this increased to 8 degrees to 98 degrees after treatment. The indications and technique are described.     

Double V-Y flap for correction of proximal interphalangeal joint flexion contractures

A double V-Y flap made up of skin available at the site is an alternative to grafts or cross-finger flaps for release of proximal interphalangeal joint contractures. After the initial incision, the technique involves loosening of the contracted skin so that perpendicular nutrient microvessels are preserved. Suggested postoperative management includes subcutaneous dorsal Kirschner wires to maintain extension without jeopardizing the vascular supply of the flap and gentle stretching of the skin as soon as the wires are removed. Three cases are presented to illustrate the variety of applications of double V-Y technique.     

A robot-assisted study of intrinsic muscle regulation on proximal interphalangeal joint stiffness by varying metacarpophalangeal joint position.

The tightness of intrinsic hand muscles is a common cause of finger joint stiffness. The purposes of this study were to develop a robot-assisted methodology to obtain torque-angle data of a finger joint, and to investigate the regulation of the intrinsic muscles on finger joint stiffness. Our robot system features the integration of a low payload robot arm, a controller, and a force/torque transducer. The system provided highly reproducible torque-angle curves. Torque-angle data of the proximal interphalangeal joint with the metacarpophalangeal joint at 0 and 60 degrees were obtained from eight asymptomatic hands. The torque-angle curve shifted with the position of the metacarpophalangeal joint. As the metacarpophalangeal joint flexion angle changed from 60 to 0 degrees, the equilibrium of the proximal interphalangeal joint increased more than 20 degrees, and joint stiffness increased more than 50%. The dependence of the stiffness of the proximal interphalangeal joint on metacarpophalangeal joint position supports the regulatory role of the intrinsic muscles on finger joint mechanics. This regulatory mechanics is likely amplified in hands with intrinsic muscle tightness, justifying the commonly used Bunnell Intrinsic Tightness Test.     

Pyrocarbon proximal interphalangeal joint arthroplasty: outcomes of a cohort study

Pyrocarbon arthroplasty of the proximal interphalangeal joint is a relatively new concept. Early studies have been encouraging, reporting improved pain and function, but a largely unchanged arc of motion. Subsidence of the implant is common, but how it relates to outcome has not been analyzed. This study was performed to review the results of 57 pyrocarbon proximal interphalangeal implanted joints. Results showed a statistically significant increase in the arc of motion, excellent pain relief, and improved function. Subsidence was observed on radiographs in 40% of joints, but no correlation was found compared with arc of motion or function. The incidence of complications is fairly high and usually related to the peri-articular soft tissues, but they are usually minor and do not require further treatment. From this review, we can recommend the use of this implant for treatment of arthritis of the proximal interphalangeal joint.     

Classification and treatment of postburn proximal interphalangeal joint flexion contractures in children

Two hundred and sixty-four surgically treated proximal interphalangeal joint flexion contractures in children were reviewed. A classification system on the basis of contracture severity was devised to assess the efficacy of treatment. Contracture severity was determined from preoperative radiographs and physical examination. Eighty-eight percent of the digits were successfully treated (postoperative contracture less than 20 degrees). Unsatisfactory results (12% of digits) were directly proportional to the severity of the contracture and tended to occur in older children with large total body surface burns. The time interval between burn and contracture release did not correlate with contracture severity or therapeutic failure. The most common cause of an unsatisfactory result was failure to fully release the contracture.     

A study of the flexor digitorium superficialis tendon in flexion and extension at the proximal interphalangeal joint.

Using a physical model to represent the detailed morphology of the flexor digitorium superficial tendon, the functions of the fibrous arrangement of this tendon in the human fingers were studied for flexion and extension of the proximal interphalangeal joint. In extension of the joint, the fibrous pattern acted as a dynamic ligament for the joint. In flexion, the arrangement of fiber bundles of the tendon contributed to the balanced distribution of forces across the joint's surfaces and for mechanical interplay with the deep long flexor tendon in the region of the joint.     

Osteoarthritis of the proximal interphalangeal joint

Most patients with symptomatic osteoarthritis of the proximal interphalangeal joint should be managed nonoperatively. When operative intervention becomes necessary, therapeutic options include joint fusion or flexible implant arthroplasty. Both relieve pain; however, an implant, while preserving mobility, is subject to fatigue and ultimate failure.     

Ganglions of the proximal interphalangeal joint

Ganglions of the proximal interphalangeal joint are uncommon. Six patients (nine ganglions) were treated surgically. The lesions presented on the ulnar aspect of the extensor mechanism between the lateral band and the central slip and communicated with the joint by means of a stalk. Mild degenerative joint disease was noted in each case. Surgical excision provided relief of symptoms, and no patient has experienced any recurrence to date.