Les luxations des articulations interphalangiennes proximales des doigts longs: Étude anatomo-clinique et déduction thérapeutique

Abstract

The authors report an anatomo-clinic study on dislocations of the PIP joint in order to point out the lesions and the adequate treatment. This study is composed of two parts: first an anatomoclinical study of 29 dislocations all of which were operated on principle after a clinical and radiographic examination. The second part is a complementary anatomical study of 20 cadaveric joints based on an analysis of the different stabilizing structures of the joint. The study showed that, in order to get a dislocation of the PIP joint, it is necessary that two stabilizing formations be damaged. There is a major lesion and a minor one. The major lesion is characteristic of the type of the dislocation. Anterior dislocations were very rare in this study. The major lesion is a rupture or desinsertion of the central slip of the extensor tendon and the minor lesion is a tear in the collateral ligament. The treatment must be surgical because of the major lesion of the extensor apparatus. Quite different from the anterior lesions are the posterior and the lateral dislocations. They are more frequent. Although they have some similarities, they are, in fact, very different from an anatomoclinical and a therapeutic point of view. In posterior dislocations the major lesion is a rupture of the volar plate. The minor lesion is a partial desinsertion of the collateral ligament. These dislocations are stable after reduction. According to the authors, the best treatment is orthopedic, with a partial immobilization preventing the last degrees of extension. The major lesion in lateral dislocations is a rupture or avulsion of the collateral ligament and the minor lesion is a partial tear of the volar plate. After reduction they are unstable, and thus justify, according to the authors, an operative treatment, especially as they are often associated with cartilaginous lesions.