Ténodèse du flexor digitorum superficialis pour les déformations en hyperextension de l’articulation IPP dans l’arrachement chronique de la plaque palmaire

Abstract

Purpose Injuries of finger proximal interphalangeal (PIP) joint are among the most common trauma of the upper limb. As a result of a severe PIP sprain, the avulsion of the volar plate from the phalanx can lead to instability of the joint. This lesion causes a finger hyperextension disabling deformity, which leads to pain and functional restriction. A late diagnosis is not infrequent and the volar plate is usually retracted or thinned, thus a functional repair has to be researched. With this goal Littler, conceived a flexor digitorum superficialis tenodesis (FDS) in 1959. The purpose of this report is to describe a modified Littler FDS tenodesis technique for the correction of chronic, traumatic joint hyperextension of PIP joint and to present the follow-up. Nine patients presenting a chronic, post-traumatic PIP joint hyperextension were evaluated by one of the consultant in hand surgery. They were treated with a modified Littler FDS tenodesis using a mini bone-anchor placed on the volar aspect of the P1, to insert and stretch directly the tendon slip. Patients were reviewed and evaluated at a follow up of 12 months. Results were classified as excellent in 2 cases, good in 6 cases, fair in one case. To make the tenodesis, the flexor sheath was incised between the A1 and A2 pulleys. The ulnar slip of the FDS was cut as proximally as possible. A mini bone anchor was then placed at the centre of the P1 in a slight sidelong proximal-to-distal direction. The FDS slip was sutured to the anchor, carefully tensioning it so that the PIP joint was approximately 5°-10° short of full physiological extension. The wound was covered with a slight dressing and a temporary small orthoses was applied dorsally, leaving the flexion motion free. Patients were invited to start an immediate gradual active motion. We believe that the results of this PIP tenodesis are strongly related with the fixation technique of the tendon slip. The goal is to avoid a wide opening of the flexor sheath, a long postoperative immobilization, rehabilitation and splinting. The results of FDS tenodesis using a mini-invasive technique and starting an immediate postoperative assisted mobilization, seem to be good and reliable over time.