Ténodèse par mini-ancre du flexor digitorum superficialis pour les déformations en hyperextension de l’articulation IPP dans l’arrachement chronique de la plaque palmaire. Technnique originale

Abstract

As a result of a severe sprain, the avulsion of the volar plate can lead to instability of the PIP joint. This lesion causes a finger hyperextension disabling deformity, which lead 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 in 1959. The purpose of this report is to describe a modified Littler's technique for the correction of chronic, traumatic joint hyperextension. 15patients with a diagnosis of chronic post-traumatic hyperextension instability of the PIP joint were treated surgically in three years. The flexor sheath was incised between the A1 and A2 pulleys. The ulnar slip of the FDS was cut as proximally as possible. A minibone 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 orthoses was applied dorsally, leaving the flexion motion free. Postoperatively patients were invited to start an early gradual finger active motion, wearing an extension block splint. Forty days after surgery, clinical outpatient evaluations were carried on to evaluate joint stability, pain, range of motion. The use of an annular splint was recommended for two further months, avoiding strenuous manual activities. Two patients were lost at follow-up. At six months after surgery, 13 patients were revalued. The range of motion, time lost from work and the functional results were recorded. At last follow up, 7 of the 13 reviewed patients presented an excellent functional recovery, equivalent to complete resolution of the hyperextension and pain, attainment of ROM comparable to the contralateral finger and a stable joint. Others 6 patients obtained as well good results, with remission of the functional impairment and pain, but a residual moderate joint hyperextension or a slight PIP joint flexion contracture was observed. A case of recurrence was recorded, consecutively to a premature traumatic work-related activity. The average time lost from work was equal to 24 days. The FDS tenodesis via a bone anchor combined with early active PIP joint protected motion resulted in this trial to be effective and reliable over time.