Accessory Collateral Ligament Research Articles

Smile incision and reverse shotgun approach in distal interphalangeal joint arthrodesis

BackgroundArthrodesis serves as the traditional therapeutic approach for advanced distal interphalangeal joint (DIPJ) arthritis. However, the conventional technique may prove insufficient when the excision of pronounced volar and lateral spurs is required. To address this, we innovated the 'smile incision with reverse shotgun approach'. This method enhances joint exposure and yields superior cosmetic results by extending the transverse skin incision over the DIPJ and cleaving the accessory collateral ligament, thereby improving access to the volar and lateral joint margins. This article meticulously elucidates the surgical procedure and presents preliminary results of its implementation.MethodThe clinical data of 22 consecutive patients (36 fingers) who received DIPJ arthrodesis by this procedure during March 2018 to October 2022, with a mean follow-up period of 9.8 months, were reviewed. Patients’ demographics, union rate, complications, radiographic findings, as well as visual analogue scale (VAS) for pain and satisfaction, were collected and analyzed.ResultsThirty-five of 36 fingers achieved uneventful bony union (97.2%). The average VAS for pain and satisfaction as well as he coronal plane deviation of DIPJ significantly improved after the operation (all, P < 0.05). No skin necrosis, nail deformity, or infection were observed during the follow-up period.ConclusionThe smile incision and reverse shotgun approach provided excellent DIPJ exposure, high union rate, and cosmetic appearance for DIPJ arthrodesis surgery. This technique may be a good surgical option for DIPJ arthrodesis when more volar part joint preparation and more volar implant insertion sites are necessary.

Dorsal capsule release and lateral band translocation for a stiff swan neck deformity without articular involvement.

The treatment for proximal interphalangeal joint (PIP) stiffness in extension requires extensor tenolysis, concomitant procedures to restore flexion, and intensive therapy. A stiff swan neck deformity without articular involvement is rare and the treatment is always challenging. Six patients with stiff swan neck deformities were operated between 2016 and 2023, and the outcome was analyzed retrospectively. A dorsal capsule release and radial lateral band translocation volar to the PIP joint axis were done. This translocation was maintained by a sling formed by the flexor digitorum superficialis and the free margins of the accessory collateral ligament. The range of movements in the PIP joint, visual analog scale (VAS), and functional outcomes were analyzed by the Michigan Hand Outcome Questionnaire (MHOQ) score. The mean follow-up was 49.5months (range 48-52months). The mean preoperative PIP joint extension was 8 (range 5-10) degrees of extension), and the mean preoperative PIP joint flexion was 0. All patients improved after the surgery and the mean flexion of the PIP joint at follow-up was 95 degrees; extension was 1 degree (range 0-5 degrees). The mean Michigan Hand Outcomes Questionnaire (MHOQ) score was 92 (range 90-95) and the VAS was 0. Dorsal capsule contracture release and lateral band translocation to the volar axis of the PIP joint seem to be the possibilities for correcting stiff swan neck deformity. IV, retrospective case study.

Biomechanical Analysis of Thumb Ulnar Collateral Ligament Tear Kinematics.

Background: Thumb ulnar collateral ligament (UCL) injuries are common, but the kinematics of these injuries have not been comprehensively described, especially regarding kinematic changes with progressive UCL injury. Methods: Eleven cadaveric thumbs underwent kinematic testing under 4 conditions: intact, partial tear (50%) of the proper UCL, full tear of the proper UCL, and complete tear of both the proper and accessory UCL. Kinematic testing parameters included varus/valgus stress, pronation/supination, and volar/dorsal translation at -10 degree, 0 degree, 15 degree, and 30 degree of metacarpophalangeal flexion. Results: Partial tear of the proper UCL did not result in significant increases in laxity in any direction compared with intact (P ≥ .132). Full tear of the proper UCL resulted in a significant increase in valgus angulation (18.8° ± 1.7° vs 11.5° ± 1.5°; P = .024) and pronation (15.4° ± 2.5° vs 12.6° ± 2.3°; P = .034) at 30 degree of flexion relative to intact. Complete tear of both the proper and accessory collateral ligaments resulted in increased valgus angulation at all degrees of flexion (P < .001). Complete tear also resulted in a significant volar translation at 0 degree, 15 degree, and 30 degree of flexion (P ≤ .016). Conclusion: Partial tear of the proper UCL does not significantly affect the stability of the joint, but full tear of the proper UCL increases valgus instability at 30 degree of flexion. Complete tear of the UCL is necessary for increased varus/valgus instability at all degrees of flexion and results in significant increases in pronation/supination and volar translation.

Bilateral Locking of the Metacarpophalangeal Joint

The purposes of this article were to present an exemplary case of bilateral locked metacarpophalangeal (MCP) joint of the second metacarpal and to review the literature for a more comprehensive understanding of this condition. For the literature review, PubMed and Google Scholar research were performed using the term "metacarpophalangeal joint (MCP joint) locking or locked metacarpophalangeal joint (MCP Joint)" with a set of inclusion and exclusion criteria. We recently treated a patient with bilateral locked MCP, which presented to our office on 2 separate occasions in the space of 3 years. The left hand was affected in 2015 and the right hand in 2018. After clinical and imaging investigations, the patient was operated on. The patient had a locking of the accessory collateral ligament behind a radial sided prominence of the second metacarpal head. After surgery, the patient regained full function of her index finger. On the basis of our literature review, we found 47 cases described in the literature, plus our case, the index finger (22), and the long finger (11) were most commonly involved. Left untreated, the locked MCP joint may lead to a flexion contracture and disabilities in performing daily life activities. The diagnosis is mainly clinical. The radiographs can show degenerative changes or a particular shape of the metacarpal head/neck as a first clue to the possible cause. Gentle closed reduction can be attempted, but surgery is most often required. The surgical approach depends on the presumed localization of the pathology.

Effect of McGlamry Elevator Placement on the Plantar Plate Origin

Category: Lesser Toes Introduction/Purpose: Lesser metatarsal phalangeal (MTP) joint plantar plate tears have been implicated in a variety of lesser toe pathologies, and plantar plate repair (PPR) through a dorsal approach has become increasingly popular as a treatment of lesser toe deformities and lesser MTP instability. With the aid of a McGlamry elevator, releasing the collateral ligaments and micro-suture passing techniques, the plantar plate is repaired under direct visualization. While this approach is seen as a reliable alternative, the consequence of this technique on local MTP joint anatomy is not yet well understood. The purpose of this study is to describe the proximal plantar plate attachment and to quantify the amount of soft tissue disruption of the lesser toe MTP joint anatomy with insertion of a McGlamry elevator. Methods: Fresh frozen human cadaveric feet were dissected, and the proximal plantar plate attachment of the second, third, and fourth toe MTP joints (n=6) were examined, focusing on the relationship of structures connecting the distal metatarsal shaft and head to the plantar plate. The accessory collateral ligament insertions and proximal plantar plate attachments were measured using digital calipers. Next, the second, third, and fourth rays (n=12) of separate fresh frozen cadaveric specimens were isolated. An 11mm McGlamry elevator was then inserted in standard surgical fashion in both a more shallow (limited exposure) and deeper (greater exposure) position. Using mini C-arm fluoroscopy, radiographs were taken in both positions, and the depth of insertion along the metatarsal was measured. Results: The proximal plantar plate attachment to the metatarsal is most robust just proximal to the lateral articular margin and this attachment extends an average of 10.42mm (SD= 2.71mm) proximally along the metatarsal neck and shaft. In addition there are stout proximal plantar plate attachments at the bilateral insertion sites of the accessory collateral ligament (ACL) which are thick and broad with an average insertion length of 9.01mm (SD=1.35mm). Insertion of a McGlamry elevator resulted in stripping of the distal plantar soft tissues over an average of 21.58% of the total metatarsal length (SD=4.43%) for shallow placement and 34.87% (SD=4.40%) for deep placement with a significant difference of 7.96% between the two positions (p&lt;.00001). Conclusion: Current techniques of plantar plate repair through a dorsal approach require releasing collateral ligaments and proximal stripping of the plantar plate from the metatarsal for adequate visualization. We suggest that this significantly destabilizes the metatarsal from the plantar plate as it strips approximately the distal most one third of the metatarsal including all major proximal plantar plate attachments to the metatarsal. As surgical techniques continue to evolve and improve, surgeons should consider avoiding the placement of a McGlamry elevator as this can destabilize the proximal attachment of the plantar plate to the metatarsal.

Rotational stability test for the diagnosis of radial collateral ligament rupture in the fingers: Anatomical study

Diagnosing rupture of the radial collateral ligament (RCL) of the finger metacarpophalangeal (MCP) joints is difficult. The aim of this cadaver study was to validate a rotational test for the MCP after RCL transection. With the MCP and proximal interphalangeal joints in flexion, rotation along the axis of the proximal phalanx was applied through an extended distal interphalangeal joint to 36 cadaver fingers. Each finger's pulp described an arc of pronation and supination that was noted on the palm. The test was repeated three times: before transection, after transection of the proper collateral ligament (CL) and after transection of both the proper and accessory CLs. Rotational arcs were measured in pronation and supination. Mean length of the pronation arc after transection of the main RCL was 17.53mm, while it was only 12.41mm before transection for the supination arc. Mean length of the pronation arc after transection of both CLs was 22.83mm compared to only 11.93mm before transection. Our results show a significant difference in pronation stability of the MCP joint after transection of the RCL proper. We can conclude that this rotational stability test is a valid test for diagnosing RCL rupture in MCP joints.

Locked metacarpophalangeal joint of long fingers: Clinical presentation, literature review, and a treatment-oriented classification

Objectives: The purpose of this article was to present two exemplary cases of the disorder known as locked metacarpophalangeal (MCP) joint of long fingers, to review the literature and to recommend the possible surgical approaches based on the involved anatomic structures. Patients and Results: We recently took care of two patients with locked MCP joint representing the two main etiologies of this disorder. After clinical and imaging investigations both patients were operated. The first patient had a locked intra-articular loose body in the third metacarpophalangeal joint, which was undetectable on MRI. The second had a locking of the accessory collateral ligament behind a radial sided prominence of the second metacarpal head. Both had a satisfactory outcome after surgery. Conclusion: Left untreated, the locked MCP joint may lead to a flexion contracture. The diagnosis is mainly clinical. The radiographs can show degenerative changes or a particular shape of the metacarpal head/neck as a first clue to the possible cause. A MRI may help to precise the origin of the locking. Gentle closed reduction can be attempted, but surgery is most often required. The surgical approach depends on the presumed localization of the pathology.

Arthroscopic repair of thumb metacarpophalangeal ligament injuries – a prospective series

Thumb metacarpophalangeal sprains are one of the most common hand injuries + as others joint trauma, arthroscopic management may enhance results while decreasing morbidity. The aim of this work was to improve surgical recovery and outcomes in thumb metacarpophalangeal collateral ligament ruptures using a new and simple arthroscopic repair. We experimented first the procedure on 8 cadaveric thumbs then we initiate a prospective series including all surgical acute (< 3 weeks) ligament ruptures without avulsion fractures. Over a period of 2 years, 17 patients [14 ulnar collateral ligament (UCL) and 3 radial collateral ligament (RCL) injuries] were included. Diagnosis was obtained using a bilateral examination, X rays and ultrasound. We used a 1.9 mm arthroscope with only two 2 mm-long portals - one optical portal (dorsolateral for UCL injuries, dorsomedial for RCL injuries) and one instrumental portal near of the collateral ligament rupture. Through this instrumental portal, we were able to reduce the Stener lesion and repair ligaments using a 2 mm titanium suture screw anchor. A splint was kept for 3 weeks followed by physiotherapy. A postoperative X ray was performed to confirm the anchor position then physical examination after 3, 6 and 12 weeks. Analysis criteria were: – preoperative - demographic data, diagnosis conditions; – perioperative - duration of the surgery, all ligament lesions observed at 360°; – postoperative - MP range of motion and KeyPinch strength, pain, stability testing, time off work, potential complications (scare, nerve damage). All patients were reviewed three times. Preoperative criteria - all preoperative radiographic volar subluxations were associated with the arthroscopic report of a complete rupture of at least one part (accessory or proper part) of the collateral ligament. Peroperative criteria - duration of surgery was 24 minutes (15–32). Ligament assessment - all UCL ruptures were distal (n = 14), all RCL ruptures were proximal (n = 3), 5 accessory collateral ligament damages were contralateral to the main ligament rupture. Postoperative criteria - in UCL ruptures (n = 14), postoperative X rays demonstrated that all anchors were localized in the palmar half of the phalanx, 12 in the palmar third. About strength and motion - at 3 weeks - ROM - 50%, KeyPinch - 35% + 6 weeks - ROM - 85%, KeyPinch - 68% + 12 weeks - ROM - 90%, KeyPinch 87%. None chronic instability and none dorsal sensitive nerve damage were noticed. Arthroscopic repair of thumb metacarpophalangeal injuries enables a precise ligamentous diagnosis. This is a safe procedure to perform an accurate repair and achieve a quick recovery with excellent outcomes.

Arthroscopic repair of thumb metacarpophalangeal ligament injuries: A prospective series

Thumb metacarpophalangeal sprains are one of the most common hand injuries; as others joint trauma, arthroscopic management may enhance results while decreasing morbidity. The aim of this work was to improve surgical recovery and outcomes in thumb metacarpophalangeal collateral ligament ruptures using a new and simple arthroscopic repair. We experimented first the procedure on 8 cadaveric thumbs then we initiate a prospective series including all surgical acute (< 3weeks) ligament ruptures without avulsion fractures. Over a period of 2 years, 17 patients [14 ulnar collateral ligament (UCL) and 3 Radial collateral ligament (RCL) injuries] were included. Diagnosis was obtained using a bilateral examination, X-rays (without stress) and US. We used a 1,9-mm arthroscope with only two 2-mm-long portals: one optical portal (dorsolateral for UCL injuries, dorsomedial for RCL injuries) and one instrumental portal near of the collateral ligament rupture. Through this instrumental portal, we were able to reduce the Stener lesion and repair ligaments using a 2-mm titanium suture screw anchor. A splint was kept for 3 weeks followed by physiotherapy. A postoperative X-ray was performed to confirm the anchor position then physical examination after 3,6 and 12 weeks. Analysis criteria were: – preoperative: demographic data, diagnosis condition; – perioperative: duration of the surgery, all ligament lesions observed at 360°; – postoperative: MP range of motion and key-pinch strength, (% of the contralateral side), pain, stability testing, time off work and sports, potential complications (scare, sensitive nerve damage). All patients were reviewed three times. Preoperative criteria: all preoperative radiographic volar subluxations were associated with the arthroscopic report of a complete rupture of at least one part (accessory or proper part) of the collateral ligament. Peroperative criteria: duration of surgery was 24 minutes (15–32). Ligament assessment: all UCL ruptures were distal (n = 14), all RCL ruptures were proximal (n = 3), 5 accessory collateral ligament damages were contralateral to the main ligament rupture. Postoperative criteria: in UCL ruptures (n = 14), postoperative X-rays demonstrated that all anchors were localized in the palmar half of the phalanx, 12 in the palmar third. About strength and motion: after 3 weeks: ROM: 50%, Key-pinch: 35%. After 6 weeks: ROM: 85%, key-pinch: 68%. After 12 weeks: ROM: 90%, key-pinch 87%. None chronic instability and none dorsal sensitive nerve damage were noticed. Time off work was 3 weeks (0–8). Arthroscopic repair of thumb metacarpophalangeal injuries enables a precise ligamentous diagnosis. This is a safe procedure to perform an accurate repair and achieve a quick recovery with excellent outcomes.

Change in the collateral and accessory collateral ligament lengths of the proximal interphalangeal joint using cadaveric model three-dimensional laser scanning.

The purpose of this study was to assess the lengths of the index and middle finger proximal interphalangeal joint ligaments and determine the relative changes in the collateral and accessory collateral ligament lengths at 0°, 45° and 90° flexion. We generated three-dimensional scans of 16 finger (eight index and eight middle) proximal interphalangeal joints to assess relative changes in ligament length. Significant changes were found between 45°-90° and 0°-90° for the ulnar collateral ligament of the index finger and both collateral ligaments of the middle finger between 45°-90° and 0°-90°. No significant changes in length were found for the radial collateral ligament of the index finger or the accessory collateral ligaments of the index and middle fingers. Overall, it was found that the collateral ligament length changed significantly, but there was no significant change in the accessory collateral ligaments. Therapeutic IV.

Surgical Techniques for Correction of Traumatic Hyperextension Instability of the Proximal Interphalangeal Joint: A Biomechanical Study

To compare the biomechanical strengths of 5 surgical techniques for treatment of traumatic hyperextension instability of the proximal interphalangeal (PIP) joint. Thirty-six cadaveric fingers were randomly assigned to 6 groups: normal control, volar plate repair, flexor digitorum superficialis tenodesis (FDST), single lateral band transfer (SLBT), double lateral band transfer, and dual split lateral band transfer. For each experimental specimen, the volar plate and accessory collateral ligaments were transected, the PIP joint was hyperextended to 90°, and a PIP joint stabilizing procedure was completed. The ultimate strength of each procedure was ascertained by loading to failure, and the fingers were dissected to determine the pathoanatomy of failure. Force-displacement curves were used to estimate the stiffness of each group, and multiple pairwise statistical comparisons were performed. The mean PIP joint stiffness in the control group was significantly greater than the mean PIP joint stiffness in the FDST and SLBT groups, but not significantly different from the mean PIP joint stiffness in the other 3 groups. There were no significant differences in the mean PIP joint stiffness between the 5 joint stabilizing techniques. The SLBT, double lateral band transfer, and dual split lateral band transfer repairs all failed by massive disruption of the flexor tendon sheath, whereas the volar plate repairs and FDST repairs failed by either suture anchor pullout or suture breakage. The stiffness of 5 surgical techniques to stabilize a traumatic hyperextensible PIP joint did not vary significantly. The 5 described techniques to stabilize a posttraumatic PIP joint hyperextension deformity may provide for equal restraint to PIP joint hyperextension instability in the early postoperative period. The choice of procedure should take into consideration other factors notstudied, including the potential for PIP joint flexion contracture and long-term durability.

In Vivo Length Changes of the Proximal Interphalangeal Joint Proper and Accessory Collateral Ligaments During Flexion

To investigate the length changes in proper collateral ligament (PCL) and accessory collateral ligament (ACL) during flexion of the proximal interphalangeal (PIP) joint invivo and how portions of the PCL and ACL stabilize the PIP joint. We obtained computed tomography scans of the index, middle, and ring fingers of one hand from 6 volunteers at 0°, 30°, 60°, 90°, and full flexion of the PIP joint. Radial and ulnar PCL and ACL were measured and analyzed with computer modeling. The data showed that during flexion the average length of the dorsal portion of the radial and ulnar PCL increased significantly and reached a maximum at 90°. The volar portion of the radial and ulnar PCL and the distal portion of the radial and ulnar ACL shortened continuously from extension to full flexion. The proximal and middle portions of each ACL are nearly isometric, the dorsal portion of each PCL becomes taut only in flexion, and the volar portion of PCL and the distal portion ofACL become taut only in extension. The current findings indicate that the dorsal portion of PCLis the most stabilizing structure during flexion of the PIP joint, and that the volar portion of PCL and the distal portion of ACL provide the crucial lateral stability to the joint at extension. The results may provide information relevant to the ligaments of PIP joint reconstruction and rehabilitation.

Ligament preserving technique for a locked metacarpophalangeal joint of the index finger.

BackgroundLocking of metacarpophalangeal joint (MPJ) of the index finger occurs when volar radial osteophytes of the metacarpal head catch the accessory collateral ligament. We devised a ligament-preserving approach to quickly restore the MPJ motion while protecting the radial collateral ligament.MethodsWe retrospectively reviewed the results of nine patients treated for a locked MPJ of the index finger. In three patients, closed reduction was successful. In six cases, volar radial osteophytes were excised from the metacarpal head using a ligament-preserving technique through a longitudinal incision on the radial side. We analyzed osteophyte shape and height as demonstrated by X-ray and computed tomography (CT). Function was evaluated by examining the range of motion, recurrence, Disabilities of the Arm, Shoulder and Hand (DASH) score, and MPJ stability based on the key pinch strength. One male and eight female patients were followed for an average of 33 months (range, 12 to 65 months); the average age of patients was 41 years (range, 34 to 47 years). The average duration of locking of the MPJ was 23 days (range, 1 to 53 days).ResultsThe sharp type of osteophytes was identified in six patients and the blunt type of osteophytes was indentified in three patients. The average height of radial osteophytes on the index finger metacarpal was 4.6 ± 0.4 mm in the axial CT image. At the final follow-up, the average extension limitation decreased from 26° (range, 10° to 45°) to 0°, and further flexion increased from 83° (range, 80° to 90°) to 86°. There was no recurrent locking after surgery. The DASH score improved from 24.3 to 7.2. Key pinch strength improved from 67.3% to 90.4%.ConclusionsWe obtained satisfactory outcomes in irreducible locking of the MPJ of the index finger by excising volar radial osteophytes of the metacarpal head using a ligament-preserving approach.

Anatomic double-bundle reconstruction with free tendon graft for chronic ulnar instability of the thumb metacarpophalangeal joint.

Failed primary treatment of thumb metacarpophalangeal ligament injuries may lead to chronic instability. Different treatments have been described such as secondary ligament suture, fusion, dynamic or static procedures. Techniques to restrain the joint stability with various grafts of different configurations have been published, but most of these address only the proper collateral ligament. Experimental data revealed the importance of the accessory collateral ligament in stabilizing the metacarpophalangeal joint. In a former, true anatomic ligament reconstruction a bone-tendon graft was used; the tendon was split longitudinally to reconstruct both parts of the collateral ligament. This technique was modified by the author: a resorbable interference screw was used to fix a free tendon graft double in the metacarpal head, creating 2 identical bundles for reconstruction of both the proper and the accessory collateral ligament. The results of the first 10 patients with chronic ulnar instability in their otherwise intact thumb are reported. The mean follow-up was 15 months. Eight patients had excellent result and 2 patients had good result according to the Glickel grading system. The mean loss of motion in the metacarpophalengeal joint was 9% and the mean loss of pinch strength was 9% compared with the contralateral thumb. The technical details, pitfalls, complications, and rehabilitation are described in this paper.

Locked Metacarpophalangeal Joint of the Middle Finger Caused by a Lipoma in the Flexor Tenosynovium: A Case Report.

The locking of the metacarpophalangeal (MCP) joint of a finger is a common entity that is characterized by a loss of active and passive extension of the MCP joint with normal mobility of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints. This disorder should be distinguished from “trigger finger,” which occurs much more frequently. The locked MCP joint mostly occurs with sudden onset in the index or middle finger in adults or the elderly1. Locking often is caused by the collateral or accessory collateral ligament that catches on the prominent radial condyle of the metacarpal head or osteophytes on the volar metacarpal head1. Other reported causes are irregularities of the articular surfaces of the MCP joint, tears of the collateral ligaments or palmar plate, an intra-articular loose body, and sesamoid entrapment2. We report a case of a locked MCP joint that was caused by a lipoma in the flexor tenosynovium of the middle finger. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. Over a two-year period, a sixty-two-year-old woman had experienced an extension lag at the MCP joint of the right middle finger without evidence of a particular cause. She denied any prior experiences of the snapping phenomenon in the involved digit. Although passive extension initially had been possible, the patient had developed painful triggering at the MCP joint and eventually had difficulty with writing and keyboard use. Subsequently, she had noticed a soft and painless tumor on the right palm. Upon initial presentation to our institution, there had been no change in …

Extension Type Locked Metacarpophalangeal Joint of the Little Finger due to Hyperextension Injury

The extension type locked metacarpophalangeal joint of the little finger is an extremely rare condition characterized by loss of flexion with little or no loss of extension. The most common cause for locking is entrapment of a strap of the ruptured palmar plate. We treated a locked metacarpophalangeal joint of the little finger due to a hyperextension injury. The mechanism of locking was a torn part of the palmar ligament that forcefully rides across the prominence of the radial condyle of the metacarpal bone together with the accessory collateral ligament. These dislocated parts of the ligament formed a constricting bundle that prevented closed reduction. Locking was released successfully by an open reduction using the dorsal approach of the metacarpophalangeal joint without complication.

Angular correction related to excision of specific cords in fasciectomy for Dupuytren’s disease

Named cords were excised sequentially at fasciectomy for Dupuytren's disease and the resultant correction in the joint angle was measured intra-operatively in 99 fingers. Eighty-two metacarpophalangeal and 59 proximal interphalangeal joints were affected. At the metacarpophalangeal joint, excision of the central cord resulted in 82% correction in 69 joints, and spiral/lateral cord excision resulted in an additional 12% correction in 10 joints. At the proximal interphalangeal joint, excision of the central cord resulted in 44% correction in 36 joints, spiral/lateral cord excision resulted in an additional 19% correction in 16 joints, and retrovascular cord excision resulted in a further 23% correction in 27 joints. Subsequent division of the accessory collateral ligament resulted in a further 14% correction in 14 joints. Larger pre-operative angles of the proximal interphalangeal joint were associated with a retrovascular cord, and larger combined angles were associated with an increasing number of pathological structures involved. The data explain the complexity of surgery at the proximal interphalangeal joint, where four structures are implicated in causing flexion deformity.

Spontane fixierte Blockade des Zeigefingergrundgelenks in Beugestellung

Spontaneous fixations of MP-joints of fingers and thumbs are rare and are often a challenging task for hand surgeons. We present a 25-year-old female office employee with a fixed painless MP-joint of the left index finger in 90° flexion with normal PIP- und DIP-joint range of motion. Using the palmar approach to the MP-joint the entrapped accessory collateral ligament which was constrained by a prominent radial condylus could be identified. Operative removal of the prominence has released the joint. An uncomplicated wound healing has followed with completely unrestricted range of motion. If a closed reduction should be considered, it ought to be done cautiously without anaesthetics. A failed -reduction entails an operative revision using the palmar approach.

Three-dimensional analysis of the palmar plate and collateral ligaments at the proximal interphalangeal joint

The purpose of this study was to analyze the palmar plate complex at the proximal interphalangeal joint using a three-dimensional (3D) technique, which makes it easier to understand the dimensions of structures and their relationship to the adjacent components. This method allows individual elements to be removed virtually, facilitating clearer observation of each component. Sixteen cadaveric specimens were dissected and reconstructed in a 3D virtual environment. The palmar plate is made up of a distal, fibrous portion and a proximal, membranous portion, which anchors distally on the base of the middle phalanx and is continuous with the bilateral check-rein ligaments proximally. The accessory collateral ligaments and the A3 pulley suspend the palmar plate laterally.

New and Improved Medical Test Costs Just One Cent

Evaluating a scientific paper often starts with an assessment of the manuscript’s technical construction and the project design; these elements often characterize the reader’s “first impression.” From this perspective, the article by McKeon et al. makes a good first impression. In this cadaver dissection study, stability of the thumb metacarpophalangeal joint is assessed after progressive release of the proper and accessory collateral ligaments. The authors identify radiographic parameters that correlate with metacarpophalangeal joint instability, noting in particular that radial translation of the proximal phalanx relative to the thumb metacarpal head correlates with disruption of both collateral ligament structures. This paper is easy to read, and the technical details of the experimental environment and anatomic dissection are detailed and clear. The radiographic reproductions, which are especially critical to the presentation of the data, are well prepared and simple to understand. The authors wrote a good Discussion section in which they properly frame the practical considerations related to a reliable radiographic finding that correlates with complete ulnar collateral ligament disruption. Furthermore, this project is important because ulnar collateral ligament injuries of the thumb are very …