Dislocation Of Proximal Interphalangeal Joint Research Articles

Neglected Dorsal Proximal Interphalangeal Joint Dislocation Treated by Volar Plate Arthroplasty: A Case Series.

Chronic unreduced dislocations of the proximal interphalangeal joint are uncommon, and management principles for these injuries have not been defined. The dislocation can be volar or dorsal and closed reduction is rarely successful owing to soft tissue contractures. Treatment options in literature reviews for such rare injuries included open reduction of pip joint with volar plate arthroplasty, extension block pinning, hemi hamate arthroplasty, pip joint arthrodesis, Suzuki dynamic frame fixation, open reduction and repair of capsule and collateral ligaments with suture anchors. Few cases of amputation following treatment were even reported in literature emphasizing the role of meticulous soft tissue handling in such neglected cases of hand. We report six cases of neglected (more than threemonths old) dorsal dislocation of the PIP joint of the hand, treated with volar plate arthroplasty and extension block pinning. A functional range of motion with a stable joint can be achieved in such injuries with volar plate arthroplasty, as long as the articular cartilage is relatively preserved andbone loss is <30%.

Proximal interphalangeal joint dislocations and fracture-dislocations.

Although proximal interphalangeal joint dislocations are generally straightforward to treat, fracture-dislocations are among the most difficult hand injuries to manage. Fracture patterns range from simple to treat palmar plate avulsion fractures to complex, unstable pilon fractures of the base of the middle phalanx, where achieving adequate reduction and fixation can be extremely difficult. Moreover, these fractures may present sub-acutely or chronically, which greatly adds to the complexity of the case. It is therefore no surprise that clinical results vary and are often difficult to predict. We will discuss the clinical presentations, the various dislocation and fracture-dislocation patterns, treatment options and the complications of these injuries.

Comparison of 3 Dynamic External Fixation Devices for Proximal Interphalangeal Joint Dorsal Fracture-Dislocations in a Cadaver Model

Several improvised dynamic external fixation devices are used for treating unstable dorsal proximal interphalangeal (PIP) joint fracture-dislocations. We compared the effectiveness of 3 constructs for simulated dorsal PIP joint fracture-dislocations in a cadaver model. We tested 30 digits from 10 fresh-frozen, thawed cadaver hands. We aimed to remove the palmar 50% of the base of each digit's middle phalanx (P2), simulating an unstable dorsal PIP joint fracture-dislocation. Each PIP joint was then stabilized via external fixation with either a pins-and-rubber-bands construct, pins-only construct, or tuberculin syringe-pins construct. We allocated 10 digits per fixation group. The finger tendons were secured to a computer-controlled stepper motor-driven linear actuator. Via this mechanism, all PIP joints were taken through 1,400 cycles of flexion-extension. With the PIP joint in neutral extension, we measured the P2 dorsal translation at baseline, after fixator stabilization, and after the motion protocol. The actual mean P2 palmar defect created was 48% of the base. All PIP joints were unstable after creating the defect, with a mean initial P2 dorsal displacement of 3.7 mm. After application of the fixators, all PIP joint dislocations were reduced. The median residual P2 dorsal displacements were 0.0 mm for the pins-rubber bands group, 0.1 mm for the pins-only group, and 0.5 mm for the syringe-pins group. There were no cases of PIP joint redislocation after flexion-extension cycling, and the median dorsal P2 displacements were 0.0 mm for the pins-rubber bands group; 0.0 mm for the pins-only group; and 0.5 mm for the syringe-pins group. All 3 external fixators restored PIP joint stability following simulated dorsal fracture-dislocation, with all reductions maintained after motion testing. The syringe-pins construct had significantly greater median residual P2 dorsal displacement after the initial reduction and motion testing, which is of unclear clinical importance. This study informs surgeon decision-making when considering dynamic external fixator options for dorsal PIP joint fracture-dislocations.

Volar dislocation of the proximal interphalangeal joint

The author reports a volar dislocation of the right-hand ring finger's proximal interphalangeal joint in 65-year-old women presented two days after the injury. Apparent shortening, rotation and ulnar deviation of the finger are the classical clinical findings. Radiographs are essential in differentiating between the variants of volar dislocation. Type 1 dislocation presents as irreducible dislocation because of the entangled proximal phalanx in the buttonhole and always associated with the same side collateral ligament injuries. Type 2 dislocation is reducible because of the central slip rupture and a resultant boutonniere deformity. The author reported a case with a complex spectrum of injury, causing the volar dislocation of the proximal interphalangeal joint with the proximal migration of the middle phalanx and radial displacement. This was because of the same side collateral ligament rupture and central slip avulsion. Central slip reconstruction and radial collateral ligament repair produced a stable, painless joint and a full range of movement at the final follow-up. V • Type 2 Volar dislocation of the proximal interphalangeal joint is rare. • It is reducible and has central slip injury with boutonniere deformity. • Central slip reconstruction and collateral ligament repair produce stable joint.

Case report: Open reduction and extension block pinning with volar plate reconstruction for 1 month PIP joint dislocation

Proximal interphalangeal (PIP) fracture-dislocation is a common injury that results from “jamming” a finger. It can be classified according to displacement of proximal phalanx over middle phalanx. For simple dislocation treatment can be closed reduction and splinting. For old cases open reduction is usually required. Following open reduction stability of the joint is checked and accordingly augmentation of stability is done. For unstable injuries, a variety of surgical interventions have been described including extension block pinning, open reduction internal fixation, volar plate arthroplasty, static or dynamic external fixation, and hemi-hamate reconstruction. For fracture dislocation treatment varies with the degree of articular surface involvement, which determines stability of the joint. We present the case of an unstable, subacute middle finger PIP dorsal fracture dislocation in a young female for which attempts of closed reduction were given elsewhere but it could not be reduced. With volar approach we reduced the joint and for augmentation of the stability we did volar plate reconstruction using z-plasty of A3 pully. For additional stability we did extension block pinning.

Double Interphalangeal Joint Dislocation of the Finger in Adolescent Athletes: A Review of Two Cases and the Relevant Literature

Double interphalangeal joint dislocation of the same finger is a rare condition. We report two cases of adolescent athletes with distal and proximal interphalangeal joint dislocation. The diagnosis was confirmed with plain radiograph, while anatomical reduction was easily obtained with gentle longitudinal traction. A simple immobilization of the injured finger was applied by buddy taping for two weeks. Early mobilization as tolerated was recommended, and they have made a full return to their previous status of activities within 5 months. We also provide a review of the literature detailing demographic characteristics, cause and mechanism of injury with associated injuries, treatment options, and functional outcomes in this population.

SnakeBite wound with open volar proximal interphalangeal joint dislocation of little toe: An uncommon rural case

Snake-bite injuries are uncommon events but a significant number of cases are reported from rural areas. The basic principles of diagnosis and management of snake-bite injuries should be known to rural practitioners and prompt referral should be done in selected cases. The extremity bite may occasionally result in localized cellulitis and soft tissue infection that may complicate later into underlying bone invilement. Dislocation following the open wound in these setting is rare occurrence that needs proper knowledge for its diagnosis and management.

Ratio of dislocation types of the proximal interphalangeal joint of the fingers: A new classification system for initial therapy

BackgroundWe proposed a new system named the sagittal, coronal, axial, rotational and fracture (SCARF) classification, which can simply explain any condition of proximal interphalangeal (PIP) joint dislocations of the fingers. The purpose of this study was to verify that this classification would contribute to management of PIP joint dislocations at the initial therapy. We determined ratios of five factors in PIP dislocations with SCARF by interpreting radiographs and assessed the interobserver and intraobserver variability. MethodsIn total, 68 fingers in 67 consecutive patients were studied. The SCARF classification is composed of five factors: (1) sagittal plane displacement is rated by dorsal (D), volar (V), or neutral (N); (2) coronal plane displacement, by ulnar (U), radial (R), or neutral (N); (3) axial force, by compression (C), traction (T), or no (N); (4) rotational displacement, by supine (S), prone (P), or neutral (N); and (5) fracture concomitance, by minus (−) or plus (+). The row of the five characters explains each condition of PIP joint dislocations. Interobserver and intraobserver variability was determined after six orthopedic surgeons independently classified the same radiographs twice. ResultsAll 68 dislocations were classified into 14 types, unless fracture concomitance was considered. The most common type was DUNN (35%). In coronal plane displacements, the two ulnar fingers showed a higher tendency to the ulnar position. Ring finger fracture concomitance was higher than in middle fingers or little fingers. In interobserver analysis, mean kappa coefficient for each factor was 0.63, 0.75, 0.68, 0.33, and 0.84, respectively. In intraobserver analysis, that was 0.73, 0.79, 0.71, 0.41, and 0.81, respectively. ConclusionsEven other than hand specialists can specify the type of every PIP dislocation by using the SCARF classification and will have better understanding of the disorder. It would contribute to management of PIP dislocations at the initial therapy. Type of study/level of evidenceDiagnostic II.

Reconstruction of volar plate avulsion injury of proximal interphalangeal joint with mini-anchor

Objective To investigate the clinical efficacy of mini-bone anchor in the treatment of volar plate avulsion injury of proximal interphalangeal joint. Methods From June 2015 to May 2018, 5 patients with dorsal dislocation of proximal interphalangeal joint caused by finger hyperextension injury were treated. The volar plate avulsion accompanied by articular surface avulsion fracture at the base of middle phalanx occurred. The volar approach was used to remove fragments and reconstruct the insertion of volar plate avulsion with mini-anchor. Results All the wounds achieved primary healing. The follow-up period ranged from 4 to 26 months with an average of 12 months. The flexion and extension of the proximal interphalangeal joint ranged from 50° to 85°. The joint was stable and had no lateral abnormal movement. There was no obvious pain and discomfort during the joint movement. According to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were excellent in 2 cases and good in 3 cases. Conclusion The reconstruction of volar plate insertion with mini-bone anchor can provide the initial stability of the proximal interphalangeal joint, help early functional exercise, and help to reconstruct the basal articular surface of the middle phalanx. It is one of the ideal choices for the treatment of volar plate avulsion injury of proximal interphalangeal joint. Key words: Volar plate; Treatment outcome; Proximal interphalangeal joint; Mini-anchor

Treatment of intra-articular fracture or dislocation of the proximal interphalangeal joint by modified dynamic traction external fixator

Objective To study the application of modified dynamic Kirschner wire-rubber traction external fixator in the treatment of intra-articular fracture or dislocation of the proximal interphalangeal joint. Methods From January 2014 to June 2017, 23 patients (32 fingers) with intra-articular fracture or dislocation of the proximal interphalangeal joints were treated by modified dynamic Kirschner wire-rubber traction external fixator after closed reduction under C arm X ray machine guidance. Results After 8 to 12 weeks, the fractures healed and the joint function recovered to the greatest extent. All the patients were follow-up for 3 to 15 months. No obvious complications such as adhesion and joint stiffness occurred. According to TAM functional evaluation, the results were graded as excellent in 19 cases and good in 4 cases. Conclusion The modified dynamic Kirschner wire-rubber traction external fixator is exquisite and simple. It does not produce iatrogenic blood supply damage during the treatment of intra-articular fracture or dislocation of the proximal interphalangeal joint. It is conducive to fracture healing, supports early functional exercise, protects joint function to the greatest extent, and closed reduction can promote early fracture healing. Key words: Fractures,bone; Dislocations; Proximal interphalangeal joint; Dynamic Kirschner wire-rubber traction external fixator

Irreducible Dislocations of the Proximal Interphalangeal Joint: Algorithm for Open Reduction and Soft-tissue Repair.

The "jammed finger" is among the most common hand injuries and may include simple sprains, dislocations, fractures, and fracture-dislocations. In contrast, irreducible dislocations of the proximal interphalangeal joint are rare injuries. However, they must not be overlooked in the primary assessment, because persistent subluxation may lead to joint contracture, severely compromising hand function. Irreducible dislocations are challenging injuries with interposed soft tissues, preventing closed reduction. Thorough preoperative diagnosis and soft-tissue imaging guide the approach to open reduction and repair of injured periarticular structures. We introduce a systematic algorithm with considerations on classification and management of irreducible proximal interphalangeal joint dislocations. The algorithm is useful for the primary assessment and for hand surgeons responsible for open reduction and rehabilitation.

Functional evaluation of volar plate advancement arthroplasty in fracture dislocation of proximal interphalangeal joint

Introduction: Injuries of the proximal interphalangeal joint ranging from simple sprain to fracture dislocation, are most common injuries of the hand labelled as jammed finger. The management of these injuries are difficult and challenging to hand surgeon with potential long term sequelae of residual pain and stiffness. So our aim is to evaluate the result of volar plate advancement arthroplasty in these injuries. Materials and Methods: This is a retrospective study conducts between 2013 to 2017. In our study 10 cases (8 male and 2 female with average age 26.9y) of fracture dislocation of PIP joint with average 5.3 weeks after injury, operated by advancement of volar plate arthroplasty (in 3 case as a primary and in 7 cases as a secondary reconstructive procedure) with inclusive criteria of unstable joint and > 40% involvement of volar surface of middle phalanx. Results: The average follow up was 20.9 months with preoperative ROM was 15.70. The ROM improved to 910 in fresh and 720 in late cases . The result of over- all study shows good result with functional gain in range of movement. Discussion: The surgeon must choose an appropriate treatment based on fracture pattern, joint stability , duration. Stability of the joint is paramount in determining the appropriate treatment, which should aim to facilitate early mobilisation and restoration of function. Conclusion: volar plate arthroplasty gives stable joint and functional range of motion.

Reduction of a finger in the out-of-hospital arena?

Introduction: Paramedics can find themselves called to digit dislocations. This is challenging as a dislocation can present in various ways, bringing residual damage to tissue and underlying structures from prolonged displacement. The aim is to limit impact on the welfare of the patient and the paramedic's objective is always to get the dislocation reduced as soon as a possible in a quick and safe manner. Dislocation: The most common dislocation of the digit is at the proximal interphalangeal joint (PIPJ), also known as the ‘coach's finger’. PIPJ injuries are commonly seen in ball sports; the dislocation is mainly dorsal in presentation, and normally closed and stable. It is vital that the paramedic undertakes an in-depth digit assessment in order to be equipped with an appropriate treatment plan for the presentation, which can manage the dislocated digit. Discussion—pain relief: While there has been extensive study of systemic analgesia in emergency medical services (EMS), there is little out-of-hospital research on digit ring blocks and the use of regional anesthetics by paramedics in the pre-hospital setting. X-ray: The evidence is contradictory as some insist that X-ray must be carried out pre-reduction, where other authors state that reduction first is acceptable, but only after a thorough assessment. Reduction: There is a distinct lack of evidence for out-of-hospital digit reduction, too sparse for any robust argument to be built. Conclusion: The suggestion is that reduction of the PIPJ dislocation in the out-of-hospital arena is not supported, owing to a lack of evidence. Until more studies are carried out and patient follow-up is proved to be negative with no ongoing digit impact, this skill needs to be undertaken in appropriate locations supported by X-ray.

Revision Proximal Interphalangeal Arthroplasty: An Outcome Analysis of 75 Consecutive Cases

To examine the outcomes and complications associated with revision proximal interphalangeal (PIP) joint arthroplasty. An analysis of 75 consecutive revision PIP joint arthroplasties in 49 patients, performed between 1998 to 2012, was performed. The mean age at the time of surgery was 58 years. Thirty-two patients had a history of prior PIP joint trauma, and 18 patients had rheumatoid arthritis. There were 12 constrained (silicone) implants and 63 nonconstrained implants (34 pyrocarbon and 29 metal-plastic). Over the 14-year period, 19 (25%) fingers underwent a second revision surgery. Second revision surgeries were performed for infection, instability, flexion contracture, and heterotopic ossification. The 2-, 5-, and 10-year survival rates were 80%, 70%, and 70%, respectively, for patients requiring a second revision for PIP joint arthroplasty. Worse outcomes were seen with postoperative dislocations, pyrocarbon implants, and when bone grafting was required. Two operations were complicated by intraoperative fractures, but neither required stabilization. Sixteen patients undergoing revision surgery experienced a postoperative complication, including 2 infections, 1 postoperative fracture, 3 cases of heterotopic ossification, and 10 PIP joint dislocations. The volar approach and the use of a pyrocarbon implant was associated with increased rates of heterotopic ossification, whereas preoperative instability increased the rates of PIP joint dislocation following revision. At a mean of 5.3 years (range, 2-10 years) follow-up, 98% of patients had good pain relief but decreased PIP joint total arc of motion. Proximal interphalangeal joint arthroplasty in the revision setting represents a challenge for surgeons. Revision arthroplasty was associated with a 70% 5-year survival but with a high incidence of complications. Instability was associated with worse outcomes. In this series, silicone and metal-polyethylene implants had lower rates of implant failure and postoperative complications than ones made from pyrocarbon.

The Power of a Soccer Ball: A Traumatic Open Finger Dislocation-A Rare Case Presentation.

Proximal interphalangeal joint dislocations are injuries observed frequently and caused by axial loading on the finger in the extension. In this paper we present a traumatic open finger dislocation due to a ball hitting a wrestler. It was successfully treated with reduction and the volar plate and collateral bond fixation were applied with absorbable sutures.

Proximal interphalangeal joint dislocations and treatment: an evolutionary process.

BackgroundProximal interphalangeal joint (PIPJ) dislocations represent a significant proportion of hand clinic visits and typically require frequent follow-ups for clinical assessment, orthotic adjustments, and physiotherapy. There are a large number of treatment options available for PIPJ dislocations, yet no prospective or controlled studies have been carried out, largely due to the diversity of the various types of injuries.MethodsWe retrospectively reviewed all the PIPJ dislocations in our institution over a five-year period and directly compared the different splinting techniques that we have used over this time frame.ResultsThere were a total of 77 dislocations of the PIPJ (57 men and 20 women) that were included in our study. We found that our management has shifted gradually from complete immobilisation to controlled early mobilisation with figure-of-eight splints. Following treatment, the range of motion of the PIPJ in the figure-of-eight group was significantly greater than that in the other three methods (P<0.05) used. There were significantly fewer hospital visits in the figure-of-eight splint group than in the other treatment groups.ConclusionsThe treatment of PIPJ dislocations has undergone a significant evolution in our experience. Early controlled mobilisation has become increasingly important, and therefore, splints have had to be adapted to allow for this. The figure-of-eight splint has yielded excellent results in our experience. It should be considered for all PIPJ dislocations, but careful patient selection is required to achieve optimum results.

The Hook Plate Technique for Fixation of Phalangeal Avulsion Fractures

Avulsion fractures of the phalanges involve small osseous fragments that are usually attached to structures that are necessary for stability or movement of the joint. Satisfactory healing of the fracture to preserve joint function may require open reduction and internal fixation, which can be difficult because of the small size of the fragments. We used a hook plate fashioned from a 1.3-mm Synthes titanium plate in thirteen patients with a phalangeal avulsion fracture. Four patients had an avulsion fracture of the volar plate with dorsal proximal interphalangeal joint dislocation, four had a dorsal avulsion fracture of the extensor central slip from the middle phalanx, three had a flexor digitorum profundus avulsion fracture from the distal phalanx, and two had an avulsion fracture of the phalangeal insertion of the collateral ligament. Union without complications was achieved in all cases. After an average duration of follow-up of seventeen months, all patients had a good to excellent result and the average total interphalangeal motion was 149°. This indirect fixation technique produces stable fixation allowing early active finger motion.

Irreducible dorsal fracture dislocation of proximal interphalangeal joint locking by the intra-articular avulsion fracture of volar plate from its proximal origin at proximal phalanx: case report

Irreducible dorsal fracture dislocation of proximal interphalangeal joint locking by the intra-articular avulsion fracture of volar plate from its proximal origin at proximal phalanx: case report

Complete Avulsion of the Extensor Mechanism of a Finger with Simultaneous Dislocation of the Proximal Interphalangeal Joint

We report a rare case of open dislocation of the proximal interphalangeal (PIP) joint, associated with simultaneous avulsion of the central band and distal insertion of the extensor mechanism, rapture of the proximal volar plate, and rapture of the ulnar collateral ligament of the PIP joint.Although isolated IP joint injuries are common, they rarely occur simultaneously in a single finger. Even more rarely are they accompanied by a complete avulsion of the extensor mechanism. Operative restoration of the injured structures is a necessity in order to achieve a good functional outcome.An initial forceful flexion of the finger resulting to rapture of the extensor apparatus and then followed by finger hyperextension and PIP joint dislocation is our perception of the possible mechanism of this extremely rare injury.

Boutonniere deformity of the second toe after planter dislocation of proximal interphalangeal joint: a case report

The boutonniere deformity is a well-known deformity in the fingers, however, its appearance on a lessor toe is extremely rare. In the present case, the deformity resulted from a rupture of the central slip of the extensor tendon and the shift of the lateral bands to the planter side after reduction of a traumatic planter dislocation of the PIP joint of the second toe. Surgical repair of the extensor mechanism brought good results.