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. 2023 Oct 3;6(1):98-102.
doi: 10.1016/j.jhsg.2023.07.016. eCollection 2024 Jan.

Dorsal Approach for Management of Proximal Interphalangeal Joint Flexion Contracture

Jessica B Hawken  1 , Robert J Goitz  1
Affiliations

Dorsal Approach for Management of Proximal Interphalangeal Joint Flexion Contracture

Jessica B Hawken et al. J Hand Surg Glob Online. .

Abstract

Proximal interphalangeal (PIP) joint contracture is a common, difficult clinical problem that can arise from minor trauma. Management is difficult because outcomes are unpredictable and often poor, due to residual flexion deformities postoperatively. The dorsal approach for flexion contracture of the PIP joint is not discussed in present literature. In this technique guide, we wish to describe and explain the rationale for a dorsal approach. In our experience, a dorsal approach allows for ease of access to all pathologic structures, with simple positioning of the digit to allow access to volar structures, as well as when addressing more than one digits with a PIP contracture. Finally, similar to the midaxial approach, the dorsal approach also eliminates any volar soft tissue concerns and need for supplemental coverage.

Keywords: Dorsal approach; Joint contracture; PIP joint.

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Figures

Figure1
Figure1
Patient’s fixed deformity.
Figure 2
Figure 2
Attempted extension of the patient’s deformity demonstrating a supple distal interphalangeal joint.
Figure 3
Figure 3
Dorsal appearance of the patient’s deformity.
Figure 4
Figure 4
The incision is placed dorsally directly over the extensor mechanism. The incision can be made radially or ulnarly depending on skin contractures or pliability.
Figure 5
Figure 5
The exposure is carried down through the extensor mechanism, and the first release is the transverse retinacular bands.
Figure 6
Figure 6
Ladder branch demonstrating the proximal extent of the volar plate.
Figure 7
Figure 7
For release of the volar plate both radially and ulnarly, our preferred technique is using a freer elevator to sweep across, detaching the volar plate.
Figure 8
Figure 8
The final structure is the flexor sheath.
Figure 9
Figure 9
The flexor sheath was the final remaining taut structure in this patient preventing extension.
Figure 10
Figure 10
Upon release of the flexor sheath, the digit is able to be fully extended.
Figure 11
Figure 11
Attention is returned dorsally.
Figure 12
Figure 12
The redundant extensor mechanism is addressed.
Figure 13
Figure 13
The extensor mechanism is imbricated and repaired, and a PIP joint cross-pin is placed to hold the extension achieved.
See this image and copyright information in PMC

References

    1. Leibovic S.J., Bowers W.H. Anatomy of the proximal interphalangeal joint. Hand Clin. 1994;10(2):169–178. - PubMed
    1. Ghidella S.D., Segalman K.A., Murphey M.S. Long-term results of surgical management of proximal interphalangeal joint contracture. J Hand Surg Am. 2002;27(5):799–805. - PubMed
    1. Mansat M., Delprat J. Contractures of the proximal interphalangeal joint. Hand Clin. 1992;8(4):777–786. - PubMed
    1. Brüser P., Poss T., Larkin G. Results of proximal interphalangeal joint release for flexion contractures: midlateral versus palmar incision. J Hand Surg Am. 1999;24(2):288–294. - PubMed
    1. Curtis R.M. Capsulectomy of the interphalangeal joints of the fingers. J Bone Joint Surg Am. 1954;36A(6):1219–1232. - PubMed

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