The Treatment of Chronic Flexion Contractures of the Proximal Interphalangeal Joint

Abstract

A method of treatment of chronic flexion contractures of the PIP joint is presented, with the results obtained in 19 patients treated between 1989 and 1992 after a follow-up of from 6 to 53 months. The flexion contractures, with an extension deficit which ranged between 70 and 90 degrees, had been present for a period of between 2 months and 24 years. Our treatment program involves the surgical release of the unreducible PIP joint followed by the use of static and/or dynamic splints. Surgery is performed using a midlateral approach; the accessory collateral ligament and the flexor sheath are incised and, after the volar plate and check-rein ligaments have been excised, forced hyperextension is applied. The main collateral ligaments are carefully spared and freed from the condyle if there are any remaining adhesions. In our 19 patients, complete extension of the finger was achieved in 11 cases (57.9%); in the remaining 8 cases (42.1%) the residual extension deficit ranges from 10 to 15 degrees. In our experience this combined surgical and rehabilitative approach had led to consistently good results with minimal complications.

Anatomy of the Collateral Ligaments of the Proximal Interphalangeal Joint

“…Other investigators have used line drawings similar to his in reports on the stiff PIPJ. 7,12 The description by Bowers 2 was similar to the findings in this study but with some differences. Bowers 2 described the origin of the PCL as being located eccentrically in the concave area on the side of the condyles of the proximal phalanx.…”

“…In general the orientation of the PCL is shown as oblique and/or cord-like and narrow in its anteroposterior dimension. [3][4][5][6][7][8][9][10][11][12] Other investigators describe it as being a broader structure. 2 The ACL usually is shown as a substantial structure that is triangular in shape and to which stabilizing properties are ascribed.…”

Proximal Interphalangeal Joint Release in Dupuytren’s Disease of the Little Finger

“…The concept of surgical correction of proximal interphalangeal joint contracture by release of the capsuloligamentous structures of the joint was described by Watson et al (1979) and subsequently addressed by other authors over the last 20 years (Abbiati et al, 1995;Diao and Eaton, 1993;Rajesh et al, 2000;Tonkin et al, 1985). Andrew (1991), in a cadaveric study, demonstrated not only that full correction of proximal interphalangeal joint contracture in Dupuytren's disease could be attained by surgical means but identified the accessory collateral ligaments and volar plate as the important structures involved.…”

Biomechanical Differences of the Proximal Interphalangeal Joint Volar Plate During Active and Passive Motion: A Dynamic Ultrasonographic Study

“…2,7,13,14 Clinically, adhesion of the VP is one of the important factors causing a flexion contracture of the PIP joint. 10,11,[15][16][17][18] Releasing contractures of the VP and its supporting structures is a treatment option for the contracture; however, it may still be difficult to obtain a satisfactory surgical outcome. [15][16][17][18] Although its importance is well recognized, there has been little investigation of the normal biomechanical behavior of the VP.…”

“…10,11,[15][16][17][18] Releasing contractures of the VP and its supporting structures is a treatment option for the contracture; however, it may still be difficult to obtain a satisfactory surgical outcome. [15][16][17][18] Although its importance is well recognized, there has been little investigation of the normal biomechanical behavior of the VP. 1,5 We previously conducted a dynamic ultrasonographic study of the biomechanics of the VP 19 and showed that the normal VP motion was mainly composed of sliding, elevating, and rolling in the recess (Fig.…”