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Irreducible dorsal dislocation of the interphalangeal joint of the thumb due to the palmar plate. A case report
63 © Soci4t4 d'E,dition de l'Assoeiation d'Enseignement Mddical des H6pitaux de Paris, 1998
Irreducible dorsal dislocation of the interphalangeal joint of the thumb due to the palmar plate A case report
E GERARD, R. PEM, P. GARBUIO, L. OBERT, Y. TROPET
SUMMARY : Dorsal dislocation of the thumb interphalangeal joint is rare. Only very few cases of irreducible dislocation has been reported at this joint. The authors report a case of compound irreducible dislocation due to the palmar plate interposition. The sesamoid, the flexor pollicis longus have been reported to block reduction of the dorsal dislocation of the thumb interphalangeal joint doctors on casualities should not insist if reduction is not easily obtained, the patient should then be guide towards a surgical team for surgical treatment. Ann Chir Main (Ann Hand S u r g ) , 1998, 17, n ° 1, 63-67. M O T S - C L ] ~ S : I n t e r p h a l a n g e a l joint. - T h u m b . - P a l m a r plate. - I r r e d u c i b l e dislocation,
INTRODUCTION
CASE REPORT
Dorsal dislocation of the interphalangeal joint of the thumb is rather rare compared to other lesions of the radial side of the hand. Irreducible forms of such lesions are exceptional since an exhaustive review of the literature revealed only a few reported cases. We report a similiar case and review several different cases reported elsewhere in order to analyse such lesions.
This case refers to a 34-year-old right-handed m a n u a l w o r k e r who fell f r o m his bicycle. He presented to the casualty department with open trauma o f the right thumb. Physical examination confirmed a deformed thumb displaying hyperextension on slight rotation at the interphalangeal joint. There was a contended skin lesion on the palmar side of the joint.
Department of Orthopaedic, Traumatologic and Plastic Surgery, CHU J. Minjoz Hospital, BESAN~ON (France). Manuscrit re~u a la R~daction le 20 novembre 1997. Aceept~ le 12 f~vrier 1998.
Correspondance : Dr F. GOrard, Clinique Saint-Joseph, 3, bd Saint-Germain, 35300 FOUGERES.
64
DORSAL DISLOCATION OF THE IP JOINT OF THE THUMB
Fig 1. - Preoperative anteroposterior X-ray of the thumb, demonstrating radial dislocation of the IP joint. Fig. 1. - L'incidence radiographique de face montre une luxation radiale de I'articulation interphalangienne. Fig. 1. - Radiografia preoperatoria del pulgar en muestra la luxaciCn radial de la IF.
la
que se
Standard X-rays confirmed dorso-radial dislocation of the IPjoint of the thumb (fig. 1 and 2). Local ring anesthesia of the thumb was immediately performed in the casualty department, but several attempts by a qualified surgeon to reduce the dislocation by external manipulation proved to be unsuccessful. The patient was then transferred to the operating room for surgical management. Under intravenous anesthesia of the right upper limb, a zig-zag palmar approach to the thumb was performed by enlarging the preexisting skin lesion. Surgical exploration showed that the base of the distal phalanx overlapped the neck of the proximal phalanx. The palmar plate, roughly 1 cm long, was still attached to the base of the distal phalanx and partly covered the dorsal face of the proximal phalanx. The ulnar ligamentous complex was ruptured. The dislocation was reduced by direct traction on the palmar plates. Testing of the IP joint showed lateral instability due to rupture of the ulnar liga-
ANNALES DE C H I R U R G I E DE LA MAIN
1998,
Er~u~U~MBR~SUPER~,~I~
17, n ° 1
ANNALS OF HAND ANDUPPERLIMB SURGERY
Fig. 2. - Preoperative lateral X-ray showing dorsal variety of the IP dislocation. Fig. 2. - La radiographie prCoperatoire de profil retrouve une variete dorsale de luxation de I'articulation interphalangienne Fig. 2. - Radiografia preoperatoria que muestra la luxacidn de la IF.
mentous complex. The IP joint also showed a tendency to hyperextension on the stress-test. This instability led the surgeon to perform temporary fixation of the IP joint using an axial pin. Neither the torn ligamentous complex nor the palmar plate was repaired. Postoperatively, the wound healed without any problem. The pin was removed 21 days after treatment and 12 physiotherapy sessions were prescribed. The patient was reviewed 7 months later. Physical examination revealed a painless thumb with a normal appearance. Active motion ranged from 0 to 40 ° of flexion. Thumb-finger (pinch) grip was strong. A stress-test showed ulnar lateral instability of 10°, not reported by the patient. He said he was very satisfied with the result of his thumb in spite of the loss of motion of the IP joint. Standard x-rays revealed a normal IP joint. Stress X-rays confirmed 10 ° of lateral instability on the ulnar side of the joint.
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1998,
ANNALS OF HAND
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AND UPPER LIMB
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D O R S A L D I S L O C A T I O N O F T H E I P J O I N T O F THE T H U M B
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Fig. 3 and 4. - Seven months later the joint is normal and free of degenerative arthritis. Fig. 3 et 4. - Sept mois apres, I'articulation presente un aspect normal sans arthrose. Fig. 3 y 4. - A los siete meses la articulaci6n no estfi alterada y no hay signos de artrosis degenerativa.
DISCUSSION Aetiology
Dislocation of the IP joint of the thumb seems to mostly occur during falls while dislocation of other finger joints are mainly due to direct trauma. In fact, Salamon [7] reported such a fall in each of his cases. He thought that the hand was in extension when the patient fell, but he did not give any details about the activity that led to the accident. Failla [2] reported a fall during a game, while Sabapathy's [6] patient fell from his motorbike. Kitagawa [4] reported the case of a police officer who fell while playing football. Anatomical lesions
Several distinct anatomical elements can account for irreducibility of such dislocations. Salamon [7] reported interposition of the flexor pollicis longus tendon between the ulnar condyle of the proximal
phalanx and the base of the distal phalanx. Such dorso-ulnar or dorso-radial displacement of the tendon occurs in the presence of avulsion of at least one ligamentous collateral complex. Excentration of the tendon accounts for rotation of the second phalanx detectable clinically and visible on X-rays. Pohl [5] reported similar disorders on a dislocated proximal IP joint of a long finger and managed to reduce the dislocation by direct action on the tendon. Another element that can account for irreducibility is the palmar plate. Rupture of this palmar complex is necessary to induce dislocation and it can also be responsible for irreducible lesions. Rupture of the palmar plate seems to occur mainly from the proximal phalanx, while the plate remains attached to the base of the distal phalanx, as reported by Greenfield [3], Salamon [7] and ourselves. Kitagawa [4] described a third element that may interfere with reduction. In his report, a sesamoid
66
1998, 17, n ° 1
DORSAL DISLOCATION OF THE IP JOINT OF THE THUMB
bone, free of any connections, was imprisoned within the IP joint of the thumb and was responsible for irreducibility. Failla [2] reported a similar case, but the sesamoid bone was attached to the proximal end of the avulsed palmar plate. Sabapathy [6] also described the same type of sesamoid interposition in his case report. Skin injury and surgical approach
During our review of the literature, we found only one report concerning a closed irreducible dorsal dislocation of the IP joint of the thumb (Kitagawa [4]). In fact, all other cases displayed a wound on the palmar side of the IP joint. The condyle of the proximal phalanx can generally be seen through the wound, increasing the risk of infection. Eaton [1] thinks that the high percentage of skin lesion is due to the relative stiffness of the palmar skin compared to the looser dorsal skin. Palmar skin cannot resist excessive traction. This palmar skin lesion may be used, after incision, for the surgical approach since irreducibility is due to an anterior anatomical element. However, two authors, namely Greenfield [3] and Sabapathy [6], had to perform a dorsal transtendinous incision since they could not reduce the dislocation via a palmar approach. Kitagawa [4] was the only one who used a lateral ulnar approach to the IP joint and managed to extract the sesamoid bone from the joint and repair the ulnar collateral ligamentous complex. Management of associated lesions
Although we did not repair either the palmar plate or the torn collateral ligamentous complex, there are various points of view concerning the management of these lesions. In fact, most operators have not indicated whether they tested the joint for stability. They therefore did not provide any information about ligamentous sutures. However, Kitagawa [4] repaired a collateral ligamentous complex by a "pull-out" suture. We followed Salamon's [7] attitude and deliberately ignored such ligamentous lesions. The palmar plate was never repaired in this review. We think that such lesions should be repaired only in the case of osseous avutsion of the palmar plate. Excision of the sesamoid bone seems legitimate, as it does not play any precise role within the palmar plate at the IP joint of the thumb. Failla [2], who found such a bone still attached to the proximal edge of the palmar plate, decided not to excise it. In any case, whether this sesamoid bone is excised or left attached to the palmar plate, the final result does not seem to be affected.
ANNALES DE C H I R U R G I E DE LA MAIN
E~Du~MBr~S~R~EUR ANNALSOFHAND ANDUPPERLII~IB SURGERY
Immobilisation
Each operator seems to adopt his own attitude concerning immobilisation of the thumb. Salam0n [7] preferred immediate rehabilitation when the joint was stable after reduction and three weeks of immobilisation in the case of an unstable joint. Kitagawa [4] preferred three weeks of immobilisation after repairing the ulnar collateral ligamentous complex. We adopted the same attitude as Failla [2], who immobilised the IP joint by axial pinning for three weeks. This allowed a better supervision of the palmar wound. Final functional result
Final results are roughly equivalent in almost all reported cases. Greenfield [3] reported active flexion of 45 ° post-operatively resulting in active flexion of 60 ° at final evaluation. Failla [2] and Kitagawa [4] reported 45 ° of active flexion of the IP joint, although Kitagawa latter operated his patient twelve days after injury. However, Sabapathy's [6] patient developed a stiff but painless joint due to septic arthritis.
CONCLUSION When managing dorsal dislocation of the IP joint of the thumb, emergency physicians should not insist if reduction is not easily obtained. In fact, repeated attempts to reduce the dislocation might worsen the case. A close analysis of standard X-rays should look for elements hindering reduction. The patient should then be referred to a surgical team for appropriate management in an operating theatre. Suitable treatment results in a satisfactory functional thumb despite partial loss of active flexion.
REFERENCES i. EATON R.G. - L6sions r6centes et anciennes des ligaments des doigts. In : TUBIANA R.,Traitd de Chirurgie de la main, Tome 2. Paris, Masson, 1984. 2. FAILLA J.M. - Irreducible thumb interphalangeal joint dislocation dne to a sesamoid and palmer plate. A case report..1.. Hand Surg., 1995, 20A, 490-491. 3. GREENFIELD G.Q. -Dislocation of the interphalangeal joint of the thumb. J. Trauma., 1981, 21, 901-901. 4. KITAGAWA H., KASHIMOTO T. - Locking of the thumb at the interphalangeal joint by one of the sesamoid bones. A case report. Bone Joint Surg., 1984, 66A, 1300-1301. 5. POHL A.L. - Irreducible dislocation of the distal interphalangeal joint. Br. J. Plast. Surg., 1976, 29, 227-220. 6. SABAPATHY S.R., BOSE V.C., REX C. -Irreducible dislocation of the interphatangeal joint of the thumb due to sesamoid bone interposition. A case report. J. Hand Surg., 1995, 20A, 487-489. 7. SALAMON P.B., GELBERMAN R.H. - Irreductible dislocation of the interphalangeal joint of the thumb. J. Bone Joint Surg., 1978, 601t, 400-401.
ANNALES DE C H I R U R G I E DE L A MA1)~ ET DUMEMBRESUPERIEUR A N N A L S OF H A N D ANDUPPERLIMB SURGERY
1998, 17, n° 1 DORSAL DISLOCATION OF THE IP JOINT OF THE THUMB
67
GERARD F., PEM R., GARBUIO P., OBERT L., TROPET Y. Luxation dorsale irr6ductible de l'articulation interphalangienne du pouce due ~tla plaque palmaire. (En Anglais). Ann Chir Main (Ann Hand Surg), 1998, 17, n ° 1, 63-67.
GERARD F., PEM R., GARBUIO P., OBERT L., TROPET Y. - Luxacidn dorsal irreductible de la articulacidn interfalfingica del pulgar a causa de la placa volar. Ann Chir Main (Ann Hand Surg), 1998, 17, n ° 1, 63-67.
RI~SUMI~ : La luxation dorsale de l'articulation interphalangienne du pouce est rare. Seuls quelques cas de luxations irr6ductibles sont rapport6s. Les auteurs rapportent un cas d'irr6ductibilit6 due ~ l'interposition de la plaque palmaire dans l'articulation. Des cas d'incarc6ration des s6samoides ou d'interposition du tendon du l o n g f l 6 c h i s s e u r du p o u c e o n t 6 g a l e m e n t 6t6 r a p p o r t 6 s . E n p r 6 s e n c e d ' u n e l u x a t i o n d o r s a l e de l'interphalangienne du pouce si la r6duction apparait i m p o s s i b l e p a r m a n o e u v r e s e x t e r n e s , les a u t e u r s r e c o m m a n d e n t de ne pas insister mais d ' o p t e r p o u r un abord chirurgical qui p e r m e t t r a de lever l'interposition.
R E S I J M E N : L a l u x a c i 6 n dorsal de la a r t i c u l a c i 6 n interfalfingica del pulgar es rara. Solo algunos casos de luxacidn irreductible sa hart descrito. Los autores p r e s e n t a n un caso de irreductibilidad a causa de la interposicidn de la placa volar en la articulacidn. Se han descrito igualmente casos de incarceracidn de los sesamoideos o de interposicidn del tenddn del flexor largo del pulgar. En presencia de una luxacidn dorsal de la interfalfingica del pulgar si la reducci6n no es posible mediante maniobras externas, los autores recom i e n d a n de no continuar insistiendo y de optar por el abordaje quirfirgico que permitirfi eliminar la interposici6n.
MOTS-CLI~S : Articulation interphalangienne. - Pouce. Plaque palmaire. - Luxation irr6ductible.
PALABRAS-CLAVE: Articulacidn interfalfingica. - Pulgar. Placa volar. - Luxacidn irreductible.
i
GERARD F., PEM R., GARBUIO P., OBERT L., TROPET Y. - Ann Chir Main (Ann Hand Surg), 1998, 17, n ° 1, 63-67.
mmm
Irreducible dorsal dislocation of the interphalangeal joint of the thumb due to the palmar plate A case report
E GERARD, R. PEM, P. GARBUIO, L. OBERT, Y. TROPET
SUMMARY : Dorsal dislocation of the thumb interphalangeal joint is rare. Only very few cases of irreducible dislocation has been reported at this joint. The authors report a case of compound irreducible dislocation due to the palmar plate interposition. The sesamoid, the flexor pollicis longus have been reported to block reduction of the dorsal dislocation of the thumb interphalangeal joint doctors on casualities should not insist if reduction is not easily obtained, the patient should then be guide towards a surgical team for surgical treatment. Ann Chir Main (Ann Hand S u r g ) , 1998, 17, n ° 1, 63-67. M O T S - C L ] ~ S : I n t e r p h a l a n g e a l joint. - T h u m b . - P a l m a r plate. - I r r e d u c i b l e dislocation,
INTRODUCTION
CASE REPORT
Dorsal dislocation of the interphalangeal joint of the thumb is rather rare compared to other lesions of the radial side of the hand. Irreducible forms of such lesions are exceptional since an exhaustive review of the literature revealed only a few reported cases. We report a similiar case and review several different cases reported elsewhere in order to analyse such lesions.
This case refers to a 34-year-old right-handed m a n u a l w o r k e r who fell f r o m his bicycle. He presented to the casualty department with open trauma o f the right thumb. Physical examination confirmed a deformed thumb displaying hyperextension on slight rotation at the interphalangeal joint. There was a contended skin lesion on the palmar side of the joint.
Department of Orthopaedic, Traumatologic and Plastic Surgery, CHU J. Minjoz Hospital, BESAN~ON (France). Manuscrit re~u a la R~daction le 20 novembre 1997. Aceept~ le 12 f~vrier 1998.
Correspondance : Dr F. GOrard, Clinique Saint-Joseph, 3, bd Saint-Germain, 35300 FOUGERES.
64
DORSAL DISLOCATION OF THE IP JOINT OF THE THUMB
Fig 1. - Preoperative anteroposterior X-ray of the thumb, demonstrating radial dislocation of the IP joint. Fig. 1. - L'incidence radiographique de face montre une luxation radiale de I'articulation interphalangienne. Fig. 1. - Radiografia preoperatoria del pulgar en muestra la luxaciCn radial de la IF.
la
que se
Standard X-rays confirmed dorso-radial dislocation of the IPjoint of the thumb (fig. 1 and 2). Local ring anesthesia of the thumb was immediately performed in the casualty department, but several attempts by a qualified surgeon to reduce the dislocation by external manipulation proved to be unsuccessful. The patient was then transferred to the operating room for surgical management. Under intravenous anesthesia of the right upper limb, a zig-zag palmar approach to the thumb was performed by enlarging the preexisting skin lesion. Surgical exploration showed that the base of the distal phalanx overlapped the neck of the proximal phalanx. The palmar plate, roughly 1 cm long, was still attached to the base of the distal phalanx and partly covered the dorsal face of the proximal phalanx. The ulnar ligamentous complex was ruptured. The dislocation was reduced by direct traction on the palmar plates. Testing of the IP joint showed lateral instability due to rupture of the ulnar liga-
ANNALES DE C H I R U R G I E DE LA MAIN
1998,
Er~u~U~MBR~SUPER~,~I~
17, n ° 1
ANNALS OF HAND ANDUPPERLIMB SURGERY
Fig. 2. - Preoperative lateral X-ray showing dorsal variety of the IP dislocation. Fig. 2. - La radiographie prCoperatoire de profil retrouve une variete dorsale de luxation de I'articulation interphalangienne Fig. 2. - Radiografia preoperatoria que muestra la luxacidn de la IF.
mentous complex. The IP joint also showed a tendency to hyperextension on the stress-test. This instability led the surgeon to perform temporary fixation of the IP joint using an axial pin. Neither the torn ligamentous complex nor the palmar plate was repaired. Postoperatively, the wound healed without any problem. The pin was removed 21 days after treatment and 12 physiotherapy sessions were prescribed. The patient was reviewed 7 months later. Physical examination revealed a painless thumb with a normal appearance. Active motion ranged from 0 to 40 ° of flexion. Thumb-finger (pinch) grip was strong. A stress-test showed ulnar lateral instability of 10°, not reported by the patient. He said he was very satisfied with the result of his thumb in spite of the loss of motion of the IP joint. Standard x-rays revealed a normal IP joint. Stress X-rays confirmed 10 ° of lateral instability on the ulnar side of the joint.
ANNALES DE CHIRURGIE DE LA MAIN
El" DU MEMBRE SUPI~III EUR
1998,
ANNALS OF HAND
17, n ° 1
AND UPPER LIMB
SURGERY
D O R S A L D I S L O C A T I O N O F T H E I P J O I N T O F THE T H U M B
65
Fig. 3 and 4. - Seven months later the joint is normal and free of degenerative arthritis. Fig. 3 et 4. - Sept mois apres, I'articulation presente un aspect normal sans arthrose. Fig. 3 y 4. - A los siete meses la articulaci6n no estfi alterada y no hay signos de artrosis degenerativa.
DISCUSSION Aetiology
Dislocation of the IP joint of the thumb seems to mostly occur during falls while dislocation of other finger joints are mainly due to direct trauma. In fact, Salamon [7] reported such a fall in each of his cases. He thought that the hand was in extension when the patient fell, but he did not give any details about the activity that led to the accident. Failla [2] reported a fall during a game, while Sabapathy's [6] patient fell from his motorbike. Kitagawa [4] reported the case of a police officer who fell while playing football. Anatomical lesions
Several distinct anatomical elements can account for irreducibility of such dislocations. Salamon [7] reported interposition of the flexor pollicis longus tendon between the ulnar condyle of the proximal
phalanx and the base of the distal phalanx. Such dorso-ulnar or dorso-radial displacement of the tendon occurs in the presence of avulsion of at least one ligamentous collateral complex. Excentration of the tendon accounts for rotation of the second phalanx detectable clinically and visible on X-rays. Pohl [5] reported similar disorders on a dislocated proximal IP joint of a long finger and managed to reduce the dislocation by direct action on the tendon. Another element that can account for irreducibility is the palmar plate. Rupture of this palmar complex is necessary to induce dislocation and it can also be responsible for irreducible lesions. Rupture of the palmar plate seems to occur mainly from the proximal phalanx, while the plate remains attached to the base of the distal phalanx, as reported by Greenfield [3], Salamon [7] and ourselves. Kitagawa [4] described a third element that may interfere with reduction. In his report, a sesamoid
66
1998, 17, n ° 1
DORSAL DISLOCATION OF THE IP JOINT OF THE THUMB
bone, free of any connections, was imprisoned within the IP joint of the thumb and was responsible for irreducibility. Failla [2] reported a similar case, but the sesamoid bone was attached to the proximal end of the avulsed palmar plate. Sabapathy [6] also described the same type of sesamoid interposition in his case report. Skin injury and surgical approach
During our review of the literature, we found only one report concerning a closed irreducible dorsal dislocation of the IP joint of the thumb (Kitagawa [4]). In fact, all other cases displayed a wound on the palmar side of the IP joint. The condyle of the proximal phalanx can generally be seen through the wound, increasing the risk of infection. Eaton [1] thinks that the high percentage of skin lesion is due to the relative stiffness of the palmar skin compared to the looser dorsal skin. Palmar skin cannot resist excessive traction. This palmar skin lesion may be used, after incision, for the surgical approach since irreducibility is due to an anterior anatomical element. However, two authors, namely Greenfield [3] and Sabapathy [6], had to perform a dorsal transtendinous incision since they could not reduce the dislocation via a palmar approach. Kitagawa [4] was the only one who used a lateral ulnar approach to the IP joint and managed to extract the sesamoid bone from the joint and repair the ulnar collateral ligamentous complex. Management of associated lesions
Although we did not repair either the palmar plate or the torn collateral ligamentous complex, there are various points of view concerning the management of these lesions. In fact, most operators have not indicated whether they tested the joint for stability. They therefore did not provide any information about ligamentous sutures. However, Kitagawa [4] repaired a collateral ligamentous complex by a "pull-out" suture. We followed Salamon's [7] attitude and deliberately ignored such ligamentous lesions. The palmar plate was never repaired in this review. We think that such lesions should be repaired only in the case of osseous avutsion of the palmar plate. Excision of the sesamoid bone seems legitimate, as it does not play any precise role within the palmar plate at the IP joint of the thumb. Failla [2], who found such a bone still attached to the proximal edge of the palmar plate, decided not to excise it. In any case, whether this sesamoid bone is excised or left attached to the palmar plate, the final result does not seem to be affected.
ANNALES DE C H I R U R G I E DE LA MAIN
E~Du~MBr~S~R~EUR ANNALSOFHAND ANDUPPERLII~IB SURGERY
Immobilisation
Each operator seems to adopt his own attitude concerning immobilisation of the thumb. Salam0n [7] preferred immediate rehabilitation when the joint was stable after reduction and three weeks of immobilisation in the case of an unstable joint. Kitagawa [4] preferred three weeks of immobilisation after repairing the ulnar collateral ligamentous complex. We adopted the same attitude as Failla [2], who immobilised the IP joint by axial pinning for three weeks. This allowed a better supervision of the palmar wound. Final functional result
Final results are roughly equivalent in almost all reported cases. Greenfield [3] reported active flexion of 45 ° post-operatively resulting in active flexion of 60 ° at final evaluation. Failla [2] and Kitagawa [4] reported 45 ° of active flexion of the IP joint, although Kitagawa latter operated his patient twelve days after injury. However, Sabapathy's [6] patient developed a stiff but painless joint due to septic arthritis.
CONCLUSION When managing dorsal dislocation of the IP joint of the thumb, emergency physicians should not insist if reduction is not easily obtained. In fact, repeated attempts to reduce the dislocation might worsen the case. A close analysis of standard X-rays should look for elements hindering reduction. The patient should then be referred to a surgical team for appropriate management in an operating theatre. Suitable treatment results in a satisfactory functional thumb despite partial loss of active flexion.
REFERENCES i. EATON R.G. - L6sions r6centes et anciennes des ligaments des doigts. In : TUBIANA R.,Traitd de Chirurgie de la main, Tome 2. Paris, Masson, 1984. 2. FAILLA J.M. - Irreducible thumb interphalangeal joint dislocation dne to a sesamoid and palmer plate. A case report..1.. Hand Surg., 1995, 20A, 490-491. 3. GREENFIELD G.Q. -Dislocation of the interphalangeal joint of the thumb. J. Trauma., 1981, 21, 901-901. 4. KITAGAWA H., KASHIMOTO T. - Locking of the thumb at the interphalangeal joint by one of the sesamoid bones. A case report. Bone Joint Surg., 1984, 66A, 1300-1301. 5. POHL A.L. - Irreducible dislocation of the distal interphalangeal joint. Br. J. Plast. Surg., 1976, 29, 227-220. 6. SABAPATHY S.R., BOSE V.C., REX C. -Irreducible dislocation of the interphatangeal joint of the thumb due to sesamoid bone interposition. A case report. J. Hand Surg., 1995, 20A, 487-489. 7. SALAMON P.B., GELBERMAN R.H. - Irreductible dislocation of the interphalangeal joint of the thumb. J. Bone Joint Surg., 1978, 601t, 400-401.
ANNALES DE C H I R U R G I E DE L A MA1)~ ET DUMEMBRESUPERIEUR A N N A L S OF H A N D ANDUPPERLIMB SURGERY
1998, 17, n° 1 DORSAL DISLOCATION OF THE IP JOINT OF THE THUMB
67
GERARD F., PEM R., GARBUIO P., OBERT L., TROPET Y. Luxation dorsale irr6ductible de l'articulation interphalangienne du pouce due ~tla plaque palmaire. (En Anglais). Ann Chir Main (Ann Hand Surg), 1998, 17, n ° 1, 63-67.
GERARD F., PEM R., GARBUIO P., OBERT L., TROPET Y. - Luxacidn dorsal irreductible de la articulacidn interfalfingica del pulgar a causa de la placa volar. Ann Chir Main (Ann Hand Surg), 1998, 17, n ° 1, 63-67.
RI~SUMI~ : La luxation dorsale de l'articulation interphalangienne du pouce est rare. Seuls quelques cas de luxations irr6ductibles sont rapport6s. Les auteurs rapportent un cas d'irr6ductibilit6 due ~ l'interposition de la plaque palmaire dans l'articulation. Des cas d'incarc6ration des s6samoides ou d'interposition du tendon du l o n g f l 6 c h i s s e u r du p o u c e o n t 6 g a l e m e n t 6t6 r a p p o r t 6 s . E n p r 6 s e n c e d ' u n e l u x a t i o n d o r s a l e de l'interphalangienne du pouce si la r6duction apparait i m p o s s i b l e p a r m a n o e u v r e s e x t e r n e s , les a u t e u r s r e c o m m a n d e n t de ne pas insister mais d ' o p t e r p o u r un abord chirurgical qui p e r m e t t r a de lever l'interposition.
R E S I J M E N : L a l u x a c i 6 n dorsal de la a r t i c u l a c i 6 n interfalfingica del pulgar es rara. Solo algunos casos de luxacidn irreductible sa hart descrito. Los autores p r e s e n t a n un caso de irreductibilidad a causa de la interposicidn de la placa volar en la articulacidn. Se han descrito igualmente casos de incarceracidn de los sesamoideos o de interposicidn del tenddn del flexor largo del pulgar. En presencia de una luxacidn dorsal de la interfalfingica del pulgar si la reducci6n no es posible mediante maniobras externas, los autores recom i e n d a n de no continuar insistiendo y de optar por el abordaje quirfirgico que permitirfi eliminar la interposici6n.
MOTS-CLI~S : Articulation interphalangienne. - Pouce. Plaque palmaire. - Luxation irr6ductible.
PALABRAS-CLAVE: Articulacidn interfalfingica. - Pulgar. Placa volar. - Luxacidn irreductible.
i
GERARD F., PEM R., GARBUIO P., OBERT L., TROPET Y. - Ann Chir Main (Ann Hand Surg), 1998, 17, n ° 1, 63-67.
mmm