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Palmar dislocation of the proximal interphalangeal joint requiring open reduction: A case report
Palmar dislocation of the proximal interphalangeal joint requiring open reduction: A case report A case is described of a palmar dislocation of the proximal interphalangeal joint that required open reduction because of interposition of the central extensor tendon. (J HAND SURG 9A:717-8, 1984.)
L. De Smet, M.D., and M. Vercauteren, M.D., Ghent. Belgium
Palmar dislocation of the proximal interphalangeal (PIP) joint of the finger is an uncommon injury. Unlike dorsal dislocations, reduction (with closed manipulation) is not always possible. This article describes a case of irreducible palmar dislocation caused by entrapment of an intact central extensor tendon in the PIP joint. Case report A 22-year-old girl sustained a twisting injury to the long finger of her left hand. She was holding the halter of her horse when the horse suddenly threw its head back, catching the patient's finger in the halter ring. Physical examination of the left hand revealed painful swelling of the PIP joint of the long finger. Radiographs disclosed palmar dislocation of this joint (Fig. I). Closed reduction under interdigital nerve block was unsuccessful. Exposure of the dislocation was through a curved dorsal incision, exposing the head of the proximal phalanx. The radial lateral extensor tendon was displaced in a palmar direction and the central extensor tendon was entrapped in the joint (Fig. 2). Reduction was easily achieved after removing the central extensor tendon from the joint space. No residual instability was observed and the dorsal capsule of the PIP joint was repaired with a 5.0 nylon suture. The joint was immobilized in extension with a transfixation wire. Two weeks later, the wire was removed and gentle mobilization was started. A full range of motion was regained 2 months after injury.
From the Department of Physical Medicine and Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium. Received for publication Nov. 21, 1983; accepted in revised form Jan. 30, 1984. Reprint requests: Dr. L. De Smet, Department of Physical Medicine and Orthopaedic Surgery, Ghent University Hospital, De Pintelaan 185, B 9000, Ghent, Belgium.
Fig. 1. Palmar dislocation of the PIP joint.
Discussion Palmar dislocations of the PIP joint are often irreducible because of entrapment of dorsal soft tissue structures.1. 2 Open reduction with repair of associated lesions is required in these cases. Spinner and ChoP reported five cases with residual boutonniere deformity, two of which were reduced by closed methods. Rupture of the central extensor tendon has been reported to be a frequently associated lesion. Entrapment of an intact central extensor tendon has been reported four times~-6 and open reduction is recommended in these cases. THE JOURNAL OF HAND SURGERY
717
The Journal of HAND SURGERY
De Smer alld Vercauterell
The authors thank Ms. Iris Wojtowicz for translation of their manuscript into English.
REFERENCES
lET
LET
CET
Fig. 2. Schematic representation of intraoperative findings. CET = central extensor tendon; LET = lateral extensor tendon.
I. Spinner M, Choi B: Anterior dislocation of the proximal interphalangeal joint. A cause of rupture of the central slip of the extensor mechanism. J Bone Joint Surg [Am] 52: 1329-36, 1970 2. Neviaser R , Wilson J: Interposition of the extensor tendon resulting in persisting subluxation of the proximal interphalangeal joint of the finger. Clin Orthop 83: 118-20, 1972 3. Johnson F, Greene M: Another cause of irreducible dislocation of the proximal interphalangeal joint of a finger. J Bone Joint Surg [Am] 48:542-4, 1966 4. Murakami Y. Irreducible volar dislocation of the proximal interphalangeal joint of the finger. Hand 6:87-90, 1974 5. Posner M, Wilenski M: Irreducible volar dislocation of the proximal interphalangeal joint of a finger caused by interposition of an intact central slip. J Bone Joint Surg [Am] 60: 133-4, 1978 6. Meyn M: Irreducible volar dislocation of the proximointerphalangeal joint. Clin Orthop 158:2 15-8, 1982
Stiffness of small-bone external fixation methods: An experimental study A variety of small-bone external fixation methods were evaluated to determine bending and torsional stiffness. Several methods of external pin stabilization with bone cement and with a commercial device were used. Among experimental variables examined were: the number of pins, pin diameter, pin length, pin spacing, and pin threading. The most rigid fixation was achieved with four pins held with a wire-reinforced bone cement fixator. Pin diameter was the most significant variable in the determination of stiffness with this configuration. (J HAND SURG 9A:718-24, 1984.)
Steven A. Stuchin, M.D., and Frederick J. Kummer, Ph.D., New York, N.Y.
From the Department of Orthopaedics, Hospital for Joint Diseases, Orthopaedic Institute, New York, N. Y . Received for publication April 12, 1983; accepted in revised form Dec. 23, 1983 . Reprint requests: Steven A. Stuchin , M.D ., Department of Orthopaedics, Hospital for Joint Diseases, Orthopaedic Institute, 301 E. 17th St., New York , NY 10003.
718
THE JOURNAL OF HAND SURGERY
The rigidity of various internal fixation systems for small-bone fractures has been studied intensively .I-5 Although a number of external fixation techniques have been described, objective data as to their relative stiffness have not been reported .6 - 9 Furthermore, no comparative experimental data of internal
L. De Smet, M.D., and M. Vercauteren, M.D., Ghent. Belgium
Palmar dislocation of the proximal interphalangeal (PIP) joint of the finger is an uncommon injury. Unlike dorsal dislocations, reduction (with closed manipulation) is not always possible. This article describes a case of irreducible palmar dislocation caused by entrapment of an intact central extensor tendon in the PIP joint. Case report A 22-year-old girl sustained a twisting injury to the long finger of her left hand. She was holding the halter of her horse when the horse suddenly threw its head back, catching the patient's finger in the halter ring. Physical examination of the left hand revealed painful swelling of the PIP joint of the long finger. Radiographs disclosed palmar dislocation of this joint (Fig. I). Closed reduction under interdigital nerve block was unsuccessful. Exposure of the dislocation was through a curved dorsal incision, exposing the head of the proximal phalanx. The radial lateral extensor tendon was displaced in a palmar direction and the central extensor tendon was entrapped in the joint (Fig. 2). Reduction was easily achieved after removing the central extensor tendon from the joint space. No residual instability was observed and the dorsal capsule of the PIP joint was repaired with a 5.0 nylon suture. The joint was immobilized in extension with a transfixation wire. Two weeks later, the wire was removed and gentle mobilization was started. A full range of motion was regained 2 months after injury.
From the Department of Physical Medicine and Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium. Received for publication Nov. 21, 1983; accepted in revised form Jan. 30, 1984. Reprint requests: Dr. L. De Smet, Department of Physical Medicine and Orthopaedic Surgery, Ghent University Hospital, De Pintelaan 185, B 9000, Ghent, Belgium.
Fig. 1. Palmar dislocation of the PIP joint.
Discussion Palmar dislocations of the PIP joint are often irreducible because of entrapment of dorsal soft tissue structures.1. 2 Open reduction with repair of associated lesions is required in these cases. Spinner and ChoP reported five cases with residual boutonniere deformity, two of which were reduced by closed methods. Rupture of the central extensor tendon has been reported to be a frequently associated lesion. Entrapment of an intact central extensor tendon has been reported four times~-6 and open reduction is recommended in these cases. THE JOURNAL OF HAND SURGERY
717
The Journal of HAND SURGERY
De Smer alld Vercauterell
The authors thank Ms. Iris Wojtowicz for translation of their manuscript into English.
REFERENCES
lET
LET
CET
Fig. 2. Schematic representation of intraoperative findings. CET = central extensor tendon; LET = lateral extensor tendon.
I. Spinner M, Choi B: Anterior dislocation of the proximal interphalangeal joint. A cause of rupture of the central slip of the extensor mechanism. J Bone Joint Surg [Am] 52: 1329-36, 1970 2. Neviaser R , Wilson J: Interposition of the extensor tendon resulting in persisting subluxation of the proximal interphalangeal joint of the finger. Clin Orthop 83: 118-20, 1972 3. Johnson F, Greene M: Another cause of irreducible dislocation of the proximal interphalangeal joint of a finger. J Bone Joint Surg [Am] 48:542-4, 1966 4. Murakami Y. Irreducible volar dislocation of the proximal interphalangeal joint of the finger. Hand 6:87-90, 1974 5. Posner M, Wilenski M: Irreducible volar dislocation of the proximal interphalangeal joint of a finger caused by interposition of an intact central slip. J Bone Joint Surg [Am] 60: 133-4, 1978 6. Meyn M: Irreducible volar dislocation of the proximointerphalangeal joint. Clin Orthop 158:2 15-8, 1982
Stiffness of small-bone external fixation methods: An experimental study A variety of small-bone external fixation methods were evaluated to determine bending and torsional stiffness. Several methods of external pin stabilization with bone cement and with a commercial device were used. Among experimental variables examined were: the number of pins, pin diameter, pin length, pin spacing, and pin threading. The most rigid fixation was achieved with four pins held with a wire-reinforced bone cement fixator. Pin diameter was the most significant variable in the determination of stiffness with this configuration. (J HAND SURG 9A:718-24, 1984.)
Steven A. Stuchin, M.D., and Frederick J. Kummer, Ph.D., New York, N.Y.
From the Department of Orthopaedics, Hospital for Joint Diseases, Orthopaedic Institute, New York, N. Y . Received for publication April 12, 1983; accepted in revised form Dec. 23, 1983 . Reprint requests: Steven A. Stuchin , M.D ., Department of Orthopaedics, Hospital for Joint Diseases, Orthopaedic Institute, 301 E. 17th St., New York , NY 10003.
718
THE JOURNAL OF HAND SURGERY
The rigidity of various internal fixation systems for small-bone fractures has been studied intensively .I-5 Although a number of external fixation techniques have been described, objective data as to their relative stiffness have not been reported .6 - 9 Furthermore, no comparative experimental data of internal