Advertisement

Proximal Phalangeal Joint Injuries

  • Simon MacLean
  • Gregory I. BainEmail author
Chapter

Abstract

The PIP joint is frequently injured in combat sports and often underplayed by participants, coaches, and medical staff. Outcomes are often poor due to delayed presentation, controversies as to ideal treatment, and technical challenges of repair and reconstruction of the joint.

Clinical and radiographic assessment is crucial. If surgical treatment is deemed necessary, the treating surgeon should have an array of strategies in his armamentarium. A thorough understanding of the anatomy and biomechanics of the joint is crucial.

Primary aim is for repair of the injury—the method of which will be dictated by the size and quality of bone and soft tissue. Internal and external fixation methods can be used. Reconstructive strategies are often more complex in nature. Salvage procedures should be reserved for cases presenting late or not amenable to repair or reconstruction. Stiffness is common. The goal of surgical treatment therefore is to maintain anatomical reduction and stability yet permitting early range of motion.

This chapter highlights these issues the surgeon faces when confronted with these challenging injuries.

Keywords

Proximal interphalangeal joint Combat sports Fracture-dislocation Internal fixation External fixation Collateral ligaments Volar plate Hemi-hamate 

Supplementary material

Video 2.1

Sagittal anatomy and extensor apparatus in motion. Following a PIP joint injury, the volar plate is likely to become scarred, restricting PIP joint extension. In addition the vincula and the adjacent “mesentery” become edematous and restrict tendon motion. Copyright Dr. Gregory Bain (MOV 5708 kb)

References

  1. 1.
    McCue FC, Andrews JR, Hakala M, Gieck JH. The coach’s finger. Am J Sports Med. 1974;2(5):270–5.  https://doi.org/10.1177/036354657400200503.CrossRefGoogle Scholar
  2. 2.
    Bain, GI, Polites N, Higgs BG et al. Functional motion of the joints of the hand. The American Academy of Orthopaedic Surgeons: Rosemont, IL; 1999.Google Scholar
  3. 3.
    Bain G, Hunt J, Mehta J. Operative fluoroscopy in hand and upper limb surgery. One hundred cases. J Hand Surg J Br. 1997;22(5):656–8.  https://doi.org/10.1016/S0266-7681(97)80368-3.CrossRefGoogle Scholar
  4. 4.
    Bain GI, Mehta JA. The proximal interphalangeal joint: surgical and mobilisation options. Br J Hand Ther. 1998;3(4):13–8.  https://doi.org/10.1177/175899839800300404.CrossRefGoogle Scholar
  5. 5.
    Bain GI, Polites N, Higgs BG, Heptinstall RJ, McGrath AM. The functional range of motion of the finger joints. J Hand Surg Eur Vol. 2015;40(4):406–11.  https://doi.org/10.1177/1753193414533754.CrossRefPubMedGoogle Scholar
  6. 6.
    Bain G, Roth J, Mehta J. Injuries of the proximal interphalangeal joint. Hand Ther. 1998;3(4):9–12.  https://doi.org/10.1016/S0072-968X(79)80048-0.CrossRefGoogle Scholar
  7. 7.
  8. 8.
    Minamikawa Y, Horii E, Amadio PC, Cooney WP, Linscheid RL, An K-N. Stability and constraint of the proximal interphalangeal joint. J Hand Surg Am. 1993;18(2):198–204.  https://doi.org/10.1016/0363-5023(93)90345-4.CrossRefPubMedGoogle Scholar
  9. 9.
    Bowers WH. Injuries and complications of injuries to the capsular structures of the interphalangeal joints. In: Bowers WH, editor. The Interphalangeal joints. New York: Churchill Livingstone; 1987.Google Scholar
  10. 10.
    Dray GJER. Dislocations and ligament injuries in the digits. In: Green DP, editor. Operative hand surgery. New York: Churchill Livingstone; 1993.Google Scholar
  11. 11.
    Kiefhaber TR, Stern PJ, Grood ES. Lateral stability of the proximal interphalangeal joint. J Hand Surg Am. 1986;11(5):661–9.  https://doi.org/10.1016/S0363-5023(86)80008-9.CrossRefPubMedGoogle Scholar
  12. 12.
    Carlo J, Dell PC, Matthias R, Wright TW. Collateral ligament reconstruction of the proximal interphalangeal joint. J Hand Surg. 2016;41(1):129–32.  https://doi.org/10.1016/j.jhsa.2015.10.007.CrossRefGoogle Scholar
  13. 13.
    Lee JI, Jeon WJ, Suh DH, Park JH, Lee JM, Park JW. Anatomical collateral ligament reconstruction in the hand using intraosseous suture anchors and a free tendon graft. J Hand Surg Eur Vol. 2012;37(9):832–8.  https://doi.org/10.1177/1753193412436947.CrossRefPubMedGoogle Scholar
  14. 14.
    Mantovani G, Pavan A, Aita MA, Argintar E. Surgical reconstruction of PIP joint collateral ligament in chronic instability in a high performance athlete. Tech Hand Up Extrem Surg. 2011;15(2):87–91.  https://doi.org/10.1097/BTH.0b013e3181efa215.CrossRefPubMedGoogle Scholar
  15. 15.
    Elson RA. Rupture of the central slip of the extensor hood of the finger. A test for early diagnosis. J Bone Joint Surg Br. 1986;68(2):229–31.CrossRefGoogle Scholar
  16. 16.
    Shah CM, Sommerkamp TG. Fracture dislocation of the finger joints. J Hand Surg Am. 2014;39(4):792–802.  https://doi.org/10.1016/j.jhsa.2013.10.001.CrossRefPubMedGoogle Scholar
  17. 17.
    Elfar J, Mann T. Fracture-dislocations of the proximal interphalangeal joint. J Am Acad Orthop Surg. 2013;21(2):88–98.  https://doi.org/10.5435/JAAOS-21-02-88.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Dobyns JH, McElfresh EC. Extension block splinting. Hand Clin. 1994;10(2):229–37. http://www.ncbi.nlm.nih.gov/pubmed/8040201. Accessed 7 June 2017.PubMedGoogle Scholar
  19. 19.
    Light T. Buttress pinning techniques. Orthop Rev. 1981;10:49–55.Google Scholar
  20. 20.
    Hamilton SC, Stern PJ, Fassler PR, Kiefhaber TR. Mini-screw fixation for the treatment of proximal interphalangeal joint dorsal fracture–dislocations. J Hand Surg Am. 2006;31(8):1349–54.  https://doi.org/10.1016/j.jhsa.2006.07.011.CrossRefGoogle Scholar
  21. 21.
    Cheah AEJ, Tan DMK, Chong AKS, Chew WYC. Volar plating for unstable proximal interphalangeal joint dorsal fracture-dislocations. J Hand Surg Am. 2012;37(1):28–33.  https://doi.org/10.1016/j.jhsa.2011.08.030.CrossRefGoogle Scholar
  22. 22.
    Bain GI, McGuire DT, McGrath AM. A simplified lateral hinge approach to the proximal interphalangeal joint. Tech Hand Up Extrem Surg. 2015;19(3):129–32.  https://doi.org/10.1097/BTH.0000000000000094.CrossRefPubMedGoogle Scholar
  23. 23.
    Eaton RG, Malerich MM. Volar plate arthroplasty of the proximal interphalangeal joint: a review of ten years’ experience. J Hand Surg Am. 1980;5(3):260–8. http://www.ncbi.nlm.nih.gov/pubmed/7400563. Accessed 7 June 2017.CrossRefGoogle Scholar
  24. 24.
    Burton RI, Eaton RG. Common hand injuries in the athlete. Orthop Clin North Am. 1973;4(3):809–38. http://www.ncbi.nlm.nih.gov/pubmed/4783899. Accessed 7 June 2017.PubMedGoogle Scholar
  25. 25.
    Bain GI, Mehta JA, Heptinstall RJ, Bria M. Dynamic external fixation for injuries of the proximal interphalangeal joint. J Bone Joint Surg Br. 1998;80(6):1014–9. http://www.ncbi.nlm.nih.gov/pubmed/9853495. Accessed 7 June 2017.CrossRefGoogle Scholar
  26. 26.
    Deitch MA, Kiefhaber TR, Comisar BR, Stern PJ. Dorsal fracture dislocations of the proximal interphalangeal joint: surgical complications and long-term results. J Hand Surg Am. 1999;24(5):914–23.  https://doi.org/10.1053/jhsu.1999.0914.CrossRefPubMedGoogle Scholar
  27. 27.
    Williams RMM, Hastings H, Kiefhaber TR. PIP fracture/dislocation treatment technique: use of a hemi-hamate resurfacing arthroplasty. Tech Hand Up Extrem Surg. 2002;6(4):185–92. http://www.ncbi.nlm.nih.gov/pubmed/16520599. Accessed 7 June 2017.CrossRefGoogle Scholar
  28. 28.
    Williams RMM, Kiefhaber TR, Sommerkamp TG, Stern PJ. Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft. J Hand Surg Am. 2003;28(5):856–65. http://www.ncbi.nlm.nih.gov/pubmed/14507519. Accessed 7 June 2017.CrossRefGoogle Scholar
  29. 29.
    Calfee RP, Kiefhaber TR, Sommerkamp TG, Stern PJ. Hemi-hamate arthroplasty provides functional reconstruction of acute and chronic proximal interphalangeal fracture-dislocations. J Hand Surg Am. 2009;34(7):1232–41.  https://doi.org/10.1016/j.jhsa.2009.04.027.CrossRefGoogle Scholar
  30. 30.
    Katsaros J, Milner R, Marshall N. Perichondrial arthroplasty incorporating costal cartilage. J Hand Surg Am. 1995;20(2):137–42. http://journals.sagepub.com/doi/abs/10.1016/S0266-7681(05)80039-7. Accessed 7 June 2017.CrossRefGoogle Scholar
  31. 31.
    Hasegawa T, Yamano Y. Arthroplasty of the proximal interphalangeal joint using costal cartilage grafts. J Hand Surg J Br. 1992;17(5):583–5.  https://doi.org/10.1016/S0266-7681(05)80248-7.CrossRefGoogle Scholar
  32. 32.
    Tsai T-M, Jupiter JB, Kutz JE, Kleinert HE. Vascularized autogenous whole joint transfer in the hand—a clinical study. J Hand Surg Am. 1982;7(4):335–42.  https://doi.org/10.1016/S0363-5023(82)80140-8.CrossRefPubMedGoogle Scholar
  33. 33.
    Foucher G. Vascularized joint transfers. Oper hand Surg. 1993;2:1201–21. https://scholar.google.com.au/scholar?q=foucher+1993+vascularized&btnG=&hl=en&as_sdt=0%2C5. Accessed 7 June 2017.Google Scholar
  34. 34.
    Khouri JS, Bloom JMP, Hammert WC. Current trends in the management of proximal interphalangeal joint injuries of the hand. Plast Reconstr Surg. 2013;132(5):1192–204.  https://doi.org/10.1097/PRS.0b013e3182a48d65.CrossRefPubMedGoogle Scholar
  35. 35.
    Badia A, Riano F, Ravikoff J, Khouri R, Gonzalez-Hernandez E, Orbay JL. Dynamic intradigital external fixation for proximal interphalangeal joint fracture dislocations. J Hand Surg Am. 2005;30(1):154–60.  https://doi.org/10.1016/j.jhsa.2004.07.019.CrossRefPubMedGoogle Scholar
  36. 36.
    Suzuki Y, Matsunaga T, Sato S, Yokoi T. The pins and rubbers traction system for treatment of comminuted intraarticular fractures and fracture-dislocations in the hand. J Hand Surg Br. 1994;19(1):98–107. http://www.ncbi.nlm.nih.gov/pubmed/8169490. Accessed 15 Aug 2017.CrossRefGoogle Scholar
  37. 37.
    Agee JM. Unstable fracture dislocations of the proximal interphalangeal joint of the fingers: a preliminary report of a new treatment technique. J Hand Surg Am. 1978;3(4):386–9. http://www.ncbi.nlm.nih.gov/pubmed/681726. Accessed 15 Aug 2017.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryTauranga HospitalBay of PlentyNew Zealand
  2. 2.Department of Orthopaedic SurgeryFlinders UniversityAdelaideAustralia
  3. 3.Flinders Medical CentreAdelaideAustralia

Personalised recommendations