Late volar plate repair for chronic, post-traumatic hyperextension deformity of the proximal interphalangeal joint of the little finger

Abstract

A chronic traumatic hyperextension of the proximal interphalangeal (PIP) joint can result from traumatic volar plate (VP) disruption. For the treatment of this disorder, reconstruction procedures have been traditionally recommended, because the condition of the VP was not considered susceptible to repair due to retraction or attenuation. The purpose of this paper is to present the operative technique and report the clinical results of late VP repair. Late VP repair was performed for chronic, post-traumatic hyperextension deformity of the PIP joint of the little finger resulting from VP disruption in seven consecutive patients. The range of motion and the lateral stability of the PIP joint were evaluated. The radiographic images were also used to evaluate the alignment and degenerative changes of the PIP joint. Clinical results were classified according to Catalano's criteria. Intraoperative findings showed that the VP could be mobilised and repaired in all cases. The hyperextension was well corrected, and none showed recurrence of the initial deformity. Average flexion of the PIP joint was 92° (range = 75-98°), and flexion contracture was 9° (range = 0-20°). On clinical evaluation, there were two excellent, three good, and two fair results. The postoperative radiographs revealed no degenerative change in the PIP joint in six patients. Late VP repair is a successful and reliable alternative and more physiologic than other reconstruction methods. One should first consider late VP repair, despite a long interval between injury and repair.

Chronic post-traumatic volar plate avulsions of the finger proximal interphalangeal joint: A literature review of different surgical techniques

“…In 2008, Lee et al 25 described their suture technique used on 14 patients with acute volar plate avulsion and 6 chronic patients. Regarding chronic patients, the results at a 26 published their results of 7 patients they treated with a suture with a pull-out or with an anchor, describing their extension results as "well corrected" with 2 excellent results, 3 good and 2 fair. In 2003, Catalano et al 22 were the first authors to expose their results for the treatment of volar plate chronic avulsion with FDS tenodesis.…”

“…The volar plate can be sutured directly to itself 1,9 or reattached to the bone using a minianchor. 25,26 Melone et al 1 use to exit the suture from the dorsal aspect of the P2 and to fix the PIPJ at approximately 15° to 25°of flexion with 0.35mm Kirschner wire for 3 weeks. Wollestein et al 9 prefer to suture the volar plate to itself with a single 5-0 suture of polyglycolic acid (Dexon).…”

Volar Plate Avulsion of Pip Joint: An Unusual Fielding Injury in Cricket

“…[15][16][17][18] Surgical corrections are warranted only in cases with large bony avulsions, associated dorsal instability of the PIP joint and recurrent/neglected volar plate injuries. 2,19 Surgical interventions are faced with difficulties of excessive tissue scarring and insufficiency of the volar plate tissue especially with increasing chronicity. Late volar plate repairs are technically demanding Jpmer surgeries for the aforementioned reasons and surgeons may have to resort to reconstruction procedures and flexor digitorum superficialis tenodesis procedure.…”

“…Late volar plate repairs are technically demanding Jpmer surgeries for the aforementioned reasons and surgeons may have to resort to reconstruction procedures and flexor digitorum superficialis tenodesis procedure. 2,19 The outcomes of such procedures are still inconclusive and further studies are required to determine the efficacy of these surgical interventions. All these stress, the importance of early recognition and appropriate conservative management of such injuries.…”

Avulsion Injuries of the Hand and Wrist

“…Inadequately healed or untreated volar plate injuries can lead to chronic swelling, stiffness, pain, flexion contracture, swan-neck deformity, and posttraumatic arthritis (58,60,61). Scar tis- sue forms at the volar plate attachment, which impairs flexion of the PIP joint (61).…”