The terminal tendon of the digital extensor mechanism: Part II, kinematic study

Schweitzer, Timothy P.; Rayan, Ghazi M.

doi:10.1016/j.jhsa.2004.04.025

Cited by 53 publications

(33 citation statements)

References 10 publications

(7 reference statements)

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“…The best results were in the younger patients; the worse results were in those with bony mallet finger, likely because of greater tendon shortening after resection of the bone fragment. Schweitzer and Rayan's experimental work has shown that it is very difficult to reinsert the terminal extensor tendon if it is more than 1 mm retracted [19]. Similar results were obtained by Ulkür et al who reinserted the terminal tendon on the P3 base with a bone anchor [25] and with pull-out and pull-in suture techniques [26,27].…”

Section: Surgical Treatmentsupporting

confidence: 55%

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Treatment of chronic extensor tendons lesions of the fingers

Bellemère¹

2015

Chirurgie de la Main

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Section: Surgical Treatmentsupporting

confidence: 55%

“…Scheitzer and Rayan have shown that 1 mm of tendon lengthening triggers a 25-degree DIP extensor lag and that 4 mm of lengthening leads to more than 60 degrees lag [19].…”

Section: Clinical Presentation and Functional Impairmentmentioning

confidence: 99%

Treatment of chronic extensor tendons lesions of the fingers

Bellemère¹

2015

Chirurgie de la Main

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“…Moreover, these authors reported that in the DIP resting position, the intact tendon showed at a 22° angle. Likewise, the TT has been reported to exhibit an average 25° angle with a 1‐mm lengthening and a 36° angle with a 2‐mm lengthening 8. As little as 1 mm of TT shortening can result in a disturbance of the DIP joint balance 8.…”

Section: Discussionmentioning

confidence: 99%

Combinatorial roles of extrinsic and intrinsic muscles in extension strength of the distal interphalangeal joint

Murai

Tanaka

Aoki³

2011

Journal Orthopaedic Research

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In this study, we observed a combinatorial relationship between intrinsic and extrinsic muscles to extend the distal phalanx via the terminal tendon of the finger extensor. Eleven fresh-frozen human cadaver digit rays were used in these experiments (four index, four middle, three ring digits). All fingers had full joint motion without degenerative diseases. Fingers were individually mounted in a custom built jig fixed by a 1-mm Kirschner wire that was driven into the rotational center of the distal interphalangeal (DIP) and proximal interphalangeal joints. Loads were applied to the extensor digit and dorsal interosseous tendons without flexor tendons, via sutures attached over low-friction pulleys. Extension forces that crossed the DIP joint were measured by a force transducer coupled with a materials-testing machine. We observed a steep inclination of the extensor forces produced by the intrinsic muscles, and there were no significant differences in comparisons among loads (200, 400, 600, and 800 g). The inclination slope increased with an increase of load (p < 0.001). Additionally, the inclinations of the non-linear phases among all finger types were not statistically different. Thus, the contribution between the extrinsic and intrinsic muscles in providing extensor forces to the distal phalanx was similar. Keywords: terminal tendon; distal interphalangeal joint; extrinsic muscle; intrinsic muscleThe terminal tendon (TT) is the most distal portion of the extensor mechanism near the distal interphalangeal (DIP) joint. Specifically, the TT inserts into the distal base of the distal phalanx. The normal extension function of the TT is dependent on its component extrinsic and intrinsic muscles.1 Injuries to the TT can lead to digital deformities, such as mallet finger, which is caused by a disturbance of the joint balance that is maintained by the forces of the extrinsic and intrinsic muscles. Additionally, flexion and hyperextension deformities of the DIP joint are components of swan neck and boutonniere deformities.Tendinous mallet finger due to closed disruption of the TT is typically treated nonsurgically with extension splinting of the DIP joint. Extension splinting has been reported to be effective even when treatment commences several months after injury.2 The most logical option for surgical reconstruction of chronic mallet finger involves extensor tendon scar excision and direct repair of the extensor tendon. Unfortunately, after the operation, full extension of the DIP joint may not be possible. Reconstruction of the extensor mechanism with a tendon graft (spiral oblique retinacular ligament reconstruction) has been reported to be successful, but it is a somewhat technically demanding procedure.3 A rather simple but elegant procedure devised by Fowler involves rebalancing the extensor mechanism by transecting the insertion of the central slip, 4 thereby transmitting increased extensor force and excursion to the TT. 5 However, every surgical procedure may leave a small extension lag. Even if the ...

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“…The surgical technique presented in this study is made possible by the unique characteristic of the pulp. Numerous fibrous septa of the pulp allows for enough traction force needed for good visualisation for anatomical reduction of the bony mallet finger [16][17][18]. The technique introduced in this study has the following advantages:…”

Section: Discussionmentioning

confidence: 99%

Open accurate reduction for irreducible mallet fractures through a new pulp traction technique with primary tendon repair

Kang

Lee

2012

Journal of Plastic Surgery and Hand Surgery

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Sixteen patients with bony mallet fingers were treated by a new technique of open reduction through a T-shaped dorsal incision and oblique wire fixation via pulp traction with additional primary extensor repair. Surgical indications included fractures with intra-articular involvement over 1/3 of the articular surface, distal phalanx subluxation, and displacement greater than 3 mm irreducible by extension block pinning. The cases were analysed prospectively for a mean follow-up period of 12 months. The results were evaluated using Crawford's criteria. Eleven cases were evaluated as excellent, three cases as good, and two cases as fair. Complications included three cases with transient nail deformity, two cases with flexion limitation of 5° and 10°, and three cases with extension lag between 5°-10°. This new method of accurate reduction achieves good clinical outcomes, with comparatively less complications in mallet fractures irreducible to closed extension block reduction.

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The terminal tendon of the digital extensor mechanism: Part II, kinematic study

Cited by 53 publications

References 10 publications

Treatment of chronic extensor tendons lesions of the fingers

Treatment of chronic extensor tendons lesions of the fingers

Combinatorial roles of extrinsic and intrinsic muscles in extension strength of the distal interphalangeal joint

Open accurate reduction for irreducible mallet fractures through a new pulp traction technique with primary tendon repair

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