- See:
boutonniere injury:
- Discussion:
-
flexion contracture:
- treatment should start with static or dynamic splinting;
- in the study by Bruser et al 1999, a midlateral incision yielded a more normal ROM than a palmar incision;
- use of a palmar incision may cause a skin defect to open once the contracture is relieved and may require skin grafting
as well as a delay in ROM;
-
midlateral incision:
- may be approached from the radial or ulnar side of the digit;
- neurovascular bundle is identified and retracted palmarly;
-
transverse retinacular ligament is released;
- visualize the accessory collateral ligament and the palmar plate and release their proximal attachments;
- in some cases, a tenolysis of the FDS tendon and incision of the A3 pulley are necessary;
- ref: Results of proximal interphalangeal joint release for flexion contractures: midlateral versus palmar incision.
P. Bruser MD et al.
J. Hand Surg. Vol 24-A. 1999. p 288-294.
-
stiffness following frx:
- may be related to improper positioning of the hand after reduction;
- articular fractures may become are often associated with delays in union due to fibrinolysis in the synovial fluid;
- best results are obtained when joint becomes stiff in neutral position;
-
treatment:
- when joint is stiff in extension,
transverse retinacular ligaments are transected;
- then collateral ligaments are transected from dorsal to palmar until passive motion is regained;
