Flexion Contacture of the PIP Joint



- 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.

    - 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



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, October 4, 2012 11:00 am