Phalangeal Injury


   - Amputation of the Finger and Hand
   - Arthrodesis of the MP joint and Finger Joints
   - Boutonnere Injuries
   - Characteristics of Phalangeal and Metacarpal Fractures
   - Compression Screws
   - Condylar Frx
   - Crossed Finger Flap
   - Dislocations of PIP
   - Digit Reimplantation
   - Dislocations:
           - Dorsal Dislocation of the PIP joint
           - Dorsal Dislocation of the DIP joint
           - Dorsal Dislocation of the Thumb IP joint
           - Rotary PIP Subluxation
           - Volar PIP Dislocation
   - Extensor Tendon Mechanism
   - Extension Block Casting
   - Extra-Octave Frx
   - F.D.P. Avulsion
   - Finger Incisions
   - Finger Tip Injuries
   - Fractures:
           - Distal Phalangeal Frx
           - Fracture Dislocations of the PIP Joint
           - Middle Phalanx Frx
           - Pediatric Phalangeal Frx
           - Proximal Phalanx Fracture
           - Thumb Fractures
   - Grayson's Ligament
   - Lateral Bands
   - Mallet Deformity / Fractures
   - Nail Bed Injuries
   - Oblique Retincular Ligament
   - Paronychia
   - Rheumatoid Arthritis: PIP Joint 
   - Skin and Soft Tissue Replacement in the Hand
   - Surgical Approaches
   - Swan Neck Deformity
   - Tendon Injuries
   - Thumb Deformities in RA
   - Thumb Soft Tissue Defects
   - Transverse Retinacular Ligament
   - Trigger Finger
   
 - Anatomy:  
    - length of 3 phalangeal segments follows closely ratio of 1:1.618 (golden mean) of Fibonacci series discovered by Leonardo de Pisa
         - thus from distal to proximal, the length of each phalanx is sum of length of the more distal two segments;
         - this normal skeletal relationship & alignment will keep intrinsics & extrinsic muscle tendon units in equilibrium;
    - PIP Joint:
         - PIP joint is essentially a hinge joint, allowing only flexion and extension, and is more stable than MP joint;
         - vast majority of PIP collateral ligament ruptures occur at proximal attachment;
         - on stress x-ray, angulation of < 20 deg implies good prognosis;
         - checkrein ligaments;
                - swallotail extensions of volar plate along volar proximal phalanx which may thicken producing PIP flexion contracture;
                - during release of checkrein ligaments, protect transverse communicating vessels, which supply vincular system, & lie underneath checkreins, and merge in the midline;

- Exam:
   - finger aligment & rotation:
         - determined by noting relationship of fingernails w/ digits in full extension and in flexion;
    - area of precise PIP joint tenderness:
         - dorsal (central slip), radial/ulnar (collateral lig.), volar (volar plate)
   - inability to actively extend the PIP joint against resistance is diagnostic of rupture of central slip (boutonnere lesion);

- Fracture Dislocations of the PIP Joint

- Complications of Treatment:
    - malrotation:
          - avoided only by noting rotational symmetry of fingernails;
          - also note symmetry of flexed fingers which should normally point to the tubercle of scaphoid;
          - spiral fractures produce rotary deformities;
    - malunion: seen after spiral, transverse, or articular frx;
    - muscle imbalance: seen w/ transverse frxs;
    - 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;
    - flexion contracture:

- Resurfacing Arthroplasty:
    - indicated for traumatic arthritis of PIP joint;
    - volar plate can be used & advanced across painful, stiff PIP joint;
    - may achieve up to 80% of normal & good pain reduction






Use of the anterior branch of the medial antebrachial cutaneous nerve as a graft for the repair of defects of the digital nerve.

The conservative management of volar avulsion fractures of the P.I.P. joint.

Unstable fracture dislocations of the proximal interphalangeal joint. Treatment with the force couple splint.

Year Book: Chip Avulsions and Ruptures of the Palmar Plate in the PIP

The Hueston flap in reconstruction of fingertip skin loss: results in a series of 41 patients.

Nail bed repair and reconstruction by reverse dermal grafts.

An innervated cross-finger flap for fingertip reconstruction.

The use of lateral V-Y advancement flaps for fingertip reconstruction.

Extensor tenolysis: a modern version of an old approach.

Early results with osseointegrated proximal interphalanageal joint prosthesis.



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

Last updated by Data Trace Staff on Thursday, October 4, 2012 10:58 am