- Discussion:
- is always detached (usually
from middle phalanx) in PIP dorsal dislocations;
- distal avulsion of volar plate in dorsal PIP dislocations makes entrapment
of plate w/in the joint unlikely (in contrast to MP joint in which
complex
dorsal dislocations prevent closed reduction);
- an irreducible dislocation of PIP joint is probably
rotary PIP subluxation:
- volar plate maintains its attachmnets to the proximal phalanx & its lateral
attachments to the accessory collateral ligament;
- collateral ligaments may also be ruptured at the time of injury;
- Treatment w/ Intraosseous Wiring:
- see:
interosseous wiring discussion;
- this technique may be indicated for volar plate avusions which occur
detach an articular fragment;
- 20 gauge wire is passed either thru two bone holes or thru the junction of the
volar plate and the fragment (if the fragment is small), and is then
passed thru parallel holes adjacent to the fracture surface on the phalanx;
- the wires should emerge on the dorsal surface of the middle phalanx, over the
triangular ligament near the mid line;
- the wires are tightened down, securing the fragment;
-
ref: Intraosseous Wiring of the Digital Skeleton.
G. Lister MD FRCS
J. Hand Surgery. Vol 3, No 5, Sept 1978.
- Case Example:
- 30 yo male who sustained multiple dorsal PIP dislocations of the middle
finger which resulted in a hyper-extension deformity and gross instability;
The proximal interphalangeal joint volar plate II.
A clinical study of hyperextension injury.
WH Bowers.
J. Hand Surgery. Vol 6. 1981. p 77-81.
Chip Avulsions and Ruptures of the Palmar Plate in the PIP
Volar plate arthroplasty for the PIP joint. A ten year review.
RG Eaton.
J. Hand Surgery. Vol 5. 1980. p 260-268.
The proximal interphalangeal joint volar plate. I.
WH Bowers.
J. Hand Surg. Vol 5. p 79. 1980.
