By Julie E. Adams
Comprised solely of scientific situations overlaying accidents to the proximal interphalangeal (PIP) joint, this concise, sensible casebook will supply orthopedic surgeons and hand surgeons with the easiest real-world options to correctly deal with the multifaceted surgical ideas for administration of the PIP. each one bankruptcy is a case that opens with a different scientific presentation, through an outline of the analysis, evaluation and administration suggestions used to regard it, in addition to the case final result and medical pearls and pitfalls. situations incorporated illustrate either operative and non-operative remedy of volar fracture dislocations, dorsal block splinting and pinning, ORIF with screw fixation, volar plate and hemi hamate arthroplasty, PIP joint fusion, and pediatric PIP joint accidents, between others. Pragmatic and reader-friendly, PIP Joint Fracture Dislocations: A medical Casebook should be a great source for orthopedic surgeons and Hand surgeons faced with either universal and complicated fractures to the PIP joint.
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Additional resources for PIP Joint Fracture Dislocations: A Clinical Casebook
Smooth K-wire dorsally through the head of the proximal phalanx, preventing terminal extension (Fig. 1). This is placed with a minidriver under power and is ideally placed adjacent to the extensor apparatus to avoid piercing the extensor tendon and creating adhesions. Position of the pin is checked with intraoperative fluoroscopy. This wire allows the finger to move through a full arc of flexion but prevents terminal extension of approximately 30–40° short of full extension, therefore preventing it from extending into a position of risk for repeat subluxation or dislocation [8, 9].
J Hand Surg 1998;23A:811–820) (Fig. 7a, b) and two were treated with ORIF, whereas all chronic injuries were treated with open reduction and soft tissue reconstruction. At an average of 55-month follow-up, PIP motion averaged 91° for acute injuries and 71° for chronic injuries, and overall 8 of 13 patients were pain-free. Radiographic abnormalities including increased posteroanterior height of the base of the middle phalanx, articular irregularity, and subluxation were common, but these findings did not correlate with clinical results.
The patient is then asked to maximally make a fist with all fingers and rupture of remaining flexor tendon adhesions may be palpated. Typically, PIP flexion to 90° is possible after several minutes, though the DIP joint is usually unable to fully flex due to stiffness. The patient was then placed into a dorsal blocking AlumaFoam splint secured to the dorsal proximal phalanx with tape and blocking PIP extension at 20°. Full active flexion and extension within the confines of the splint are begun immediately and hand therapy is initiated.