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Due to the simplicity, low cost and benefit of avoiding long-term joint immobilization, extension block pinning could be a suitable option for treating the volar base fractures of the middle phalanges. The aim of the present study was to evaluate the outcomes of using extension block pinning in chronic volar base fractures of the middle phalanges. In total, 26 patients with chronic closed volar base fractures of the middle phalanges were included our study. The mean age was 37 years (SD 11.59), and the mean follow-up time was 35 months (SD 19.41). The mean active range of motion (ROM) after surgery was 93° (SD 12.9). There was a negative correlation between the age and the ROM of the injured proximal interphalangeal joint after surgery. ROM did not correlate with the articular surface involvement or the interval between injury and surgery. We obtained a satisfactory result from extension block pinning for volar base fractures of the proximal interphalangeal joint in patients with chronic injuries. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Hemi-hamate arthroplasty is a method used to reconstruct complex fracture-dislocations of the proximal interphalangeal joint of the fingers. Other graft sites, including the toe second and third phalanges, have been proposed as alternatives to hemi-hamate arthroplasty due to variable clinical outcomes and anatomy. Through a prospective magnetic resonance imaging (MRI)-based study in asymptomatic individuals, we aimed to characterize the anatomy of the proximal interphalangeal joint and compare this with the hamate, second and third toes to determine the closest anatomical match using pre-determined measurements. Our results show that the second and third toes have greater anatomical similarity to the proximal interphalangeal joint of the fingers compared to the hamate. High-resolution MRI is a reliable method of characterizing the anatomy of these structures and could be a useful clinical tool in determining reconstructive options in the management of this challenging injury. Level of evidence: II [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis (OA) contributes increasingly to disability worldwide. There is ample high-quality research on the treatment of knee and hip OA, whereas research on surgical and non-surgical treatment in hand OA is sparse. Limited evidence suggests that education and exercise may improve pain, function, stiffness, and grip strength in hand OA. The established surgical options in hand OA have disadvantages. Prostheses preserve motion but have a high complication rate, whereas fusions decrease function due to limited movement. There is an unmet need for high-quality research on treatment options for hand OA and a need for the development of effective and safe movement-sparing therapies. This study aims to compare the effects of a motion-preserving surgical treatment (denervation of the proximal interphalangeal (PIP) joint) with a patient education and exercise program on patient-reported outcomes and objective function in painful PIP OA. Methods: In this parallel-group, two-armed, randomized, controlled superiority trial (RCT), 90 participants are assigned to surgical PIP joint denervation or education and exercise. Pain on load 1 year after intervention is the primary outcome measure. Secondary outcome measures include pain at rest, Patient-Rated Wrist and Hand Evaluation (PRWHE), HQ8 score, EQ5D-5L, objective physical function, complications, two-point discrimination, Mini Sollerman, consumption of analgesics, and the need for further surgery. Assessments are performed at baseline, 3 and 6 months, and 1 year after intervention. Discussion: There are no previous RCTs comparing surgical and non-surgical treatment in PIP OA. If patient education plus exercise or PIP denervation improve function, these treatments could be implemented as first-line treatment options in PIP OA. However, if denervation does not achieve better results than non-surgical treatment, it is not justified to use in PIP OA. Trial registration: Prospectively registered in ClinicalTrials.gov (NCT05980793) on 8 August 2023. URL https://classic.clinicaltrials.gov/ct2/show/NCT05980793. [ABSTRACT FROM AUTHOR]

Background: Intra-articular fractures of the proximal interphalangeal joint (PIPJ) can result in poor outcomes if inadequately treated. Dynamic external fixation and internal fixation with plates and/or screws are two treatment options. The role of combining these two methods is unclear. The aim of this study is to determine the outcomes of patients with intra-articular fractures of the PIPJ treated with a combination of dynamic external fixation with a plate and/or screws. Methods: A retrospective review was conducted on 18 consecutive cases of intra-articular fractures of the PIPJ treated with pins and rubber band traction system (PRTS) combined with dorsal internal fixation with plates and/or screws. The patients' average age was 51 years (range: 20–81 years). The fracture patterns were volar-type (n = 2), dorsal-type (n = 4) and pilon-type (n = 12). Data with regard to time to surgery, interphalangeal joint range of motion, grip strength, VAS for pain, Quick DASH score, complications, duration of follow-up and return to work were collected. Results: The levels of articular involvement were stable (n = 1), tenuous (n = 5) and unstable (n = 12). The average time to surgery was 9 days, and the average follow-up period was 15 months. The fracture was fixed with a dorsal plate and screws in 10 patients and with only screws in eight patients. All patients had PRTS. All patients returned to their original occupation and the fractures united in good alignment. The average grip strength was 86% of that of the unaffected side. The average active PIPJ motion was 85° (range: 50°–106°), and the average active distal interphalangeal joint (DIPJ) motion was 48° (range: 10°–90°). Conclusions: Our results show that a combination of PRTS and open reduction and fixation with plate and/or screws achieved a good range of motion and articular reduction. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

Abstract Background Osteoarthritis (OA) contributes increasingly to disability worldwide. There is ample high-quality research on the treatment of knee and hip OA, whereas research on surgical and non-surgical treatment in hand OA is sparse. Limited evidence suggests that education and exercise may improve pain, function, stiffness, and grip strength in hand OA. The established surgical options in hand OA have disadvantages. Prostheses preserve motion but have a high complication rate, whereas fusions decrease function due to limited movement. There is an unmet need for high-quality research on treatment options for hand OA and a need for the development of effective and safe movement-sparing therapies. This study aims to compare the effects of a motion-preserving surgical treatment (denervation of the proximal interphalangeal (PIP) joint) with a patient education and exercise program on patient-reported outcomes and objective function in painful PIP OA. Methods In this parallel-group, two-armed, randomized, controlled superiority trial (RCT), 90 participants are assigned to surgical PIP joint denervation or education and exercise. Pain on load 1 year after intervention is the primary outcome measure. Secondary outcome measures include pain at rest, Patient-Rated Wrist and Hand Evaluation (PRWHE), HQ8 score, EQ5D-5L, objective physical function, complications, two-point discrimination, Mini Sollerman, consumption of analgesics, and the need for further surgery. Assessments are performed at baseline, 3 and 6 months, and 1 year after intervention. Discussion There are no previous RCTs comparing surgical and non-surgical treatment in PIP OA. If patient education plus exercise or PIP denervation improve function, these treatments could be implemented as first-line treatment options in PIP OA. However, if denervation does not achieve better results than non-surgical treatment, it is not justified to use in PIP OA. Trial registration Prospectively registered in ClinicalTrials.gov (NCT05980793) on 8 August 2023. URL https://classic.clinicaltrials.gov/ct2/show/NCT05980793 .

Volar plate injuries of the proximal interphalangeal (PIP) finger joint are common. Conservative treatment involves orthoses to limit hyperextension at the PIP joint yet allow movement of the joints to prevent joint stiffness and deformity. Custom-made dorsal blocking orthoses are recommended treatments. Previous research also supports the use of a figure-of-8 orthosis, although the comparative effectiveness of these orthoses is not currently known. This study aimed to compare the figure-of-8 orthosis and dorsal blocking orthosis for changes in the range of movement, pain, and function following stable volar plate PIP joint injuries and to compare the number of hand therapy appointments required. A parallel-group pilot randomized controlled trial. This trial was registered with the Australian and New Zealand Clinical Trials Registry (Trial ID: CTRN12619000449134). Participants aged 13-65 years were recruited from an outpatient hand therapy service and randomly assigned to experimental or control groups. The experimental group of 20 participants received a custom-made thermoplastic figure-of-8 orthosis limiting the extension to 15-20 degrees. The control group of 22 participants had a dorsal blocking orthosis, which was serially extended by 10 degrees weekly starting at 30 degrees flexion. Participants were blinded to their group allocation. Outcome measures included range of movement, edema, pain, function, and number of hand therapy appointments. Data collection was completed by the treating therapist who was not blinded to group assignment. Data analysis included a series of mixed-model analyses of variance to examine changes over time. Forty-two participants were recruited and had their data analyzed. No significant between-group differences were observed for DIP flexion, PIP flexion, pain, and function from baseline to follow-up. Both groups exhibited significant improvements in these outcomes over time (p < 0.001); effect sizes ranged from small to large (0.28-0.79). On average, the intervention group required 4 (±1.5) appointments compared to 6 (±1.5) in the control group over the same period representing a significant difference (p < 0.001). Both dorsal blocking and figure-of-8 orthoses provide similar outcomes. The use of a figure-of-8 orthosis, or a dorsal block orthosis fabricated in maximal comfortable extension depending on severity, could reduce the number of appointments and increase convenience for patients. • Dorsal blocking and figure-of-8 orthoses are effective for volar plate injuries. • Improvements in movement, edema, pain, and function were observed in both groups. • Figure-of-8 orthosis, or a dorsal block orthosis fabricated in maximal comfortable extension, could reduce the number of appointments. [ABSTRACT FROM AUTHOR]

Volar fracture–dislocations of the proximal interphalangeal joint are rare injuries caused by an axial force on a flexed digit resulting in an avulsion fracture of the dorsal lip of the middle phalanx with volar dislocation of the joint. This volar subtype is analogous to the more common dorsal subtype with a mirror image fracture on the dorsal lip of the middle phalanx. The main significance in this type of injury lies in the disruption of the extensor mechanism at the central slip. The goals of treatment, apart from restoring a congruent and stable joint, is to restore the extensor mechanism to prevent a boutonnière deformity. In this article, we summarise the current literature and discuss the principles for treatment of this uncommon injury. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Introduction Small joints replacement is a valid treatment for deforming osteoarthritis and traumatic injuries to the phalangeal joints of the hand to restore motor hand functions. Various types of implants differing in shape, biomechanics and material composition have been developed. The purpose of the study was to evaluate long-term results of the proximal interphalangeal joint arthroplasty of the hand using various implants and identify their advantages. Material and methods We retrospectively reviewed 78 cases of proximal interphalangeal joint replacement in 64 patients. Outcomes were assessed at 6 months and at follow-up stages with preoperative and postoperative measurements of the range of motion in the joint evaluating pain, radiographs and outcomes measures using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Results The range of motion in the prosthetic joint increased significantly at different follow-up periods with all types of implants. The pain syndrome decreased. Radiographs revealed 10 cases of aseptic instability in the group of constrained prostheses. The DASH assessment showed high subjective satisfaction with the treatment. Discussion We could not find papers reporting PIP joint arthroplasty using SBI D.G.T. implant system. A retrospective study of RM Finger arthroplasty of the PIP joint indicated restored joint stability with AROM improvement and with low pain, although it had a high rate of complications. We recorded no complications with this implant model. Some authors would not recommend the RM Finger implant (Mathys) for PIP joint replacement. Arthroplasty of small joints of the hand with MOJE kermik-implantate showed satisfactory outcomes for 82 % of patients at a long term Conclusion Arthroplasty of the PIP joint of the hand using various implant designs resulted in greater mobility of the upper limbs, a lower pain due to subjective improvement in the functionality at a long term. Although the procedures were effective with all implant designs the reliability of changes in the parameters was more evident with nonconstrained implants.

Introduction: Dorsal fracture dislocations (DFD) of the proximal interphalangeal joint (PIPJ) are challenging fractures. A palmar surgical approach and plate fixation has a high complication rate, including flexor contractions, reduction of range of motion (ROM) and secondary need for plate removal. Methods: We use the flexor tendon pulleys to cover the mini plate with the assumption that it may reduce the adhesion between the mini plates and the tendons and reduce postoperative complications. We present the outcomes of using this technique in eight patients. Results: All patients had an excellent outcome at a mean follow-up of 17 months, and none required removal of the implants. Conclusions: This study presents a surgical technique that may potentially reduce the high complication rate found after ORIF for treatment of DFD of the PIPJ. Therefore, improving the clinical outcomes after this type of surgery. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: A flexion contracture (FC) of the proximal interphalangeal (PIP) joint can have a profound negative influence on daily activity. The outcomes of surgical release of the PIP joint in literature are based on small sample size studies done several decades ago. The aim of this study is to report the outcomes of surgical treatment for post-traumatic FC of the PIP joint and to identify factors that affect these outcomes. Methods: This single institute retrospective study included patients from 2000 to 2020. We only included patients with post-traumatic FC of the PIP joint. We evaluated the demographic characteristics, cause of FC, surgical approaches and the various procedures conducted. We surveyed postoperative complications. During the study period, we asked about their current symptoms and evaluated their operative outcomes as excellent, good, fair or poor through the phone. Results: The average FC recovery angle was 37.3°. The small finger was the most affected, and the most common cause of FC was a tendon laceration. The volar plate complex release was the most frequently conducted procedure. The FC improvement was positively correlated to the degree of preoperative FC. The more severe preoperative flexion–extension arc was presented, the more FC recovery was achieved after operation. Patients who underwent multiple procedures had a higher degree of preoperative FC, and better correction was achieved with multiple procedures than with a single procedure. The most critical complication was recurrence. Conclusions: We were able to obtain average 37.3° of extension by surgical treatment. The more severe the FC presented before surgery, the greater the need for multiple procedures, however, this resulted in a significant increase in joint extension. Nevertheless, caution should be exercised regarding recurrence and could occur even with an experienced surgeon. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

Abstract Background Acute closed volar plate injury of the proximal interphalangeal joint (PIP) is a common hand injury. In the past, there were few objective evaluation imaging methods for the degree of volar plate injury. The purpose of this study was to investigate the role of high frequency ultrasonography in diagnosing volar plate injury, and to explore whether ultrasound can provide a beneficial guidance to clinical decision-making and appropriate treatment adopting through accurate US classification of volar plate injury. Methods From May 2019 to may 2022, 41 patients diagnosed with volar plate injury were included in this study. All patients underwent ultrasonography and X-ray examinations. The sonographic features were analyzed. A new kind of classification of volar plate injury based on ultrasonography findings was described. Results Either an injury of volar plate or an avulsion fracture of middle phalangeal base was identified clearly on ultrasonography, according to which volar plate injury could be divided into three types: A, B and C. Type A, avulsion fracture of the middle phalangeal base without volar plate rupture; Type B, full thickness tear of the volar plate without avulsion fracture; Type C, partial thickness tear of the volar plate. The average thickness of the three types of injured volar plate measured by ultrasound was 0.33 ± 0.05 cm, and the average thickness of the volar plate at the same site of the corresponding finger on the contralateral side was 0.22 ± 0.03 cm. There was significant difference between the two group (t = 11.823, p = 1.2476 *10^(-14)). Conclusions High frequency ultrasonography could be a reliable, accurate, convenient and non-radioactive diagnostic imaging technique in the evaluation of acute closed volar plate injury of PIP. And ultrasound could provide a beneficial guidance to clinical decision-making and appropriate treatment adopting through accurate US classification.

Background: Literature investigating the long-term outcomes of prosthesis options for proximal interphalangeal (PIP) joint arthroplasty is scarce, with most reports combining indications and underlying pathologies in analyses. In this study, we aim to compare silicone, pyrocarbon and metal prostheses in PIP joint arthroplasty for primary degenerative osteoarthritis (OA). Methods: A review of scientific literature published between 1990 and 2021 was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Relevant studies were screened and the appropriate data was extracted. An evaluation of clinical outcomes (range of motion [ROM] and pain), complications (reoperation) and survival rates for each prosthesis was performed. Results: Twelve studies were included for analysis with a total of 412 PIP joints. ROM was 66.6°, 55.8° and 46.4° for metal, silicone and pyrocarbon implants, respectively. Silicone implants had the best pain score on the visual analogue scale (1.2) followed by the pyrocarbon (2.6) and metal (3.9) groups. Complication rates were lowest in silicone implants (11.3%) compared to 18.5% in pyrocarbon and 22.4% in metal prostheses. Survival did not differ significantly amongst the three groups. Conclusions: Our findings suggest that for patients with primary degenerative OA, PIP joint arthroplasty using a silicone prosthesis can provide greater pain relief with lower complication rates compared to other implant options. Level of Evidence: Level III (Therapeutic) [ABSTRACT FROM AUTHOR]

Purpose: To assess the efficacy and safety of intra-arterial injection of imipenem/cilastatin sodium (IPM/CS) via a needle placed into the radial artery or ulnar artery (RA/UA) for distal interphalangeal and proximal interphalangeal joint osteoarthritis (DIP/PIP-OA). Materials and Methods: This is a retrospective single-arm cohort study. Ninety-two patients [92% women, mean (SD) age 55(8.3) years] with a primary DIP/PIP-OA meet the American College of Rheumatology criteria for hand osteoarthritis with pain ≥ 4 on the 0–10 numeric rating scale (NRS) were enrolled. All procedures were performed by injecting IPM/CS through a 24-gauge needle percutaneously inserted into the RA/UA. Two procedures were planned; the second procedure was scheduled 1–2 months after the first. NRS, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, Patient Global Impression of Change (PGIC) scale, and procedure-related adverse events were evaluated. Results: Technical success, defined as injection of IPM/CS into the RA/UA, was achieved in all patients. Clinical success, defined as a reduction of 2 points or more in the NRS at 12 months, was 77% (95% confidence interval 68–85%). The NRS improved from the baseline to 3, 6, and 12 months (7.8 ± 1.6 vs. 3.8 ± 2.6, 3.9 ± 2.7, and 4.0 ± 2.8, respectively, all p < 0.001). The QuickDASH score improved from the baseline to 12 months (27 ± 15 vs. 19 ± 17, p < 0.001) respectively. No major adverse events were observed. Conclusions: Intra-arterial injection of IPM/CS is a feasible treatment option for DIP/PIP-OA. [ABSTRACT FROM AUTHOR]

Background: Acute closed volar plate injury of the proximal interphalangeal joint (PIP) is a common hand injury. In the past, there were few objective evaluation imaging methods for the degree of volar plate injury. The purpose of this study was to investigate the role of high frequency ultrasonography in diagnosing volar plate injury, and to explore whether ultrasound can provide a beneficial guidance to clinical decision-making and appropriate treatment adopting through accurate US classification of volar plate injury. Methods: From May 2019 to may 2022, 41 patients diagnosed with volar plate injury were included in this study. All patients underwent ultrasonography and X-ray examinations. The sonographic features were analyzed. A new kind of classification of volar plate injury based on ultrasonography findings was described. Results: Either an injury of volar plate or an avulsion fracture of middle phalangeal base was identified clearly on ultrasonography, according to which volar plate injury could be divided into three types: A, B and C. Type A, avulsion fracture of the middle phalangeal base without volar plate rupture; Type B, full thickness tear of the volar plate without avulsion fracture; Type C, partial thickness tear of the volar plate. The average thickness of the three types of injured volar plate measured by ultrasound was 0.33 ± 0.05 cm, and the average thickness of the volar plate at the same site of the corresponding finger on the contralateral side was 0.22 ± 0.03 cm. There was significant difference between the two group (t = 11.823, p = 1.2476 *10^(-14)). Conclusions: High frequency ultrasonography could be a reliable, accurate, convenient and non-radioactive diagnostic imaging technique in the evaluation of acute closed volar plate injury of PIP. And ultrasound could provide a beneficial guidance to clinical decision-making and appropriate treatment adopting through accurate US classification. [ABSTRACT FROM AUTHOR]

Background: Surgical approaches to the proximal interphalangeal (PIP) joint often require disruption of soft tissue stabilizers. Additionally, PIP joint injuries frequently result in soft tissue disruption. This study evaluates the necessity of repairing soft tissue stabilizers by assessing their role in maintaining native joint congruity. Methods: Eight specimens were used to evaluate congruity at 0° and 30° flexion when loaded with 2 N of valgus force. This was performed in the native joint and after sequential sectioning of the surrounding ligaments in order: volar plate (VP), radial collateral ligament (CL), and ulnar CL. The skin flap was sutured with the ligaments unrepaired and the load was reapplied. Radiographs were taken after each load and used to measure the joint line convergence angle (JLCA). Results: Mean JLCA increased in both degrees of flexion after ligaments were sectioned but was only significantly different from the native joint after the VP was disrupted along with 1 CL. Joint congruity improved following repair of the skin flap in both degrees of flexion but was not significant. Joints were more congruent in 30° flexion for all subgroups, but none were significantly different compared to 0° flexion. Conclusions: Disruption of the VP is insufficient to significantly alter PIP joint congruity. While sectioning of both the VP and CLs resulted in a statistically significant change in joint congruity, mean JLCA demonstrated changes of minor clinical significance. The osseous anatomy of the phalanges imparts inherent stability that maintains a congruent joint despite loss of the soft tissue stabilizers. [ABSTRACT FROM AUTHOR]

Acute calcific periarthritis (ACP) in the interphalangeal joints of the hand is rare, with less than 100 cases reported. A rare case of ACP in a proximal interphalangeal (PIP) joint of the hand, in a young black woman, after acute trauma, is presented. She experienced severe pain and limited range of motion, and was medicated with an oral corticoid, which was followed by a rapid resolution of the symptoms. At six months, there were no signs of clinical or radiographic recurrence. Recognition of ACP allows for avoiding unnecessary treatments. In this case, treatment with corticoids might have played a role in a faster recovery. [ABSTRACT FROM AUTHOR]

This is a retrospective study to evaluate the outcome of volar plate interposition arthroplasty for proximal interphalangeal joint post-traumatic osteoarthritis with a minimum 5-year follow-up. We identified patients receiving volar plate interposition arthroplasty for post-traumatic osteoarthritis in proximal interphalangeal joints. The measurements included the numeric pain scale (on a scale of 0–10), the proximal interphalangeal joint active range of motion, the Michigan Hand Outcomes Questionnaire, the perioperative radiograph of the involved digit, proximal interphalangeal joint stability, and pinch strength. Eight patients with a median age of 44 years old (interquartile range (IQR): 29.3–56.8) were included in this study. The median follow-up period was 6.5 years (range of 5–11 years). The median numeric pain scale improved from 5 (IQR: 4.3–6.0) preoperatively to 0 (IQR 0–0.8) at the follow-up evaluation (p = 0.011). All digits demonstrated stability during manual stress testing compared to their noninjured counterparts. The median active proximal interphalangeal joint arc of motion improved from 25° to 55° (p = 0.011). The pinch strength of the fingers on the injured hand was weaker than those on the contralateral hand (2.2 Kg vs. 3.7 Kg, p = 0.012). We suggested that volar plate interposition arthroplasty may be an alternative surgical option for post-traumatic osteoarthritis in the proximal interphalangeal joints. [ABSTRACT FROM AUTHOR]

Background: The hemi-hamate arthroplasty is utilised for the management of complex fracture-dislocations for injuries of the proximal interphalangeal joints (PIPJ) of the fingers. PIPJ outcomes are well described, including the post-operative range of motion, grip strength and osteochondral graft union. However, there is a paucity of evidence analysing the rate of donor site morbidity and complications. This systematic review aims to present the published morbidity of the donor site for the hemi-hamate arthroplasty. Methods: A search was conducted in MEDLINE, Embase, Emcare, CINAHL and ProQuest Nursing and Allied Health databases from their inception which yielded 384 articles to be screened. Pertinent anatomy, harvesting techniques and post-operative donor site care of the hemi-hamate arthroplasty is reviewed. Results: One hundred three cases of hemi-hamate arthroplasty were included in this review with seven (6.8%) complications presented, one of which required operative intervention. Conclusion: Donor site morbidity resulting from harvesting an osteochondral graft for a hemi-hamate arthroplasty is low. The overall quality of evidence from the studies in this review is low, highlighting the need for further robust prospective trials. Level of evidence: Not gradable. [ABSTRACT FROM AUTHOR]

Finger injuries involving the proximal interphalangeal (PIP) joint are common, particularly among athletes. Injury severity is often underappreciated at initial presentation and may be dismissed broadly as a "jammed finger" injury. Delayed diagnosis and treatment of certain injuries can have an important impact on the patient's chance of regaining full function. Central slip and PIP volar plate injuries are frequently encountered injuries that, if left untreated, can lead to the permanent loss of function of the proximal interphalangeal joint. Despite the differing mechanisms of these 2 pathologies, volar plate hyperextension injuries often present with a PIP joint flexion contracture and mild distal interphalangeal joint hyperextension deformity. This is similar to a boutonniere deformity seen after an injury to the central slip, and thus, has been referred to as a "pseudo-boutonnière" deformity. Distinguishing these 2 diagnoses is important, as treatment differs, and highlights the importance of thoroughly understanding the anatomy and relevant clinical applications when evaluating PIP joint injuries. [ABSTRACT FROM AUTHOR]

Camptodactyly is a relatively rare hand deformity presenting as the proximal interphalangeal joint's nontraumatic and progressive flexion contracture. Most cases are limited to the fifth finger. The severity and type of camptodactyly should be considered to optimize treatment. Since many structures at the finger base can be involved in the pathogenesis of the deformity, surgical treatment for this particular type of deformity is challenging. This paper aims to bring insight into camptodactyly's pathogenesis and treatment options. We discuss the indication and pitfalls of surgical treatment options for particular camptodactyly types and present a case of a fourteen-year-old boy who was admitted to our department with proximal interphalangeal joint flexion contracture of the left fifth digit. [ABSTRACT FROM AUTHOR]

Background: Comminuted fractures of the proximal interphalangeal (PIP) joint are one of the most difficult fractures to treat in hand surgery. Hooks and rubber traction frames are an easy way to do this for fractures. This study aims to describe the outcomes of patients with PIP joint fractures with rubber traction frames. Materials and Methods: The results of sixteen patients with PIP joint fractures between 2020 and 2022 were analyzed retrospectively. Patient's age and sex, time between trauma and surgery, postoperative follow-up period, affected joint site, postoperative complications, PIP and distal interphalangeal (DIP) joint range of motion, and cause of injury were recorded. Results: Ten (62.5%) patients were male and six (37.5%) patients were female in this study. The average age of patients was 28.50 ± 3.42 years. The average range of motion of the PIP joint at 12 months postoperatively was 4.88° to 86.25°. During that period, the patient's average range of motion of the DIP joint ranged from 4.38° to 86.25°. Malunion/nonunion and osteomyelitis were not seen in any patient. Conclusion: A pin and rubber traction frame is a safe and effective method for difficult phalanx joint fractures.

Introduction: Proximal Interphalangeal (PIP) Joint fracture dislocation commonly observed to involve one or both the condyles of proximal phalanx or base of middle phalanx. Clinical aspects of PIP joint fracture dislocation typically include pain, swelling, and restricted movements over the site of the lesion. Achieving functional and painless range of motion at the PIP joint is a reasonable outcome. The ideal goal for treating these comminuted intra-articular fractures of the PIP joint is to achieve anatomical reduction and stable fixation of the fracture fragments combined with traction followed by early mobilization to prevent joint stiffness. Thereby, the purpose of this study is to evaluate the effectiveness of dynamic external traction systems to allow both reduction of fracture fragments by capsule-ligamentotaxis and early mobilization. Materials and Methods: A total of thirty patients with PIP joint fracture dislocation who were operated with a dynamic external traction system were assessed as a part of the study between the period of December 2019 and July 2021. All the patients included in the study showed a PIP joint fracture dislocation on anteroposterior and lateral radiographs of the 2nd, 3rd, 4th, or 5th phalanx. All patients were operated for PIP joint fracture dislocation with dynamic external traction system under general anesthesia or regional block under fluoroscopy guidance and assessed for functional outcome postoperatively according to Ishida scoring system. Results: According to Ishida scoring system, our study observed 19 (63.33%) cases with excellent outcome, 6 (20%) cases with good, 4 (13.33%) cases with fair, and 1 (3.33%) case with poor outcome compared to a study conducted by Ishida et al., which observed 9 (39.13%) cases with excellent outcome, 6 (26.08%) with good, and 6 (26.08%) with fair outcomes each and 2 (0.08%) cases with poor outcome. Conclusion: In this prospective study, we have concluded that the dynamic distraction external fixation of PIP joint fracture dislocation is a good method for obtaining early rehabilitation of the patient with minimal complications. The technique ensures an anatomic reduction, stable fixation, good union, and early mobilization with good and fast recovery. However, this is a small study and requires a larger sample size for definitive conclusion.

Abstract Background The digital artery-based V–Y advancement flap is a widely used flap for soft tissue coverage in the treatment of flexion contracture of the proximal interphalangeal (PIP) joint. A standard method for the flap design and a mathematical method to predict the advance distance have not been well established. In this study, we proposed a simplified method for the design of V–Y advancement flaps based on digital arteries and used a geometric model to predict the advance distance for the flexion contracture correction surgery. Methods According to the general concept of hand flap design and law of cosine, we proposed three principles in the design of the digital artery-based V–Y advancement flap that should be followed. Since 2021 to 2022, finger geometric data of 120 fingers (index, middle, ring, and small fingers) from 30 healthy participants were collected and analysed to evaluate the necessary advance distance and flap tip angle for PIP flexion contracture correction of different fingers by our flap design method. Results The middle finger needed a significantly longer advance distance compared to other fingers in the same degree flexion contracture correction. The ring finger had the largest length-to width ratio and smallest flap tip angle among the four fingers in the V–Y flap design. No vertical scar crossed the flexion creases and flap tip angle

Proximal interphalangeal joint flexion contracture is a frequent condition in hand therapy. Clinicians most frequently apply orthosis management for conservative treatment. Orthoses should apply forces for long periods of time following the total end range time (TERT) concept. These forces necessarily transmit through the skin; however, skin has physiological limitations determined by blood flow. Using three fresh frozen human cadavers, this study quantified and compared forces, skin contact surfaces and pressure of two finger orthoses, an elastic tension digital neoprene orthosis (ETDNO) and an LMB 501 orthosis. The study also investigated the effects of a new method of orthosis construction (serial ETDNO orthoses) that customizes forces to a specific finger position. We evaluated forces and contact surfaces for multiple ETDNO models tailored to the cadaver fingers in multiple PIP flexion positions. The results showed that the LMB 501 orthosis applied pressures beyond the recommended limits if applied for more than eight hours a day. This fact was the cause of time limited LMB orthosis application. This results also show that, at 30° of PIPJ flexion, straight ETDNOs created a mean pressure approaching the end of the recommended pressure limits. If the therapist modified the ETDNO design, the skin pressure decreased and reduced the risk of skin damage. With the results of this study, we concluded that for PIPJ flexion contracture, the upper limit of force application is 200 g (1.96 N). Forces beyond this amount would likely cause skin irritation and possibly skin injuries. This would cause a reduction in the daily TERT and limit outcomes. [ABSTRACT FROM AUTHOR]

• Prescription of exercise relative motion orthoses is common practice with limited evidence. • Exercise relative motion orthosis (RM) orthosis were implemented for 6 weeks to improve limited proximal interphalangeal joint motion. • Active and passive proximal interphalangeal joint movement improved, agreeing with unpublished results. • Patient comments were mostly positive about exercise RM orthosis wear. • Orthotic wear instruction for exercise RM orthoses differs from protective RM orthoses. Prospective, multicenter, consecutive case series There are 3 categories of relative motion orthoses; protective, exercise and adaptive, with only 2 unpublished studies that prescribed for exercise. These orthoses are of 2 types: relative motion extension (RME) orthoses and relative motion flexion (RMF) orthoses. To describe prescription of relative motion (RME and RMF) exercise orthoses when used to assist recovery of proximal interphalangeal joint (PIPJ) movement after injury or surgery. Therapists enrolled patients who had limited PIPJ movement after injury or surgery and demonstrated greater passive than active isolated PIPJ movement. Relative motion exercise orthoses and usual hand therapy treatments were implemented for 6 weeks. Measures of PIPJ motion, pain, and patient-report of orthotic wear time and perceived benefit were recorded at the time of orthotic intervention, at 3 weeks and at 6 weeks. Eight therapists from 4 private hand therapy clinics implemented RM exercise orthoses in 14 patients with limited PIPJ flexion (RME orthoses) and 6 patients with limited PIPJ extension (RMF orthoses). One participant prescribed a RMF orthosis failed to complete the study. Isolated PIPJ active flexion improved for those prescribed RME orthoses (n = 14/14) and isolated PIPJ active extension improved for those prescribe a RMF orthosis (n = 2/5). Most patient-reports were positive about the relative motion experience. Although diagnoses and prescription times differed, the outcomes of this patient series prescribed relative motion exercise orthoses agree with those of 2 unpublished case series; all in support relative motion exercise orthoses to improve limited PIPJ movement. Future studies implementing relative motion exercise orthoses to recover limited PIPJ movement after injury or surgery may be worthwhile. [ABSTRACT FROM AUTHOR]

Swan neck deformity is characterized by hyperextension of the proximal interphalangeal joint and limited extension of the distal interphalangeal joint, showing the shape of a swan's neck. The deformity can occur either acutely or chronically. A common acute cause of this deformity is trauma, and a common chronic cause is a secondary deformity due to rheumatoid arthritis. The treatment of swan neck deformity tends to depend on the knowledge and experience of the physician because the number of cases that hand surgeons can experience is limited, and there are no clear guidelines on treatment options. This review introduces the known causes of swan neck deformity and its treatment options. For swan neck deformity, the cause of the deformity, the elapsed time, the stage of the deformity, the biomechanical relationship between adjacent joints, and the functional limitations and needs of the patients must be considered when determining the treatment method. Based on these considerations, an appropriate choice should be made between nonsurgical and surgical treatment. The patients should receive a full explanation before treatment that an optimal outcome is not always guaranteed. The treatment process requires full understanding and cooperation from the patient. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis of the proximal interphalangeal (PIP) joint of the finger often leads to global hand-function detriment. Different techniques for the arthrodesis of the proximal interphalangeal joint have been described that all lead to union in a reasonable percentage of patients and period of time. This biomechanical study aims to analyze and compare the primary stability of different techniques of arthrodesis to render postoperative immobilization unnecessary. Methods: Arthrodeses of 40° of composite cylinders were tested with different techniques in four-point bending for stability in extension as well as flexion. Results: In extension, the compression screw and the compression wires showed the highest stability—whereas in flexion, plate fusion was superior. Tension band, cerclage or compression screw fusion showed the best compromise in flexion/extension stability. Conclusions: Fusion techniques that apply compression to the fusion show superior stability. Cerclage, tension band and compression screws might be able to provide enough stability to withstand the forces exerted during unencumbered activities of daily living. Arthrodesis with plates should be limited to patients with special indications and require immobilization during consolidation. [ABSTRACT FROM AUTHOR]

Focusing on fingers with proximal interphalangeal joint flexion contractures, this study seeks to determine whether significant differences exist between the joint passive range of motion PROM improvement when receiving higher doses of daily total end range time (TERT) compared to those that receive lower doses. The study randomized a parallel group of fifty-seven fingers in fifty patients with concealed allocation and assessor blinding. Divided into two groups receiving different doses of daily total end range time with an elastic tension digital neoprene orthosis, they also participated in an identical exercise program. Patients reported orthosis wear time, and the researchers performed goniometric measurements at every session during the three-week period. The primary outcome related the time patients wore the orthosis to the degrees of improvement in PROM extension. Compared to group B (daily TERT of twelve hours), group A (TERT, twenty+ hours) showed a statistically significant greater improvement in PROM after three weeks of treatment. Group A improved by a mean of 29° compared to group B's mean of 19° improvement. This study provides evidence that a higher dose of daily TERT can generate better results in the treatment of the proximal interphalangeal joint flexion contractures. [ABSTRACT FROM AUTHOR]

The proximal interphalangeal joint is critical for good hand function. Its anatomical complexities often predispose it to stiffness, involving damage to one or more structures. Improving or resolving the stiffness and increasing the range of motion require an accurate assessment and understanding of the pathogenesis. The surgical strategy can then be tailored accordingly. In some cases, restoration to pre-injury level may not be possible and this condition still represents an unsolved problem in hand surgery. Level of evidence: V [ABSTRACT FROM AUTHOR]

A 40-year-old patient and a 45-year-old patient presented with chronic dorsal and lateral subluxation of the proximal interphalangeal (PIP) joint of the little finger and underwent surgeries. Through a dorsal approach, the ulnar lateral band was transected and transferred to the radial side through the volar side of the PIP joint. The transferred lateral band and the remnant of the radial collateral ligament were secured with an anchor on the radial side of the proximal phalanx. Satisfactory results were obtained without the loss of flexion and recurrence of subluxation of the finger. This method enabled the correction of both dorsal and lateral instability of the PIP joint through a dorsal incision. The modified Thompson–Littler technique was useful for chronic instability of the PIP joint.– Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: Open reduction and internal fixation with a plate is one of the alternative treatments for fracture–dislocation of the proximal interphalangeal (PIP) joint. However, it does not always lead to satisfactory results. The aim of this cohort study is to describe the surgical procedure and discuss the factors affecting the treatment results. Methods: We retrospectively reviewed 37 cases of consecutive unstable dorsal fracture–dislocation of the PIP joint treated using a mini-plate. The volar fragments were sandwiched with a plate and dorsal cortex, and screws were used as subchondral support. The average rate of articular involvement was 55.5%. Five patients had concomitant injuries. The mean age of the patients was 40.6 years. Mean time between injury and operation was 11.1 days. The average postoperative follow-up duration was 11 months. Active ranges of motion, % total active motion (TAM) were evaluated postoperatively. The patients were divided into two groups according from Strickland score and Gaine score. Fisher's exact test, Mann–Whitney U test and a logistic regression analysis were used to evaluate the factors affecting the results. Results: The average active flexion, flexion contracture at the PIP joint, and % TAM were 86.3°, 10.5° and 80.6%, respectively. Group I included 24 patients who had both excellent and good scores. Group II included 13 patients who had neither excellent nor good scores. When the groups were compared, there was no significant relationship between the type of fracture–dislocation and the extent of articular involvement. There were significant associations between outcomes and patient age, period from injury to surgical intervention and presence of concomitant injuries. Conclusions: We concluded that meticulous surgical technique leads to satisfactory results. However, factors, including the patient's age, time from injury to surgery and the presence of concomitant injuries needing adjacent joint immobilisation, contribute to unsatisfactory outcomes. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

A 28-year–old female recreational athlete presented with middle finger proximal interphalangeal joint pain, stiffness, and ulnar deviation deformity 2 years after internal fixation of a middle phalanx base fracture-dislocation. Radiographs revealed posttraumatic changes on both sides of the proximal interphalangeal joint. Having failed nonsurgical measures, she elected to proceed with surgical reconstruction. Intraoperatively, we confirmed substantial articular damage on both sides of the joint. We proceeded with hemi-hamate autograft for 80% of the middle phalanx base. We used a cobalt chrome proximal phalanx component. After healing, the patient returned to all daily-living and athletic activities with resolution of preoperative pain, stiffness, and deformity. Twelve years after surgey, she had no pain or substantial limitations because of the finger. We measured 80° of proximal interphalangeal joint motion. The grip and fingertip-pinch strength were 91% and 73%, respectively, of the contralateral dominant hand. Radiographs showed no progressive changes compared to 3 years after surgery.

Background: The digital artery-based V–Y advancement flap is a widely used flap for soft tissue coverage in the treatment of flexion contracture of the proximal interphalangeal (PIP) joint. A standard method for the flap design and a mathematical method to predict the advance distance have not been well established. In this study, we proposed a simplified method for the design of V–Y advancement flaps based on digital arteries and used a geometric model to predict the advance distance for the flexion contracture correction surgery. Methods: According to the general concept of hand flap design and law of cosine, we proposed three principles in the design of the digital artery-based V–Y advancement flap that should be followed. Since 2021 to 2022, finger geometric data of 120 fingers (index, middle, ring, and small fingers) from 30 healthy participants were collected and analysed to evaluate the necessary advance distance and flap tip angle for PIP flexion contracture correction of different fingers by our flap design method. Results: The middle finger needed a significantly longer advance distance compared to other fingers in the same degree flexion contracture correction. The ring finger had the largest length-to width ratio and smallest flap tip angle among the four fingers in the V–Y flap design. No vertical scar crossed the flexion creases and flap tip angle < 20° was found in the tentative V–Y flap design for the 120 fingers. Conclusions: Our flap design method provides a proper advance distance and flap length-to-width ratio without common skin complications in the flap design for PIP flexion contracture of index, middle, ring and small fingers. This geometric model provides a mathematical basis for prediction of advance distance and flap tip angle in the design of a digital artery-based V–Y advancement flap. [ABSTRACT FROM AUTHOR]

Proximal interphalangeal joint (PIPJ) arthrodesis is a salvage option in the management of end-stage PIPJ arthropathy. Numerous techniques have been described, including screws, Kirschner wires, tension band wiring, intramedullary devices, and plate fixation. There remains no consensus as to the optimum method, and no recent summary of the literature exists. A literature search was conducted using the MEDLINE, EMBASE, and PubMed databases. English-language articles reporting PIPJ arthrodesis outcomes were included and presented in a systematic review. Pearson χ2 and 2-sample proportion tests were used to compare fusion time, nonunion rate, and complication rate between arthrodesis techniques. The mean fusion time ranged from 5.1 to 12.9 weeks. There were no statistically significant differences in fusion time between arthrodesis techniques. Nonunion rates ranged from 0.0% to 33.3%. Screw arthrodesis demonstrated a lower nonunion rate than wire fusion (3.0% and 8.5% respectively; P =.01). Complication rates ranged from 0.0% to 22.1%. Aside from nonunions, there were no statistically significant differences in complication rates between arthrodesis techniques. The available PIPJ arthrodesis techniques have similar fusion time, nonunion rate, and complication rate outcomes. The existing data have significant limitations, and further research would be beneficial to elucidate any differences between techniques. [ABSTRACT FROM AUTHOR]

Introduction: As smartphones become ubiquitous, medical issues associated with their continuous and long-term use become more common. Here, however, we report on a case of acute proximal interphalangeal (PIP) joint articular injury in the 5th finger caused by a smartphone ring holder. Case report: A woman in her twenties visited our clinic with an aching pain, rubefaction, swelling, and a bending disorder in the PIP joint of the 5th finger of her left hand. The evening before her visit at approximately 8 o'clock, she had viewed her smartphone for about 30 minutes, grasping it with her ring holder with her 5th finger. Subsequently swelling had developed in the PIP joint. Our diagnosis was that she had suffered a PIP joint injury due to the use of the ring holder. We treated her with cold packs, and the symptoms subsided after 4 days. Conclusion: We warn of the potential of smartphone ring holders to cause acute proximal interphalangeal joint articular injury in the 5th finger. [ABSTRACT FROM AUTHOR]

The long-term outcomes of extension block pinning used to treat unstable dorsal fracture-dislocations of the proximal interphalangeal joint have been investigated in a single centre. Thirty-one patients (33 fingers) had a clinical and radiological assessment at a mean follow-up of 16 years. Excluding one joint salvaged with an arthrodesis, the mean active range of motion of the joints was 80° with a mean 5° extension deficit. The mean active range of motion of the distal interphalangeal joint was 64°. The mean Patient-Rated Wrist and Hand Evaluation score was 6, indicating, minimal disability. The mean numeric rating scale for overall subjective pain on a scale of 0–10 was 1 and was not associated with the active range of movement. The Kallman osteoarthritis score and the range of movement of the proximal interphalangeal joint had a negative association. The long-term outcomes were satisfactory and similar to the mid-term follow-up results of the same patient cohort reported 11 years earlier. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Case: A case of Francisella tularensis finger proximal interphalangeal joint septic arthritis secondary to feral cat bite is presented. The patient underwent operative debridement on presentation. On postoperative day 5, a gram-negative rod resembling F. tularensis was identified. The patient received 4 weeks of gentamicin for culture-confirmed ulceroglandular tularemia. At the final follow-up, the infection had resolved, and full function of the digit had been regained. Conclusion: Francisella tularensis septic arthritis secondary to a feral cat bite is exceedingly rare but should be considered in the appropriate clinical context. Proper identification and treatment with antibiotics is essential for a positive outcome. [ABSTRACT FROM AUTHOR]

Purpose: This study compared screw and Kirschner-wire (K-wire) fixation for intra-articular fractures of the proximal phalanx head regarding the success of union and functional outcomes. Methods: In this retrospective study, we enrolled patients with closed intra-articular fractures of the proximal phalangeal head treated between January 2011 and December 2021. Patients with open wounds, tendon or neurovascular injuries, comminuted fractures, or middle phalangeal fractures were excluded. Patients' demographics, bone union, proximal interphalangeal (PIP) joint range of motion (ROM), grip power, and complications were collected and analyzed. The percentage of intra-articular surface involvement and the number of bone fragments were also analyzed in relation to the functional results. Results: Among 41 patients, 21 were managed with screw fixation, and the remaining 20 with K-wire fixation. The mean union rate was 100% in the screw fixation group and 95.0% in the K-wire fixation group, with no statistically significant difference (p=0.488). Other functional parameters (PIP joint ROM, time to bone union, and grip power) were not significantly different between the two groups. Regardless of the treatment modality, the PIP joint ROM showed significant negative associations with the involvement of more intra-articular surfaces (p<0.001) and the presence of a greater number of bone fragments (p=0.040). Conclusion: In intra-articular fractures of the proximal phalanx head, the treatment modality (screw or K-wire) did not affect the treatment outcome. Instead, the percentage of intra-articular surface involvement and the number of bone fragments showed significant negative associations with the PIP joint ROM after treatment. [ABSTRACT FROM AUTHOR]

Arthroplasty of the small joints of the hand and fingers is a complex problem facing the hand surgeon. Pyrocarbon implants have been available for several decades. They were originally thought to provide better functional outcomes than silicone implants in patients, mostly due to recreation of the joint anatomy. In a recent publication, pyrocarbon proximal interphalangeal joint (PIPJ) arthroplasty was found to have a higher complication and revision rate. We present a patient with pyrocarbon metallosis of the PIPJ in a revision arthroplasty procedure. Level of Evidence: Level V (Therapeutic).

Due to the simplicity, low cost and benefit of avoiding long-term joint immobilization, extension block pinning could be a suitable option for treating the volar base fractures of the middle phalanges. The aim of the present study was to evaluate the outcomes of using extension block pinning in chronic volar base fractures of the middle phalanges. In total, 26 patients with chronic closed volar base fractures of the middle phalanges were included our study. The mean age was 37 years (SD 11.59), and the mean follow-up time was 35 months (SD 19.41). The mean active range of motion (ROM) after surgery was 93° (SD 12.9). There was a negative correlation between the age and the ROM of the injured proximal interphalangeal joint after surgery. ROM did not correlate with the articular surface involvement or the interval between injury and surgery. We obtained a satisfactory result from extension block pinning for volar base fractures of the proximal interphalangeal joint in patients with chronic injuries. Level of evidence: IV., Competing Interests: Declaration of conflicting interestsThe author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: This study evaluated 1.0-mm mini suture anchors for repairing the central slip of the extensor mechanism at the proximal interphalangeal joint. Studies have reported a requirement for central slip fixation to withstand 15 N during postoperative rehabilitation exercises and 59 N during forceful contraction., Methods: Index and middle fingers from 10 matched pairs of cadaveric hands were prepared with 1.0-mm mini suture anchors with 2-0 sutures or threaded with 2-0 sutures through a bone tunnel (BTP). In total, 10 index fingers from unmatched hands were prepared with suture anchors and fixed to the extensor tendons to evaluate the tendon/suture interface response. Each distal phalanx was secured to a servohydraulic testing machine, and ramped tensile loads were applied to suture or tendon until failure., Results: All anchors for the all-suture bone tests failed because of pullout from the bone (Mean failure force = 52.5+/-17.3 N). Three anchors from the tendon-suture pull out test failed by pullout from the bone and seven failed at the tendon/suture interface (Mean failure force = 49.0+/-10.1 N)., Conclusions: The 1.0-mm mini suture anchor provides enough strength for early short-arc motion, but it may not be adequate for forceful contraction in the early postoperative rehabilitation stage., Clinical Relevance: The site of fixation, the type of anchor, and the type of suture used are key factors to consider for early range of motion, after surgery., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)