Extensor tendon rupture and preoperative mri confirmations of suture anchor prolapse: a case report and literature review.

BACKGROUND: While suture anchors are widely used in medical procedures for their advantages, they can sometimes lead to complications, including anchor prolapse. This article presents a unique case of suture anchor prolapse at the base of the distal phalanx of the little finger after extensor tendon rupture reconstruction surgery. CASE PRESENTATION: A 35-year-old male, underwent extensor tendon rupture reconstruction using a non-absorbable suture anchor. After seven years the patient visited our outpatients complaining of stiffness, pain, and protrusion at the surgical site. Initial X-ray imaging suggested suggesting either a fracture of the distal phalanx or tendon adhesion but lacked a definitive diagnosis. Subsequent magnetic resonance imaging (MRI) revealed bone connectivity between the middle and distal phalanges with irregular signal shadow and unclear boundaries while maintaining a regular finger shape. MRI proved superior in diagnosing prolapsed suture anchors, marking the first reported case of its kind. Surgical intervention confirmed MRI findings. CONCLUSIONS: Suture anchor complications, such as prolapse, are a concern in medical practice. This case underscores the significance of MRI for accurate diagnosis and the importance of tailored surgical management in addressing this uncommon complication.

Diagnosis and treatment of flexor tendon injuries of the hand: what the radiologist needs to know.

This article reviews the diagnosis and treatment of flexor tendon injuries of the hand highlighting flexor tendon anatomy, important pre-operative imaging findings, surgical options, and post-operative complications. Imaging plays a key role in guiding treatment of these difficult to manage injuries. Thus, it is important for radiologists to have a sound understanding of factors important in treatment decision-making. In the pre-operative setting, accurately identifying the location of the torn proximal tendon stump in subacute and chronic injuries helps dictate whether the patient is a candidate for a primary flexor tendon repair or may require a tendon reconstruction to restore function. In the post-operative setting, the status of the repair and presence of surrounding adhesions help dictate if and when the patient will require subsequent surgery and whether that surgery will be a tenolysis, revision repair, reconstruction, or fusion.

Quick and safe: why a k-wire-extension-block-fixation of a bony mallet finger is the favoured treatment.

INTRODUCTION: Mallet fingers are the most common tendon injuries of the hand. Bony avulsion distal finger extensor tendon ruptures causing a mallet finger require special attention and management. In this monocentral study, we analyzed the clinical and individual outcomes succeeding minimal invasive k-wire extension block treatment of bony mallet fingers. MATERIALS AND METHODS: In a retrospective study, we sent a self-designed template and a QUICK-DASH score questionnaire to all patients, who were treated because of a bony mallet finger between 2009 and 2022 and fulfilled the inclusion criteria. A total of 244 requests were sent out. 72 (29.5%) patients participated in the study. Forty-five men and twenty-seven women were included. RESULTS: 98.7% (n = 75) of the cases were successfully treated. Patients were highly satisfied with the treatment (median 8.0; SD ± 2.9; range 1.0-10.0). Based on the QUICK-DASH score, all patients showed no difficulties in daily life. The extent of avulsion did not influence the outcome. CONCLUSION: We conclude that the minimally invasive treatment of a bony mallet finger should be offered to every patient, because it is safe, fast, and reliable. Thus, we propose to perform extension-block pinning independently of the articular area.

Direct fixation of fracture fragment with modified double Kirschner wires for the treatment of old bony mallet finger.

BACKGROUND: The management of old bony mallet fingers is complicated. The purpose of this study was to describe direct fixation of fracture fragment with modified double Kirschner wires (K-wires) for treatment of old bony mallet finger, and to evaluate the functional outcomes during long-term follow-up. METHODS: Forty-nine patients with old bony mallet finger were enrolled and underwent surgical treatment from August 2014 to January 2021 in our hospital. Patients were divided into two groups according to whether they had undergone triple K-wires fixation or modified double K-wires with a dorsal brace fixation. The operation time, mean number of intraoperative fluoroscopy, bone union time, functional recovery and incidence of complications were monitored. RESULTS: Neither QuickDASH nor visual analogue scale measurement found statistically significant difference between the two groups (P > 0.05). However, the patients that underwent fixation with double K-wires and a dorsal brace required a shorter operation time and fewer intraoperative fluoroscopy, and exhibited a significantly greater mean final active range of the distal interphalangeal joint flexion, compared to those treated with triple K-wires (P < 0.01). CONCLUSION: Direct fixation of fracture fragment with modified double K-wires was an easy and feasible procedure which could achieve anatomical reduction and stable fixation of the dorsal fracture block of old bony mallet finger with relatively few complications.

Jersey finger type IV: a case report.

Avulsion of the flexor digitorum profundus, usually known as jersey or rugby finger, is a rare condition that can only be treated surgically. It is mostly reported in sports injuries, in which the diagnosis is easily made. It is less frequent in household accidents, but should not be ignored because good results are time-dependent. Type IV jersey finger is the combination a fracture of the volar base of the distal phalanx and avulsion of the flexor digitorum profundus. This is a rare variety, and the surgical approach has not been discussed in detail. We introduce here a case report describing the clinical aspect, diagnostic approach, surgical technique and results at 6 months.

Posttraumatic Osteoarthritis of the Distal Interphalangeal Joint: A Follow-Up Study of 12 Years After Nonsurgical Treatment of Mallet Finger Fractures.

PURPOSE: In treatment of mallet finger fractures (MFFs), the aim is to minimize residual extension lag, reduce subluxation, and restore congruency of the distal interphalangeal (DIP) joint. Failure to do so may increase the risk of secondary osteoarthritis (OA). However, long-term follow-up studies focusing on OA of the DIP joint after an MFF are scarce. The purpose of this study was to assess OA, functional outcomes, and patient-reported outcome measures (PROMs) after an MFF. METHODS: A cohort study was performed with 52 patients who sustained an MFF at a mean of 12.1 years (range, 9.9-15.5 years) previously and who were treated nonsurgically. A healthy contralateral DIP joint was used as the control. Outcomes were radiographic OA, using the Kellgren and Lawrence and Osteoarthritis Research Society International classifications, range of motion, pinch strength, and PROMs (Patient-Rated Wrist Hand Evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, Michigan Hand Outcome Questionnaire, 12-item Short Form Health Survey). Radiographic OA was correlated with PROMs and functional outcomes. RESULTS: At follow-up, there was an increase in OA in 41% to 44% of the MFFs. Of all the MFFs, 23% to 25% showed a higher degree of OA than the healthy control DIP joint. Range of motion (mean difference ranging from -6° to -14°) and Michigan Hand Outcome Questionnaire score (median difference, -1.3) were decreased after MFFs but not to a clinically relevant extent. Radiographic OA was weakly to moderately correlated with functional outcomes and PROMs. CONCLUSIONS: Radiological OA after an MFF is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint, which does not clinically affect PROMs. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Closed Traumatic Zone 2 Flexor Tendon Injury of the Long Finger - A Case Report.

Closed rupture of the flexor digitorum profundus (FDP) tendon causes loss of flexion at the distal interphalangeal joint. Following trauma, these are known to present as avulsion fractures (Jersey finger) commonly in ring fingers. Traumatic tendon ruptures at the other flexor zones are seldom noted and are often missed. In this report, we present a rare case of closed traumatic tendon rupture of the long finger FDP at zone 2. Though it was missed initially, was confirmed with Magnetic Resonance Imaging and underwent successful reconstruction using an ipsilateral palmaris longus graft. Level of Evidence: Level V (Therapeutic).

Open Reduction and Internal Fixation of Dorsal Fracture-Dislocation of the Proximal Interphalangeal Joint Using a Plate: A Series of 37 Patients.

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).

Does Inclination of the Toe Proximal Phalangeal Head Affect the Outcomes of Vascularized Joint Transfers? Retrospective Study of 22 Joint Transfers.

BACKGROUND: Different shapes of the proximal phalangeal head of toe proximal interphalangeal joints (e.g., oval and circular) are observed in vascularized joint transfers. The difference in shape implies the varying degrees of inclination of the articular surfaces between toes. This study investigated the impact of articular inclination on outcomes after toe joint transfers for finger proximal interphalangeal joint reconstruction. METHODS: Twenty-one patients who underwent vascularized joint transfer from May of 2009 to May of 2018 were included. Their mean age was 33.4 years and mean follow-up period was 28.9 months. All patients had a type I central slip according to the Te classification. Articular surface inclination was measured on lateral radiographic views. RESULTS: Passive range of motion of the toe proximal interphalangeal joint before vascularized joint transfer was 71.1 ± 9.6 degrees. The functional range of motion of the reconstructed proximal interphalangeal joint was 60.0 ± 17.0 degrees. The extensor lag after the joint transfer was 9.4 ± 19.6 degrees. The articular inclination of the toe joint was 71.9 ± 9.7 degrees. A Pearson correlation analysis of all variables, including age, preoperative range of motion of the toe joint, postoperative range of motion of the reconstructed joint, articular inclination of the toe joint, and extensor lag of the reconstructed joint with toe articular inclination, was performed. There was no significant correlation between articular inclination of the toe joint and extensor lag of the reconstructed joint ( p = 0.226). CONCLUSION: The articular surface inclination of the toe did not affect the functional range of motion after joint transfer. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Floating phalanx; simultaneous double dislocation of the interphalangeal joint in a finger: A case report and literature review.

Isolated proximal and distal interphalangeal joint (DIPJ) dislocations are widely seen as a result of sporting injuries and major trauma. The combination of dorsal dislocation of the DIPJ in the same finger concomitant to traumatic dorsal dislocation of the proximal interphalangeal joint (PIPJ) is a rarely seen injury. The case is, here, presented of a 65-year-old female patient with proximal and DIPJ dislocation of the right-hand ring finger accompanied by volar and dorsal plate injuries in the proximal and distal joints. With this case, it was aimed to introduce a new term of 'floating phalanx' into medical literature. The treatment was applied to the patient of closed reduction under peripheral block and the application of an aluminium finger splint in semiflexion. In a 24-month follow-up period, the 4th finger of the patient was observed to be stable and has pain-free range of movement. This case is an uncommon case of volar and dorsal plate avulsion fractures with PIPJ and DIPJ dorsal dislocation treated successfully with closed reduction and conservative treat-ment with excellent functional results.

Extension Block Pinning Vs Single Kirshner Wiring To Treat Bony Mallet Finger. A Retrospective Study.

BACKGROUND AND AIM: Bony Mallet Finger or Mallet Fracture is a common injury of the hand, which follows a forced flexion of the extended distal interphalangeal joint, that leads to a bony avulsion of the distal phalanx. Depending on fracture extension and dislocation, those lesions can either be treated conservatively or surgically. Several surgical options have been described in the literature. The aim of this study is to compare retrospectively two percutaneous pinning techniques: the extension block technique according to Ishiguro vs an original single Kirshner wiring (Umbrella technique). METHODS: Between January 1998 and December 2019, among all patients treated surgically for a Mallet Fracture with either the Ishiguro' and the Umbrella technique, 98 have been included in this study. All patients have been assessed one year after surgery using the Crawford method. RESULTS: With both techniques better results have been achieved in younger patients and for those treated early. The umbrella technique seems to have better results in patients with fracture classified as 2b or 2c (Wehbe and Schneider classification), whereas the Ishiguro technique seems more appropriate for patients with a 1b fracture. Complication rate and typology vary depending on the used technique. CONCLUSIONS: The Ishiguro' and the Umbrella technique both lead to good results for the treatment of surgical Mallet Fractures. The choice of the best type of pinning should mainly depend on fracture extension and time elapsed from trauma.

Traumatic Zone II Flexor Tendon Injury Repair Through a Traumatic Dorsal Approach.

Zone II flexor tendons present unique challenges for repair because of their complex anatomy in a confined space. The approach for zone II injuries is often dictated by preexisting traumatic skin lacerations, with a midaxial or volar approach being most common. In some injuries, this approach is not viable, and alternative approaches must be considered. A 45-year-old man presented with a traumatic crush injury that caused complete disruption of the skin, tendon, capsule, collateral ligament, and volar plate and laceration of the flexor digitorum profundus in zone II near the proximal interphalangeal joint. Given the large, near-circumferential zone of injury, we used the traumatic dorsal wound for the flexor tendon for repair. There are no reports of this approach in the literature. Postoperatively, the proximal interphalangeal joint was immobilized for 6 weeks with a K-wire. The patient was followed in the clinic and prescribed occupational therapy. At the 4-month postoperative visit, the patient had a healed incision, no signs of infection, and intact median/radial sensations. Functional testing showed a loose composite fist, improved range of motion, and 2-cm tip-to-palm deficiency of the index finger. Grip strength was 85 lb in the right hand and 60 lb in the left hand. Although patients are not always expected to regain full function, their postoperative course may be further complicated by adhesion and the need for tenolysis. Given these historical complications of tendon repair and our patient's ability to return to work with satisfactory functional outcomes, this approach may be a viable option for treating this unique injury pattern. [Orthopedics. 2022;45(4):e216-e219.].

Hamate vs. capitate grafting for proximal interphalangeal joint fracture-dislocation: an MRI-based study of 35 hands.

We examined the MRI scans of 35 adult hands to assess the feasibility of the hamate and the capitate as potential donor grafts in the management of comminuted intra-articular fractures at the base of the middle phalanges. Essentially neither the hamate nor the capitate were perfect anatomic matches in most digits, but the capitate had the advantage of having more uniform facets, and the capitate facet shapes were similar to those of the little finger. The measurement of angles in the coronal and sagittal plane showed that in some respects the differences between the potential graft and the base of the middle phalanges were smaller for the capitate than for the hamate. Moreover, the sagittal morphology of the capitate made it less prone to joint overstuffing than the hamate. We conclude that the capitate may be considered as a graft donor in selected cases, especially for the little finger.

Irreducible Phalangeal Fractures Due to Incarceration into the Extensor Tendon Apparatus - A Report of Two Patients.

Irreducible phalangeal fractures are uncommon, and if neglected can cause fracture non-union or functional deficits of the affected digit. We present two patients with irreducible phalangeal fractures - one in a child with a juxta-epiphyseal middle phalanx fracture incarcerated into the triangular ligament of the extensor apparatus and another in an adult following incarceration of a fractured proximal phalanx into the common intrinsic tendon on the radial side. Both required open reduction to extricate the incarcerated fracture ends, achieving good union and excellent functional outcomes. Level of Evidence: Level V (Therapeutic).

Blocking Plate for Volar Proximal Interphalangeal Joint Fracture Dislocation.

PURPOSE: To assess the use of a 2-mm miniplate as a dorsal blocking plate to stabilize the central avulsion fragment in a proximal interphalangeal joint (PIP) volar fracture dislocation. METHODS: This was a case series comprising 8 patients with volar fracture dislocation of the PIP joint. The average age of the patients was 36 years. The patients were managed by this technique within an average of 11 days following the injury. The clinical outcome measurements included the assessment of pain and range of motion of the PIP and distal interphalangeal joints. RESULTS: The average follow-up duration was 20 months. The mean visual analog scale pain score was 1.9. The average range of motion of the PIP joint was 82°, whereas the average range of motion of the distal interphalangeal joint was 43°. Reduction of the subluxation was achieved in all cases, with no articular step remaining. CONCLUSIONS: A dorsal blocking plate is a simple technique, associated with a satisfactory outcome, for volar fracture dislocation injuries of the PIP joint. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.

Comparison of interfragmentary pinning versus the extension block technique for acute Doyle type 4c mallet finger.

The aim of this study was to compare the closed reduction interfragmentary pinning method (IPM) with the extension block technique (EBT) for bony mallet finger. Patients who underwent mallet finger operations were screened retrospectively for the following inclusion criteria: Doyle type 4c, age between 18 and 75 years, less than 4 weeks to surgery, and more than 1 year of follow-up time. Group I underwent a closed reduction IPM, and group II underwent the EBT. Lateral radiographs taken during the preoperative and final examination were used to evaluate the size and amount of displacement from the distal interphalangeal (DIP) joint and the dorsal fragment as well as the articular surface. Operation times were compiled from patient records. During the final examination, pain and DIP joint range of motion (ROM) were assessed and complications were recorded. The Crawford criteria were used for functional results. Fifteen patients in group I (8 men, 7 women) and 17 patients in group II (10 men, 7 women) were evaluated. Age, gender, time to surgery and follow-up time showed no statistically significant differences between the two groups. The differences in fragment size, preoperative and postoperative joint displacement, amount of dorsal displacement and DIP joint ROM were not statistically significant between the two groups. However, the operation time was significantly shorter time in group I than in group II (p=0.000). The average time to fracture union was significantly longer in group I (7.3 weeks) than in group II (6 weeks) (p=0.013). The EBT has faster time to union and is a safer method with lesser risk of arthritis and fragmentation. The IPM can be an alternative with shorter operation time, less pin bed infection and nail bed damage, especially in Doyle type 4c cases with large fragments.

Concurrent Ring Finger Middle Phalanx Fracture and Jersey Finger in a Rugby Player.

Avulsions of the flexor digitorum profundus (FDP) tendon and phalanx fractures are both common injuries for rugby players, but these concurrent injuries in the same finger have not been previously described. This case describes a 20-year-old female rugby player who sustained a right ring finger comminuted, mildly displaced middle phalanx fracture. The patient was evaluated by a hand surgeon 3 weeks after the injury, and non-operative management with a splint was elected. One week later, upon further examination, the patient demonstrated persistent inability to flex the distal interphalangeal joint (DIPJ) of the ring finger. Ultrasound was inconclusive but an MRI demonstrated avulsion of the FDP tendon from the distal phalanx, consistent with a jersey finger injury. The patient subsequently underwent open repair of the FDP tendon. This case illustrates the importance of careful physical exam and index of suspicion for coexisting injuries.