Surgical reconstruction of PIP joint collateral ligament in chronic instability in a high performance athlete: case report and description of technique.

We present a case report describing the surgical technique for the reconstruction of the proximal interphalangeal (PIP) joint collateral ligament using autograft palmaris longus tendon graft. We accomplished this successfully in a high performance professional athlete presenting with chronic instability of the PIP joint. Our surgical reconstructive technique recreated anatomic ligament position, while correcting multidirectional instability without disruption of the other dynamic anatomic structures of the PIP joint. Our results demonstrated excellent clinical and functional results, and we offer our technique as an alternative to tenodesis procedures for individuals with professions that demand PIP motion.

TFCC reattachment after traumatic DRUJ instability: a simple alternative to arthroscopic management.

With current trends favoring open reduction with internal fixation for distal radius fractures, distal radius-ulnar joint instabilities that were once clinically silent as a result of prolonged immobilization are now being recognized as a significant cause of morbidity. Arthroscopic management has proven to be both an effective and technically challenging treatment for triangular fibrocartilage complex (TFCC) tears. TFCC reattachment offers a safe, reproducible means of managing acute posttraumatic distal radioulnar join (DRUJ) instability after distal radius volar plating. With this technique, 30 patients at an average of 43 months were examined for continued DRUJ instability, range of motion, and radiographic evaluation for radius union, posttraumatic DRUJ arthritis, and hardware failure. Postoperative Gartland scores showed 88.6% excellent, 5.7% good, and 5.7% fair results. We conclude TFCC reattachment is a safe and effective alternative for treatment of acute DRUJ instability after open reduction with internal fixation of the distal radius, especially when equipment or experience does not support arthroscopic treatment.