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PIP joint approach
1.
2. Volume 41, published 2016
Received for publication August 11, 2015
Accepted in revised form November 15, 2015
Impact Factor: 1.64
3. Andre Eu-Jin Cheah, MD, MBA
Assistant Professor
Department of Orthopaedic Surgery
Yong Loo Lin School of Medicine
National University of Singapore
Consultant
Department of Hand & Reconstructive
Microsurgery
University Orthopaedics, Hand & Reconstructive
Microsurgery Cluster
National University Health System, Singapore
4. Jeffrey Yao, MD
Associate Professor
Robert A. Chase Hand and Upper Limb Center,
Department of Orthopaedic Surgery,
Stanford University Medical Center,
Redwood City, CA
Affiliation
International Wrist Investigators Workshop
American Academy of Orthopaedic Surgeons
American Society for Surgery of the Hand
American Association for Hand Surgery
Arthroscopy Association of North America
43. Extensor lag of 5’-20 despite approach
AROM poor in arthroplasty compared with short term
fracture fixation
Decrease of DIP AROM disturbance to lateral band
46. Central slip reconstruction
FDS tenodesis
Access to base of P2
Access to head of P1
Dorsal
Volar
Volar
Dorsal
Guided by Surgeon’s experience !!!
Hinweis der Redaktion
Impact factor 0.47
lateral bands are stabilized centrally by the triangular ligament. And laterally by TRL
TRL: originates from the flexor sheath at the level of the PIP joint and inserts into the lateral bands
2, 3 more surgical exposure
Left:Proximal interphalangeal joint VP (asterisk) is accessed after retracting the flexor tendons to one side.
Right:Alternative route to the VP (asterisk) between the 2 slips of the FDS
the proximal attachment of the PCLs may be released proximally or distally to allow the joint to be shotgunned open
The flexor sheath and ACLs are incised between the A2 and A4 pulley on either side of the VP
2, 3 more surgical exposure
Longitudinal split of the entire central slip with elevation of the 2 halves laterally with each lateral band, to expose the articular surface and the collateral ligaments
Black and red asterisks show the central slip insertion and P1 head, respectively. Dashed lines indicate the split extensor
tendon.
proximal release of one collateral ligament (blue asterisk). Black asterisk shows the central slip insertion; dashed line shows the
intact collateral ligament.
Black and red asterisks show the central slip insertion and P1 head, respectively. Dashed lines indicate the split extensor
tendon.
proximal release of one collateral ligament (blue asterisk). Black asterisk shows the central slip insertion; dashed line shows the
intact collateral ligament.
Black and red asterisks show the central slip insertion and P1 head, respectively. Dashed lines indicate the split extensor
tendon.
proximal release of one collateral ligament (blue asterisk). Black asterisk shows the central slip insertion; dashed line shows the
intact collateral ligament.
2 drill holes are made at the base of P2 at the insertion of the central slip, a nonabsorbable 3-0 or 4-0 suture is passed through
these holes, and a subsequent mattress repair of the central slip is done
Distally based triangular extensor tendon flap designed (dashed line). Asterisk shows the central slip attachment.
The triangular tendon flap is then raised to expose the distal P1, collateral ligaments (blue asterisks), and articular surface while preserving the central slip attachment (black
asterisk).
Interval between the central slip and lateral bands can be used as access to the PIP joint. The black asterisk shows the central slip attachment, the red asterisk indicates the P1 head,
and the dashed line shows the tendon split.
A midlateral skin incision is made from the middle of the P1 to the middle of the P2
A window is made in the lateral surface of the flexor sheath to identify and protect the flexor tendons before the VP (black asterisk) is incised
recession but not complete release
Extensor lag of 5’-20’in every approach
AROM poor in arthroplasty compared with short term fracture fixationrecurring soft tissue change in arthrosis
Decrease of DIP AROM disturbance to lateral band