PIPJ TREATMENT CASE

PIPJ Treatment Case

PIPJ Treatment Case

About injury

It is injured the middle joint of the 3 joints in your finger. It is called the proximal interphalangeal joint (PIPJ) in left non dominant little finger. It is a hinge joint, which allows flexion forward into the palm and extension / straightening.

Question 1

From the top of the finger being forced back and therefore putting strain on the joint. If the force is great enough it will tear the ligament or pull off a piece of bone.

Question 2

It is hinge joint ligament injury specifically at centre.

PIPJ wounds are widespread and may lead to important pain, stiffness, volatility and degenerative arthritis.

Ideal remedy engages accomplishing a steady congruent junction with early shift.



Anatomy

Hinge junction enclosed and stabilized by:

Volar plate - Proximally slim addition, distally, lateral margins thickened conceiving socket for head of proximal phalanx.

Lateral and accessory collateral ligaments.

Extensor expansion - injects into groundwork of the middle phalanx and also makes falls that become confluent with the intrinsic meanss. This confluence constitutes the lateral musicians, which are connected to the volar aspect of a capsule by the oblique and transverse retinacular ligaments.

Assessment

Examine for areas of local tenderness palpate all above structures in turn .Asses joint stability, passive and active ROM (use digital block if pain prevents proper investigation)

Never suppose need of full flexion or active extension is due to pain. Aclosed rupture of the centered fall may be missed until the boutonniere deformity develops.

Elson check for centered fall rupture

From 90 degrees of flexion, persevering dynamically endeavours to extend the PIP junction against resistance. The nonattendance of elongation force at the PIP junction, and fixed elongation at the distal junction, indicate entire rupture of the centered slip.

Radiography

AP.

Lateral.

Oblique - condylar fractures may be more apparent on the oblique.

Nutrient arteries in the district of the distal condyles of the proximal phalanx may mimic an undisplaced fracture.

Treatment

Principles

Elevation.

Early ROM - usually late troubles are stiffness not instability.

Most PIP junction wounds do not require open reduction.

Oballpoint reduction and interior fixation are indicated for:

Intra-articular fractures.

Unstable fractures.

Fractures those are stable only in flexion.

Classification

PIPJ wounds drop into three categories:

Dislocations.

Avulsion.

Intra articular.

Dislocations

Reducible vs Irreducible.

Dorsal - commonest, simplest, rupture of volar plate and portion of collateral ligament, hyperextension force. Usually reducible and stable. Intermittently more complex and irreducible when constituent of torque strength, the head of the proximal phalanx may be displaced between the volar plate and the flexor tendon and act as a buttonhole by tightly grasping the portion of the phalanx immediately behind the head, preventing closed reduction. These dorsal displacements necessitate open decrease and repair, and subsequent active motion protected by buddy taping and an extension block movement commenced between 3 and 5 days postoperatively.

Volar- less common. NB central slip injury. Tend to be irreducible and unstable. Usually requires open decrease, after which the digit should generally be immobilized in extension for 7 days before hardworking protective shift is commenced. Unrecognized or insufficiently renovated volar dislocation results in a continual boutonniere deformity requiring later surgery, with generally poor late ...