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Stability of acute dorsal fracture dislocations of the proximal interphalangeal joint: a biomechanical study.

MedStar author(s):

Citation: J Hand Surg [Am]. 39(1):13-8, 2014 Jan.Journal of Hand Surgery - American Volume. 39(1):13-8, 2014 Jan.PMID: 24211175Institution: Curtis National Hand CenterForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Dislocations/su [Surgery] | *Finger Injuries/su [Surgery] | *Finger Joint/pp [Physiopathology] | *Finger Joint/su [Surgery] | *Intra-Articular Fractures/su [Surgery] | Biomechanical Phenomena/ph [Physiology] | Dislocations/di [Diagnosis] | Dislocations/pp [Physiopathology] | Finger Injuries/di [Diagnosis] | Finger Injuries/pp [Physiopathology] | Fluoroscopy | Humans | Intra-Articular Fractures/di [Diagnosis] | Intra-Articular Fractures/pp [Physiopathology] | Models, Anatomic | Range of Motion, ArticularYear: 2014 Local holdings: Available in print through MWHC library: 1999 - 2002, Available online from MWHC library: 1995 - presentISSN:

0363-5023

Name of journal: The Journal of hand surgeryAbstract: CLINICAL RELEVANCE: Knowledge of the typical amount of middle phalanx defect and degree of proximal interphalangeal joint extension that can lead to joint instability may improve management of mechanically important proximal interphalangeal joint fracture dislocations.Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.CONCLUSIONS: Simulated volar articular bony defects of 20% were stable, whereas those with 60% and 80% defects were unstable during digital motion. Stability in the 40% group was variable and appeared to be the threshold for stability.METHODS: Eighteen digits on 6 hands were tested through full proximal interphalangeal joint range of motion using computer-controlled flexion and extension via the digital tendons. We collected proximal interphalangeal joint kinematic cine data in a true lateral projection with mini-fluoroscopy. We measured the amount of dorsal middle phalanx translation in full proximal interphalangeal joint extension. As we cycled the joint from full flexion into extension, we recorded the angle at which subluxation occurred.PURPOSE: We performed a cadaveric biomechanical study to characterize proximal interphalangeal joint stability after an injury to different amounts of the volar articular base of the middle phalanx (intact, 20%, 40%, 60%, and 80% volar defects).RESULTS: No specimens with 20% volar bony defect subluxated. All specimens in the 60% and 80% groups subluxated at an average flexion angle of 67degree (range, 10degree to 90degree) in the 60% group and at all degrees of flexion in the 80% group. In the 40% group, 28% of specimens demonstrated subluxation at an average flexion angle of 14degree (range, 4degree to 40degree). Mean dorsal translation of the middle phalanx in relation to the proximal phalanx at full digital extension was 0.2 mm in the 20% group, 0.8 mm in the 40% group, 3.2 mm in the 60% group, and 3.1 mm in the 80% group.All authors: Means KR Jr, Parks BG, Tsai MA, Tyser ARFiscal year: FY2014Digital Object Identifier:

http://dx.doi.org/10.1016/j.jhsa.2013.09.025

Date added to catalog: 2016-07-15

Holdings ( 1 )
Title notes ( 7 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	24211175	Available		24211175

Available in print through MWHC library: 1999 - 2002, Available online from MWHC library: 1995 - present

CLINICAL RELEVANCE: Knowledge of the typical amount of middle phalanx defect and degree of proximal interphalangeal joint extension that can lead to joint instability may improve management of mechanically important proximal interphalangeal joint fracture dislocations.Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

CONCLUSIONS: Simulated volar articular bony defects of 20% were stable, whereas those with 60% and 80% defects were unstable during digital motion. Stability in the 40% group was variable and appeared to be the threshold for stability.

METHODS: Eighteen digits on 6 hands were tested through full proximal interphalangeal joint range of motion using computer-controlled flexion and extension via the digital tendons. We collected proximal interphalangeal joint kinematic cine data in a true lateral projection with mini-fluoroscopy. We measured the amount of dorsal middle phalanx translation in full proximal interphalangeal joint extension. As we cycled the joint from full flexion into extension, we recorded the angle at which subluxation occurred.

PURPOSE: We performed a cadaveric biomechanical study to characterize proximal interphalangeal joint stability after an injury to different amounts of the volar articular base of the middle phalanx (intact, 20%, 40%, 60%, and 80% volar defects).

RESULTS: No specimens with 20% volar bony defect subluxated. All specimens in the 60% and 80% groups subluxated at an average flexion angle of 67degree (range, 10degree to 90degree) in the 60% group and at all degrees of flexion in the 80% group. In the 40% group, 28% of specimens demonstrated subluxation at an average flexion angle of 14degree (range, 4degree to 40degree). Mean dorsal translation of the middle phalanx in relation to the proximal phalanx at full digital extension was 0.2 mm in the 20% group, 0.8 mm in the 40% group, 3.2 mm in the 60% group, and 3.1 mm in the 80% group.

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