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J Hand Surg Am. 2012 Mar;37(3):440-5. doi: 10.1016/j.jhsa.2011.10.054. Epub 2012 Feb 3.

Corrective osteotomy and ligament repair for longstanding radial collateral ligament tear of the proximal interphalangeal joint: case series.

Author information

1
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Japan. miyakeosk@umin.ac.jp

Abstract

PURPOSE:

To evaluate the clinical outcomes of corrective osteotomy and ligament repair for longstanding radial collateral ligament tears of the proximal interphalangeal (PIP) joint.

METHODS:

We retrospectively evaluated 4 patients with 5 longstanding tears in the radial collateral ligaments of the PIP joints. The average age at the time of surgery was 51 years (range, 40-62 y). The average time from the initial injury to surgery was 31 years (range, 22-40 y). Plain radiographs revealed an ulnar slope at the PIP joint surface with degenerative changes in all fingers. We corrected the slope using a closing wedge osteotomy of the neck of the proximal phalanx secured with a headless screw. We then repaired the radial collateral ligament by overlapping the elongated ligament. Range of motion exercises were started 2 weeks after surgery. To evaluate the results, we compared preoperative and postoperative range of motion, ulnar deviation, instability, pain, and level of satisfaction. Average follow-up was 27 months (range, 18-48 mo).

RESULTS:

All osteotomies had united at an average of 3 months. We observed no major changes in range of motion, but flexion contracture gradually appeared in 1 high-demand patient. The average preoperative angle of ulnar deviation was 36° and was corrected to a postoperative angle of 2°. The average angle of lateral instability improved after surgery from 22° to 1°. Finger pain disappeared or decreased in 3 low-demand patients but persisted in 1 high-demand patient. Two low-demand patients were very satisfied and 1 low-demand patient was satisfied; however, 1 high-demand patient was dissatisfied with the results of surgery.

CONCLUSIONS:

Corrective osteotomy and ligament repair can result in a straight and stable joint with a good range of motion in low-demand patients. This method could be a treatment option for carefully selected patients.

PMID:
22305826
DOI:
10.1016/j.jhsa.2011.10.054
[Indexed for MEDLINE]

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