The proximal interphalangeal joint: arthritis and deformity.

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Abstract

Conflict of interest statement: ICMJE Conflict of interest statement: D. Herren declares royalties from KLS Martin, activity relating to the submitted work; board membership of and stock options from Medartis AG Basel, activities outside the submitted work. 11. J Hand Surg Am. 2021 Aug;46(8):712.e1-712.e6. doi: 10.1016/j.jhsa.2021.01.003. Epub 2021 Mar 22. Y-Shaped Tendon Graft-A Technique in the Reconstruction of Posttraumatic Chronic Boutonniere Deformity. Liu YJ(1), Ding XH(2), Ji X(3), Jiao HS(1), Ren SQ(1), Zhang HX(1). Author information: (1)The Hand Surgery Center of CPLA, 971st Hospital of the CPLA Navy, Qingdao, China. (2)The Hand Surgery Center of CPLA, 971st Hospital of the CPLA Navy, Qingdao, China. Electronic address: dingxhqd@yeah.net. (3)Department of Foot and Hand Trauma Surgery, Qingdao Central Hospital, Qingdao, China. PURPOSE: Current reconstruction strategies for chronic posttraumatic boutonniere deformities have variable outcomes and are prone to complications. This study aimed to describe the clinical outcomes of a Y-shaped tendon graft technique. METHODS: In this retrospective case study, we reviewed the files of 18 patients treated with the Y-shaped tendon graft between January 2010 and January 2017. The technique involves release of the central slip, lateral bands, and transverse retinacular ligaments at the proximal interphalangeal (PIP) joint, total excision of scar tissue in the central slip and at the insertion site, and construction of 3 1.5-mm unicortical holes at the base of the middle phalanx, through which a Y-shaped graft of the palmaris longus is inserted to reconstruct the central slip and stabilize the lateral bands in a dorsal position. Clinical evaluations included measuring the active range of motion in the PIP joint and distal interphalangeal (DIP) joint, grip strength, Souter score, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. RESULTS: The mean age of patients was 36.1 years, and 12 of the 18 patients were men. The average follow-up period was 23 months (range, 13-38 months). The preoperative PIP joint extension deficit was 48.0° ± 5.0° compared with 10.9° ± 9.3° after surgery. The preoperative DIP joint active flexion was 34.4° ± 8.0° compared with 71.4° ± 8.6° after surgery The outcomes based on the Souter score were 11 excellent, 5 good, and 2 poor. The QuickDASH score was 17.7 ± 6.4 before surgery and 11.2 ± 7.2 after surgery. CONCLUSIONS: The Y-shaped tendon graft can be a useful procedure for the correction of chronic boutonniere deformity; in our patient series, this provided good or excellent results in 16 of 18 patients. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV. Copyright © 2021 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.jhsa.2021.01.003