Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Pipjw

951 views

Published on

  • Be the first to comment

  • Be the first to like this

Pipjw

  1. 1. PIPJ Anatomy
  2. 2. Proximal Interphalangial Joint Anatomical & functional locus of finger function Site of most common ligament injury in the hand Most ligament injury are incomplete with maintenance of joint congruity & stability In certain injuries (eg. Lateral dislocations & hyperextension injuries) --> complete rupture of one or more supporting structures Treatment based on accurate diagnosis of pathological lesions & degree of clinical dysfunction
  3. 3. Anatomy PIPJ - Hinge joint Arc of motion up to 1100 Stability:  Articular contours  Periarticular ligaments  Secondary stabilization by adjacent tendon & retinacular systems
  4. 4. Anatomy - Bony Factors Head of PP - 2x concentric condyles seperated by an intercondylar notch Condyles (PP) articulate with 2x concave fossa in the broad, flattened base of MP separated by a median ridge Tongue-and-groove contour & breadth of congruence add stability by resisting lateral & rotatory stress (esp. when PIPJ is fully extended)
  5. 5. Anatomy - Ligamentous factors Radial & ulnar collateral ligaments Primary restraints to radial & ulnar deviation force Proper & accessory component Both arise from the concave fossae on lateral aspects of each condyle & pass obliquely & volary to their insertions Anatomically confluent but distinguished by their points of insertion Proper collateral lig. --> volar 1/3 base of MP Accessory collateral lig. --> volar plate
  6. 6. Anatomy - Volar Plate  Floor of joint  Suspended laterally by collateral ligs.  Distal portion inserts across volar base of MP (only densely attached at its lateral margins - col. lig. insertion)  Thinner centrally & blends with MP volar periosteum  Central portion tapers proximally into an areolar sheet & laterally thickens to form a pair of check ligaments  Secondary stabilizer against lateral deviation esp when PIPJ extended but only when collaterals torn
  7. 7. Check ligaments:+Originate from periosteum of PP1 just inside walls ofA2 pulley at its distal margin and are confluent withproximal origins of C1 pulley+prevent hyperextension while permitting full flexionthereby providing maximum stability with minimumbulk
  8. 8. PIPJ Stability  Key: strong conjoined attachment of the paired collateral lig. & the volar plate into the volar 1/3 of the MP  Ligament-box configuration produces a 3D strength that strongly resists PIPJ displacement  For MP displacement to occur, the ligament-box complex must be disrupted in at least 2 planes
  9. 9. PIPJ Stability Based on load to failure cadeveric studies & clinical observation, collateral ligs. fail proximally about 85% of the time while the volar plate avulses distally up to 80% of the time At lower angular velocities of side-to-side deformation, the collateral ligs. tend to fail in their midsubstance
  10. 10. PIPJ - Secondary Stabilization  Secondary stabilization by adjacent tendon & retinacular systems
  11. 11. PIPJ dislocations
  12. 12. Dorsal PIPJ Dislocation
  13. 13. Dorsal PIPJ Dislocations Mechanism: PIPJ hyperextension combined with some degree of longitudinal compression Frequently occurs in ball-handling sports Usually produces soft tissue or bone injury to the distal insertions of the 3D ligament-box complex. The greater the longitudinal force, the more likelihood for fracture dislocation Rarely, VP ruptures volarly & become interposed within the PIPJ causing irreducible dislocation Volar fracture may even become trapped within the flexor sheath and inhibit motion.
  14. 14. Dorsal PIPJ Dislocations  Type I (hyperextension): VP avulsed; incomplete longitudinal split in col. ligs.; articular surfaces remain congruous.  Type II (dorsal dislocation): complete rupture VP; complete split in col. ligs.; MP resting on dorsum of PP.  Type III (fracture-dislocation): disruption at the volar base of MP where VP is inserted; stable vs unstable injuries
  15. 15. Dorsal PIPJ Dislocations  Stable Type III:  fracture < 40% of volar base MP; significant portion of col. ligs. still attached; possible congruous reduction  Unstable Type III:  fracture > 40% of volar base MP; little or no col. ligs. attached; congruous reduction unlikely; depressed volar articular defect
  16. 16. Dorsal PIPJ Dislocations Treatment depends on open vs closed, stable vs unstable injuries Rx principles:  Patient education  Avoidance of prolonged immobilisation
  17. 17. Dorsal PIPJ Dislocations Operative Mx:  Debridement & joint washout for open injuries  Dorsal block splinting  ? Role of primary VP repair  Other specific techniques for unstable PIPJ injuries:  Dynamic skeletal traction  Extension block pinning  Trans-articular pinning  ORIF  Volar plate arthroplasty  FDS tenodesis (for chronic hyperextension deformity of PIPJ)
  18. 18. Dorsal PIPJ Dislocations Complications of operative Mx:  Redisplacement  Angulation  Flexion contracture  DIPJ stiffness

×