Repair of finger deformity

1. Case Presentations
November 15th 2016

2. HPI
• 26 RHD F with multiple enchondromatosis c/o pain and stiffness in
right MF, RF, SF.
• Sustained injuries/fractures to these fingers throughout her life, 3
years ago while fighting off mugger, treated non-operatively.
• Pain, stiffness and deformity have progressed, now has difficulty with
daily activities such as typing, gripping athletic equipment.
• Denies paresthesias

3. HPI
• Meds: Lutera
• Allergy: NKDA
• PMH: Enchondromatosis, multiple finger fractures in childhood
• PSH: none
• Fam Hx: non-contributory
• ROS: neg

4. Exam Right Hand
• Middle Finger: Swan neck deformity – PIP hyperextension to 65
degrees, DIP flexion 35 degrees. Passively correctable. Full active
flexion of MCP, PIP, DIP. Unable to actively extend DIP. NVI
• Ring Finger: PIP Flexion contracture of 20 degrees. Mechanical block
to flexion at 80 degrees with pain. MCP, DIP motion preserved. NVI
• Small Finger: Abduction deformity of MCPJ with extension, corrects
with flexion. Laxity of radial collateral ligament. Full active extension
and flexion of MCP, PIP, DIP. NVI

6. Small & Ringer Fingers
• SF: MC osteoplasty, curettage, bone grafting. Radial collateral
ligament repair, radial capsulodesis.
• RF: Exploration volar PIPJ, Excision loose body from distal recess of
proximal phalanx

13. Post-op
• Placed in intrinsic plus splint
• Seen in office 11/14/16 for 2 week follow-up
• Custom removable intrinsic plus splint
• Begin OT

14. Landsmeer: Dynamic tenodesis effect linking PIP & DIP extension
Harris & Rutledge: Provides lateral stability to the PIP

15. Clinical Relevance
• IP joint motion interdependent
• Landsmeer’s functional description = foundation of
surgical correction
Littler (1967): Volar transfer of lateral band proximally,
distal insertion left intact. Corrects PIP hyperextension.
*requires intact terminal extensor
Thompson (1978): SORL reconstruction to address PIP
& DIP deformity
Kleinman & Petersen (1984): Used SORL concept
for correction of mallet deformity. Soft tissue fixation