Release of Posttraumatic Metacarpophalangeal  and Proximal Interphalangeal Joint Contractures..

1. Professor M. A. Imam
MD, MSc (Orth)(Hons), D.SportMed, Ph.D., FRCS (Tr. and Orth.)
Consultant Trauma and Upper Limb Surgeon, Rowley Bristow Orthopaedic Unit, Chertsey
Professor and MD, Smart Health Academic Unit, University of East London, London, UK
Email: Info@theArmDoc.co.uk
www.TheArmDoc.co.uk
@MoAImam
Release of Posttraumatic Metacarpophalangeal
and Proximal Interphalangeal Joint Contractures

2. Posttraumatic metacarpophalangeal (MCP)
joint and proximal interphalangeal (PIP)
contractures may develop directly as a result
of injury to the joints and adjacent tissues or
indirectly as a result of excessive
immobilization or poor splinting of the hand.
Is it MCP or PIP?

8. • Joint capsule
• Collateral ligament contracture
• Flexor tendon adhesions
• Intrinsic musculature contracture
• Extensor tendon adhesions
• Skin
• subcutaneous tissue scarring
Structures Most Involved

9. • Long-standing scarring and contracture of the fingers
capsule invariably lead to adhesions to the adjacent
flexor sheath and extensor mechanism
• Cartilage gradually atrophies and softens with disuse.
• Surface irregularities may develop.
NATURAL HISTORY

10. • Contracture of the volar plate or the capsular structures
• Collateral ligament contracture
• Scar contracture over the joint
• Volar skin contracture
• Flexor sheath contracture
• Extensor tendon contracture or adhesions
• Interosseous contracture or adhesions
• A bony block or exostosis
•Curtis has reported that a contracture of the PIP joint can be due to the following:

11. IMAGING AND OTHER DIAGNOSTIC STUDIES
• Plain radiographs of the hand are made to evaluate for extrinsic and
intrinsic causes of joint stiffness.
•Extrinsic
• Metacarpal neck or
shaft fracture
• Metacarpal fracture
malunion
• Proximal phalangeal
fracture
• Proximal phalangeal
fracture malunioN
•Intrinsic
• Intra-articular fracture: Articular
incongruity may serve as a bony
restraint to joint motion.
• Arthritic changes: Cartilage softening
and erosion often result in some
degree of radiographically apparent
arthritis.

12. •MCP extension contracture from extrinsic extensor muscle spasticity or intrinsic muscle
paralysis or denervation
•MCP loss of flexion from proximal phalanx apex volar malunion
•PIP contracture from tendon imbalances, including boutonnière deformity and swan-
neck deformity
•Skin contracture
•Dupuytren disease
DIFFERENTIAL DIAGNOSIS

13. NONOPERATIVE MANAGEMENT
As a general rule, inflammation and edema will subside
and range of motion will improve for a minimum of 3 to
4 months after a traumatic or surgical insult to the hand.

14. NONOPERATIVE MANAGEMENT
Most MCP contractures occur in extension. In addition to
regular exercises, dynamic flexion splints (daytime) and
static extension splints (nighttime) are useful.
MCP

15. NONOPERATIVE MANAGEMENT
Most PIP contractures occur in flexion.
Treatment begins with application of a nonelastic extension force across the PIP joint for
an extended time.
This can be done with serial finger casts or commercially available splints such as the
Joint Jack (Joint Jack Co., Wethersfield, CT) or wire-foam splints.
Once the contracture is corrected, elastic splints such as the Joint Spring or clock-spring
splints can be used.
PIP

16. Email: Info@TheArmDoc.co.uk
M Imam