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Effect of proximal phalangeal fracture deformity on extensor tendon function
J W Vahey1, D A Wegner, H Hastings
1Orthopaedic Specialists of Nevada, Las Vegas 89106, USA.
The Journal of Hand Surgery
|August 26, 1998
Summary
Proximal phalangeal fractures can cause extensor lag due to bone-tendon discrepancies. This study found a direct relationship between bone shortening/angulation and proximal interphalangeal (PIP) joint lag, emphasizing accurate bone-tendon alignment.
Area of Science:
- Orthopedic surgery
- Hand surgery
- Biomechanics
Background:
- Extensor lag is a frequent complication following proximal phalangeal fractures.
- Fractures can lead to extensor tendon dysfunction through adhesions or malunion, affecting joint extension.
Purpose of the Study:
- To quantify how proximal phalangeal angulation and shortening impact proximal interphalangeal (PIP) joint extension.
- To determine the extensor digitorum communis tendon's capacity to compensate for PIP joint lag.
Main Methods:
- Simulated proximal phalangeal malunions in six cadaveric middle fingers.
- Radiographic measurement of extensor lag following simulated bone deformities.
Main Results:
- A linear correlation was observed between extensor tendon lengthening/shortening and PIP joint lag (average 12 degrees lag/mm discrepancy).
- Increasing degrees of palmar apex angulation resulted in proportionally greater PIP joint lag.
- Extensor tendon reserve was measured between 2-6 mm before sagittal band tightening.
Conclusions:
- Accurate restoration of the bone-tendon relationship is crucial for managing proximal phalangeal fractures.
- Quantifying the impact of malunion on extensor lag aids in surgical planning and patient outcomes.