Thayer D T
Department of Surgery, Oregon Health Sciences University, Portland.
Hand Clin. 1988 Feb;4(1):1-4.
Pain-free stability in the DIP joint is essential for effective stable pinch. Distal interphalangeal joint injuries usually achieve this function when treated as described. Stiffness in the DIP joint is not ideal, but its presence after treatment is not a major functional limitation if the joint is painless and aligned in the proper position. Mallet fingers are common injuries that usually are treated in extension splinting. Profundus injuries are uncommon injuries that require a high degree of clinical suspicion and are complex to repair. Due to its close proximity, the PIP joint can suffer from coexistent, unrecognized injury. Furthermore, the uninjured PIP joint can become stiff from unnecessary splinting. Therefore, it is essential that the PIP joint be carefully assessed and treated, if necessary, so that full motion can be maintained in the PIP joint. As with any hand injury, treatment and rehabilitation of the DIP joint should be designed to be effective, yet should not compromise overall hand function. It is logical that the more traumatic the injury, the stiffer the joint will become. It is equally logical that more involved surgical repairs also have a high yield of postoperative stiffness. The treating physician is encouraged to share this knowledge with the patient prior to initiating treatment, as this will decrease patient dissatisfaction.
远侧指间关节（DIP关节）无痛性稳定对于有效且稳定的捏取动作至关重要。远侧指间关节损伤按所述方法治疗通常可实现这一功能。DIP关节僵硬并不理想，但如果关节无痛且位置正确，治疗后出现僵硬也并非主要功能限制。锤状指是常见损伤，通常采用伸直位夹板固定治疗。指深屈肌损伤较为罕见，需要高度的临床怀疑，且修复复杂。由于距离较近，近端指间关节（PIP关节）可能存在未被识别的并存损伤。此外，未受伤的PIP关节可能因不必要的夹板固定而僵硬。因此，必须仔细评估PIP关节，必要时进行治疗，以保持PIP关节的全范围活动。与任何手部损伤一样，DIP关节的治疗和康复应设计得有效，但不应损害手部整体功能。损伤越严重，关节越僵硬，这是合乎逻辑的。同样合乎逻辑的是，更复杂的手术修复术后僵硬的发生率也较高。鼓励治疗医生在开始治疗前与患者分享这一知识，因为这将减少患者的不满。
