Hery Jean-Charles, Picart Baptiste, Malherbe Mélanie, Hulet Christophe, Lombard Aude
Department of Orthopedics and Traumatology, Caen University Hospital, Caen, France.
Arch Plast Surg. 2021 Nov;48(6):635-640. doi: 10.5999/aps.2021.00220. Epub 2021 Nov 15.
Injuries to the proximal interphalangeal (PIP) joint are common and complex. However, the treatment of osteochondral defects of the head of the proximal phalanx has rarely been described. Herein, we propose a new technique for the management of unicondylar defects of the proximal phalanx that can restore joint amplitudes and provide PIP stability.
In this cadaveric feasibility study, unicondylar defects were generated using striking wedges and chisels. First, a transverse tunnel measuring 2 mm in diameter passing through the head of the proximal phalanx was made. A second tunnel at the base of the middle phalanx with the same diameter was then created. The hemitendon of the flexor carpi radialis graft was passed through each of these tunnels. The proximal end of the graft was interposed in the area with a loss of bone substance. The ligamentoplasty was then tensed and fixed by two anchors on the proximal phalanx. Joint amplitudes and frontal stability were measured preoperatively and postoperatively.
There was no significant change in the joint's range of motion: preoperatively, the mean mobility arcs were -2° to 113.80°, and they were -2° to 110° after the procedure (P=0.999). There was no significant difference in joint stability (P>0.05).
Ligamentoplasty with PIP interposition appears to be a possible solution for the management of unicondylar defects of the proximal phalanx. An evaluation of clinical results is planned in order to definitively confirm the validity of this procedure.
近端指间关节（PIP）损伤常见且复杂。然而，近端指骨头骨软骨缺损的治疗方法鲜有报道。在此，我们提出一种治疗近端指骨单髁缺损的新技术，该技术可恢复关节活动度并提供PIP稳定性。
在这项尸体可行性研究中，使用冲击楔和凿子制造单髁缺损。首先，在近端指骨头处制作一条直径为2毫米的横向隧道。然后在中节指骨基部制作一条直径相同的隧道。将桡侧腕屈肌腱移植的半腱穿过这些隧道。将移植肌腱的近端置于骨质缺损区域。然后通过两个锚钉在近端指骨上拉紧并固定韧带成形术。术前和术后测量关节活动度和额状面稳定性。
关节活动范围无显著变化：术前平均活动弧为-2°至113.80°，术后为-2°至110°（P=0.999）。关节稳定性无显著差异（P>0.05）。
PIP置入韧带成形术似乎是治疗近端指骨单髁缺损的一种可行方法。计划对临床结果进行评估，以最终确认该手术的有效性。
