Surgical technique for volar plate, collateral ligament reconstruction, and neglected dislocation of the proximal interphalangeal joint in the fifth finger: A case report.

INTRODUCTION AND IMPORTANCE

Chronic unreduced dislocations of the proximal interphalangeal joint are uncommon and management principles for these injuries have not been defined. The dislocation can be either volar or dorsal and closed reduction is rarely successful due to soft tissue contractures.

CASE PRESENTATION

A 61-year-old woman presented with a 17-year-old deformity of her left fifth finger, sustained from a bathroom slip. Initially, the patient complained of pain and deformity. After failed of conservative treatment, patient was referred for surgical intervention. Physical examination revealed a dorsal (posterior) deformity. X-ray showed displacement and ulnar deviation of the proximal interphalangeal (PIP) joint of the left fifth finger. The patient underwent operative management with open reduction and radial collateral ligament reconstruction using proximal phalanx intraosseous suturing and volar plate reconstruction. One day after surgery, the patient achieved a passive range of motion (PROM) of 0-80° and an active range of motion (AROM) of the proximal interphalangeal joint (PIPJ).

CLINICAL DISCUSSION

Untreated or unreduced PIPJ dislocations are rare. These injuries are usually caused by hyperextension forces on the finger. Chronic dislocation of the proximal phalanx is uncommon. The stability of the PIPJ is maintained by the volar plate, collateral ligaments, and extensor expansion. Open reduction of persistent PIPJ dislocations can successfully produce a functional range of motion with a stable joint.

CONCLUSION

A functional range of motion with a stable joint can be achieved as long as the articular cartilage is relatively preserved after surgery.