Surgical Release of Proximal lnterphalangeal Joint Flexion Contracture: Palmar Approach

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Journal of the Korean Society for Surgery of the Hand 2007;12(2):50-55.
Published online June 1, 2007.

Chong-Kwan Kim, Jae-Ik Jung, Chin-Woo Jin, Sung-Weon Jung, Kyung-Tae Wang, Woo-Sik Kim, Ki-Hwan Kim

근위 지관절 굴곡 구축의 수술적 치료: 수장부 접근법

김종관, 정재익, 진진우, 정성원, 왕경태, 김우식, 김기환

Abstract

Purpose
To evaluate the usefulness and functional results of the palmar approach to release the flexion contracture of the proximal interphalangeal joint (PIPJ). Materials and Methods: From March 2003 to February 2006, 20 cases were reviewed after surgical release of flexion contracture of the PIPJ. Mean ages were 42.4 ages and mean period of follow-up were 12 months. The cause of injury were 9 cases of crushing injury, 6 cases of fracture and dislocation, 3 cases of tendon injury and 2 cases of infectious disease. We used the palmar approach to release the flexion contracture of the PIPJ and assessed the preoperative and postoperative range of motion (ROM) of the PIPJ and evaluated the functional outcome. Results: The preoperative mean ROM was 54 degree, postoperative 6weeks mean ROM was 72 degree and final mean ROM was 86 degree. The improvement of ROM was better at final follow-up than at postoperative 6 weeks because of postoperative edema and wound problem. Complication were a case of neurovascular injury and 3 cases of partial necrosis and skin defect in extensive release which were healed spontaneously. Satisfactory result were in 16 cases but unsatisfactory result were in 4 cases. Conclusion: The palmar approach to release the flexion contracture of the PIPJ could improve the extension ROM but extensive release might result in postoperative edema and skin defect which delayed the rehabilitation. Adequate release and early ROM exercise were important to achieve satisfactory results.

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