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Flexion Contacture of the PIP Joint

- See: boutonniere injury

- Discussion:
    - flexion contracture:
          - treatment should start with static or dynamic splinting;
          - in the study by Bruser, et al (1999), a midlateral incision yielded a more normal ROM than a palmar incision;
                - use of a palmar incision may cause a skin defect to open once the contracture is relieved and may require skin grafting as well as a delay in ROM;
                - midlateral incision:
                       - may be approached from the radial or ulnar side of the digit;
                       - neurovascular bundle is identified and retracted palmarly;
                       - transverse retinacular ligament is released;
                       - visualize the accessory collateral ligament and the palmar plate and release their proximal attachments;
                       - in some cases, a tenolysis of the FDS tendon and incision of the A3 pulley are necessary;
          - ref: Results of proximal interphalangeal joint release for flexion contractures: midlateral versus palmar incision.

    - stiffness following frx:
          - may be related to improper positioning of the hand after reduction;
          - articular fractures may become are often associated with delays in union due to fibrinolysis in the synovial fluid;
          - best results are obtained when joint becomes stiff in neutral position;
          - treatment:
                - when joint is stiff in extension, transverse retinacular ligaments are transected;
                - then collateral ligaments are transected from dorsal to palmar until passive motion is regained