Article

Treatment of soft tissues defects in the central slip of the extensor tendon at
the proximal interphalangeal (PIP) joint is challenging because of the potential
for stiffness and boutonniere deformity. The bypass procedure proposed by Oberlin
for secondary injuries is an attractive solution. This salvage procedure uses a
free tendon graft (palmaris longus) that is intercalated between the extensor
indicis proprius muscle and the base of the middle phalanx. This study reports on
the first cases of acute central slip defect treated in an emergency setting.
Four patients with an average age of 37 years (range 11-69) were treated by the
same surgeon using the bypass procedure. Clinical evaluations consisted of
measuring the active range of motion in the PIP joint, QuickDASH, Total Active
Motion (TAM) and strength with a Jamar(R) dynamometer. All patients had
reintegrated their injured finger into their body image within three months. At
the last follow-up, the average active mobility was 0-5-76.5 degrees . The
functional outcomes were similar at nine months, with an average mobility of
0-13-72 degrees . The two patients who were working at the time of injury were
able to return to work in the third month. Various procedures such as tendon
plasty, transfer or graft have been described in the literature for posttraumatic
chronic boutonniere deformity. In cases where significant defects exist not only
in the tendon, but the bone and skin, the bypass procedure is an effective
approach to achieving satisfactory functional outcomes.
CI - Copyright (c) 2014 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS