Article
Reconstruction of the Extensor Tendon of the Proximal Interphalangeal Joint (PIPJ) using a distally based slip of Flexor Digitorum Superficialis (FDS)
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Authors
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Karen Smith
- Middlemore Hospital, Auckland, New Zealand
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Shirley Collocott
- Middlemore Hospital, Auckland, New Zealand
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: In 1971, H Graham Stack described a case report using a slip of FDS as a distally based tendon transfer to reconstruct the central slip of the extensor mechanism of the PIPJ.
Essentially overlooked since then, this technique provides an excellent option for uncomplicated central slip reconstruction but can also be used, with more limited outcome, in more complex cases with extensor tendon or intrinsic muscle loss.
We present a small prospective series of 6 patients who underwent this procedure.
Methods: Six patients, identified as suitable for extensor tendon reconstruction with this technique were entered into the study.
The surgical technique was a modification of that originally described by H Graham Stack. Only one distally based slip of FDS was used; this being passed via a drill hole at the base of the middle phalanx to its dorsum, at the site of the original insertion of the central slip. The FDS slip was then woven (Pulvertaft weave) under appropriate tension, into the extensor mechanism over the proximal phalanx. A very strong repair was obtained allowing immediate protected mobilization.
The six patients were prospectively reviewed.
Results and Conclusions: Follow up averaged 18 months (3-48).
There were 4 patients who had central slip injuries of which one patient had multiple operations before his reconstruction procedure and one other had a simultaneous PIPJ release.
Their mean gain in active extension was 73 degrees with a mean loss of 15.5 degrees of flexion.
In the 2 patients with major trauma, improvement was less; the active PIPJ extension gained was 28 and 21 degrees respectively with both patients each loosing 15 degrees of flexion; while seemingly a small net gain the improvement in arc of movement in these very injured fingers was thought to be, from the patient's perspective, worthwhile.
In conclusion, this surgical technique provides a strong reconstruction suitable for early mobilization, with satisfactory early results. Better in simple central slip defects, the technique is robust enough to use in severe injuries, even those with loss of intrinsic function, but a more modest outcome should be expected.
