PIPJ and MCPJ injuries

Question 1

PIPJ injuries

Answer 1

Dorsal simple - no bony injury
- volar plate injured
- good prognosis
- stable injury - collaterals gone but tendons intact
- neighbour strapping or dynamic splint (bedford splint) and get moving

Volar simple - no bony injury
- central slip injured - elson’s test
- worst prognosis
- likely to have central slip so unstable
- splint in hyperextension - kapnier - central slip splint and get moving to stop collaterals becoming stiff

Complex (#)
- dorsal - treat like simple
- volar lip fracture - dorsalblocking splint or wire
- pilon - complete articular - poor prognosis
static or dynamic ex-fix frame
brunner approach, retract FDS and FDP - detach volar plate - hammate graft

Question 2

MCPJ dislocations

Answer 2

simple - reducible
complex - irreducible

do not apply traction - volar plate falls into joint
push to reduce instead
if irreducible - open approach - volar approach - NV bundles but easier to get volar plate

Question 3

thumb MCPJ - collateral injury - UCL

Answer 3

• skiers thumb - acute
• gamekeepers - chronic

mode
- hyper abduction/ extension at MCPJ

anatomy of UCL
- resists valgus strain
- accessory - acts in extension
- proper - acts in flexion - test 30deg
- complete - unstable in flexion and extension

Stener lesion
- UCL displaces above the ABP aponeurosis
- radiographs, US, MRI
- partial tear - splint - 4-6wks
- opens >30 deg - repair ligament with mini mitek
- chronic - reconstruct, abductor advancement or MCPJ fusion