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Posttraumatic Proximal Interphalangeal Joint Flexion Contractures

Dr. Hogan is Assistant Professor, Naval Medical Center, Portsmouth, VA. Dr. Nunley is Chief, Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.

Neither of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Hogan and Dr. Nunley.

Reprint requests: Dr. Hogan, Department of Orthopaedic Surgery, Charette Health Care Center, 620 John Paul Jones Circle, Portsmouth, VA 23708.

Normal motion of the proximal interphalangeal joint requires bony support, intact articular surfaces, unimpeded tendon gliding, and uncompromised integrity of the collateral ligaments and volar plate. Deficiency in any one of these structural requirements can lead to a loss of finger joint motion and decreased hand function. Once finger extension is lost, options include nonsurgical or surgical treatment. Nonsurgical treatment such as splinting or serial casting should be tried before attempting surgical intervention. When severe flexion deformity exists or the vascular status of the finger has been compromised, arthrodesis or amputation should be undertaken instead of procedures to regain motion. Surgical options for regaining motion include external fixators and open surgical release. Although they can lead to improved extension at the proximal interphalangeal joint, external fixators carry a risk of reduced finger flexion and pin site infection. Most clinical series of patients who have undergone surgical release document improvement in flexion contracture between 25° to 30° and a shift of the flexion/extension arc into a more functional range. Close follow-up after surgery is warranted, with frequent physical therapy and splinting.