gms | German Medical Science

Objectives/Interrogation: Post-traumatic proximal interphalangeal joint (PIPJ) contracture of the digit is common and is associated with impaired function of the hand. After surgical release of PIPJ contractures, relapse often occurs. We performed a novel treatment strategy with a PIPJ adipofascial flap (PIPJAF) to resurface the PIPJ after release. This study examines 2 groups of patients with similar joint contracture release where one group is resurfaced with a flap and the other without.

Methods: During January 2010 to January 2018, 10 patients received single-digit PIPJ flexion contracture release and PIPJAF resurfacing whereas 20 patients received a stepwise release as a control group. A total of 30 joints were compared and the degree of extension lag improvement over time was measured during over an average of 292.4 days.

Results and Conclusions: In the PIPJAF group, greater extension lag improvement was observed compared to control group (37.0±19.2 vs. 21.0±19.5, p=0.055). The ratio of improvement was also significantly higher in the PIPJAF group (0.79±0.26 vs. 0.49±0.46, p=0.049). PIPJAF group appeared to have beneficial effect (p=0.042) while following number of operations, associated fractures and maximum VAS scores one week postoperatively were negatively associated in univariate analysis (p<0.05). From generalized estimating modelling, PIPJAF resurfacing has a significantly positive effect on extensor lag improvement along with time (r=2.235, p=0.04). Patients that receive PIPJAF resurfacing following PIPJ contracture release may have a better result in improving extensor lag and maintaining it. Recovery of the PIPJ motion may be quicker as well compared to conventional release alone.