A Biomechanical Study of Distal Interphalangeal Joint Subluxation After Mallet Fracture Injury
Purpose There is no consensus in the literature regarding the size of a mallet fracture fragment that may lead to subluxation of the distal interphalangeal (DIP) joint. The purpose of this study was to determine the relationship between the size of the dorsal articular fragment and DIP joint subluxa...
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Veröffentlicht in: | The Journal of hand surgery (American ed.) 2008, Vol.33 (1), p.26-30 |
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description | Purpose There is no consensus in the literature regarding the size of a mallet fracture fragment that may lead to subluxation of the distal interphalangeal (DIP) joint. The purpose of this study was to determine the relationship between the size of the dorsal articular fragment and DIP joint subluxation in a cadaveric mallet fracture model. Methods Twenty-nine fresh-frozen fingers without evidence of DIP joint osteophytes were dissected to the metacarpal base. The mean age of the 17 donors at the time of death was 69 years (range, 46 to 89 years). Obliquely oriented fractures through the dorsal lip of the distal phalanx were randomly created with an osteotome (range, 27% to 69% of the joint surface). Each finger was fully flexed and extended 1,200 times by applying alternating tension to the flexor and extensor tendons. Fluoroscopic images were obtained and digitized for measurements of fracture fragment size and DIP joint subluxation. Results Sixteen DIP joints remained reduced and 13 distal phalanges subluxated palmarward. Subluxation was not observed when the fracture fragment measured less than 43% of the joint surface, whereas subluxation consistently occurred when the defect measured greater than 52% of the articular surface. Subluxation averaged 18% ± 7% of the overall joint surface in these specimens. There was no correlation between the amount of joint subluxation and the percentage of articular surface damage (p = .22). Conclusions This study supports the concept that a mallet fracture with a large articular fragment may be unstable. Palmar subluxation of a DIP joint without preexisting arthritic deformity is expected when more than one half of the dorsal articular surface is injured. |
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The purpose of this study was to determine the relationship between the size of the dorsal articular fragment and DIP joint subluxation in a cadaveric mallet fracture model. Methods Twenty-nine fresh-frozen fingers without evidence of DIP joint osteophytes were dissected to the metacarpal base. The mean age of the 17 donors at the time of death was 69 years (range, 46 to 89 years). Obliquely oriented fractures through the dorsal lip of the distal phalanx were randomly created with an osteotome (range, 27% to 69% of the joint surface). Each finger was fully flexed and extended 1,200 times by applying alternating tension to the flexor and extensor tendons. Fluoroscopic images were obtained and digitized for measurements of fracture fragment size and DIP joint subluxation. Results Sixteen DIP joints remained reduced and 13 distal phalanges subluxated palmarward. Subluxation was not observed when the fracture fragment measured less than 43% of the joint surface, whereas subluxation consistently occurred when the defect measured greater than 52% of the articular surface. Subluxation averaged 18% ± 7% of the overall joint surface in these specimens. There was no correlation between the amount of joint subluxation and the percentage of articular surface damage (p = .22). Conclusions This study supports the concept that a mallet fracture with a large articular fragment may be unstable. Palmar subluxation of a DIP joint without preexisting arthritic deformity is expected when more than one half of the dorsal articular surface is injured.</description><identifier>ISSN: 0363-5023</identifier><identifier>EISSN: 1531-6564</identifier><identifier>DOI: 10.1016/j.jhsa.2007.09.006</identifier><identifier>PMID: 18261661</identifier><identifier>CODEN: JHSUDV</identifier><language>eng</language><publisher>New york, NY: Elsevier Inc</publisher><subject>Aged ; Biological and medical sciences ; Biomechanical Phenomena ; Biomechanics. Biorheology ; Cadaver ; Distal interphalangeal joint ; distal phalanx ; Female ; Finger Joint ; Finger Phalanges - injuries ; Fractures, Bone - complications ; Fractures, Bone - diagnostic imaging ; Fractures, Bone - physiopathology ; Fundamental and applied biological sciences. Psychology ; Humans ; Injuries of the limb. Injuries of the spine ; Joint Capsule - diagnostic imaging ; Joint Dislocations - diagnostic imaging ; Joint Dislocations - etiology ; Joint Dislocations - physiopathology ; Male ; mallet finger ; mallet fracture ; Medical sciences ; Middle Aged ; Orthopedic surgery ; Orthopedics ; Radiography ; Range of Motion, Articular ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Tissues, organs and organisms biophysics ; Traumas. Diseases due to physical agents</subject><ispartof>The Journal of hand surgery (American ed.), 2008, Vol.33 (1), p.26-30</ispartof><rights>American Society for Surgery of the Hand</rights><rights>2008 American Society for Surgery of the Hand</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-d3a54723ae75e4c6058006b1bed21106df7d3f1580828acb14d4ec8f4c957a13</citedby><cites>FETCH-LOGICAL-c439t-d3a54723ae75e4c6058006b1bed21106df7d3f1580828acb14d4ec8f4c957a13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0363502307007800$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,4010,27900,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20085444$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18261661$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Husain, Sohail N., MD</creatorcontrib><creatorcontrib>Dietz, Jeffrey F., MD</creatorcontrib><creatorcontrib>Kalainov, David M., MD</creatorcontrib><creatorcontrib>Lautenschlager, Eugene P., PhD</creatorcontrib><title>A Biomechanical Study of Distal Interphalangeal Joint Subluxation After Mallet Fracture Injury</title><title>The Journal of hand surgery (American ed.)</title><addtitle>J Hand Surg Am</addtitle><description>Purpose There is no consensus in the literature regarding the size of a mallet fracture fragment that may lead to subluxation of the distal interphalangeal (DIP) joint. The purpose of this study was to determine the relationship between the size of the dorsal articular fragment and DIP joint subluxation in a cadaveric mallet fracture model. Methods Twenty-nine fresh-frozen fingers without evidence of DIP joint osteophytes were dissected to the metacarpal base. The mean age of the 17 donors at the time of death was 69 years (range, 46 to 89 years). Obliquely oriented fractures through the dorsal lip of the distal phalanx were randomly created with an osteotome (range, 27% to 69% of the joint surface). Each finger was fully flexed and extended 1,200 times by applying alternating tension to the flexor and extensor tendons. Fluoroscopic images were obtained and digitized for measurements of fracture fragment size and DIP joint subluxation. Results Sixteen DIP joints remained reduced and 13 distal phalanges subluxated palmarward. Subluxation was not observed when the fracture fragment measured less than 43% of the joint surface, whereas subluxation consistently occurred when the defect measured greater than 52% of the articular surface. Subluxation averaged 18% ± 7% of the overall joint surface in these specimens. There was no correlation between the amount of joint subluxation and the percentage of articular surface damage (p = .22). Conclusions This study supports the concept that a mallet fracture with a large articular fragment may be unstable. Palmar subluxation of a DIP joint without preexisting arthritic deformity is expected when more than one half of the dorsal articular surface is injured.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Biomechanical Phenomena</subject><subject>Biomechanics. Biorheology</subject><subject>Cadaver</subject><subject>Distal interphalangeal joint</subject><subject>distal phalanx</subject><subject>Female</subject><subject>Finger Joint</subject><subject>Finger Phalanges - injuries</subject><subject>Fractures, Bone - complications</subject><subject>Fractures, Bone - diagnostic imaging</subject><subject>Fractures, Bone - physiopathology</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Humans</subject><subject>Injuries of the limb. Injuries of the spine</subject><subject>Joint Capsule - diagnostic imaging</subject><subject>Joint Dislocations - diagnostic imaging</subject><subject>Joint Dislocations - etiology</subject><subject>Joint Dislocations - physiopathology</subject><subject>Male</subject><subject>mallet finger</subject><subject>mallet fracture</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Orthopedic surgery</subject><subject>Orthopedics</subject><subject>Radiography</subject><subject>Range of Motion, Articular</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Tissues, organs and organisms biophysics</subject><subject>Traumas. Diseases due to physical agents</subject><issn>0363-5023</issn><issn>1531-6564</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc2O0zAURi0EYsrAC7BA2cAuwf9JJYRUBgYGDWLRWWM59g11SJNiO4i-PTe0AokFK8vW-T5dn0vIU0YrRpl-2Vf9LtmKU1pXdF1Rqu-RFVOClVppeZ-sqNCiVJSLC_IopZ5STAn1kFywhmumNVuRL5viTZj24HZ2DM4OxTbP_lhMXfE2pIz3mzFDPOzsYMevgPePUxhzsZ3bYf5pc5jGYtMhUXyywwC5uI7W5TkC5vo5Hh-TB50dEjw5n5fk7vrd3dWH8vbz-5urzW3ppFjn0gurZM2FhVqBdJqqBn_TshY8Z4xq39VedAxfG95Y1zLpJbimk26tasvEJXlxqj3E6fsMKZt9SA4GHBqmOZma8kagDAT5CXRxSilCZw4x7G08GkbNItX0ZpFqFqmGrg2OgaFn5_a53YP_GzlbROD5GbAJHXbRji6kPxx2NUpKidyrEweo4keAaJILMDrwIYLLxk_h_3O8_ifuhvB7a9_gCKmf5jiiZMNM4oaa7bL-Zfu0xhIUKn4B8oOp8Q</recordid><startdate>2008</startdate><enddate>2008</enddate><creator>Husain, Sohail N., MD</creator><creator>Dietz, Jeffrey F., MD</creator><creator>Kalainov, David M., MD</creator><creator>Lautenschlager, Eugene P., PhD</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2008</creationdate><title>A Biomechanical Study of Distal Interphalangeal Joint Subluxation After Mallet Fracture Injury</title><author>Husain, Sohail N., MD ; Dietz, Jeffrey F., MD ; Kalainov, David M., MD ; Lautenschlager, Eugene P., PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-d3a54723ae75e4c6058006b1bed21106df7d3f1580828acb14d4ec8f4c957a13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Biomechanical Phenomena</topic><topic>Biomechanics. Biorheology</topic><topic>Cadaver</topic><topic>Distal interphalangeal joint</topic><topic>distal phalanx</topic><topic>Female</topic><topic>Finger Joint</topic><topic>Finger Phalanges - injuries</topic><topic>Fractures, Bone - complications</topic><topic>Fractures, Bone - diagnostic imaging</topic><topic>Fractures, Bone - physiopathology</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Humans</topic><topic>Injuries of the limb. Injuries of the spine</topic><topic>Joint Capsule - diagnostic imaging</topic><topic>Joint Dislocations - diagnostic imaging</topic><topic>Joint Dislocations - etiology</topic><topic>Joint Dislocations - physiopathology</topic><topic>Male</topic><topic>mallet finger</topic><topic>mallet fracture</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Orthopedic surgery</topic><topic>Orthopedics</topic><topic>Radiography</topic><topic>Range of Motion, Articular</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Tissues, organs and organisms biophysics</topic><topic>Traumas. Diseases due to physical agents</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Husain, Sohail N., MD</creatorcontrib><creatorcontrib>Dietz, Jeffrey F., MD</creatorcontrib><creatorcontrib>Kalainov, David M., MD</creatorcontrib><creatorcontrib>Lautenschlager, Eugene P., PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of hand surgery (American ed.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Husain, Sohail N., MD</au><au>Dietz, Jeffrey F., MD</au><au>Kalainov, David M., MD</au><au>Lautenschlager, Eugene P., PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Biomechanical Study of Distal Interphalangeal Joint Subluxation After Mallet Fracture Injury</atitle><jtitle>The Journal of hand surgery (American ed.)</jtitle><addtitle>J Hand Surg Am</addtitle><date>2008</date><risdate>2008</risdate><volume>33</volume><issue>1</issue><spage>26</spage><epage>30</epage><pages>26-30</pages><issn>0363-5023</issn><eissn>1531-6564</eissn><coden>JHSUDV</coden><abstract>Purpose There is no consensus in the literature regarding the size of a mallet fracture fragment that may lead to subluxation of the distal interphalangeal (DIP) joint. The purpose of this study was to determine the relationship between the size of the dorsal articular fragment and DIP joint subluxation in a cadaveric mallet fracture model. Methods Twenty-nine fresh-frozen fingers without evidence of DIP joint osteophytes were dissected to the metacarpal base. The mean age of the 17 donors at the time of death was 69 years (range, 46 to 89 years). Obliquely oriented fractures through the dorsal lip of the distal phalanx were randomly created with an osteotome (range, 27% to 69% of the joint surface). Each finger was fully flexed and extended 1,200 times by applying alternating tension to the flexor and extensor tendons. Fluoroscopic images were obtained and digitized for measurements of fracture fragment size and DIP joint subluxation. Results Sixteen DIP joints remained reduced and 13 distal phalanges subluxated palmarward. Subluxation was not observed when the fracture fragment measured less than 43% of the joint surface, whereas subluxation consistently occurred when the defect measured greater than 52% of the articular surface. Subluxation averaged 18% ± 7% of the overall joint surface in these specimens. There was no correlation between the amount of joint subluxation and the percentage of articular surface damage (p = .22). Conclusions This study supports the concept that a mallet fracture with a large articular fragment may be unstable. Palmar subluxation of a DIP joint without preexisting arthritic deformity is expected when more than one half of the dorsal articular surface is injured.</abstract><cop>New york, NY</cop><pub>Elsevier Inc</pub><pmid>18261661</pmid><doi>10.1016/j.jhsa.2007.09.006</doi><tpages>5</tpages></addata></record> |
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subjects | Aged Biological and medical sciences Biomechanical Phenomena Biomechanics. Biorheology Cadaver Distal interphalangeal joint distal phalanx Female Finger Joint Finger Phalanges - injuries Fractures, Bone - complications Fractures, Bone - diagnostic imaging Fractures, Bone - physiopathology Fundamental and applied biological sciences. Psychology Humans Injuries of the limb. Injuries of the spine Joint Capsule - diagnostic imaging Joint Dislocations - diagnostic imaging Joint Dislocations - etiology Joint Dislocations - physiopathology Male mallet finger mallet fracture Medical sciences Middle Aged Orthopedic surgery Orthopedics Radiography Range of Motion, Articular Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Tissues, organs and organisms biophysics Traumas. Diseases due to physical agents |
title | A Biomechanical Study of Distal Interphalangeal Joint Subluxation After Mallet Fracture Injury |
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