Surgical Management

Volar dislocations require surgical intervention if a closed reduction cannot be obtained, the joint surface is incongruous after reduction or there is a greater than 30-degree extensor lag. The joint can be approached through a dorsal incision. The interposed extensor mechanism should be extricated from the joint. This should be done under local or wrist block anesthesia and active extension tested to determine if extensor mechanism repair is necessary. If the PIP joint is unstable or the extensor tendon is repaired, the joint may need to be pinned in extension; otherwise, extension splinting is adequate.

Most volar rotatory dislocations can be reduced and treated closed. Indications for operative intervention include inability to reduce the joint by closed manipulation or incongruity of the joint after reduction. The joint should be approached through a midaxial incision on the side of the collateral ligament that was damaged. Wrist block anesthesia is preferred so that the patient can participate in active evaluation of the extensor mechanism after reduction. If there is soft tissue interposition (usually the lateral band), it must be removed from the joint. The joint is then reduced and the lateral band is repaired, or if that is not possible, it may be excised. Because stiffness, not instability, is the major problem with this injury, it is not necessary to repair the collateral ligament if joint congruity can be restored.

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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