Executive Editor: Chris Colton

Authors: Fiesky Nuñez, Renato Fricker, Matej Kastelec, Terry Axelrod

Distal phalanx

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Glossary

Dorsal to the DIP joint
The dorsal approach to the distal interphalangeal (DIP) joint is indicated for extensor tendon avulsion fractures of the ... enlarge

Indications

The dorsal approach to the distal interphalangeal (DIP) joint is indicated for extensor tendon avulsion fractures of the dorsal base of the distal phalanx, or intraarticular fractures with palmar dislocation.
It is also indicated for DIP arthrodesis.


Note the crisscross alignment of the fibers within the conjoint extensor tendons, and also within the triangular ligament. enlarge

Surgical anatomy

Note the crisscross alignment of the fibers within the conjoint extensor tendons, and also within the triangular ligament.


Damage to the nail matrix must be avoided, since it may cause permanent deformity of the nail. enlarge

Damage to the nail matrix must be avoided, since it may cause permanent deformity of the nail.


There are three common skin incisions: The H-shaped, the Y-shaped, and the lazy S-shaped incision. enlarge

Skin incision

There are three common skin incisions: The H-shaped, the Y-shaped, and the lazy S-shaped incision.
The H-shaped incision is usually modified by diverging the sides slightly, to improve vascularity.


An alternative incision, designed to reduce potential soft tissue trauma, is a simple transverse incision, which ... enlarge

Transverse incision

An alternative incision, designed to reduce potential soft tissue trauma, is a simple transverse incision, which will give enough exposure for osteosynthesis or for joint surface preparation for arthrodesis.


Depending on the shape of the skin incision, flaps should be elevated and held with fine sutures to minimize soft-tissue trauma. enlarge

Elevate the skin flaps

Depending on the shape of the skin incision, flaps should be elevated and held with fine sutures to minimize soft-tissue trauma.
Tiny veins will appear, and should be coagulated with the bipolar forceps, as necessary, to gain exposure of the joint.


Divide the terminal extensor tendon with either a transverse tenotomy, a step cut, or a long oblique cut. The step cut and ... enlarge

Division of the extensor tendon

Divide the terminal extensor tendon with either a transverse tenotomy, a step cut, or a long oblique cut.
The step cut and the oblique cut facilitate repair.


The retinacular ligament of Landsmeer passes obliquely from the palmar aspect at the attachment of the A3 pulley to ... enlarge

Preserve the Landsmeer ligament

The retinacular ligament of Landsmeer passes obliquely from the palmar aspect at the attachment of the A3 pulley to the terminal conjoint extensor tendon. This ligament must be preserved to avoid a mallet deformity.
If it proves necessary to divide this ligament, it must be repaired carefully.


Retract the terminal extensor tendon proximally, in order to expose the DIP joint. enlarge

Expose the joint

Retract the terminal extensor tendon proximally, in order to expose the DIP joint.


Repair the extensor tenotomy with multiple fine nonresorbable mattress sutures. enlarge

Wound closure

Repair the extensor tenotomy with multiple fine nonresorbable mattress sutures.

v2.0 2016-06.30