Evolution of Technology

Dynamic Uniplanar External Fixation

Treatment to reverse the debilitating soft tissue contractures has traditionally been ineffective with splints, which are limited by the ability of the skin to tolerate pressure at the skin-splint interface. Serial casting, another labor intensive option, has the complication of limiting flexion in adjacent joints.

Evolution of Procedure

Proximal Interphalangeal Joint Flexion Contracture Treatment

The anatomy of the PIPJ lends itself to rapid and seemingly irreversibly flexion contractures. The flexor tendons are much stronger than the extensor tendons. Also, the surrounding soft tissue such as the volar plate and collateral ligaments tend to contract and scar in a shortened position. Once the joint becomes contracted, skin and neurovascular structures also shorten, making a rapid surgical contracture reversal difficult.

Another cause of joint contracture can be from Dupuytren’s disease, which is a proliferation of abnormal cells and collagen in the palm of the hand, resulting in contracted cords. The goal of treatment regardless of etiology is to provide a modest extension force to stimulate growth of the volar soft tissues. In cases involving Dupuytren’s contracture, targeting and breaking down the specific collagen found in the cord has also been explored.