Abstract
Introduction
This case report details the postsurgical rehabilitation and outcome of a 57-year
old neurosurgeon who underwent hemi-hamate arthroplasty and volar plate repair for
a complex ring finger proximal interphalangeal (PIP) fracture-dislocation sustained
after a fall while snowboarding. Following re-rupture and repair of his volar plate,
the patient was fitted for a “yoke” relative motion flexor orthosis, termed a JAY
(Joint Active Yoke) orthosis, in a manner reverse to that which is commonly used for
extensor-related injuries.
Study Design/Methods
A 57 yo right hand-dominant male who suffered a complex PIP fracture-dislocation with
failed volar plate repair undwent hemi-hamate arthroplasty and early active motion
following using a custom-fabricated joint active yoke orthosis.
Purpose of the Study
The purpose of this study is to illustrate the benefits of this orthosis design in
allowing for active controlled flexion of the repaired PIP joint with assist from
the adjacent fingers, while also reducing joint torque and dorsal displacement forces.
Results
A satisfactory active motion outcome was achieved with maintenance of PIP joint congruity
allowing the patient to return to work as a neurosurgeon at 2-months post-operatively.
Discussion
There is little published literature on the use of relative motion flexion orthoses
following PIP injuries. Most current studies are isolated case reports on boutonniere
deformity, flexor tendon repair, and closed reduction of PIP fractures. The following
therapeutic intervention was considered an important contributor to a favorable functional
outcome, as it minimized unwanted joint reaction forces in a complex PIP fracture-dislocation
and unstable volar plate.
Conclusion
Future research with greater level of evidence is required to establish the various
applications of relative motion flexion orthoses, as well as determine the appropriate
time at which to place the patient in a relative motion orthosis following operative
repair to prevent long-term stiffness and poor motion.
Keywords
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Article info
Publication history
Published online: March 11, 2023
Accepted:
September 13,
2022
Received in revised form:
August 16,
2022
Received:
October 12,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
