Corrective Osteotomy and Ligament Repair for Longstanding Radial Collateral Ligament Tear of the Proximal Interphalangeal Joint: Case Series

PurposeTo evaluate the clinical outcomes of corrective osteotomy and ligament repair for longstanding radial collateral ligament tears of the proximal interphalangeal (PIP) joint.MethodsWe retrospectively evaluated 4 patients with 5 longstanding tears in the radial collateral ligaments of the PIP joints. The average age at the time of surgery was 51 years (range, 40–62 y). The average time from the initial injury to surgery was 31 years (range, 22–40 y). Plain radiographs revealed an ulnar slope at the PIP joint surface with degenerative changes in all fingers. We corrected the slope using a closing wedge osteotomy of the neck of the proximal phalanx secured with a headless screw. We then repaired the radial collateral ligament by overlapping the elongated ligament. Range of motion exercises were started 2 weeks after surgery. To evaluate the results, we compared preoperative and postoperative range of motion, ulnar deviation, instability, pain, and level of satisfaction. Average follow-up was 27 months (range, 18–48 mo).ResultsAll osteotomies had united at an average of 3 months. We observed no major changes in range of motion, but flexion contracture gradually appeared in 1 high-demand patient. The average preoperative angle of ulnar deviation was 36° and was corrected to a postoperative angle of 2°. The average angle of lateral instability improved after surgery from 22° to 1°. Finger pain disappeared or decreased in 3 low-demand patients but persisted in 1 high-demand patient. Two low-demand patients were very satisfied and 1 low-demand patient was satisfied; however, 1 high-demand patient was dissatisfied with the results of surgery.ConclusionsCorrective osteotomy and ligament repair can result in a straight and stable joint with a good range of motion in low-demand patients. This method could be a treatment option for carefully selected patients.Type of study/level of evidenceTherapeutic IV.