PIPJ release little finger – Partial anterior teno-arthrolysis (PATA)
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This is a step by step operative instruction for the volar release of the proximal inter-phalangeal joint (PIPJ) using the partial anterior teno-arthrolysis (PATA) method.
The total anterior teno-artholysis (TATA) for combined distal inter-phalangeal joint (DIPJ) and PIPJ contracture releases was first described by Mr P. Saffar, a French surgeon from the Institue de la main in Paris in 1978. The PATA is a similar procedure used for release of the PIPJ alone.
The procedure can be used in a number of pathologies including PIPJ trauma, volar plate injury, Dupuytren’s contracture, spasticity and post-operative contracture or post chronic regional pain syndrome contracture. As long as the articular surface of the joint is thought to be sound then this method may be applicable.
As with all surgeries of the PIPJ the release is likely to get the joint fully straight intra-operatively however, due to a combination of post-operative scarring and a poorly functioning extensor mechanism after prolonged stretching and dysfunction, the release often results in around a 50% improvement of deformity once the patient has fully recovered.
Following surgery the patient is placed in a volar plaster for a week and then a night extension splint and hand therapy following that. The splint maintains the extension while the finger is healing but also allows the extensor to tighten up to improve function. Final results are likely to present at 3-6months.
Compared to a joint arthrodesis, this technique and other joint release procedures, aims to maintain flexion at the PIPJ. A well positioned arthrodesis will allow the flexed finger out of the palm, which can itself be quite debilitating. The resulting lack of active flexion however, particularly in the case of the gripping fingers, little and ring, results in their main function of a tight grip being lost.
P Saffar, J P Rengeval. Total Anterior Tenoarthrolysis. Treatment of the Bent Fingers. Ann. Chir. Nov 1978;32(9):579-82.
Author:Mr Mark Brewster FRCS (Tr & Orth).
Institution: The Royal Orthopaedic Hospital, Birmingham, UK.