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.
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Question 1 of 15
Which ONE answer describes the main advantage of the PATA procedure over the joint arthrodesis?CorrectIncorrect
Question 2 of 15
Which ONE of the options is an absolute contra-indication for the PATA procedure ?CorrectIncorrect
Question 3 of 15
Which ONE of the options describes the ligaments which are volar in the finger travelling from the flexor sheath to the skin?CorrectIncorrect
Question 4 of 15
Which ONE option best describes the the structure supplied by the transverse digital arteries?CorrectIncorrect
Question 5 of 15
Which ONE option best describes why the neurovascular bundle must be elevated palmately during the release?CorrectIncorrect
Question 6 of 15
Which ONE option describe the anatomy of Cleland’s ligaments?CorrectIncorrect
Question 7 of 15
Which ONE of the options describes the structures elevated palmar-ward during the release?CorrectIncorrect
Question 8 of 15
Which ONE option describe the pulley NOT elevated off palmar-ward during this procedure?CorrectIncorrect
Question 9 of 15
Which ONE option describes the tendon which may be intentionally detached from the bone in this procedure?CorrectIncorrect
Question 10 of 15
Which ONE option best described the surgical options if there is a skin contracture as well as a joint contracture?CorrectIncorrect
Question 11 of 15
Which ONE option describes the reason to use a TATA rather than a PATA procedure?CorrectIncorrect
Question 12 of 15
Which ONE option describes the pathology which caused the joint contracture treated by Leti Acciaro et al. using the PATA and TATA procedures?CorrectIncorrect
Question 13 of 15
Which adjunct did Leti Acciaro et al use to aid their surgery in severe contractors?CorrectIncorrect
Question 14 of 15
Which ONE option describes the rate of septic arthritis from the TATA/PATA procedures as describes by Lorea et al?CorrectIncorrect
Question 15 of 15
Which ONE option best describes the mean improvement in PIPJ range of movement describe by Lorea et al in their patients who started with a mean PIPJ contracture of 80 degrees?CorrectIncorrect