Proximal interphalangeal (PIP) joint contractures are common complications in hand injuries and conditions such as Dupuytren's contracture. Conventional treatment such as splinting and serial casting may result in inadequate improvement. Operative release of the contracture may be complicated by neurovascular overstretch with injury to the digital nerves or vascular compromise. Gradual distraction of the contracted joint may prevent this neurovascular injury. The multiplanar distracter was designed for three-dimensional distraction of the mandible. Distraction may be obtained in the X, Y, or Z planes. With this device, the angular relationship between two planes may be altered. A 22-year-old male with a PIP joint contraction following replantation failed conventional treatment for release. With the use of a multiplanar distracter, the flexion contraction was reduced from 95 degrees to a more functional 30 degrees using gradual angular distraction. The angle between the proximal and middle phalanges were gradually changed using the ability of the distracter to change the angular relationship in the X-Y plane. At 3 and 6 months postdistraction, the patient has maintained his 30-degree flexion angle. The multiplanar distracter is a simple technique that may be useful for the treatment of PIP joint contractures that fail conventional therapy.
Kasabian A, McCarthy J, Karp N. Use of a multiplanar distracter for the correction of a proximal interphalangeal joint contracture. Ann Plast Surg 1998;40:378-381