Scientific article
Proximal Interphalangeal Joint Volar Plate Configuration in the Crimp Grip Position

https://doi.org/10.1016/j.jhsa.2012.02.016Get rights and content

Purpose

To study the configuration of the proximal interphalangeal joint volar plate (VP) in the crimp grip position (metacarpophalangeal joint at 0° to 45° flexion, proximal interphalangeal joint at 90° to 100° flexion, and distal interphalangeal joint at 0° to 10° hyperextension) using magnetic resonance imaging techniques in healthy volunteers and cadaver fingers and to compare the results with histological sections.

Methods

Magnetic resonance imaging was performed on 24 fingers of 8 healthy volunteers and 12 fingers of 4 embalmed cadaver hands in the neutral position and in the crimp grip position. The translation of the VP body relative to the middle phalanx base during finger flexion was measured. In 6 of 12 cadaver specimens, a load of 10 N was applied to the flexor tendons to examine how this would affect the histological VP fiber configuration.

Results

When the flexor tendons were under load in the crimp grip position, the volunteers' VP body was translated an average of 3.2 mm, and the cadaver fingers' VP body was translated an average of 3.0 mm, relative to the middle phalanx base in a distal direction. Histological analysis of the crimp grip position revealed reversing fibers in the VP insertion at the base of the middle phalanx when the flexor tendons were under load and the VP body was translated. When no load was applied in the crimp grip position, no translation of the VP body occurred.

Conclusions

This article describes a VP translation in a distal direction relative to the middle phalanx base in the crimp grip position when the flexor tendons are under load.

Clinical relevance

A more precise knowledge of the histological properties of the proximal interphalangeal joint VP during finger flexion can be expected to provide greater diagnostic capabilities and can lead to a better comprehension of injuries.

Section snippets

MRI evaluation of human subjects

MRI in the crimp grip position was performed on 24 fingers (index = 8, middle finger = 8, ring finger = 8; right hand = 5, left hand = 3) of 8 healthy volunteers (men:women = 6:2, mean age 25 y, SD 3.4 y). Informed consent from each volunteer and institutional review board approval for this study were obtained. Clinical examination of the volunteers' hands confirmed normal morphology and motion. Each finger was examined with the MCP, PIP, and DIP joints in a neutral position and in the crimp

Magnetic resonance imaging evaluation of human subjects

Compared to its location in the neutral and unloaded digit, the VP body was translated from the base of the middle phalanx in a distal direction in the crimp grip position in 24 of 24 volunteers. The average distance of translation was 3.2 mm (SD, 0.07). The average lowest force that was necessary to initiate the crimp grip in the volunteers was 9.7 N (SD, 0.3). No image impairment resulted from motion artifacts in the volunteers.

Magnetic resonance imaging and histological analysis on cadaveric fingers

The Thiel14 embalming technique of the fingers had no major

Discussion

Our study showed a specific configuration with translation of the VP body of 3.2 mm in a distal direction relative to the middle phalanx base in the crimp grip position. The described VP configuration in the crimp grip appears to be physiological, as it was observed in all 24 volunteers and all 12 cadaveric long fingers. The histological analysis showed a substantial reorientation, with a shift in direction of the distal VP attachment fibers in fingers in which translation of the VP body

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