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Proximal interphalangeal joint (PIP) arthroplasty

Case contributed by Ashesh Ishwarlal Ranchod
Diagnosis certain

Presentation

Post-operative X-rays for assessment. There is a history of a compound fracture of the right ring finger involving the proximal interphalangeal articulation.

Patient Data

Age: 30 years
Gender: Male

Post operative assessment.

x-ray

Post-operative radiographs demonstrate a right fourth digit (ring finger), proximal interphalangeal joint, total arthroplasty. There is satisfactory alignment and no immediate post-operative complications. There is a normal post-surgical soft tissue appearance.

2 months follow up.

x-ray

There is progressive, right ring finger, soft tissue swelling and the patient presents with pain, limitation of motion and a visible erythematous and warm rdigit.

4 months follow up.

x-ray

These radiographs demonstrate a silicone prosthetic implant replacing the previous septic, metallic, right ring finger, PIP arthroplasty. The proximal silicone stem is barely discernible, while the distal silicone stem is poorly appreciated. There is no abnormal soft tissue swelling.

Case Discussion

This young adult patient suffered a work-related compound fracture of the right fourth digit, PIP articulation. Pre-operative imaging performed in an external department was unavailable for review and comparison. The initial post-operative views demonstrate a PIP metallic arthroplasty and are otherwise unremarkable. The patient subsequently developed septic arthritis and the metallic PIP arthroplasty was removed and septic arthritis was treated over a period of 2 months. Subsequently, a silastic (silicone) prosthesis was inserted and the patient represents for follow-up imaging, with no ongoing clinical complaints.

Digital arthroplasty is an alternative method of treatment to resection arthroplasty and arthrodesis.

The standard complications applicable to all implants also apply to digital (finger/ toe) arthroplasty. These include but are not limited to complications of anesthesia, infection (septic arthritis/ osteomyelitis/soft tissue sepsis), nerve damage and implant failure.

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