Objective To provide anatomical basis for mini plate internal fixation of bony mallet finger by anatomical study of the zoneⅠ terminal extensor tendon and adjacent tissues. Methods Ten adult hand cadavers’ upper limb specimens were dissected and the anatomical relationships between nail matrix, nail root and zoneⅠ terminal extensor tendon were observed. Microscopically, the distance from the terminal extensor tendon to nail root, nail matrix, articular surface were measured. The width of zoneⅠ terminal extensor tendon and the transverse and vertical diameters of phalangette joints were measured. Results The proximal margin of the nail root did not completely cover the germinal matrix, and the distance between the zoneⅠ terminal extensor tendon and the germinal matrix was（1.21±0.21）mm.There was a loose connective tissue between them. The width of terminal extensor tendon was（6.27±1.23）mm, horizontal thickness was (1.02±0.21) mm. The distance between the zoneⅠ terminal extensor tendon and the articular of the distal interphalanx was （1.22±0.21）mm. The transverse diameter of the distal phalanx articular surface was (8.00±2.21) mm, the longitudinal diameter was （6.22±1.21）mm. ZoneⅠ terminal extensor tendon was closely connected to the dorsal articular capsule of distal interphalangeal joint. Conclusions The longitudinal dorsal median skin incision on the distal phalangeal bone can fully reveal the tissue structure around zoneⅠ terminal extensor tendon. In fixing the avulsed fracture fragment of the distal phalanx, the plate is partially overlapped with the nail matrix, and the nail root and nail matrix need to be partially incised. The terminal extensor tendon is closely linked to the dorsal capsule of distal interphalangeal joint, where the zoneⅠterminal extensor tendon has a dorsal fibrous cartilage tissue plate, just like the volar plate.
Key words
Terminal extensor tendon /
Germinal matrix /
Bony mallet finger /
Applied anatomy /
Distal interphalangeal joint
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Theivendran K, Mahon A, Rajaratnam V. A novel hook plate fixation technique for the treatment of mallet fractures[J]. Ann Plast Surg, 2007, 58(1): 112-115. DOI: 10. 1097/01. sap. 0000232858. 80450. 27.
[2] Teoh LC, Lee JYL. Mallet fractures: a novel approach to internal fixation using a hook plate[J]. J Hand Surg Eur Vol, 2007, 32(1): 24-30. DOI: 10.1016/j.jhsb.2006.09.007.
[3] Fábio SI, Thiago AL, Rogério SI, et al. Osteosynthesis of mallet finger using plate and screws: evaluation of 25 patients[J]. Rev Bras Ortop 2016, 51(3): 268-273. DOI: 10.1016/j.rboe.2015.09.013.
[4] Toker S, Türkmen F, Pekince O, et al. et al. Extension Block Pinning Versus Hook Plate Fixation for Treatment of Mallet Fractures[J]. J Hand Surg Am, 2015, 40(8): 1591-1596. DOI: 10.1016/j.jhsa. 2015. 04. 027.
[5] Acar MA, Güzel Y, Güleç A, et al. Clinical comparison of hook plate fixation versus extension block pinning for bony mallet finger: a retrospective comparison study[J]. J Hand Surg Eur Vol, 2015, 40(8): 832-839. DOI: 10.1177/1753193415581517.
[6] 吴志鹏, 林大木, 陈星隆, 等. 应用微型钩钢板治疗骨性锤状指的临床研究[J]. 中华手外科杂志, 2015, 31(1): 9-11. DOI: 10.3760/cma.j.issn.1005-054X.2015.01.005.
[7] Slattery D, Aland C, Durbridge G, et al. The connective tissue and ligaments of the distal interphalangeal joint: a review and investigation using ultra-high field 16.4 Tesla magnetic resonance imaging[J]. J Hand Surg Eur, 2014, 39(4): 398-404. DOI: 10.1177/1753193413 496949.
[8] Slattery P. The dorsal plate of the proximal interphalangeal joint[J]. J Hand Surg Br, 1990, 15(1): 68-73. DOI: 10.1016/0266-7681(90)90052-6.
[9] 陆裕朴, 实用骨科学[M]. 北京: 人民军医出版社, 1993: 679.
[10] Tan AL, Benjamin M, Toumi H, et al. The relationship between the extensor tendon enthesis and the nNail in distal interphalangeal joint disease in psoriatic arthritis-a high-resolution MRI and histological study[J]. Rheumatology (Oxford), 2007, 46(2): 253-256. DOI: 10.1093/rheumatology/kel214.
[11] Palomo PL, de Becerro RBV, López DL, et al. Anatomic relationship of the proximal nail matrix to the extensor hallucis longus tendon insertion[J]. J Eur Acad Dermatol Venereol, 2015, 29(10): 1967-1971. DOI: 10.1111/jdv.13108.
[12] Palomo PL, de Becerro RBV, López DL, et al. Anatomic association of the proximal fingernail matrix to the extensor pollicis longus tendon: a morphological and histological study[J]. J Clin Med, 2018, 7(12): 465-475. DOI: 10.3390/jcm7120465.
PDF(3094 KB)
