Authors of section

Authors

Fiesky Nuñez, Renato Fricker, Matej Kastelec, Terry Axelrod

Executive Editor

Chris Colton

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Dorsal approach to the DIP joint

1. Indications

The dorsal approach to the distal interphalangeal (DIP) joint is indicated for extensor tendon avulsion fractures of the dorsal base of the distal phalanx, or intraarticular fractures with palmar dislocation.
It is also indicated for DIP arthrodesis.

The dorsal approach to the distal interphalangeal (DIP) joint is indicated for extensor tendon avulsion fractures of the ...

2. Surgical anatomy

Note the crisscross alignment of the fibers within the conjoint extensor tendons, and also within the triangular ligament.

Note the crisscross alignment of the fibers within the conjoint extensor tendons, and also within the triangular ligament.

Damage to the nail matrix must be avoided, since it may cause permanent deformity of the nail.

Damage to the nail matrix must be avoided, since it may cause permanent deformity of the nail.

3. Skin incision

There are three common skin incisions: The H-shaped, the Y-shaped, and the lazy S-shaped incision.
The H-shaped incision is usually modified by diverging the sides slightly, to improve vascularity.

There are three common skin incisions: The H-shaped, the Y-shaped, and the lazy S-shaped incision.

Transverse incision

An alternative incision, designed to reduce potential soft tissue trauma, is a simple transverse incision, which will give enough exposure for osteosynthesis or for joint surface preparation for arthrodesis.

An alternative incision, designed to reduce potential soft tissue trauma, is a simple transverse incision, which ...

4. Elevate the skin flaps

Depending on the shape of the skin incision, flaps should be elevated and held with fine sutures to minimize soft-tissue trauma.
Tiny veins will appear, and should be coagulated with the bipolar forceps, as necessary, to gain exposure of the joint.

Depending on the shape of the skin incision, flaps should be elevated and held with fine sutures to minimize soft-tissue trauma.

5. Division of the extensor tendon

Divide the terminal extensor tendon with either a transverse tenotomy, a step cut, or a long oblique cut.
The step cut and the oblique cut facilitate repair.

Divide the terminal extensor tendon with either a transverse tenotomy, a step cut, or a long oblique cut. The step cut and ...

6. Preserve the Landsmeer ligament

The retinacular ligament of Landsmeer passes obliquely from the palmar aspect at the attachment of the A3 pulley to the terminal conjoint extensor tendon. This ligament must be preserved to avoid a mallet deformity.
If it proves necessary to divide this ligament, it must be repaired carefully.

The retinacular ligament of Landsmeer passes obliquely from the palmar aspect at the attachment of the A3 pulley to ...

7. Expose the joint

Retract the terminal extensor tendon proximally, in order to expose the DIP joint.

Retract the terminal extensor tendon proximally, in order to expose the DIP joint.

8. Wound closure

Repair the extensor tenotomy with multiple fine nonresorbable mattress sutures.

Repair the extensor tenotomy with multiple fine nonresorbable mattress sutures.