Overview
o Central slip rupture
o PIP flexion + DIP hyperextansion
Pathomechanics
o Central slip is disrupted
o Lateral bands migrate volarly
o PIP flexion deformity develops
Clinical
o PIP flexion
o DIP hyperextension
o Late stage: rigid deformity
· Special Tests
o Elson Test
With PIP in flexion:
· Increased DIP extension ↑ → pozitif test
Treatment
o Acute Treatment
PIP extension splint
DIP left free
6 weeks
o Chronic Treatment
Nonoperative
· Prolonged splinting
Operative
· Central slip repair
· Lateral band relocation
· ORL(oblique retinacular ligament) reconstruction
· Fowler tenotomy
· Curtis procedure (stepwise approach)
Surgical options
· Littler tendon graft
· Lateral band mobilization
· ORL reconstruction
Complications
o Residual deformity
o Stiffness
o Extension lag
Pearls
o Early diagnosis is critical
o Chronic deformity is difficult to treat
o Full passive PIP motion is required before surgery