Background

Flexion contracture of the proximal interphalangeal joint is a common clinical problem which can lead to substantial functional deficit. Surgical treatment is demanding and the results are unpredictable¹.

Problem

To date there is no consensus on best treatment for flexion deformity of the proximal interphalangeal joint. The anatomy is complex and numerous components of the joint may be involved in the contracture.

Intervention

The authors have recently started to use the ‘miniflo’, a minimally invasive dorsal external fixator designed to gradually distract interphalangeal and metacarpophalangeal joints. Currently, the authors are using the miniflo primarily for post-traumatic and Dupuytrens related fixed flexion deformities of the proximal interphalangeal joint. The miniflo allows for gradual symmetrical distraction without stressing joint structures or causing trauma to surrounding soft tissues and ligaments.

Evaluation

Use of the miniflo is still considered a new and alternative approach. One of the main benefits of the device is that it enables the patient to independently distract the joint on the basis of tissue tension and tolerance. The authors have a specific post-operative therapy protocol initially focussing on wound care and oedema management techniques. Following removal of the miniflo an exercise program is prescribed centring on active flexor tendon gliding exercises, and extensor tendon strengthening. Pre and post-operative assessments are noted including; range of motion, pain, function and patient experience which are presented in a case study.

Recommendations

Further study is required to assess the long term results following use of the miniflo in a larger sample size however results to date are promising.