This 22 year old male carpenter sustained and injury to his right dominat index finger that was not treated.

he now complaints of pain and weakness when he pinches and is unable to turn a key due to the weakness of the index finger on pinching.

This is  an image of his index PIPJ

What is your diagnosis?

What is the anatomical diagnosis?

How would you treat him?

The index finger was loaded with radial strain and there is obvious laxity. This clearly indicates there is a rupture of the radial collateral ligament producing laxity on loading affecting his key pinch.

This produces instability and weakness on loading of the joint.

The treatment is to repair or reconstruct the ligament.

If there is sufficient tissue this can be reattached using a bone anchor suture.

Here through a dorsal approach the radial collateral has been exposed.

A Mitec anchor has been used here to reattach the RCL to its origin.

here is the result of a stable PIPJ after RCL reattachment.

The joint will be splinted for 6 weeks but allowing active flexion and extension avoiding radial loading.

These are the results post surgery at 6 weeks showing the patient with a stable pinch grip