[Anterior tenoarthrolysis in flexion contracture of the fingers. Apropos of 41 cases].
The "hook finger" with PIP and DIP flexion deformity, after multiple previous operations is difficult to treat. Classical PIP arthrolysis combined with tenolysis are frequently unsuccessful. We studied the result of an operation of Total Anterior Teno-Arthrolysis (TATA) as described by Saffar in 1978. Among 41 patients with a mean age of 33 years, 73 per cent had at least one previous operation, on the flexor apparatus in the majority of cases. Global PIP and DIP lack of extension was 131 degrees with a mean PIP lack of 80 degrees. The operation consists in "en bloc" lifting of the finger volar aspect including the two neuro-vascular bundles, the flexor apparatus and the two volar plate, by dissecting underneath the periosteum of phalanges palmar aspect. The denuded distal squeleton is best covered by DIP arthrodesis combined with shortening. Only one complication occurred with PIP septic arthritis. With a mean follow up of 7.6 years, four fingers were not improved, none was worsened and 37 were improved. Mean post-operative PIP extension lag was 30 degrees, giving a global (PIP and DIP) gain of 86 degrees. The PIP AROM was only improved of 38 degrees. The benefit of this salvage operation is mainly a change of the AROM in a more functional arc. This has to be clearly explained to the patient and if accepted the satisfaction is high (90 per cent in our series).