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Liverneaux P. Re: Kolovich GP, Heifner JJ. Proximal interphalangeal joint dislocations and fracture-dislocations. J Hand Surg Eur. 2023, 48: 27S-34S. J Hand Surg Eur Vol 2024:17531934241238932. [PMID: 38489592 DOI: 10.1177/17531934241238932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Affiliation(s)
- Philippe Liverneaux
- Hand Surgery Department, Strasbourg University Hospitals, Strasbourg, France
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Madi NS, Townsend CB, McEntee R, Marcus A, Tan V, Beredjiklian P. Hand-Specific External Fixation for Treatment of Complex Proximal Interphalangeal Joint Injuries. J Hand Microsurg 2024; 16:100005. [PMID: 38854365 PMCID: PMC11127539 DOI: 10.1055/s-0042-1751275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Background Complex proximal interphalangeal joint (PIPJ) fractures are challenging injuries to treat. There are multiple established treatment methods available for these injuries, including dynamic external fixation. This study reports the outcomes of complex PIPJ fractures treated with a hand-specific external fixation device. Methods Twenty-five fingers in 25 patients were treated with the DigiFix external fixator device for treatment of a PIPJ dorsal fracture dislocation (n = 16) or pilon fracture (n = 9). There were 16 males and 9 females with a mean age of 40 years (range: 14-75 years) at the time of injury. The median time from injury to surgery was 10 days (interquartile range [IQR]: 5; range: 3-49). Chart and radiographic data were reviewed retrospectively. Results The average duration of external fixation was 41 days (range: 26-62 days). At a mean follow-up of 28 weeks (range: 12-105 weeks), the mean PIPJ flexion was 82 (range: 30-105 degrees), extension was -10° (range: -30 to 0 degrees), and flexion/extension arc of motion was 72 degrees (range: 30-95 degrees). Final mean Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score was 21.5 (range: 0-65.8). There were zero major complications and six (24%) minor complications, including superficial cellulitis (4) and stiffness (2). Conclusion Dynamic external fixation for the treatment of complex PIPJ injuries allows for early range of motion and leads to favorable outcomes. This hand-specific external fixator has a reproducible technique which results in predictable and reliable PIPJ distraction.
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Affiliation(s)
- Naji S. Madi
- Department of Orthopaedic Surgery, Rutgers University, Newark, New Jersey, United States
| | - Clay B. Townsend
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Richard McEntee
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Alexander Marcus
- Orthopedic Associates of Central Jersey, Edison, New Jersey, United States
| | - Virak Tan
- Institute for Hand and Arm Surgery, Harrison, New Jersey, United States
| | - Pedro Beredjiklian
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
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Worgul CA, Stein AB. Extension-Block Pinning for Unstable Dorsal Proximal Interphalangeal Joint Fracture-Dislocations: A Simple, Percutaneous Technique With Reproducible Outcomes. Hand (N Y) 2023; 18:616-623. [PMID: 34991401 PMCID: PMC10233636 DOI: 10.1177/15589447211066352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Proximal interphalangeal (PIP) joint fracture-dislocations can be technically challenging injuries to treat, and no technique has proven to be superior nor lead to predictably good outcomes. We describe our experience of treating unstable dorsal fracture-dislocations of the PIP joint with extension-block pinning (EBP) at our institution over a 22-year period. METHODS In all, 23 patients with 24 unstable dorsal fracture-dislocations of the PIP joint treated with EBP between January 1998 and October 2020 were identified. All patients underwent closed reduction of the PIP joint and insertion of a Kirschner wire into the proximal phalanx, creating a mechanical block. Range of motion and joint congruity were assessed at final clinic follow-up. Long-term function was assessed via completion of a Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Spearman's correlation coefficient was utilized to assess if any association existed between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. RESULTS Mean range of motion at final follow-up was 83.3° and 22 of 24 PIP joints demonstrated a congruent reduction. In all, 15 of the 23 patients completed the QuickDASH questionnaire at a median long-term follow-up of 57.5 months (range: 3-157 months). Average QuickDASH score was 18.8, indicating minimal long-term disability. No statistically significant associations were found between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. CONCLUSIONS EBP offers a simple and innovative method to treat a complex injury of the PIP joint. It is technically straightforward and cheap, and produces excellent functional outcomes with minimal long-term disability.
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Abouelela A, Mubark I, Hassan M, Howells M, Ashwood N, Kitsis C. Mid-Term Outcomes of Unstable Complex Proximal Interphalangeal Joint Fracture Management Using the Ligamentotaxor® Device: A Case Series of 33 Cases. Cureus 2020; 12:e10519. [PMID: 33094060 PMCID: PMC7574824 DOI: 10.7759/cureus.10519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background and objective Fractures of the proximal interphalangeal joint (PIPJ) of the hand have always been difficult to treat, often leading to less than satisfactory outcomes. The use of dynamic external fixator devices to treat these fractures is well established and it is based on the philosophy of minimal soft tissue injury and early joint mobilization. There has been a wide variety in their designs, surgical technique, and reported outcomes. This study aimed to report the long-term outcome following the use of the Ligamentotaxor® device (Ligamentotaxor1, ArexTM, Palaiseau, France) in treating fractures of the PIPJ of the hand. Methods Between 2009 and 2018, 33 patients treated in our institution with Ligamentotaxor® for fractures of the PIPJ were followed up for a minimum period of 12 months. Radiographs and clinical records were reviewed for clinical and functional outcomes including finger range of motion (ROM), union, Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) score, and any complications. Results A total of 33 patients completed a minimum follow-up of 12 months (mean: 27.5 months). All fractures showed radiological union at a mean of 33 days. Surgery was performed within a mean of 8.9 days and surgical operating time averaged 23.7 minutes. Devices were removed at a mean of 33 days. At the end of the follow-up, the mean range of flexion was 66 degrees and the mean extension lag was six degrees. The mean QuickDASH score was 8.72. Of note, 85% of the patients experienced no limitations in their daily activities, while 35% reported pain on exertion. One patient had a pin tract infection. Four patients had cold intolerance and persistent swelling. Conclusion The results of the use of Ligamentotaxor® in this series are comparable to those of other dynamic external fixator devices reported in the literature. Thanks to its quick and easy surgical technique, the device provides an appealing option for the management of PIPJ fractures.
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Affiliation(s)
- Amr Abouelela
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Islam Mubark
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Mohammed Hassan
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Michael Howells
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Neil Ashwood
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
| | - Christos Kitsis
- Trauma and Orthopaedics, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, GBR
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Gianakos A, Yingling J, Athens CM, Barra AE, Capo JT. Treatment for Acute Proximal Interphalangeal Joint Fractures and Fracture-Dislocations: A Systematic Review of the Literature. J Hand Microsurg 2020; 12:S9-S15. [PMID: 33335365 DOI: 10.1055/s-0040-1713323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Proximal interphalangeal joint (PIPJ) fractures and fracture-dislocations are common hand injuries and recognition of this injury pattern is essential in the management of these fractures. Although a variety of treatment options have been reported in the literature, the optimal treatment remains controversial. MEDLINE, EMBASE, and The Cochrane Library Database were screened for treatment strategies of PIPJ fracture and fracture-dislocation. Demographic data and outcome data were collected and recorded. A total of 37 studies including 471 patients and 480 fingers were reviewed. PIPJ range of motion (ROM) was greatest postoperatively in patients who underwent volar plate arthroplasty at 90.6 degrees. Dynamic external fixation resulted in the lowest PIP joint ROM with an average of 79.7 degrees. Recurrent pain and osteoarthritis were most often reported in extension block pinning at 38.5 and 46.2%, respectively. Open reduction and internal fixation had the highest rate of revision at 19.7%. Overall, the outcomes of PIP fractures and fracture-dislocations are based on the severity of injury, and the necessary treatment required. Closed reduction with percutaneous pinning and volar plate arthroplasty had good clinical and functional outcomes, with the lowest complication rates. Hemi-hamate arthroplasty and dynamic external fixation were utilized in more complex injuries and resulted in the lowest PIPJ ROM. This is a therapeutic, Level III study.
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Affiliation(s)
- Arianna Gianakos
- Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, Jersey City, New Jersey, United States
| | - John Yingling
- Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, Jersey City, New Jersey, United States
| | - Christian M Athens
- Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, Jersey City, New Jersey, United States
| | - Andrew E Barra
- Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, Jersey City, New Jersey, United States
| | - John T Capo
- Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, Jersey City, New Jersey, United States
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Mabvuure NT, Pinto-Lopes R, Sierakowski A. Management of intraarticular proximal interphalangeal joint fracture-dislocations and pilon fractures with the Ligamentotaxor® device. Arch Orthop Trauma Surg 2020; 140:1133-1141. [PMID: 32448930 DOI: 10.1007/s00402-020-03482-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Fracture-dislocation and pilon injuries of the proximal interphalangeal joints (PIPJ) continue to pose significant management challenges. Stable fracture configurations can be treated with extension block splinting or pinning. Unstable fractures usually require open or closed reduction and fixation either directly/internally onto the fracture using Kirschner wires, cerclage wires, screws or miniplates or indirectly/externally by ligamentotaxis using external fixators which can be dynamic or static. Dynamic external fixators, such as Suzuki's pins and rubber traction system, S-Quattro and Hynes/Giddins frame, appear intuitive as they provide axial distraction, which reduces the fracture whilst obviating the need to open the fracture. They also allow immediate active movement whilst maintaining reduction. The Ligamentotaxor® (Arex, Pallaiseau Cedex, France) is a commercially-available dynamic external fixator which has been used at our institution since 2013. MATERIALS AND METHODS This retrospective study assessed the outcomes (interphalangeal joint active range of movement (AROM), QuickDASH score and complications) in 19 patients [mean age of 48.6 (SD 16.2)] whose proximal interphalangeal joint (PIPJ) fracture-dislocations and/or pilon fractures were treated with the Ligamentotaxor®. Injuries were classified according to Seno i.e. (1) volar lip fracture ± dorsal dislocation (2) dorsal lip fracture ± volar dislocation (3) pilon fracture. RESULTS There were fifteen (79%) pilon/Seno 3, three (16%) Seno 1 and one (5%) Seno 2 fractures. The mean PIPJ AROM was 70.6° (SD 4.48°) for all Seno classes and 70° (SD 5.6°) for the pilon subgroup. The QuickDASH score averaged to 2.65 (SD 0.88). There were two pin-site infections, three pin-site inflammations, one osteomyelitis and two complex regional pain syndrome diagnoses. One patient required arthroplasty after missing several appointments. CONCLUSIONS These results, considering the predominance of pilon fractures, compare favourably the published Ligamentotaxor® and other dynamic external fixator systems.
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Affiliation(s)
- Nigel Tapiwa Mabvuure
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, UK.
| | - Rui Pinto-Lopes
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, UK
| | - Adam Sierakowski
- St Andrews Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, CM1 7ET, UK
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Wang HZ, Zhao JY, Zhang ZS. A novel dynamic distraction external fixator for proximal interphalangeal joint fracture dislocation. J Int Med Res 2019; 47:1628-1635. [PMID: 30747021 PMCID: PMC6460624 DOI: 10.1177/0300060519826821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To evaluate the efficacy of a novel dynamic distraction external fixator for proximal interphalangeal joint (PIPJ) fracture-dislocation. Methods From March 2005 to March 2014, 20 patients with PIPJ fracture-dislocation were treated with our technique. Function scores according to the Michigan Hand Outcome Questionnaire (MHQ) score, union time, grip strength, and range of motion (ROM) were recorded before and after treatment. Results All patients completed a mean follow-up of 22 months (range, 12–60 months). All patients achieved fracture union and joint reduction. The mean union time was 3 months (range, 2–6 months). The mean postoperative MHQ score was 88.00 ± 3.42 (range, 84.00–92.00). Postoperative grip strength of the affected sides was 92% of the contralateral sides. X-rays showed that the fracture line disappeared completely with a good joint contour. The range of extension in the PIPJ was −5° (range, −10°–0°). The range of flexion in the PIPJ was 89.40° ± 9.79° (range, 75°–100°). Postoperatively, four patients had slight narrowing of the joint space and two had an uneven articular surface. Pin breakage, loosening, and tract infection were not observed. Conclusions The novel dynamic distraction external fixator is a promising option for PIPJ fracture-dislocation.
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Kostoris F, Canton G, Longo E, Romano F, Murena L. Treatment of dorsal fracture-dislocation of the proximal interphalangeal joint using the Ligamentotaxor device: clinical and radiographic preliminary results. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:90-95. [PMID: 29083359 DOI: 10.23750/abm.v88i4 -s.6799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Fracture-dislocations of the proximal interphalangeal joint are complex injuries, often difficult to treat. Several treatment options have been described. Among them dynamic external fixation proved to be a safe technique leading to good results in many authors experience. The principles of this treatment are to avoid edema, prevent stiffness and tendon adhesions, promote joint remodelling and facilitate rehabilitation. The Ligamentotaxor® device is a simple and reproducible dynamic external fixation system that has been used in recent years to treat proximal interphalangeal joint fracture-dislocations, with favourable results. The aim of the present study is to evaluate our preliminary results with the Ligamentotaxor® device for treatment of these complex lesions. METHODS Four patients between December 2015 and January 2017 were treated at our institution with the Ligamentotaxor® device. Clinical and radiographic results were evaluated at mean 6 months follow-up. RESULTS Clinical results were meanly good and appeared to be comparable to most recent literature. Mean range of motion was 60,5°, mean extension lag 18,5°. Mean QuickDASH and Michigan Hand Questionnaire scored 21.6 and 72 respectively. Radiographic evaluation showed fracture healing in all cases. No relevant complications were noted. CONCLUSION The Ligamentotaxor® device is simple to implant, provides good stability and allows an immediate gentle active movement. According to present work the preliminary results are encouraging.
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Packham TL, Ball PD, MacDermid JC, Bain JR, DalCin A. A scoping review of applications and outcomes of traction orthoses and constructs for the management of intra-articular fractures and fracture dislocations in the hand. J Hand Ther 2017; 29:246-68. [PMID: 27496982 DOI: 10.1016/j.jht.2016.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 02/02/2016] [Accepted: 04/08/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Intra-articular hand fractures can have devastating consequences for movement and function. The unique nature of the injury and diverse management strategies are a challenge for conducting trials. PURPOSE OF THE STUDY To conduct a scoping review of traction constructs for the management of intra-articular hand fractures. METHODS We conducted a systematic search of the literature, extracting data on the scope and nature of the evidence for traction constructs. RESULTS Our search yielded 87 articles addressing 3 traction constructs: (1) static traction (n = 17), (2) dynamic external fixation (n = 53), and (3) dynamic orthoses (n = 17). Active range of motion of the target joint was the most frequently reported outcome. Study designs included 36 cohorts, 21 case series, and 9 case studies: 24% contained only technical information. CONCLUSIONS The current literature addressing traction constructs consists primarily of small and low-quality studies. Evidence synthesis could improve the estimation of range of motion outcomes but would not be able to identify the best treatment. Consensus on classification of fracture patterns, routine use of outcome measures, and randomized trials are needed to compare different traction constructs and inform evidence-based care. STUDY DESIGN Scoping review. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Tara L Packham
- Hand Therapy Clinic, Department of Rehabilitation Services, Neurosciences and Trauma Program, Hamilton Health Sciences, Hamilton, Ontario, Canada; School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Pamela D Ball
- Hand Therapy Clinic, Department of Rehabilitation Services, Neurosciences and Trauma Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Joy C MacDermid
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - James R Bain
- Department of Surgery, Hamilton Health Sciences, Hamilton, Ontario, Canada; Faculty of Health Sciences, Department of Surgery and Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Arianna DalCin
- Department of Surgery, Hamilton Health Sciences, Hamilton, Ontario, Canada; Faculty of Health Sciences, Department of Surgery and Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
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Abou Elatta MM, Assal F, Basheer HM, El Morshidy AF, Elglaind SM, Abdalla MA. The use of dynamic external fixation in the treatment of dorsal fracture subluxations and pilon fractures of finger proximal interphalangeal joints. J Hand Surg Eur Vol 2017; 42:182-187. [PMID: 27756830 DOI: 10.1177/1753193416674155] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The aim of this study was to review the outcome of the treatment of finger proximal interphalangeal joint dorsal fracture subluxations and pilon fractures with a modified external fixator. We treated 36 patients (36 fingers). We assessed the ranges of motion and patient satisfaction. At final follow-up, 23 patients had no pain; 11 had pain in the cold; and two also had mild pain. None had moderate or severe pain. The mean range of proximal interphalangeal joint motion was 86° (60°-100°). The mean total active range of finger motion was 244° (range 200°-265°). This system is simple, cheap and relatively easily applied. It gives stable fixation that allows early mobilization. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - F Assal
- Hand Unit, Al-Razi Hospital, Elshwiekh, Kuwait
| | - H M Basheer
- Hand Unit, Al-Razi Hospital, Elshwiekh, Kuwait
| | | | | | - M A Abdalla
- Hand Unit, Al-Razi Hospital, Elshwiekh, Kuwait
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Kostoris F, Canton G, Longo E, Romano F, Murena L. Treatment of dorsal fracture-dislocation of the proximal interphalangeal joint using the Ligamentotaxor device: clinical and radiographic preliminary results. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017. [PMID: 29083359 PMCID: PMC6357656 DOI: 10.23750/abm.v88i4-s.6799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Fracture-dislocations of the proximal interphalangeal joint are complex injuries, often difficult to treat. Several treatment options have been described. Among them dynamic external fixation proved to be a safe technique leading to good results in many authors experience. The principles of this treatment are to avoid edema, prevent stiffness and tendon adhesions, promote joint remodelling and facilitate rehabilitation. The Ligamentotaxor® device is a simple and reproducible dynamic external fixation system that has been used in recent years to treat proximal interphalangeal joint fracture-dislocations, with favourable results. The aim of the present study is to evaluate our preliminary results with the Ligamentotaxor® device for treatment of these complex lesions. METHODS Four patients between December 2015 and January 2017 were treated at our institution with the Ligamentotaxor® device. Clinical and radiographic results were evaluated at mean 6 months follow-up. RESULTS Clinical results were meanly good and appeared to be comparable to most recent literature. Mean range of motion was 60,5°, mean extension lag 18,5°. Mean QuickDASH and Michigan Hand Questionnaire scored 21.6 and 72 respectively. Radiographic evaluation showed fracture healing in all cases. No relevant complications were noted. CONCLUSION The Ligamentotaxor® device is simple to implant, provides good stability and allows an immediate gentle active movement. According to present work the preliminary results are encouraging.
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Affiliation(s)
- Francesco Kostoris
- Correspondence: Francesco Kostoris, Strada di Fiume 447, 34149 Trieste (Italy), Tel. +39 0403994730, Fax +39 0403994544, E-mail address:
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Liverneaux P, MacFarlane RJ, Brown DJ. Re: MacFarlane RJ, Gillespie S, Cashin F, Mahmood A, Cheung G, Brown DJ. Treatment of fracture subluxations of the proximal interphalangeal joint using a ligamentotaxis device: a multidisciplinary approach. J Hand Surg Eur. 2015, 40: 825-31. J Hand Surg Eur Vol 2016; 41:559-61. [PMID: 27179048 DOI: 10.1177/1753193416632645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- P Liverneaux
- Hand Surgery Department, Strasbourg University Hospital, Illkirch, France
| | | | - D J Brown
- The Royal Liverpool University Hospital, Liverpool, UK
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13
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Current concepts in treatment of fracture-dislocations of the proximal interphalangeal joint. Plast Reconstr Surg 2015; 134:1246-1257. [PMID: 25415092 DOI: 10.1097/prs.0000000000000854] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Proximal interphalangeal joint fracture-dislocations are common injuries that require expedient and attentive treatment for the best outcomes. Management can range from protective splinting and early mobilization to complex surgery. In this review, the current concepts surrounding the management of these injuries are reviewed. METHODS A literature review was performed of all recent articles pertaining to proximal interphalangeal joint fracture-dislocation, with specific focus on middle phalangeal base fractures. Where appropriate, older articles or articles on closely related injury types were included for completeness. The methodology and outcomes of each study were analyzed. RESULTS When small avulsion fractures are present, good results are routinely obtained with reduction and early mobilization of stable injuries. Strategies for management of the unstable dorsal fracture-dislocation have evolved over time. To provide early stability, a variety of techniques have evolved, including closed, percutaneous, external, and internal fixation methods. Although each of these techniques can be successful in skilled hands, none has been subjected to rigorous, prospective, comparative trials. Volar dislocations fare less well, with significant loss of motion in many studies. Pilon fractures represent the most complicated injuries, and return of normal motion is not expected. CONCLUSIONS The best outcomes can be achieved by (1) establishing enough stability to allow early motion, (2) restoring gliding joint motion rather than noncongruent motion, and (3) restoring the articular surface congruity when possible. Although the majority of literature on this topic consists of expert opinion and retrospective case series, the consensus appears to favor less invasive techniques whenever possible.
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