Injuries Around the Proximal Interphalangeal Joint

Proximal interphalangeal joint dislocations and fracture-dislocations

Although proximal interphalangeal joint dislocations are generally straightforward to treat, fracture-dislocations are among the most difficult hand injuries to manage. Fracture patterns range from simple to treat palmar plate avulsion fractures to complex, unstable pilon fractures of the base of the middle phalanx, where achieving adequate reduction and fixation can be extremely difficult. Moreover, these fractures may present sub-acutely or chronically, which greatly adds to the complexity of the case. It is therefore no surprise that clinical results vary and are often difficult to predict. We will discuss the clinical presentations, the various dislocation and fracture-dislocation patterns, treatment options and the complications of these injuries.

Percutaneous Intramedullary Reduction Technique for Impacted Middle Phalanx Base Fractures

Proximal interphalangeal joint injuries are common and are a major risk for functional deficits of the finger that affect range of motion and grip strength. Impacted intra-articular fractures and fracture dislocations of the middle phalanx base are challenging to treat because of troublesome joint reduction and difficulties in achieving articular congruity. Although treatment algorithms have been published, the anatomically delicate proximal interphalangeal joint often remains incomplete in function and may result in post-traumatic pain, stiffness, and osteoarthritis. This article describes a percutaneous intramedullary reduction technique for impacted middle phalanx fractures as a treatment option to achieve articular congruity with minimal surgical trauma. The reduction technique may be considered for selected patients with impacted fractures of the base of the middle phalanx with or without joint dislocation.