[Dynamic external traction system for management of distal displaced fractures of the head of the proximal phalanx]

Mid-term Outcomes of Treatment of Fracture Dislocation of the Proximal Interphalangeal Joint with Gexfinger®-A New Dynamic External Fixator

Background: Fracture dislocations of the proximal interphalangeal joint (PIPJ) are challenging injuries and a dynamic external fixator frame is often used. We devised a dynamic external fixator device called the Gexfinger^® that allows greater control of the degree of traction. The aim of this study is to report the mid-term outcomes of this device. Methods: This is a retrospective study of patients with fracture dislocation of the PIPJ who were treated with the Gexfinger^® over a 3-year period. Clinical data with regard to the patient, the injury, treatment and period of follow-up were recorded. The outcome measures included time to return to work, arc of motion at the interphalangeal joints, grip strength, visual analogue score (VAS) for pain, patient satisfaction and complications. Results: We studied 26 patients (17 men and 9 women) with an average age of 38 years. The average articular surface involvement was 56%. The mean period between injury and surgery was 6 days and the frames were maintained for 5.5 weeks on average. The mean follow-up period was 8.5 weeks. All patients returned to work at an average of 7 weeks. The mean arc of motion at the PIPJ and distal interphalangeal joint (DIPJ) were 82° and 65°, respectively and the mean grip strength was 83% of the contralateral side. 22 patients reported no pain at the final follow-up. Fifteen patients were very satisfied, 8 satisfied and 3 unsatisfied. Two patients had stiffness of the PIPJ. Conclusions: The mid-term outcomes of the Gexfinger^® are similar to other methods of dynamic traction described in literature. It is modular, easy to assemble and allows a greater control of the degree of traction. In combination with additional screws and/or K-wires, it has allowed us to treat a wide spectrum of PIPJ fracture dislocations with good outcomes. Level of Evidence: Level IV (Therapeutic).

Treatment of dorsal fracture-dislocation of the proximal interphalangeal joint using the Ligamentotaxor device: clinical and radiographic preliminary results

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.

["Floating interphalangeal joint". A case report]

We report the case of a combination of closed extra-articular phalangeal fractures of the thumb, creating a floating interphalangeal joint. The lesions described were the result of a direct trauma to the thumb during the earthquake in Haiti in January 2010. It was fixed seven days after the trauma using a percutaneous external fixation with a dorsal frame or Martinique's "Ti'fix" - a modification of the Beaubourg fixator. We describe this simple, economical and improved quality method of fixation. Consolidation permitted the removal of the external fixator a month after surgery, followed by early mobilization. We report the functional and aesthetic results at 1-year follow-up.

[The digital external fixator, new equipment (24 cases report)]

Phalangeal fractures and osteoarticular infections can be challenging injuries to manage, and their treatment is frequently complicated by deformity and stiffness. External fixation techniques have a well-established role in the treatment of these injuries. The mini-Hoffman external fixator is a particularly simple apparatus in design and in application. We report a technique of digital external fixator with a new original material developed in the service. It is an inexpensive and simple technique with good stability. The technical procedure is simple, consisting of two joints, Kirchner pins, 4mm diameter screwdrivers and a motor. Between 2001 and 2006, we used this method to treat 24 patients in a prospective study. The mean age was 35 years (range 16 to 68 years) with a male predominance, left hand predominance (14 cases), and carpenter's hand was the most frequent indication (11 cases). Mean duration of follow-up was two years (6 months to 5 years). Functional results were excellent in 12 cases and bad in six cases. Complications included a case of ischemic necrosis of the finger, two cases of secondary displacement, three cases of sepsis, two cases of algodystrophy and a case of pseudoarthrosis.

Pins and rubber traction system for intra-articular proximal interphalangeal joint fractures revisited

The Pins and Rubber Traction System (PRTS) can be used to treat proximal interphalangeal intra-articular fractures. Our experience is that outcomes are not always excellent and that many patients have reduced joint function or residual deformities. The aim of this study was to evaluate the reasons behind the poorer outcomes of some of the patients treated with this system. A retrospective clinical and radiological evaluation was performed on 15 patients after a minimum of 2 years' follow-up. The mean interphalangeal joint flexion range was 66 degrees (range 0-100) in our series. The review of the literature shows an average active interphalangeal joint flexion of 78 degrees (range 64-95). Reasons for this difference include preoperative delay, technical deficiencies, the learning curve, a lack in postoperative physiotherapy and degenerative changes due to the longer follow-up. Although the Pins and Rubber Traction System seems a simple procedure, a learning curve is necessary to avoid pitfalls.

Treatment of complex proximal interphalangeal joint fractures using a new dynamic external fixator: 15 cases

The management of proximal interphalangeal joint fractures of the fingers is difficult. Dynamic traction splinting systems are cumbersome and the Suzuki fixator does not prevent secondary fracture displacement. Fifteen cases were treated with a new dynamic external fixator with distraction, the Ligamentotaxor. In two cases, additional fixation was required with a screw. After 10 months, grip strength scored 85.7% compared with the contralateral hand, flexion achieved 76.3 degrees and the extension deficit was 19.6 degrees . The visual analogical scale pain level (VAS) was 1.9 and the Quick DASH score totalled 16.9. Revision treatment was needed for sepsis for one patient. A case of secondary fracture displacement was corrected in the outpatient clinic. Consolidation was achieved in all cases. In conclusion, despite imperfect outcomes for these complex fractures, we believe that the Ligamentotaxor technique is useful.