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Kaplan GO, Özdemir FDM, Uzun H, Ustun GG. Pins and Rubbers Traction System for Treatment of Intraarticular Fractures of Distal Interphalangeal Joint. J Hand Surg Asian Pac Vol 2024; 29:211-216. [PMID: 38726499 DOI: 10.1142/s242483552450022x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Background: The pins and rubber traction system (PRTS) has proven effective in managing intra-articular fractures of the proximal interphalangeal joint. However, there is scant evidence in the literature regarding its efficacy in treating distal interphalangeal joint (DIPJ). This study aims to investigate the outcomes of PRTS in the treatment of comminuted intra-articular fractures of the DIPJ. Methods: We conducted a retrospective review of patients with comminuted intra-articular fractures of the DIPJ treated with PRTS between 2017 and 2021. At the final follow-up, we measured and compared the active range of motion (ROM) in both affected and non-injured contralateral fingers. The subjective evaluation utilised the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and the Visual Analogue Scale (VAS). Results: Ten patients with a mean follow-up of 13.2 months (range: 12-17) were included in the study. Fracture locations included the base of the distal phalanx in two patients, the condyle of the middle phalanx in seven and both in one patient. At the final follow-up, the average VAS score was 0.5 (range: 0-2). The average active motion of the DIPJ was 61° (range: 50°-70°) for the injured side and 76° (range: 75°-80°) for the opposite side. The mean range of DIPJ movement was 80% (range: 68%-87%) of the non-injured side. Extension deficits were observed in five patients, with a median deficit value of 10° (range: 5°-10°). The average Quick-DASH score was 2.9 (range: 0-11.3). Conclusions: The PRTS can be considered as an effective surgical technique in managing comminuted intra-articular fractures of the DIPJ. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- G O Kaplan
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - F D M Özdemir
- Department of Plastic, Reconstructive and Aesthetic Surgery, Güven Hospital, Ankara, Turkey
| | - H Uzun
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - G G Ustun
- Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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2
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Pitfalls and suggestions for the treatment of open, comminuted fractures of the middle phalanx using custom made dynamic external fixators: a retrospective case series. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3
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A traction orthosis for the treatment of proximal phalangeal fractures. J Hand Ther 2021; 35:537-540. [PMID: 33785235 DOI: 10.1016/j.jht.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/19/2021] [Indexed: 02/03/2023]
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4
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Breahna A, Mishra A, Arrowsmith J, Lindau T. The management of acute fracture dislocations of proximal interphalangeal joints: a systematic review. J Plast Surg Hand Surg 2020; 54:323-327. [PMID: 32633587 DOI: 10.1080/2000656x.2020.1788041] [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] [Indexed: 10/23/2022]
Abstract
LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anca Breahna
- Department of Plastic Surgery, Countess of Chester Hospital
| | - Anuj Mishra
- Department of Plastic Surgery, University Hospital of South Manchester
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5
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Nanno M, Kodera N, Tomori Y, Takai S. Pins and rubbers traction system for fractures of the proximal interphalangeal joint. J Orthop Surg (Hong Kong) 2020; 27:2309499019840771. [PMID: 30987517 DOI: 10.1177/2309499019840771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE We aimed to evaluate the clinical results using the pins and rubbers traction system (PRTS) as described by Suzuki et al. for unstable intra-articular fractures of the proximal interphalangeal (PIP) joint and to assess the efficacy and the indication of the technique of the PRTS. METHODS Thirty-nine fingers in 39 patients (mean age 46.0 years) with unstable fractures of the PIP joint were treated by the PRTS. The mean interval between injury and surgery was 30.8 days. Active and passive exercise of range of motion of all fingers was started immediately after surgery. Radiographic and clinical results were evaluated at the final examination. RESULTS The mean period the PRTS was applied was 6.4 weeks. The mean follow-up period was 8.9 months. Anatomical union was obtained in all patients. No joint instability, no malunion, nor osteomyelitis was observed. At the final examination, the average active range of motion of the PIP joint was 74.6°. The average Visual Analogue Scale for pain and Quick Disability of Arm, Shoulder, and Hand score were 1.2 and 3.2, respectively. CONCLUSIONS The current study demonstrated good results of the PRTS for unstable intra-articular fractures of the PIP joint. Furthermore, satisfactory results were obtained in cases of an incomplete amputation at the PIP joint, a pathological fracture due to bone tumor, and an osteochondral defect due to comminuted fracture of the proximal phalangeal head, where costal osteochondral bone was transplanted. From this study, the PRTS is recommended as a useful treatment because it is widely effective for various unstable fractures of the PIP joint.
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Affiliation(s)
- Mitsuhiko Nanno
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
| | - Norie Kodera
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
| | - Yuji Tomori
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
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6
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Satake Y, Nanno M, Kodera N, Takai S. Use of a Costal Osteochondral Graft for Reconstruction of a Proximal Phalanx Head with a Comminuted Fracture of the Proximal Interphalangeal Joint. J NIPPON MED SCH 2020; 87:37-42. [PMID: 31776319 DOI: 10.1272/jnms.jnms.2020_87-107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report the use of costal osteochondral grafting with a pins and rubbers traction system (PRTS) for treatment of a complex cartilage defect of the proximal interphalangeal (PIP) joint in a 41-year-old male carpenter who had inadvertently incompletely severed his finger with a power saw. The skin laceration extended to the dorsal aspect of his ring finger and resulted in incomplete loss of the ulnar condyle and comminution of the radial condyle of the proximal phalanx of the PIP joint. The diagnosis was intra-articular PIP joint open fracture of the left ring finger with a 60% defect of the proximal phalanx joint surface. Three weeks after the injury, PIP joint reconstruction was performed with a costal osteochondral graft harvested at the osteochondral junction of the fifth rib. The volar side of the proximal phalanx cortex and the condyles of the proximal phalanx on each side, which included the origin of the collateral ligaments, were preserved. The graft was shaped to match the defect, and biplane fixation with three miniscrews was subsequently performed. Last, a PRTS was attached. At 6 months postoperatively, the patient returned to his job; at 12 months postoperatively, the joint was stable and free of pain. This technique enabled preservation of joint stabilizers and rigid fixation of the graft, resulting in a good outcome. Our modified costal osteochondral graft with a PRTS is useful for severe intra-articular fractures of the PIP joint and should be considered before salvage procedures.
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Affiliation(s)
- Yoshihiko Satake
- Department of Orthopedic Surgery, International University of Health and Welfare Hospital.,Department of Orthopedic Surgery, Nippon Medical School
| | | | - Norie Kodera
- Department of Orthopedic Surgery, Nippon Medical School
| | - Shinro Takai
- Department of Orthopedic Surgery, Nippon Medical School
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Hemi-hamate osteochondral autograft for acute dorsal proximal interphalangeal fracture-dislocations. Eur J Trauma Emerg Surg 2019; 47:825-829. [PMID: 31811335 DOI: 10.1007/s00068-019-01281-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Our aim was to investigate the clinical and radiological results of a hemi-hamate autograft arthroplasty method in patients with acute trauma who had a fragmented fracture of the proximal palmar joint surface of the middle phalanx and dorsal PIP subluxation. METHODS A total of 13 fingers from 13 patients who met the criteria were included in the study (11 men and 2 women) and prospectively reviewed. The mean age of the patients was 39.5 years. The mean interval between the injury and surgery was 6.3 days. The active movement of the DIP, PIP, MP and wrist joints was started on postoperative day. Follow-ups were performed at 6 weeks, 3, 6 and 12 months postoperatively. Range of motion for the DIP, PIP and MP joints, DASH and VAS scores, grip strength, two-point discrimination, finger pulp and palmar curve distance were evaluated. RESULTS All PIP joints were stable against coronal and sagittal stress at the 1st postoperative year and there was no limitation in wrist movements. Two-point discrimination was < 5 mm in all fingers. Union was achieved in all grafts except one. The mean active total PIP range of motion was 82.3°, DIP range of motion was 61.1°, MP joint motion was 87°. The mean DASH score was 7.6, and the mean VAS score was 1.5. The mean grip strength was 33.7 kg, which was 93% of the healthy side. The mean finger pulp and palmar curve distance was 8.6 mm. CONCLUSIONS We believe that HHA is an appropriate alternative in cases of acute dorsal PIP fracture-dislocations with an intact middle phalanx dorsal cortex that is not suitable for primary fixation, with the advantages of obtaining stable joint and satisfactory functional results.
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8
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Doering TA, Greenberg AS, Tuckman DV. Dorsal Plating for Intra-articular Middle Phalangeal Base Fractures With Volar Instability. Hand (N Y) 2019; 14:620-625. [PMID: 29790792 PMCID: PMC6759971 DOI: 10.1177/1558944718777868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Intra-articular middle phalangeal base fractures with volar instability are rare injuries with scant literature on optimal management. Our purpose is to describe our method of dorsal plating and report postoperative outcomes. Methods: This study is a retrospective case review of 5 patients with intra-articular middle phalangeal base fractures with volar proximal interphalangeal joint instability, measuring subjective, clinical, and radiographic outcomes. Results: Patient age averaged 38.2 years (range, 23-56 years), and 80% were male. Sporting injuries were the most common mechanism (80%). Time to surgery averaged 7 days, and postoperative follow-up duration averaged 19.6 months (median 8 months). All fractures were intra-articular at the proximal interphalangeal joint with volar instability. There were no complications and no patients required secondary surgery. Grip strength was maintained and range of motion was good, based on the American Society for Surgery of the Hand Total Active Motion score. Average Quick Disability of the Arm, Shoulder and Hand was 0.5 (range, 0-2.3), 100% of patients were satisfied, and average visual analog pain score was 1.2. Patients returned to work at a median of 4 days. There was radiographic union at an average of 6.6 weeks (range, 6-7 weeks) in all fractures. Conclusions: Dorsal plating using a 1.5-mm modular hand plate is a viable option for rigid fixation of intra-articular middle phalangeal base fractures with volar instability. This fixation method allows for early range of motion without complications in this case series. All fractures united, and patients had minimal functional deficits and were able to maintain good range of motion.
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Affiliation(s)
- Travis A. Doering
- Northwell Health, New Hyde Park, NY,
USA,Travis Doering, Department of Orthopaedics,
Northwell Health, 270-05 76th Avenue, Office 250, New Hyde Park, NY 11040, USA.
| | - Andrew S. Greenberg
- Northwell Health, New Hyde Park, NY,
USA,Orthopaedic Associates of Manhasset,
Great Neck, NY, USA
| | - David V. Tuckman
- Northwell Health, New Hyde Park, NY,
USA,Orthopaedic Associates of Manhasset,
Great Neck, NY, USA
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9
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Abstract
Proximal interphalangeal joint (PIPJ) injuries are common and challenging to treat, involving a spectrum of conditions ranging from isolated ligamentous injuries to severe fracture dislocations. The main goal of treatment is to achieve a congruent, stable joint, which is key to achieving early range of motion and a favorable outcome. Injuries that do not compromise the stability of the joint may be treated nonsurgically, whereas those that render the joint unstable may be managed with one of many surgical strategies available. This article focuses on the current practices of treatment of injuries around the PIPJ.
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Affiliation(s)
- Ruth En Si Tan
- Department of Hand and Reconstructive Microsurgery, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, 119228, Singapore
| | - Andre Eu Jin Cheah
- Department of Hand and Reconstructive Microsurgery, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, 119228, Singapore.
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10
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Dynamic "Homemade" Digital External Fixators for Proximal Interphalangeal Joint Injuries. J Hand Surg Am 2018; 43:875.e1-875.e12. [PMID: 29751977 DOI: 10.1016/j.jhsa.2018.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/18/2018] [Indexed: 02/02/2023]
Abstract
The purpose of this article is to discuss the indications and surgical techniques of "homemade" digital external fixators constructed from easily available and inexpensive hardware (K-wires and dental rubber bands).
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11
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Lo CH, Nothdurft SH, Park HS, Paul E, Leong J. Distraction ligamentotaxis for complex proximal interphalangeal joint fracture dislocations: a clinical study and the modified pins rubber band traction system revisited. BURNS & TRAUMA 2018; 6:23. [PMID: 30094267 PMCID: PMC6081902 DOI: 10.1186/s41038-018-0124-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 07/03/2018] [Indexed: 11/10/2022]
Abstract
Background The purpose of this study is to present our experience with the modified pins and rubber band traction system, discuss problems encountered, and make recommendations to optimize outcomes. Methods Data was collected prospectively from November 2013 to March 2017 at a tertiary referral hospital in Melbourne, Australia. Patients with closed complex proximal interphalangeal joint fracture dislocations that were considered unsuitable for other surgical options were included in the study. Patients underwent dynamic skeletal distraction using the modified (Deshmukh) pins rubber band traction system. Outcomes were measured using the Nominal Rating Scale for pain; Disabilities of the Arm, Shoulder, and Hand (DASH) score; active and passive range of motion; patient rating scale; and complications. Results Twenty patients underwent the procedure, and 19 were included in analyses. At the final follow-up assessment, an average of 62° and 77° was achieved for proximal interphalangeal joint active and passive range of motion, respectively. Pain levels were low (median score of 0 at rest and 1 ranging, out of 10). Four patients suffered minor pin site infections. Conclusion Distraction ligamentotaxis is a useful part of the armamentarium, especially in the absence of more suitable procedures. It is important to select appropriate patients, educate, and ensure adherence to postoperative therapy. Employing the Deshmukh frame modification streamlines the theatre processes, and removal of wires at approximately 4 weeks minimizes risk of pin site infection.
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Affiliation(s)
- Cheng Hean Lo
- 1Department of Plastic and Reconstructive Surgery, Monash Health (Dandenong Hospital), 135 David St, Dandenong, Victoria 3175 Australia
| | - Simone H Nothdurft
- 2Monash Health (Dandenong Hospital), 135 David St, Dandenong, Victoria 3175 Australia
| | - Hye-Sung Park
- 1Department of Plastic and Reconstructive Surgery, Monash Health (Dandenong Hospital), 135 David St, Dandenong, Victoria 3175 Australia
| | - Eldho Paul
- 3Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004 Australia
| | - James Leong
- 1Department of Plastic and Reconstructive Surgery, Monash Health (Dandenong Hospital), 135 David St, Dandenong, Victoria 3175 Australia.,4Department of Surgery, Monash University, Wellington Road, Clayton, Victoria 3800 Australia
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12
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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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13
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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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14
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Abou Elatta MM, Assal F, Basheer HM, Ibrahim MM. The Use of a Simple Dynamic External Fixator for the Treatment of Volar Fracture Subluxation of Proximal Interphalangeal Joints of the Fingers. Tech Hand Up Extrem Surg 2016; 20:161-165. [PMID: 27776005 DOI: 10.1097/bth.0000000000000140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Volar fracture dislocation is very uncommon, with few series reported in the literature. Patients with such injuries were treated by modified dynamic external fixators. The mean follow-up was 18 months (range, 6 to 92 mo). The mean range of interphalangeal (proximal interphalangeal) joints and distal interphalangeal joints were 90 and 74 degrees, respectively. The total active range of motion (TAM) was excellent (256 degrees). The mean quick disabilities of the arm, shoulder and hand score was 1.2. The advantages of our external fixators are that they are simple, cheap, adjustable, and allow immediate range of motion.
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16
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Khan W, Fahmy N. The S-Quattro in the Management of Acute Intraarticular Phalangeal Fractures of the Hand. ACTA ACUST UNITED AC 2016; 31:79-92. [PMID: 16290912 DOI: 10.1016/j.jhsb.2005.09.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2004] [Accepted: 09/15/2005] [Indexed: 11/30/2022]
Abstract
Intraarticular phalangeal fractures of the hand are difficult and challenging to manage. Dynamic external fixation devices offer the advantages of allowing distraction of the impacted fracture and early joint mobilization. We present our study of 100 patients with a variety of fractures who were treated with the S-Quattro technique over a 6-year period, with an average follow-up of 10.5 months. The mean active range of motion regained was 92° for proximal interphalangeal joints (81 fractures), 82° for distal interphalangeal joints (10 fractures), 91° for metacarpophalangeal joints (6 fractures) and 80° for interphalangeal joints of the thumb (3 fractures). Only nine patients complained of mild or moderate pain. Postoperative radiographic appearances were satisfactory in all but five out of the 100 patients. This device is a simple and effective technique for the management of these difficult fractures. It offers advantages in terms of versatility, ease of application, good tolerance by patients, few complications and good outcome.
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Affiliation(s)
- W Khan
- Department of Orthopaedics & Trauma, Stepping Hill Hospital, Stockport, UK.
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17
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Lee JYL, Teoh LC. Dorsal Fracture Dislocations of the Proximal Interphalangeal Joint Treated by Open Reduction and Interfragmentary Screw Fixation: Indications, Approaches and Results. ACTA ACUST UNITED AC 2016; 31:138-46. [PMID: 16293355 DOI: 10.1016/j.jhsb.2005.09.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2005] [Revised: 07/25/2005] [Accepted: 09/18/2005] [Indexed: 10/25/2022]
Abstract
Many operative and non-operative treatments of dorsal fracture dislocations of the proximal interphalageal (PIP) joint have been described. Return of good joint function requires anatomical reduction of the articular fragments and restoration of joint congruity and a stable functional arc of motion, with the fixation construct stable enough for early mobilization. To prevent recurrent dorsal subluxation, the attachments of the ligamentous palmar restraints and the bony buttress provided by the palmar lip of the middle phalanx base must be restored. Open reduction and internal interfragmentary screw fixation using 1.5 or 1.3 mm screws was employed in 12 fingers in 10 patients with unstable dorsal fracture dislocations of the PIP joints of Schenck grades III and IV. At an average follow-up of 8.7 months, all patients in this series achieved good to excellent results and an average total active interphalangeal motion of 132° (range 105°–165°). Additional benefits over non-operative techniques included improved patient comfort and simplified nursing care and therapy supervision.
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Affiliation(s)
- J Y L Lee
- Department of Hand Surgery, Singapore General Hospital, Singapore.
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18
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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 Vol 2015; 40:825-31. [PMID: 26056129 DOI: 10.1177/1753193415578305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 02/28/2015] [Indexed: 02/03/2023]
Abstract
Complex fracture subluxations of the proximal interphalangeal joint are often difficult to treat and their outcome variable. A number of methods for treatment of these injuries have been described. We have used a ligamentotaxis device (Ligamentotaxor, Arex, Palaiseau Cedex, France) since 2008. We performed 28 operations in 28 patients with complex proximal interphalangeal joint injuries over a 3-year period. Patients followed a standardized postoperative rehabilitation regime, including fixator adjustment as necessary. The mean age was 33 years (range 18-67). The mean time to surgery was 7 days. At final follow-up (mean 22 months, range 6-52) the mean proximal interphalangeal joint range of motion was 85° (range 60°-110°). The mean QuickDASH functional outcome score was 4.8 (range 0-36.4). Our results compare favourably with other devices reported in the literature.
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Affiliation(s)
- R J MacFarlane
- Liverpool Upper Limb Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - S Gillespie
- Liverpool Upper Limb Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - F Cashin
- Liverpool Upper Limb Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - A Mahmood
- Liverpool Upper Limb Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - G Cheung
- Liverpool Upper Limb Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - D J Brown
- Liverpool Upper Limb Unit, Royal Liverpool University Hospital, Liverpool, UK
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Shen XF, Mi JY, Rui YJ, Xue MY, Chou J, Tian J, Chim H. Delayed treatment of unstable proximal interphalangeal joint fracture-dislocations with a dynamic external fixator. Injury 2015; 46:1938-44. [PMID: 26144906 DOI: 10.1016/j.injury.2015.06.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/09/2015] [Accepted: 06/10/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fracture-dislocations of the proximal interphalangeal joint (PIPJ) remain a challenging problem to treat. Although there are a number of papers describing the use of dynamic external fixators and force couples for treatment of unstable PIPJ fracture-dislocations acutely, the literature is scarce on delayed treatment of PIPJ fracture-dislocations, where malunion of the articular surface may theoretically compromise postoperative range of motion (ROM) at the PIPJ. The purpose of this study was to evaluate the effectiveness of dynamic distraction external fixation (DDEF) for the delayed treatment of PIPJ fracture-dislocations at least 3 weeks after the inciting injury. METHODS Ten consecutive patients were treated with delayed DDEF between 2010 and 2013. Postoperative ROM at the PIPJ was measured. Disabilities of the Arm, Shoulder and Hand (DASH) score and Michigan Hand Outcomes Questionnaire were administered to all patients postoperatively. RESULTS Mean time from injury to surgery was 27.5 days. The mean follow-up period was 23.7 months (range 10-36). The mean active ROM at the PIPJ on final postoperative follow-up was 83.9° (range 52-100). None of the patients experienced pin-tract infections. Mean DASH score was 3.7+3.4 and mean Michigan Hand Outcomes Questionnaire score was 97.3+3.0. All patients returned to work and resumed normal activities. CONCLUSIONS Delayed treatment of unstable PIPJ fracture-dislocations with a DDEF is effective in restoring function to the PIPJ. Nascent malunion of the PIPJ articular surface does not compromise postoperative outcomes and the joint surface undergoes remodelling over time to restore a smooth and functional articular surface.
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Affiliation(s)
- Xiao Fang Shen
- Department of Hand Surgery, Wuxi 9th People's Hospital, Wuxi, Jiangsu, China
| | - Jing Yi Mi
- Department of Hand Surgery, Wuxi 9th People's Hospital, Wuxi, Jiangsu, China
| | - Yong Jun Rui
- Department of Hand Surgery, Wuxi 9th People's Hospital, Wuxi, Jiangsu, China.
| | - Ming Yu Xue
- Department of Hand Surgery, Wuxi 9th People's Hospital, Wuxi, Jiangsu, China
| | - Jiandong Chou
- Department of Hand Surgery, Wuxi 9th People's Hospital, Wuxi, Jiangsu, China
| | - Jian Tian
- Department of Hand Surgery, Wuxi 9th People's Hospital, Wuxi, Jiangsu, China
| | - Harvey Chim
- Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
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Pélissier P, Gobel F, Choughri H, Alet JM. Proximal interphalangeal joint fractures treated with a dynamic external fixator: A multicenter and retrospective study of 88 cases. ACTA ACUST UNITED AC 2015; 34:245-50. [PMID: 26359858 DOI: 10.1016/j.main.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 07/03/2015] [Accepted: 08/08/2015] [Indexed: 10/23/2022]
Abstract
Ligamentotaxis is now a well-established treatment method for proximal interphalangeal (PIP) joint fractures. Despite satisfactory results, the technique is considered complex and the devices cumbersome. The aim of this study was to evaluate a miniaturized dynamic external fixator (Ligamentotaxor(®)) for the management of these fractures. Eighty-six patients with 88 fractures of the PIP joint were treated at 10 European hand surgery centers. The device was applied within eight days of the injury and was removed 40-45 days after the injury. Treatment complications included superficial infection (4 cases), osteoarthritis (1 case), and localized but resolving complex regional pain syndrome (4 cases). The fracture healed in all cases. At final follow-up (mean: 15.2 months), average range of motion was 70° (range: 0-110°). Functional results were comparable between the 10 participating centers. Pain occurred upon exertion in 47% of the patients, 40% were sensitive to weather changes and 26% experienced constant pain. The mean QuickDASH score was 15.7 (range: 11-37) and 83.7% of the patients had no limitations during their daily activities. The results of this series are similar to those reported in other studies of PIP fracture treatment with external fixators. This technique is reliable and reproducible. The device is easy to handle by surgeons and well tolerated by patients. We think that this simple, reliable technique could be relevant for the management of PIP joint fractures.
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Affiliation(s)
- P Pélissier
- Service de chirurgie plastique, chirurgie de la main, brûlés, centre F.X.-Michelet, CHU Bordeaux-Pellegrin, 33076 Bordeaux, France.
| | - F Gobel
- Service de chirurgie plastique, chirurgie de la main, brûlés, centre F.X.-Michelet, CHU Bordeaux-Pellegrin, 33076 Bordeaux, France
| | - H Choughri
- Service de chirurgie plastique, chirurgie de la main, brûlés, centre F.X.-Michelet, CHU Bordeaux-Pellegrin, 33076 Bordeaux, France
| | - J-M Alet
- Service de chirurgie plastique, chirurgie de la main, brûlés, centre F.X.-Michelet, CHU Bordeaux-Pellegrin, 33076 Bordeaux, France
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O'Brien LJ, Simm AT, Loh IWH, Griffiths KM. Swing traction versus no-traction for complex intra-articular proximal inter-phalangeal fractures. J Hand Ther 2015; 27:309-15; quiz 316. [PMID: 25158903 DOI: 10.1016/j.jht.2014.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/15/2014] [Accepted: 07/15/2014] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Traction orthoses are thought to optimize recovery from intra-articular finger fractures by restoring joint space and allowing early motion. Evidence to date has, however, consisted only of case series. PURPOSE OF THE STUDY To compare swing traction versus no-traction management of complex fractures of proximal inter-phalangeal (PIP) finger joints. We hypothesized that there is no long-term (i.e. >12 month) difference between swing traction and no-traction (with or without surgical fixation) in terms of motion, pain, function, patient satisfaction, or treatment cost. METHODS Adults with a history of complex PIP fractures affecting ≥30% of articular surface injury were identified from database searches at three public hospitals and a private clinic and invited to participate. X-rays taken at the time of injury were graded by two blinded assessors, and participants attended a clinic for measurement of range of motion (ROM) and self-reported function, pain, and satisfaction at least one year post injury. Participant data were then were grouped by treatment provided. One group (N = 17) was treated with swing traction and the other group (N = 14) had no-traction. The primary outcome was combined motion of the PIP and distal inter-phalangeal (DIP) joints, expressed as both total active motion and Strickland score. Secondary outcomes were physical function and symptoms as measured by the Disabilities of Arm, Shoulder and Hand (DASH), patient satisfaction, pain, complication rates, and cost of treatment, based on mean resource consumption per group. RESULTS Patients treated with swing traction had greater finger motion than those in the no-traction group, which was statistically and clinically significant. There were no differences in patient ratings of function, pain or satisfaction. Complications, such as swan-neck deformity, cold sensitivity, malunion, infection, or adhesions occurred in over half of both groups of participants. During the treatment phase, the swing traction group attended hand therapy an average of 13.3 times, and the no-traction group attended 11.7 times. Average costs for swing traction were less than for surgical fixation with no-traction. DISCUSSION The significantly different range of motion found in our study did not translate to better DASH scores. The DASH is designed to measure global upper limb physical functioning and symptoms, but lacks sensitivity in populations with finger injuries. CONCLUSIONS Patients treated with the swing traction protocol had greater range of motion in the finger, however this did not translate to improved patient ratings of function, pain or satisfaction. A basic cost comparison indicated that swing traction may be less expensive than other forms of surgical repair. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Lisa J O'Brien
- Department of Occupational Therapy, The Alfred, Melbourne, Victoria, Australia; Department of Occupational Therapy, Monash University, Melbourne, Victoria, Australia.
| | - Andrew T Simm
- Plastic and Reconstructive Unit, Melbourne Health, Melbourne, Victoria, Australia
| | - Ian W H Loh
- Department of Plastic Surgery, The Alfred, Melbourne, Victoria, Australia
| | - Kim M Griffiths
- Department of Occupational Therapy, Monash Health, Melbourne, Victoria, Australia
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Colegate-Stone T, Marenah K, Compson J, Tahmassebi R, Tavakkolizadeh A. Functional Outcomes Following Pilon Fractures of the Middle Phalanx Managed with the Ligamentotaxor External Fixator. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2015; 20:285-9. [PMID: 26051770 DOI: 10.1142/s0218810415500252] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The surgical aims in managing displaced intra-articular fractures of the base of the middle phalanx include early joint reduction, maintaining congruence and early mobilization. Achieving this can be a challenge. However dynamic external fixators offer a solution. The study aim was to evaluate the use and outcomes of the Ligamentotaxor external fixator in patients with such injuries. METHODS A total of 12 patients were managed with this device and outcomes were assessed. All patients reached clinical and radiological union. RESULTS An average range of movement to the proximal interphalangeal joint of 63° was noted along with an average end of care-cycle quick-DASH score of 9.1. Two patients developed pin-site infections. CONCLUSIONS The outcomes seen support the use of the Ligamentotaxor in the management of middle phalanx intra-articular fractures. It is simple to apply, potentially avoids the secondary complications of open reduction and gives reproducible results. However judicious patient selection is advised.
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Affiliation(s)
- Toby Colegate-Stone
- 1 Department of Orthopaedic & Trauma Surgery, Kings College Hospital, London, UK
| | - Kebba Marenah
- 1 Department of Orthopaedic & Trauma Surgery, Kings College Hospital, London, UK
| | - John Compson
- 1 Department of Orthopaedic & Trauma Surgery, Kings College Hospital, London, UK
| | - Ramon Tahmassebi
- 1 Department of Orthopaedic & Trauma Surgery, Kings College Hospital, London, UK
| | - Adel Tavakkolizadeh
- 1 Department of Orthopaedic & Trauma Surgery, Kings College Hospital, London, UK
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Barksfield RC, Bowden B, Chojnowski AJ. Hemi-hamate arthroplasty versus transarticular Kirschner wire fixation for unstable dorsal fracture-dislocation of the proximal interphalangeal joint in the hand. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2015; 20:115-119. [PMID: 25609284 DOI: 10.1142/s0218810415500161] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Following the introduction of the hemi-hamate arthroplasty (HHA) technique to our unit, we sought to evaluate the early clinical outcomes achieved with this method of fixation and compare these with simple trans-articular Kirschner wire (K-wire) fixation for dorsal fracture dislocations (DFD) of the proximal interphalangeal joint (PIPJ). Ninteen patients underwent fixation of these injuries with either K-wire fixation (12/19) or hemi-hamate bone grafting (7/19) between 2005 and 2011. At a mean follow-up of 14 weeks median arc of movement at the PIPJ was 65° (range 31° to 108°) following HHA and 56° (range 9° to 85°) (p = 0.82) following temporary transarticular K-wire fixation. Median fixed flexion deformity (FFD) was 20° and 15° for hemi-hamate bone grafting and K-wire fixation respectively. Based upon our findings, transarticular K-wire fixation produced equivalent outcomes to HHA for unstable DFD of the PIPJ in the hand.
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Affiliation(s)
- R C Barksfield
- Hand Surgery Unit, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
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Kiral A, Erken HY, Akmaz I, Yildirim C, Erler K. Pins and rubber band traction for treatment of comminuted intra-articular fractures in the hand. J Hand Surg Am 2014; 39:696-705. [PMID: 24576751 DOI: 10.1016/j.jhsa.2013.12.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 12/23/2013] [Accepted: 12/27/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the efficacy of pins and rubber band traction for treatment of comminuted intra-articular fractures in the hand. METHODS We performed a retrospective study from 1994 to 2013 to evaluate 33 patients in whom pins and rubber band traction was employed. We clinically evaluated the active range of motion of the affected fingers after surgery. Eleven of the 33 fractures were at the proximal interphalangeal joint, 10 at the distal interphalangeal joint, 5 at the thumb interphalangeal joint, and 2 at the metacarpophalangeal joint of the thumb. The remaining 5 patients had complex fracture-dislocation of the proximal interphalangeal joints. RESULTS The mean follow-up period was 24 months. The average active motion of the metacarpophalangeal joints of the fingers was 91° (range, extension 0°-10°/flexion 85°-90°), proximal interphalangeal joints was 92° (range, extension/flexion 0°-10°/85°-100°), and distal interphalangeal joints was 73° (range, extension/flexion 0°-10°/60°-80°). The overall average of all active motion of the injured fingers except thumbs was 255° (range, 240°-270°). The average active motion of the of the thumb metacarpophalangeal joint was 56° (range, extension 5°-10°/flexion 50°-55°), and interphalangeal joint was 74° (range, extension 0°-10°/flexion 75°-80°). The average of active motion of the injured thumb metacarpal and interphalangeal joints combined was 130° (range, 125°-135°). CONCLUSIONS Pins and rubber band traction is a treatment option for comminuted displaced intra-articular fractures of the digits that offers satisfactory clinical results. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Ahmet Kiral
- Department of Orthopaedic Surgery, Anadolu Medical Center, Kocaeli, Turkey; Department of Orthopaedic Surgery, GATA Haydarpaşa Education Hospital, Istanbul, Turkey
| | - H Yener Erken
- Department of Orthopaedic Surgery, Anadolu Medical Center, Kocaeli, Turkey; Department of Orthopaedic Surgery, GATA Haydarpaşa Education Hospital, Istanbul, Turkey.
| | - Ibrahim Akmaz
- Department of Orthopaedic Surgery, Anadolu Medical Center, Kocaeli, Turkey; Department of Orthopaedic Surgery, GATA Haydarpaşa Education Hospital, Istanbul, Turkey
| | - Cengiz Yildirim
- Department of Orthopaedic Surgery, Anadolu Medical Center, Kocaeli, Turkey; Department of Orthopaedic Surgery, GATA Haydarpaşa Education Hospital, Istanbul, Turkey
| | - Kaan Erler
- Department of Orthopaedic Surgery, Anadolu Medical Center, Kocaeli, Turkey; Department of Orthopaedic Surgery, GATA Haydarpaşa Education Hospital, Istanbul, Turkey
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26
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Nilsson JA, Rosberg HE. Treatment of proximal interphalangeal joint fractures by the pins and rubbers traction system: a follow-up. J Plast Surg Hand Surg 2013; 48:259-64. [PMID: 24328898 DOI: 10.3109/2000656x.2013.870909] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jessica A Nilsson
- Department of Hand Surgery, Skåne University Hospital, Department of Clinical Sciences Malmö - Hand Surgery, Lund University , Malmö , Sweden
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Damert HG, Altmann S, Kraus A, Infanger M, Sattler D. Treatment of intraarticular middle phalanx fractures using the Ligamentotaxor®. Hand (N Y) 2013; 8:460-3. [PMID: 24426967 PMCID: PMC3840757 DOI: 10.1007/s11552-013-9553-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We evaluated the outcome of intraarticular middle phalanx fractures after dynamic treatment with the Ligamentotaxor® system. MATERIALS AND METHODS Ten consecutive patients (seven male, three female; mean age 52 years) with intraarticular middle phalanx fractures were treated with the Ligamentotaxor® between 2009 and 2011. Proximal interphalangeal joint mobility, grip strength and 'Disabilities of the Arm, Shoulder and Hand' (DASH) score were evaluated in a 15-month follow-up. The reconstitution of the intraarticular space was measured immediately after trauma, at 6 weeks and at 15 months by radiograph control. The severity of the trauma was classified according to AO. RESULTS We found B1 30 %, C1 (Seno I + II) 50 % and C3 (Seno III-V) 20 %. In 60 % of the cases, fractures were localized on the middle base of the fifth digit, in 20 % on the third digit and in 20 % on the index finger. The dynamic treatment lasted 7 weeks; patients were exposed to full workload after 9 weeks. The mean flexion mobility after 15 months reached 73° (range 60-100°), and the extension deficit was 13° (range 0-20°) on average. Grip strength attained 71.3 % (range 60-87 %) of the contralateral side. Initial x-ray after trauma compared to the x-ray after 15 months showed an intraarticular space reconstitution average of 0.5 mm (range 0.1-0.9 mm) anterior-posterior and 0.6 mm (range 0.1-1 mm) lateral. Patients evaluated their outcome with an average of 14.6 points (range 3.3-26.7) using the DASH score. CONCLUSION Good results can be obtained with the Ligamentotaxor®. We recommend it for the dynamic treatment of intraarticular middle phalanx finger fractures. Larger series and long-term results are needed.
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Affiliation(s)
- H.-G. Damert
- Department for Plastic, Aesthetic and Hand Surgery, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - S. Altmann
- Department for Plastic, Aesthetic and Hand Surgery, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - A. Kraus
- Department for Plastic, Aesthetic and Hand Surgery, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - M. Infanger
- Department for Plastic, Aesthetic and Hand Surgery, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - D. Sattler
- Department for Plastic, Aesthetic and Hand Surgery, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany
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Hirth MJ, Jacobs DJ, Sleep K. Hand-based swing traction splinting for intra-articular proximal interphalangeal joint fractures. HAND THERAPY 2013. [DOI: 10.1177/1758998313490856] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Acute intra-articular fractures of the proximal interphalangeal joint have always presented as a difficult injury to manage for the treating surgeon and therapist. Traction management enabling ligamentotaxis and motion is a popular method to manage these injuries. This case series presents the design and results of hand-based swing traction splinting which is less cumbersome for patients than other forms of traction splinting. Methods Five patients presenting with intra-articular proximal interphalangeal joint fractures underwent surgery whereby a transverse K-wire was inserted across the middle phalanx. The treating Occupational Therapist fabricated a hand-based swing traction splint to provide a distraction force from the K-wire to the splint. Range of motion and patient satisfaction were the primary outcome measures. Results All five patients reported satisfaction with their hand function following therapy involving swing traction splinting. Furthermore, range of motion was comparable to other forms of traction management reported in the literature with an 88° mean arc of motion at the proximal interphalangeal joint. Conclusion This case series demonstrates that hand-based swing traction splinting is a viable treatment option for the management of intra-articular proximal interphalangeal joint fractures. With similar outcomes to other forms of distraction that enable early movement, such as the pins and rubber traction system, this design is an alternative. The less cumbersome splint design is the main advantage over other splinting methods that apply distraction whilst also enabling early motion.
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Affiliation(s)
- Melissa J Hirth
- Occupational Therapy Department, Austin Health, Melbourne, Victoria, Australia
- Malvern Hand Therapy, Malvern, Melbourne, Victoria, Australia
| | - David J Jacobs
- Occupational Therapy Department, Austin Health, Melbourne, Victoria, Australia
| | - Kate Sleep
- Malvern Hand Therapy, Malvern, Melbourne, Victoria, Australia
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Gillespie S, Cashin F, Macfarlane RJ, Brown DJ. Prevention of extension lag using a sling attachment for Ligamentotaxor ® devices in complex proximal interphalangeal joint injuries. Ann R Coll Surg Engl 2012. [PMID: 22943248 PMCID: PMC3954394 DOI: 10.1308/003588412x13373405385214n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- S Gillespie
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
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31
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Goudie S, Dreyer S, Siddiqi R. Modified mattress suture. Ann R Coll Surg Engl 2012; 94:366. [DOI: 10.1308/rcsann.2012.94.5.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Granville-Chapman J, Elliott DS. Use a ball-ended anterior cruciate ligament reamer to protect patella tendon during minimal access tibial nailing. Ann R Coll Surg Engl 2012; 94:371. [DOI: 10.1308/rcsann.2012.94.5.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - DS Elliott
- Ashford and St Peter’s Hospitals NHS Foundation Trust,UK
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Kazi HA, Thomas TG. Use of a sharps bin to provide lower limb traction. Ann R Coll Surg Engl 2012; 94:360. [DOI: 10.1308/rcsann.2012.94.5.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- HA Kazi
- Wirral University Teaching Hospital NHS Foundation Trust,UK
| | - TG Thomas
- Wirral University Teaching Hospital NHS Foundation Trust,UK
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MacDonald ER, Renwick AA, Molloy RG. Laparoscopic hepatic flexure mobilisation. Ann R Coll Surg Engl 2012; 94:360. [DOI: 10.1308/rcsann.2012.94.5.360a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - RG Molloy
- Gartnavel General Hospital, Glasgow,UK
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35
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Gillespie S, Cashin F, Macfarlane RJ, Brown DJ. Prevention of extension lag using a sling attachment for Ligamentotaxor® devices in complex proximal interphalangeal joint injuries. Ann R Coll Surg Engl 2012; 94:367-8. [DOI: 10.1308/rcsann.2012.94.5.367a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- S Gillespie
- Royal Liverpool and Broadgreen University Hospitals NHS Trust,UK
| | - F Cashin
- Royal Liverpool and Broadgreen University Hospitals NHS Trust,UK
| | - RJ Macfarlane
- Royal Liverpool and Broadgreen University Hospitals NHS Trust,UK
| | - DJ Brown
- Royal Liverpool and Broadgreen University Hospitals NHS Trust,UK
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36
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Cheung A. Soft tissue protection from exposed K-wires. Ann R Coll Surg Engl 2012; 94:372. [DOI: 10.1308/rcsann.2012.94.5.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Cheung
- West Hertfordshire Hospitals NHS Trust,UK
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37
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Leong E, Lemon M. A knot quicker and easier than Whip stitching in anterior cruciate ligament reconstruction. Ann R Coll Surg Engl 2012. [DOI: 10.1308/rcsann.2012.94.5.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- E Leong
- Royal Surrey County Hospital nHS foundation Trust,UK
| | - M Lemon
- Royal Surrey County Hospital nHS foundation Trust,UK
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Affiliation(s)
- J Krysa
- Guy’s and St Thomas’ NHS Foundation Trust,UK
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39
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Affiliation(s)
- RP Walter
- South Devon Healthcare NHS Foundation Trust,UK
| | - S James
- South Devon Healthcare NHS Foundation Trust,UK
| | - JR Davis
- South Devon Healthcare NHS Foundation Trust,UK
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Storey RL, Gouda MR, Smith AM. A simple exercise to encourage precise suture placement. Ann R Coll Surg Engl 2012; 94:370. [DOI: 10.1308/rcsann.2012.94.5.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- RL Storey
- Leeds Teaching Hospitals NHS Trust,UK
| | - MR Gouda
- Leeds Teaching Hospitals NHS Trust,UK
| | - AM Smith
- Leeds Teaching Hospitals NHS Trust,UK
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Travers H, Mansfield S. A technique to maintain pneumoperitoneum and allow easy inspection of the abdomen after specimen delivery in laparoscopic colorectal surgery. Ann R Coll Surg Engl 2012; 94:362. [DOI: 10.1308/rcsann.2012.94.5.362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- H Travers
- Royal Devon and Exeter NHS Foundation Trust,UK
| | - S Mansfield
- Royal Devon and Exeter NHS Foundation Trust,UK
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Weddell C, McMurtrie A, Hamad AK. A simple aid to fracture reduction in the digit. Ann R Coll Surg Engl 2012; 94:369-70. [DOI: 10.1308/rcsann.2012.94.5.369a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- C Weddell
- Shrewsbury and Telford Hospital NHS Trust,UK
| | - A McMurtrie
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust,UK
| | - AK Hamad
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust,UK
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43
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Middleton PR, Ng L, Humphrey A. A technique to aid the insertion of distal locking screws. Ann R Coll Surg Engl 2012; 94:364-5. [DOI: 10.1308/rcsann.2012.94.5.364a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- PR Middleton
- County Durham and Darlington NHS Foundation Trust,UK
| | - L Ng
- Newcastle upon Tyne Hospitals NHS Foundation Trust,UK
| | - A Humphrey
- County Durham and Darlington NHS Foundation Trust,UK
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44
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Ellis G, Pridgeon S, Graham S. A technique for optimal manipulation of rotation of the flexible ureterorenoscope. Ann R Coll Surg Engl 2012; 94:365-6. [DOI: 10.1308/rcsann.2012.94.5.365a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - S Graham
- Whipps Cross University Hospital NHS TrustUK
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45
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Vitale MA, White NJ, Strauch RJ. A percutaneous technique to treat unstable dorsal fracture-dislocations of the proximal interphalangeal joint. J Hand Surg Am 2011; 36:1453-9. [PMID: 21820818 DOI: 10.1016/j.jhsa.2011.06.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 06/12/2011] [Accepted: 06/18/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Unstable dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint are complex injuries that are difficult to treat and usually require operative fixation. There are a number of surgical techniques for treating these injuries but none has emerged as superior. The purposes of this study were to describe a simple percutaneous technique to treat unstable dorsal fracture-dislocations of the PIP joint and to report short-term postoperative results. METHODS We treated 6 patients with unstable dorsal fracture-dislocations of the PIP joint with the technique of closed reduction, percutaneous fracture reduction, and pinning via a volar approach and also with dorsal block pinning. We collected information on postoperative stability, range of motion at the PIP and distal interphalangeal joints, and radiographic outcomes. We also administered the Disabilities of the Arm, Shoulder, and Hand and visual analog pain scale questionnaires. RESULTS At a mean follow-up of 18 months (range, 6-57 mo), there were no subluxation or dislocation events. The mean range of motion was from 4° of extension to 93° of flexion at the PIP joint and from 1° of extension to 73° of flexion at the distal interphalangeal joint. Radiographic analysis revealed a concentric reduction and union in all cases. The mean Disabilities of the Arm, Shoulder, and Hand score was 8 and the mean visual analog pain score was 1.4 out of 10. There were no minor or major complications. CONCLUSIONS This percutaneous technique reliably restored stability to the PIP joint, allowed for concentric reduction of the joint, and produced excellent radiographic and clinical outcomes. The postoperative management course with this technique is critical to the outcome.
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Affiliation(s)
- Mark A Vitale
- Department of Orthopaedic Surgery, New York-Presbyterian Medical Center, Columbia University, New York, NY 10032, USA
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46
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Abstract
Suzuki et al described the pins and rubbers capsuloligamentotaxis traction system for the treatment of comminuted intraarticular fractures and fracture-dislocations involving the proximal interphalangeal joint, the distal interphalangeal joint, and trapezium. Majumder et al later detailed the lessons learned from their management of patients with complex intraarticular fractures of the base of the middle phalanges of the fingers. The researchers found that the most common patient complaint was that the protruding ends of the device caught on clothing. However, the researchers did not suggest how to resolve this problem. We describe a modification of the distal tips of the Suzuki pins and rubbers axial traction pin, from the S- (or double-opposing U-) shaped morphology of the hook, to a pigtail coil: We propose that this modification has a number of advantages, being simpler, more secure, more adjustable, and safer.
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47
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Finsen V. Suzuki's pins and rubber traction for fractures of the base of the middle phalanx. J Plast Surg Hand Surg 2010; 44:209-13. [DOI: 10.3109/02844311.2010.494416] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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48
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Interphalangeal traction for comminuted fracture of middle phalanx fingers: case report. J Hand Surg Am 2010; 35:1282-5. [PMID: 20684928 DOI: 10.1016/j.jhsa.2010.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 05/04/2010] [Accepted: 05/10/2010] [Indexed: 02/02/2023]
Abstract
We report an interphalangeal traction system through capsuloligamentotaxis for the treatment of comminuted fracture of the middle phalanx. The interphalangeal (IP) traction system inserts a K-wire at the proximal and distal phalanx. The difference between our IP traction system compared with the modified Suzuki frame method is that distal IP and proximal IP joints are synchronously distracted in the fixator, and bony continuity and articular integrity are restored.
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49
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Debus G, Courvoisier A, Wimsey S, Pradel P, Moutet F. Pins and rubber traction system for intra-articular proximal interphalangeal joint fractures revisited. J Hand Surg Eur Vol 2010; 35:396-401. [PMID: 20150391 DOI: 10.1177/1753193409359493] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- G Debus
- Department of Hand Surgery, Grenoble University Hospital, Grenoble, France
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50
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Baier S, Szekeres M. The hand arc--a hand-based splint design for intraarticular fractures. J Hand Ther 2010; 23:73-76. [PMID: 19883994 DOI: 10.1016/j.jht.2009.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Accepted: 07/13/2009] [Indexed: 02/03/2023]
Abstract
When a fracture of the finger is intraarticular in nature, it adds another dimension to the rehabilitation program, as the joint space is affected and subsequently gaining motion can be a challenge. Traction splinting has been reported in the literature as one way to manage intraarticular finger fractures in an attempt to provide stability while allowing motion. These authors have modified some of the original traction splints to create a hand-based version to use for the patients with an intraarticular, proximal interphalangeal joint fracture.
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Affiliation(s)
- Sarah Baier
- Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.
| | - Mike Szekeres
- Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada
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