Pins and rubbers traction system for fractures of the proximal interphalangeal joint

Comparative analysis of dynamic external fixation, static external fixation, and internal fixation in interphalangeal joint fractures: outcomes, complications, and clinical implications

BACKGROUND AND OBJECTIVE

Proximal interphalangeal joint (PIPJ) fractures present significant therapeutic challenges in hand surgery. This systematic review evaluated the comparative efficacy of dynamic external fixation against traditional treatment modalities, integrating machine learning analysis to enhance outcome prediction and treatment selection.

METHODS

We systematically reviewed 43 clinical studies published between January 2014 and January 2024, including 26 dynamic external fixations, 6 traditional internal fixations, and 11 static external fixations. Studies were included if they reported quantitative outcomes of PIPJ fracture treatment, had a minimum follow-up of 4 weeks, and included at least 20 patients. Case series with fewer than 5 patients and non-English publications without available translations were excluded. The analysis focused on four key outcomes: range of motion (ROM), recovery time, complication rates, and functional results. We developed a neural network model to predict treatment outcomes, achieving 89.7% accuracy (95% CI 87.3-92.1%). Methodological quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool.

RESULTS

Dynamic external fixation demonstrated superior outcomes across multiple domains. ROM analysis revealed a median of 86.12° (range: 70°-95°) for dynamic fixation compared to 72.30° (range: 56°-88°) for traditional approaches (mean difference: 13.82°, 95% CI 10.24-17.40°). Dynamic fixation significantly reduced recovery duration (9.68 weeks vs. 20.47 weeks, p < 0.001). Complication profiles favored dynamic fixation, with pin tract infection rates of 2.4% versus 3.8% for traditional fixation. Functional assessment using the Ishida scoring system showed favorable outcomes in the dynamic fixation group, with a mean score of 85.3 points and 78% of cases achieving scores above 80 points.

DISCUSSION

This comprehensive systematic review provides evidence supporting the efficacy of dynamic external fixation for PIPJ fracture treatment. The findings demonstrate improved functional outcomes, accelerated rehabilitation, and reduced complication rates. The integration of machine learning analysis shows promise for optimizing patient-specific treatment selection. Further validation through large-scale, multicenter randomized controlled trials with extended follow-up periods is warranted.

Unstable Middle Phalanx Base Fractures Treated With an Internal Joint Stabilizer: Preliminary Results

BACKGROUND

Unstable fractures of the base of the middle phalanx are notorious for causing chronic loss of proximal interphalangeal (PIP) joint function, and they remain a challenge for the hand surgeon. We report on a temporary intraoperatively constructed internal joint stabilizer for unstable PIP joint injuries.

METHODS

Across 2 institutions, a retrospective chart review was performed for cases with acute presentation of pilon fracture or fracture-dislocation of the base of the middle phalanx which were surgically treated with an internal joint stabilizer. Information collected included time from injury to surgical intervention, time from implantation to device removal, complications, and preoperative and postoperative range of motion.

RESULTS

Seven patients met the inclusion criteria with a mean age of 51 (range: 24-72) years and a mean follow-up of 29 (range: 11-72) months. After removal of the fixator, the mean arc of PIP joint motion was 8° to 88° (range: 0°-100°). There were no infections, no hardware loosening or failures, and no revision procedures.

CONCLUSION

The current findings are comparable to the results for dynamic external fixators. An internal joint stabilizer for unstable injuries to the base of the middle phalanx provides satisfactory functional outcomes, allows early postoperative motion, and mitigates the routine complications which may arise with external fixation.