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Razavipour M, Ghaffari S, Dehghan M. Extension block pinning for chronic volar base fractures of the middle phalanges. J Hand Surg Eur Vol 2024:17531934241229940. [PMID: 38366358 DOI: 10.1177/17531934241229940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Due to the simplicity, low cost and benefit of avoiding long-term joint immobilization, extension block pinning could be a suitable option for treating the volar base fractures of the middle phalanges. The aim of the present study was to evaluate the outcomes of using extension block pinning in chronic volar base fractures of the middle phalanges. In total, 26 patients with chronic closed volar base fractures of the middle phalanges were included our study. The mean age was 37 years (SD 11.59), and the mean follow-up time was 35 months (SD 19.41). The mean active range of motion (ROM) after surgery was 93° (SD 12.9). There was a negative correlation between the age and the ROM of the injured proximal interphalangeal joint after surgery. ROM did not correlate with the articular surface involvement or the interval between injury and surgery. We obtained a satisfactory result from extension block pinning for volar base fractures of the proximal interphalangeal joint in patients with chronic injuries.Level of evidence: IV.
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Affiliation(s)
- Mehran Razavipour
- Orthopedic Research Center, Mazandaran University of Medical Science, Sari, Iran
| | - Salman Ghaffari
- Orthopedic Research Center, Mazandaran University of Medical Science, Sari, Iran
| | - Mojtaba Dehghan
- Orthopedic Research Center, Mazandaran University of Medical Science, Sari, Iran
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Sawant RV, Darawade N, Sonawane D, Tawde A, Bhandari N. Reconstruction of Delayed Proximal Interphalangeal Joint Fracture-Dislocation Using Hemi-Hamate Arthroplasty: A Case Report. Cureus 2024; 16:e52797. [PMID: 38389629 PMCID: PMC10883261 DOI: 10.7759/cureus.52797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
This case report aims to delineate the clinical outcomes and technical considerations of hemi-hamate arthroplasty in the reconstruction of a delayed proximal interphalangeal (PIP) joint fracture-dislocation. It underscores the procedure's viability as a reconstructive option for complex finger injuries with delayed presentation. A 23-year-old male presented six weeks post-injury with a PIP joint fracture-dislocation of the left index finger. Traditional management options were limited due to the delayed presentation and the nature of the injury. A surgical intervention was performed using an autologous osteochondral hemi-hamate graft to reconstruct the articular surface. Herein, we describe the detailed surgical steps, postoperative care, and rehabilitation protocols. Over a five-month follow-up period, the patient demonstrated significant functional improvement. The range of motion in the PIP joint increased substantially, with a notable reduction in pain levels. Radiographic assessments showed successful graft incorporation and joint alignment. The patient reported satisfaction with the aesthetic and functional outcome, highlighting an enhanced quality of life post-surgery. Hemi-hamate arthroplasty emerges as a favorable surgical option for delayed PIP joint fracture-dislocations, offering improved articular congruity, joint stability, and functional outcomes. This case contributes to the growing body of evidence supporting the procedure's effectiveness and underscores the importance of considering innovative approaches in complex hand injuries.
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Affiliation(s)
- Rishikesh V Sawant
- Department of Orthopedics, Bharati Vidyapeeth Medical College and Hospital, Pune, IND
| | - Nilesh Darawade
- Department of Hand Surgery, Shubhamkar Hand Clinic, Pune, IND
| | - Darshankumar Sonawane
- Department of Orthopedics, Bharati Vidyapeeth Medical College and Hospital, Pune, IND
| | - Anish Tawde
- Department of Arthroplasty, Krishna Institute of Medical Sciences (KIMS) Sunshine Hospital, Hyderabad, IND
| | - Nikhil Bhandari
- Department of Orthopedics, Maharashtra Institute of Medical Education and Research (MIMER) Medical College, Pune, IND
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Atiyya AN, Nabil A, Soliman R, Eldiasty A, Koriem I. Blocking Plate for Volar Proximal Interphalangeal Joint Fracture Dislocation. J Hand Surg Am 2022; 47:899.e1-899.e6. [PMID: 34538670 DOI: 10.1016/j.jhsa.2021.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/20/2021] [Accepted: 07/28/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the use of a 2-mm miniplate as a dorsal blocking plate to stabilize the central avulsion fragment in a proximal interphalangeal joint (PIP) volar fracture dislocation. METHODS This was a case series comprising 8 patients with volar fracture dislocation of the PIP joint. The average age of the patients was 36 years. The patients were managed by this technique within an average of 11 days following the injury. The clinical outcome measurements included the assessment of pain and range of motion of the PIP and distal interphalangeal joints. RESULTS The average follow-up duration was 20 months. The mean visual analog scale pain score was 1.9. The average range of motion of the PIP joint was 82°, whereas the average range of motion of the distal interphalangeal joint was 43°. Reduction of the subluxation was achieved in all cases, with no articular step remaining. CONCLUSIONS A dorsal blocking plate is a simple technique, associated with a satisfactory outcome, for volar fracture dislocation injuries of the PIP joint. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
| | - Amr Nabil
- Orthopedic Department, Ain Shams University, Cairo, Egypt
| | - Ramy Soliman
- Orthopedic Department, Ain Shams University, Cairo, Egypt
| | | | - Islam Koriem
- Orthopedic Department, Ain Shams University, Cairo, Egypt.
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Bouvet C, Beaulieu JY, Liu K, VAN Aaken J. Mid-term Outcomes of Treatment of Fracture Dislocation of the Proximal Interphalangeal Joint with Gexfinger ®-A New Dynamic External Fixator. J Hand Surg Asian Pac Vol 2022; 27:359-365. [PMID: 35404202 DOI: 10.1142/s2424835522500242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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).
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Affiliation(s)
- Cindy Bouvet
- Hand Unit, Orthopaedic Department, Geneva University Hospital, Rue Gabrielle-Perret Gentil 4, 1211 Geneva, Switzerland
| | - Jean-Yves Beaulieu
- Hand Unit, Orthopaedic Department, Geneva University Hospital, Rue Gabrielle-Perret Gentil 4, 1211 Geneva, Switzerland
| | - Kun Liu
- Department of Hand Surgery, Beijing Jishuitan Hospital, 4th Medical College of Peking University, 31 Xinjiekou East Street, 100035, Beijing, China
| | - Jan VAN Aaken
- Hand Unit, Orthopaedic Department, Geneva University Hospital, Rue Gabrielle-Perret Gentil 4, 1211 Geneva, Switzerland
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Murayama A, Watanabe K, Ota H, Kurimoto S, Hirata H. Volar plating versus external fixation for unstable dorsal fracture-dislocations of the proximal interphalangeal joint. J Hand Surg Eur Vol 2022; 47:308-313. [PMID: 34812077 DOI: 10.1177/17531934211059300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We retrospectively compared the results of volar plating and dynamic external fixation for acute unstable dorsal fracture-dislocations of the proximal interphalangeal joint with a depressed fragment. We treated 31 patients (31 fingers), 12 with volar buttress plating and 19 with dynamic external fixation. Follow-up averaged 35 and 40 months in the two groups, with a minimal 6-month follow-up. Average active flexion of the proximal interphalangeal joint was 95° after plate fixation and 87° after external fixation, with an active extension lag of -6° and -9°, respectively. Active flexion at the distal interphalangeal joint averaged 67° in the plate group and 58° in the external fixation group, with active extension lags of 0° and -5°, respectively. We conclude that both methods can obtain a good range of motion at the proximal interphalangeal joint. A limitation of the extension of the distal interphalangeal joint occurred with dynamic external fixation but not with volar buttress plating.Level of evidence: IV.
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Affiliation(s)
- Atsuhiko Murayama
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kentaro Watanabe
- Department of Health Sciences, Aichi Shukutoku University, Nagoya, Japan
| | - Hideyuki Ota
- Department of Orthopaedic Surgery and Hand Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Shigeru Kurimoto
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Malhotra G, Al Bahri ZH, Elsayed AOA, Komma VNR, Patil R. Hemihamate arthroplasties in pilon fractures: a modified approach and experience in 30 patients. J Hand Surg Eur Vol 2021; 46:928-935. [PMID: 33904323 DOI: 10.1177/17531934211008056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hemihamate arthroplasty is an established method of managing difficult Pilon fractures of the proximal interphalangeal (PIP) joint. We present our experience in 30 patients, whose injuries were further complicated by severe comminution and late presentations. Several modifications were utilized, including preoperative distraction, use of smaller size grafts and functional release of collaterals. The average follow-up period was 28 months (range 18 to 28). Postoperatively, the average range of flexion at the PIP joint improved from 30° (range 20° to 45°) preoperatively to 104° (90° to 110°) at the final follow-up. The average extension lag was 6° (0° to 20°). Five patients required secondary procedures and no patient had a recurrent dorsal dislocation. We propose these modifications in the use of hemihamate arthroplasty for the management of difficult PIP joint fractures.Level of evidence: IV.
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Affiliation(s)
- Gopal Malhotra
- Department of Hand and Microvascular Surgery, Khoula Hospital, Muscat, Sultanate of Oman
| | - Zamzam Hamed Al Bahri
- Department of Hand and Microvascular Surgery, Khoula Hospital, Muscat, Sultanate of Oman
| | | | | | - Rahul Patil
- Department of Hand and Microvascular Surgery, Khoula Hospital, Muscat, Sultanate of Oman
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Abstract
Background: Treatment of proximal interphalangeal joint (PIPJ) fracture-dislocations is difficult given the potential long-term complications of the involved finger and entire hand. Several surgical methods have been utilized for management of these injuries, none of which have shown consistently favorable results. The purpose of this systematic review of the literature is to report the post-operative outcomes of multiple treatment modalities for PIPJ fracture-dislocations in various studies. Methods: A literature review of PubMed and EMBASE databases was performed for all articles on PIPJ fracture-dislocations. Outcomes of interest included PIPJ range of motion, grip strength (% of contralateral hand), and quick disabilities of arm, shoulder, hand (QuickDASH). Articles were distributed into 5 groups by surgical method: open reduction, percutaneous fixation, dynamic external fixation, extension-block pinning, and hemi-hamate arthroplasty. Results: Forty-eight of 1679 total screened articles were included. The weighted means of post-operative range of motion (ROM; degrees) at final follow-up were open reduction 84.7 (n = 146), percutaneous fixation 86.5 (n = 32), dynamic external fixation 81.7 (n = 389), extension-block pinning 83.6 (n = 85), and hemi-hamate arthroplasty 79.3 (n = 52). Dorsal fracture-dislocations, regardless of surgical method, had an average ROM of 83.2 (n = 321), grip strength 91% (n = 132), and QuickDASH of 6.6 (n = 59) while pilon injuries had an average ROM of 80.2 (n = 48), grip strength 100% (n = 13), and QuickDASH of 11.4 (n = 13). Conclusion: Percutaneous fixation yielded the highest post-operative ROM at final follow-up while extension-block pinning resulted in the greatest grip strength. While dorsal fracture-dislocations produced higher average ROM and lower QuickDASH score, pilon fractures produced a higher grip strength. No treatment method or fracture type yielded consistently better outcomes than another.
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Affiliation(s)
- Cory Demino
- University of Pittsburgh School of Medicine, PA, USA,Cory Demino, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Suite 1010, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
| | - Megan Yates
- University of Pittsburgh School of Medicine, PA, USA
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El-Haj M, Turker T, Thirkannad SM. Management of Highly Comminuted Intra-articular Fracture Subluxations at the Proximal Interphalangeal Joint by Subchondral Buttress Fixation and Early Mobilization. Tech Hand Up Extrem Surg 2021; 25:258-63. [PMID: 34779423 DOI: 10.1097/BTH.0000000000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article describes our technique of managing highly comminuted intra-articular fracture subluxations at the proximal interphalangeal joint by subchondral buttress fixation followed by early mobilization. This technique has proven to be reliable and all patients have been able to return to their preinjury level of activity.
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9
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Abstract
The proximal interphalangeal joint (PIPJ) is a complex anatomical structure. In managing fracture dislocations about the PIPJ, the aim is to restore a congruent joint that allows for smooth gliding motion. Detailed knowledge of the anatomy and biomechanics of the PIPJ is necessary in managing these injuries with predictable success. The breadth of techniques previously described in the treatment of such injuries is testament to the difficulties faced in achieving optimal clinical and radiological outcomes. In this article we detail the anatomy and biomechanics of the PIPJ and summarize current literature and principles for the treatment of dorsal fracture dislocations.
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Affiliation(s)
- Ruth En Si Tan
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Andre Eu Jin Cheah
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
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Naguib M, Ramadan M, Ali T, El-Tantawy A. Simplified Kirschner‑wire-based dynamic external fixator for unstable proximal interphalangeal joint fractures. Eur J Trauma Emerg Surg 2020; 48:71-79. [PMID: 32712776 DOI: 10.1007/s00068-020-01443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/16/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Ligamentotaxis is a well-established treatment modality for treating challenging articular fractures. Many devices have been evolved to apply this principle to complex proximal interphalangeal joint (PIPJ) fractures. Although they gave satisfactory results, these devices were sometimes costly, complex and cumbersome. The aim of this study was to evaluate the short-term functional and radiological outcomes of treating complex intra-articular PIPJ fractures using a simplified, preloaded Kirschner‑wire (K‑wire)-based dynamic external fixator. METHODS Twenty consecutive patients with intraarticular PIPJ fractures, who fulfilled the study selection criteria, have been treated during 2018 and included in this prospective study after the approval of the responsible institutional ethics committee. Plain radiographs were used for assessing fracture reduction, congruity and healing. The visual analogue sore (VAS) and the Michigan Hand Outcome Questionnaire (MHQ) were used for functional evaluation. PIPJ range of motion (ROM) and hand grip-strength were also assessed. RESULTS At the final follow-up, all patients had no residual pain. The average PIPJ-ROM was 76.4 ± 23.51°, and the average grip-strength was 85 ± 13.95% as compared to the healthy side. The mean normalized MHQ score was 83 ± 12.63 points, with 4, 13, and 3 patients had excellent, good, and fair results retrospectively. Complications included pin tract infection (one case), stress fracture related to the applied wires (one case), and flexion contractures (four cases; three of them were symptomatic). CONCLUSIONS The used fixator technique is simple, reliable, available, reproducible, time-saving and cost-effective for managing complex PIPJ fractures while allowing early joint mobilization, which proven effective in achieving high satisfactory functional results.
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Affiliation(s)
- Mostafa Naguib
- Orthopedic and Traumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Mohammed Ramadan
- Orthopedic and Traumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Tarek Ali
- Orthopedic and Traumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmad El-Tantawy
- Orthopedic and Traumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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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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13
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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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14
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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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Najd Mazhar F, Jafari D, Taraz H, Mirzaei A. Treatment of dorsal fracture-dislocations of the proximal interphalangeal joint using the shotgun approach. J Hand Surg Eur Vol 2018; 43:499-505. [PMID: 29591322 DOI: 10.1177/1753193418766274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study assessed the outcome of open reduction and internal fixation of proximal interphalangeal joint fracture-dislocations through a shotgun approach, while keeping hemi-hamate arthroplasty as a back-up plan. After using the shotgun approach, fixation was carried out when the anterior fragment was large enough to accept two 1.5 mm screws. Sixty-three fracture-dislocations were treated in 61 patients, of whom 30 underwent internal fixation. Twenty-one of these were assessed in the final study. At a mean follow-up of 29 months, the mean range of joint motion was 80° and 102° for the injured and contralateral hand, respectively. The mean pinch and grip strengths of injured hand were 82% and 83% of contralateral hand, respectively. The mean disabilities of the arm, shoulder and hand score was 5.5. The mean visual analogue pain score was 1.6. Surgery through the versatile shotgun approach allows excellent intra-operative assessment and acceptable outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Farid Najd Mazhar
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Davod Jafari
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Taraz
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences, Tehran, Iran
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Abstract
Proximal interphalangeal joint injuries are one of the most common injuries of the hand. The severity of injury can vary from a minor sprain to a complex intra-articular fracture. Because of the complex anatomy of the joint, complications may occur even after an appropriate treatment. This article provides a comprehensive review on existing techniques to manage complications and imparts practical points to help prevent further complications after proximal interphalangeal joint injury.
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Affiliation(s)
- Sirichai Kamnerdnakta
- Department of Surgery, Section of Plastic Surgery, University of Michigan, NCRC, Building 18, G200, 2800 Plymouth Road, Ann Arbor, MI 48109, USA; Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 12th Floor, Siamintr Building, Bangkok-noi, Bangkok 10700, Thailand
| | - Helen E Huetteman
- Department of Surgery, Section of Plastic Surgery, University of Michigan, NCRC, Building 18, G200, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Kevin C Chung
- Section of Plastic Surgery, University of Michigan, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
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Giugale JM, Wang J, Kaufmann RA, Fowler JR. Mid-Term Outcomes After Open Reduction Internal Fixation of Proximal Interphalangeal Joint Dorsal Fracture-Dislocations Through a Volar, Shotgun Approach and a Review of the Literature. Open Orthop J 2017; 11:1073-1080. [PMID: 29151999 PMCID: PMC5676008 DOI: 10.2174/1874325001711011073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/24/2017] [Accepted: 08/12/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Proximal interphalangeal (PIP) fracture dislocations remain a complex injury pattern to treat. There are several treatment methods available aimed to restore stability, preserve range of motion, and reconstitute the articular surface. This study looked at the mid-term clinical and radiographic results of open reduction internal fixation through a shotgun approach of comminuted PIP fracture dislocations. Methods: A retrospective review was conducted of all PIP fracture dislocations treated through a volar, shotgun approach at a single institution over a 15-year period. Patients identified were contacted and asked to return to the office for clinical and radiographic evaluation. Patient reported outcomes were assessed with the Michigan hand questionnaire (MHQ) and visual analog scale (VAS) for pain. Results: 5 patients returned to the office for further evaluation with average follow-up of 69 months (range, 33-133 months). 3 patients were found to have post traumatic arthritis on radiographs. 1 case had recurrent instability and one case had a deep infection, both necessitating further surgical intervention. Average PIP arc of motion was found to be 79°. Average VAS score of 0 and MHQ result of 95 (out of a possible score of 100) indicating no residual pain and excellent functionality of the affected hand. Conclusion: Open reduction internal fixation of comminuted PIP fracture dislocations utilizing the volar, shotgun approach provides excellent mid-term functional results despite the high incidence of post traumatic arthritis.
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Affiliation(s)
- Juan Marcelo Giugale
- Orthopaedic Surgery Resident Department of Orthopaedic Surgery University of Pittsburgh Medical Center Pittsburgh, PA, USA
| | - Juntian Wang
- Medical Student University of Pittsburgh - School of Medicine Pittsburgh, PA, USA
| | - Robert A Kaufmann
- Associate Professor Department of Orthopaedic Surgery University of Pittsburgh Medical Center Pittsburgh, PA, USA
| | - John R Fowler
- Assistant Dean for Medical Student Research Assistant Professor Department of Orthopaedic Surgery University of Pittsburgh Medical Center Pittsburgh, PA, USA
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Foo GL, Ramruttun AK, Cheah AE, Chong AKS, Foo TL. Biomechanics of Internal Fixation Modalities for Middle Phalangeal Base Fracture Dislocation. J Hand Surg Asian Pac Vol 2017; 22:14-17. [PMID: 28205465 DOI: 10.1142/s0218810417500022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Internal fixation modalities of unstable (>50 percent articular involvement) middle phalangeal volar lip fracture-dislocations include interfragmentary screw and volar buttress plating. This study investigates the mechanical properties (yield strength, ultimate tensile strength, and stiffness) of interfragmentary screw (IS), simple buttress plating (BP) and buttress plating with subchondral screw (BP+S). METHODS Fifteen cadaveric digits (5 index, 5 middle, and 5 ring) were prepared by excising its skin envelope and flexor tendons while preserving the structures around the proximal interphalangeal joint. An oblique osteotomy involving 50 percent of the articular surface was performed, and this was fixed with based on its study group: interfragmentary screw (IS), simple buttress plating (BP) and buttress plating with subchondral screw (BP+S). These specimens were then loaded to failure. RESULTS Yield strength was as follows: BP+S (33.5±9.76 N), IS (13.6±5.46 N), and BP (8.1±3.84 N). Ultimate tensile strength was as follows: BP+S (49.1±21.4 N), IS (15.6±5.19 N), and BP (8.86±3.99 N). Stiffness was as follows: BP+S (4.77±1.32 N/mm), IS (2.44±0.86 N/mm), and BP (1.84±0.71 N/mm). CONCLUSIONS A buttress plate and screw construct confers significantly more stability than either interfragmentary screw or buttress plate only fixation in an experimental model.
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Affiliation(s)
- Gen-Lin Foo
- * Department of Hand & Reconstructive Microsurgery, National University Health System, Singapore
| | - Amit K Ramruttun
- † Department of Orthopedic Surgery, National University of Singapore, Singapore
| | - Andre Eujin Cheah
- * Department of Hand & Reconstructive Microsurgery, National University Health System, Singapore
| | - Alphonsus Kin-Sze Chong
- * Department of Hand & Reconstructive Microsurgery, National University Health System, Singapore
| | - Tun-Lin Foo
- * Department of Hand & Reconstructive Microsurgery, National University Health System, Singapore
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Waris E, Mattila S, Sillat T, Karjalainen T. Extension Block Pinning for Unstable Proximal Interphalangeal Joint Dorsal Fracture Dislocations. J Hand Surg Am 2016; 41:196-202. [PMID: 26718071 DOI: 10.1016/j.jhsa.2015.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 11/11/2015] [Accepted: 11/11/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the outcomes of extension block pinning used to treat unstable dorsal fracture dislocations of the proximal interphalangeal (PIP) joint. The factors affecting the functional outcome were analyzed. METHODS A series of 53 patients with 55 dorsal fracture dislocations of the PIP joint treated with closed reduction and extension block pinning were retrospectively reviewed. Additional percutaneous intramedullary fracture reduction (16 cases) or open fracture reduction (4 cases) had been performed. The radiological and clinical evaluations were included. RESULTS At a mean follow-up of 5.2 years (range, 1.0-10.6 years), 39 patients with 41 injured fingers were evaluated. The fracture fragments involved 30% to 69% (mean, 50%) of the articular surface of the middle phalanx. The mean range of motion was 80° (range, 35° to 115°) at the PIP joint with a mean extension loss of 6° (range, 0° to 50°) excluding 2 joints that were salvaged with arthrodesis. The mean range of motion of the distal interphalangeal joint was 68° (range, 5° to 90°). The mean visual analog scale for digit pain was 1.5/10. The reduction of the joint was achieved intraoperatively in all cases. However, after the hardware removal, recurrent minimal subluxation was observed in 12 cases (29%). Recurrent subluxation was associated with increased residual pain. The length of follow-up time had a positive correlation, whereas the patient age had a negative correlation with the range of motion of the injured PIP joint. CONCLUSIONS The extension block pinning technique is a simple and valuable technique for treating unstable dorsal PIP fracture-dislocation injuries producing satisfactory long-term results.
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Affiliation(s)
- Randy Bindra
- Orthopaedic Surgery, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD 4215, Australia
| | - Julie Colantoni Woodside
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Suite 1700, Maywood, IL 60153
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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de Haseth KB, Neuhaus V, Mudgal CS. Dorsal fracture-dislocations of the proximal interphalangeal joint: evaluation of closed reduction and percutaneous Kirschner wire pinning. Hand (N Y) 2015; 10:88-93. [PMID: 25767425 PMCID: PMC4349844 DOI: 10.1007/s11552-014-9660-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study is to evaluate the outcome of closed reduction and percutaneous Kirschner wire pinning in acute dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint. METHODS Eight men and one woman were treated with closed reduction and percutaneous Kirschner wire pinning by one orthopaedic surgeon. The ring finger was injured in six patients, the small finger in two patients and the middle finger in one patient. The mean joint surface involvement was 36 % (range, 26-49 %). The Kirschner wires were removed after an average of 28 days (range, 24-37 days). RESULTS All patients demonstrated a painless, but fusiform, swollen PIP joint after a mean follow-up of 6.5 months. The average flexion of the PIP joint was 106° (range, 80-110), and the average extension of the PIP joint was 4° short of full extension (range, 10 hyperextension-15 flexion contracture). All patients had a concentrically reduced PIP joint with a healed fracture on radiographs. Two patients had radiographic evidence of degenerative changes, but were asymptomatic. One patient developed a superficial pin track infection, which quickly resolved with a short course of antibiotics, and avascular necrosis affecting one of the condyles of the proximal phalanx. CONCLUSIONS In agreement with previous studies, closed reduction and percutaneous Kirschner wire pinning in dorsal fracture-dislocations of the PIP joint is a minimally invasive and simple technique which appears to give satisfactory outcomes in the short to intermediate term.
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Affiliation(s)
- Kristin B. de Haseth
- />Orthopaedic Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA , />Plastic, Reconstructive and Hand Surgery Department, Medisch Centrum Leeuwarden, 8934 Leeuwarden, Netherlands
| | - Valentin Neuhaus
- />Orthopaedic Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA , />Division of Trauma Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Chaitanya S. Mudgal
- />Orthopaedic Hand Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
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Tyser AR, Tsai MA, Parks BG, Means KR. Biomechanical characteristics of hemi-hamate reconstruction versus volar plate arthroplasty in the treatment of dorsal fracture dislocations of the proximal interphalangeal joint. J Hand Surg Am 2015; 40:329-32. [PMID: 25542433 DOI: 10.1016/j.jhsa.2014.10.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/30/2014] [Accepted: 10/02/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare stability and range of motion after hemi-hamate reconstruction versus volar plate arthroplasty in a biomechanical proximal interphalangeal (PIP) joint fracture-dislocation model. METHODS Eighteen digits from 6 cadaver hands were tested. We created defects of 40%, 60%, and 80% in the palmar base of each digit's middle phalanx, simulating an acute PIP joint fracture-dislocation. Each defect scenario was reconstructed with a hemi-hamate arthroplasty followed by a volar plate arthroplasty. A computer-controlled mechanism was used to bring each digit's PIP joint from full extension to full flexion via the digital tendons in each testing state, and in the intact state. During each testing scenario we collected PIP joint cinedata in a true lateral projection using mini-fluoroscopy. A digital radiography program was used to measure the amount of middle phalanx dorsal translation (subluxation) in full PIP joint extension. We recorded the angle at which subluxation, if present, occurred during each testing scenario. RESULTS Average dorsal displacement of the middle phalanx in relation to the proximal phalanx was 0.01 mm for the hemi-hamate reconstructed joints and -0.03 mm for the volar plate arthroplasty, compared with the intact state. Flexion contractures were noted in each of the specimens reconstructed with volar plate arthroplasty. Degree of contracture was directly correlated with defect size, averaging 20° for 40% defects, 35° for 60% defects, and 60° for 80% defects. We observed no flexion contractures in the hemi-hamate reconstructions. CONCLUSIONS Surgeons can use both hemi-hamate and volar plate arthroplasty to restore PIP joint stability following a fracture dislocation with a large middle phalanx palmar base defect. Use of volar plate arthroplasty led to an increasing flexion contracture as the middle phalanx palmar base defect increased. CLINICAL RELEVANCE Clinicians can use the information from this study to help with surgical decision-making and patient education.
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Affiliation(s)
- Andrew R Tyser
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Michael A Tsai
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Brent G Parks
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Kenneth R Means
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
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Watanabe K, Kino Y, Yajima H. Factors affecting the functional results of open reduction and internal fixation for fracture-dislocations of the proximal interphalangeal joint. ACTA ACUST UNITED AC 2015; 20:107-14. [PMID: 25609283 DOI: 10.1142/s021881041550015x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To clarify the factors affecting functional results of fracture-dislocations of the proximal interphalangeal (PIP) joint treated by open reduction and internal fixation (ORIF), 60 patients, including 38 patients with a dorsal fracture-dislocation and 22 with a pilon fracture, were analysed. The mean ratio of articular surface involvement was 48.5% and a depressed central fragment existed in 75.3% of the cases. ORIF was performed in 47 patients through a lateral approach using Kirschner wires and in 13 through a palmar approach using a plate or screws. The mean flexion, extension and range of motion (ROM) of the PIP joint was 89.5°, 11.5° and 78.0°, respectively. Stepwise regression analysis revealed that a delayed start of active motion exercise after surgery, elderly age and ulnar ray digit were factors affecting functional outcomes. Although ORIF allows accurate restoration of the articular surfaces, an early start of motion exercise is essential for good results.
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Affiliation(s)
- Kentaro Watanabe
- Department of Orthopaedic Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
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26
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Khouri JS, Bloom JMP, Hammert WC. Current trends in the management of proximal interphalangeal joint injuries of the hand. Plast Reconstr Surg 2013; 132:1192-204. [PMID: 24165600 DOI: 10.1097/PRS.0b013e3182a48d65] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Injuries to the proximal interphalangeal joint are commonly encountered by the hand surgeon. Proper diagnosis and treatment are vital for optimal outcomes. Proper treatment of these injuries requires a working knowledge of the anatomy of the joint and an appreciation for principles for reduction, stabilization, and early rehabilitation to provide the best outcomes possible. Injuries can include fractures of the head of the proximal phalanx, dislocations, fracture dislocations, and fractures of the base of the middle phalanx. Similar to other aspects of plastic surgery, there is little high-level evidence guiding treatment and thus most treatment is based on level III or IV evidence. The goal for treatment of any injury around the proximal interphalangeal joint is to establish a congruent joint and allow for early motion. Stiffness and posttraumatic arthritis are common following these injuries. Salvage procedures are limited to arthrodesis and arthroplasty, neither of which can restore the normal function of the hand.
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Abstract
We present our experience with 14 volar plate avulsion fractures of the fingers that were treated by excision or internal fixation and discuss the factors affecting the operative techniques and results. Fourteen cases were divided into two groups: the volar plate avulsions with excision (eight cases) and the volar plate avulsions with fixation (six). We compared clinical factors between fracture groups and between fixation methods. Fractures treated with fixation had the larger fragment, a shorter preoperative period, and the larger articular surface involvement than fractures treated with excision. Postoperative pain, average age, patients' satisfaction measured by VAS, DASH scores, grip, and pinch strength were not different between two groups. All fixated fractures healed and the time to union did not differ based on fixation method. The true size of the fracture fragment was larger than expected based on the X-ray and the fragments were usually rotated by pull of the volar plate or ligament. The size and shape of the avulsed fragment might be important factors to determine the treatment method, but the results after operation were not significantly different whether the fragment was excised or fixed.
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Abstract
Fracture-dislocations of the proximal interphalangeal joint encompass a spectrum of injury severity, ranging from injuries that require little intervention to those that require advanced reconstructive surgery for optimal outcome. Three fracture-dislocation patterns are recognized: dorsal, volar, and pilon. Acceptable outcome is dependent on achieving and maintaining a well-aligned and well-reduced joint, re-establishing normal joint kinematics, and restoring motion. Anatomic articular surface reduction is desirable but not absolutely necessary for a good outcome. Treatment depends on both the type of injury and patient-dependent factors. Optimal outcome for a specific injury is predicated on expedient diagnosis and recognition of injury severity, which enables initiation of appropriate management.
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Siddiqui F, Hossain S, Huq N. Nail hooks and elastic bands external dynamic traction for fractures of the proximal interphalangeal joint. Tech Hand Up Extrem Surg 2012; 16:148-52. [PMID: 22913996 DOI: 10.1097/BTH.0b013e31825bd4da] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intra-articular fractures of the proximal interphalangeal joint remain a treatment challenge for hand specialists. The purpose of this investigation was to review the results of 12 patients, 6 men and 6 women (average age, 21 y), who were treated using the nail hooks and elastic bands external dynamic traction technique for their intra-articular proximal interphalangeal joint fractures. Of the total 12 fractures, 6 involved the proximal phalanx and 6 involved the middle phalanx. The final arc of motion at the proximal interphalangeal joint averaged 89 degrees (range, 25 to 111 degrees). At the conclusion of treatment: 1 patient developed a radial deviation and 1 developed a slight ulnar deviation. All patients were able to return to their preinjury level of functioning. Nail hooks and elastic bands external dynamic traction provides an effective treatment for intra-articular proximal interphalangeal joint fractures. It is an inexpensive, easily applied, nonoperative method of treatment.
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Abstract
The hand is essential in humans for physical manipulation of their surrounding environment. Allowing the ability to grasp, and differentiated from other animals by an opposing thumb, the main functions include both fine and gross motor skills as well as being a key tool for sensing and understanding the immediate surroundings of their owner. Hand fractures are the most common fractures presenting at both accident and emergency and within orthopaedic clinics. Appropriate evaluation at first presentation, as well as during their management, can significantly prevent both morbidity and disability to a patient. These decisions are dependant on a wide range of factors including age, hand dominance, occupation and co-morbidities.A fracture is best described as a soft tissue injury with an associated bony injury. Despite this being the case, this paper intends to deal mainly with the bone injury and aims to discuss both the timing, as well as the methods available, of hand fracture management.
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Affiliation(s)
- Dn Haughton
- Department of Plastic Surgery, Countess of Chester Hospital, Liverpool Road Chester, CH21UL. UK
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Cheah AEJ, Tan DMK, Chong AKS, Chew WYC. Volar plating for unstable proximal interphalangeal joint dorsal fracture-dislocations. J Hand Surg Am 2012; 37:28-33. [PMID: 22018477 DOI: 10.1016/j.jhsa.2011.08.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 08/23/2011] [Accepted: 08/23/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To report our results of open reduction internal fixation with volar mini plate and screw fixation for unstable dorsal fracture dislocations (DFDs) of the proximal interphalangeal (PIP) joint. METHODS We performed a retrospective review of 13 consecutive DFDs of the PIP joint treated with volar mini plate and screw fixation, measuring both clinical and radiological outcomes. RESULTS The age range of our patients was 15 to 56 years (average, 33 y). Six injuries were related to work, 5 to sports, and 2 to motor vehicle accidents. Of the 13 DFDs, 6 were comminuted. Articular involvement ranged from 30% to 70% (average, 44%). The average time to surgery was 7 days (range, 0-23 d). Patients had follow-up of 12 to 60 months (average, 25 mo). Four patients had a postoperative course complicated by plate and screw removal at an average of 4 months later, either as part of a secondary procedure to improve range of motion or owing to patient request. All patients returned to their original occupation. Of the 13 patients, 11 were satisfied with the result, and 12 of 13 had either no or mild pain. All 13 DFDs united in good alignment but 3 showed degenerative changes. Average grip strength was 85% of the unaffected side, and average active PIP joint and distal interphalangeal joint motion arcs were 75° and 65°, respectively. Average Quick Disabilities of Arm, Shoulder, and Hand score was 4 (range, 0-9). All patients had non-tender swelling of the proximal interphalangeal joints but no signs of flexor tenosynovitis or infection. CONCLUSIONS Fixation of unstable PIP joint DFDs via a volar approach is technically feasible with mini plates and screws. This treatment allows early active range of motion and provides good objective and subjective outcomes; however, noteworthy complications occurred in 39% of patients. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Andre E J Cheah
- Department of Hand & Reconstructive Microsurgery, National University Hospital, National University Health System, Singapore.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
BACKGROUND Injury following proximal interphalangeal joint fracture dislocation is determined by the direction of force transmission and the position of the joint at the time of impact. Dorsal dislocations with palmar lip fractures are the most frequently encountered. The degree of stability is directly determined by the amount of middle phalangeal palmar lip involvement. MATERIALS AND METHODS Hemihamate arthroplasty procedure was used in the reconstruction in five cases with comminuted, impacted fractures of the proximal end of middle phalanx of the finger. Three patients were presented within 2 weeks; one patient came by one month and the other by three months following the injury. All patients presented with posterior subluxation of PIP joint. RESULTS Functional outcome following this procedure in both acute and chronic cases resulted in adequate restoration of joint stability and function. CONCLUSIONS Hemihamate arthroplasty is an adjuvant in the treatment of unstable intra-articular pilon fracture involving PIP joint.
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Affiliation(s)
- Pradeoth M. Korambayil
- Consultant Plastic Surgeons, Sushrutha Institute of Plastic, Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, India
| | - Anto Francis
- Consultant Plastic Surgeons, Sushrutha Institute of Plastic, Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, India
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35
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Faccioli N, Foti G, Barillari M, Atzei A, Mucelli RP. Finger fractures imaging: accuracy of cone-beam computed tomography and multislice computed tomography. Skeletal Radiol 2010; 39:1087-95. [PMID: 20224906 DOI: 10.1007/s00256-010-0911-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 01/04/2010] [Accepted: 02/16/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the diagnostic accuracy and radiation exposure of cone beam computed tomography (CBCT) and multislice computed tomography (MSCT) in the evaluation of finger fractures. MATERIALS AND METHODS In a 3-year period, 57 consecutive patients with post-traumatic fractures of the metacarpal-phalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints with involvement of the articular surface were studied by means of CBCT and MSCT. Student's t test was used to compare CBCT and MSCT accuracy in evaluating the percentage of joint surface involvement and in detecting bone fragments. The average tissue-absorbed doses of CBCT and MSCT were also compared. A value of p < 0.05 was considered statistically significant. Inter-observer agreement was calculated. RESULTS In all cases, CBCT allowed the percentage of articular involvement to be correctly depicted compared with MSCT, showing 100% sensitivity and specificity (p < 0.001). A total of 103 bone fragments were depicted on MSCT (mean 3.8 per patient, range 1-23). CBCT indicated 92 out of 103 fragments (89.3%) compared with MSCT (mean diameter of missed fragments 0.9 mm, range 0.6-1.3 mm), with no statistically significant difference between CBCT and MSCT (p < 0.025). Multislice CT radiation exposure was significantly higher than that of CBCT (0.18 mSv vs 0.06 mSv, p < 0.0025). Inter-observer agreement was good (overall κ = 0.89-0.96). CONCLUSIONS Cone beam CT may be considered a valuable imaging tool in the preoperative assessment of finger fractures, when MSCT is not available.
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Affiliation(s)
- Niccolò Faccioli
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy
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Chew WYC, Cheah AEJ. Volar plate and screw fixation for dorsal fracture-dislocation of the proximal interphalangeal joint: case report. J Hand Surg Am 2010; 35:928-30. [PMID: 20399037 DOI: 10.1016/j.jhsa.2010.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 02/06/2010] [Accepted: 02/10/2010] [Indexed: 02/02/2023]
Abstract
We present a case of a man who sustained a closed dorsal fracture-dislocation of his left ring finger proximal interphalangeal joint in a fall. The patient was treated surgically with plate and screw fixation via a volar approach. This method theoretically provides more secure fixation than internal fixation with screws alone, allowing early rehabilitation with active range of motion and potentially better functional outcome.
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Affiliation(s)
- Winston Y C Chew
- Hand and Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Calfee RP, Kiefhaber TR, Sommerkamp TG, Stern PJ. Hemi-hamate arthroplasty provides functional reconstruction of acute and chronic proximal interphalangeal fracture-dislocations. J Hand Surg Am 2009; 34:1232-41. [PMID: 19700071 DOI: 10.1016/j.jhsa.2009.04.027] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 04/15/2009] [Accepted: 04/20/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE Hemi-hamate resurfacing arthroplasty is a treatment alternative for the management of severe acute and chronic dorsal proximal interphalangeal (PIP) fracture-dislocations. This study was designed to determine whether this procedure would successfully restore function after such injuries. METHODS Hemi-hamate reconstructions were performed on 33 patients (mean age, 34 years) who presented to 1 hand surgery practice with dorsal PIP fracture-dislocations. Eligible patients experienced unstable dislocations with comminuted metaphyseal fractures involving at least 50% of the volar middle phalangeal surface that was not amenable to open reduction and internal fixation. We evaluated 22 patients with 14 acute (<6 weeks) and 8 chronic (mean, 30 weeks) injuries at a mean of 4.5 years (range, 1-7 years). Functional outcomes were assessed by objective and subjective measures: joint alignment/motion/stability, grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and visual analog scales (VAS) of pain and function. RESULTS After hemi-hamate reconstruction, active PIP motion averaged 70 degrees (acute 71 degrees , chronic 69 degrees ) with a mean flexion contracture of 19 degrees (range, 0 degrees to 80 degrees ). Active distal interphalangeal motion averaged 54 degrees (acute 56 degrees , chronic 51 degrees ). The mean VAS score for digit pain was 1.4 (acute 0.7, chronic 2.5). The mean DASH score of 5 (acute 2, chronic 9) and VAS functional score of 1.9 (acute 1.4, chronic 2.6) indicated little functional impairment (acute 2, chronic 9). Grip strength averaged 95% of the opposite hand. Mean coronal plane angulation at the PIP joint was 3 degrees . Ten patients reported aching with cold temperatures. One dissatisfied patient underwent revision surgery. Chronic reconstructions were associated with increased VAS pain ratings (p = .02) and higher DASH scores (p = .06). CONCLUSIONS Hemi-hamate reconstruction represents a valuable surgical procedure to address severe PIP joint fracture-dislocations. Reconstruction of chronic injuries by this method restores PIP function, albeit with more modest outcome performance. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- R P Calfee
- Department of Orthopedic Surgery, Division of Hand Surgery, Washington University School of Medicine, St. Louis, MO, USA.
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Abstract
Proximal interphalangeal joint dislocations are common athletic injuries. In dislocations and fracture dislocations, the most important treatment principle is congruent joint reduction and maintenance of stability. This article reviews the relevant anatomy, injury characteristics, and treatment options for proximal interphalangeal joint dislocations and fracture dislocations. Treatment methods discussed include closed reduction, percutaneous fixation, and open reduction.
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Affiliation(s)
- Randy R Bindra
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maguire Center Suite 1700, 2160 South 1st Avenue, Maywood, IL 60153, USA.
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Abstract
Fracture-dislocations in the small joints of the fingers are challenging injuries. The surgeon must choose an appropriate treatment based on fracture pattern, joint stability, and injury chronicity. Fracture-dislocations of the proximal interphalangeal joint are notoriously unforgiving, with potential long-term sequelae of residual pain and stiffness. Similar injuries in the distal interphalangeal joint are more tolerant of fracture displacement and even joint subluxation. Dorsal dislocations of the metacarpophalangeal joint may be associated with shearing fractures of the metacarpal head but are most notable for the volar plate interposition that may block closed reduction.
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Affiliation(s)
- R P Calfee
- Department of Orthopedic Surgery, Division of Hand Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
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40
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Abstract
Fractures of the proximal interphalangeal joint include a wide spectrum of injuries, from stable avulsion fractures to complex fracture-dislocations. Stability of the joint is paramount in determining the appropriate treatment, which should aim to facilitate early mobilisation and restoration of function.
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Affiliation(s)
- C. Y. Ng
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SU, UK
| | - C. W. Oliver
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SU, UK
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Hamilton SC, Stern PJ, Fassler PR, Kiefhaber TR. Mini-screw fixation for the treatment of proximal interphalangeal joint dorsal fracture-dislocations. J Hand Surg Am 2006; 31:1349-54. [PMID: 17027798 DOI: 10.1016/j.jhsa.2006.07.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Revised: 07/20/2006] [Accepted: 07/24/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE Surgical intervention may be necessary to treat unstable dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint of the hand. One method of stabilization is open reduction and internal fixation (ORIF). The purpose of this study was to assess the outcomes of ORIF for unstable dorsal fracture-dislocations of the PIP joint using mini-screws via a volar approach. METHODS A retrospective chart review with clinical follow-up evaluation was performed on 9 patients who had ORIF for unstable dorsal fracture-dislocations of the PIP joint. The fracture fragment(s) from the middle phalangeal base were reduced and secured using mini-screws. RESULTS A clinical evaluation was performed at an average of 42 months after surgery. The average arc of motion for the involved PIP joint was 70 degrees (range, 55 degrees -90 degrees ). The average PIP joint motion in the 2 patients with 1 fracture fragment was 85 degrees , and the average PIP joint motion for the remaining 7 patients was 65 degrees . One joint was subluxated with an intra-articular screw. Nine patients had an average flexion contracture of 14 degrees . Seven patients had no pain, and 2 had pain only with heavy activity. CONCLUSIONS Open reduction and internal fixation of unstable dorsal PIP joint fracture-dislocations using mini-screws can be considered if the fracture fragment(s) can accommodate the screws. The procedure attempts to restore the concave contour of the middle phalangeal base and permits early protected range of motion. The procedure should be approached cautiously, especially in the presence of comminution. Proximal interphalangeal joint range of motion is usually compromised; 8 of our 9 joints had a residual flexion contracture. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Stephen C Hamilton
- Department of Orthopaedic Surgery, University of Cincinnati, OH 45219, USA.
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