Complex fracture-dislocation of the proximal interphalangeal joint of the hand

Abstract

We reviewed 13 patients with a complex fracture-dislocation of the proximal interphalangeal joint of a finger and one patient with a complex fracture-dislocation of the interphalangeal joint of thumb. We had treated these injuries using a pins and rubbers traction system which had been modified to avoid friction of the pins against the bone during mobilisation of the joint in order to minimise the risk of osteolysis. A Michigan hand outcome questionnaire was used for subjective assessment. The active range of movement (AROM) of the proximal and distal interphalangeal joints and the grip strength were used for objective assessment. The mean follow-up was 34 months (12 to 49). The mean normalised Michigan hand outcome score was 84. The mean AROM of the proximal interphalangeal joint was 85 degrees and that of the distal interphalangeal joint 48 degrees. The mean grip strength was 92% of the uninvolved hand. Twelve patients have returned to their original occupations. There has been no radiological osteolysis or clinical osteomyelitis. This modified traction system has given acceptable results with a low rate of complications. It is light, cheap, effective and easy to apply.

Treatment of Proximal Interphalangeal Dorsal Fracture-Dislocation Injuries With Dynamic External Fixation: A Pins and Rubber Band System

“…The authors in several studies note that joint "remodeling" occurred, without defining this parameter. 23, 33 Syed et al found arthritis in only 1 of 9 cases, but noted that joint depression occurred in all remaining patients. 32 A strict definition was used in the current study to define arthritis and includes what other groups may have considered central depression or simply joint remodeling.…”

“…7-9 Unstable patterns require 16 static external fixation, 17 force-couple splints, 18 dynamic external fixation allowing passive ROM, 19 -22 and dynamic external fixation allowing both active and passive ROM. [23][24][25][26][27][28][29][30][31][32] Dynamic external fixators come in many varieties. All systems use pins or wires placed through the center of rotation of the proximal phalangeal head and through various sites in the middle phalanx that allow for motion of the PIP joint with the fixator in place.…”

“…All systems use pins or wires placed through the center of rotation of the proximal phalangeal head and through various sites in the middle phalanx that allow for motion of the PIP joint with the fixator in place. Forces can then be applied through the pins and across the joint with rubber bands 23,24,31,33 or springs and pulleys. 25,29,34,35 All dynamic external fixators share fundamental properties.…”

“…2 wires, bands 86 3 7/16 Badia 38 2 wires 84 6 Not reported Deshmukh 23 2 wires, bands 84 5 1/14 remodeling Agee 18 3 wires, bands 83 3 (acute) 7 weeks (chronic) 3/9 arthritis (acute) 4/7 arthritis (chronic) De Smet 39 3 wires, bands 82 6 0/8 Gaul 27 2 wires 81 3 Not reported Suzuki 31 2-3 wires, bands 80 10 Not reported Hynes 28 2 wires 76 10 Not reported Syed 32 2 wires 71 6 1/9 arthritis 8/9 joint depression de Soras 33 3 wires, bands 84% opposite Not reported 3/11 remodeling ROM, range of motion (average total) in degrees or percent opposite side. Delay to surgery defined as time of injury to placement of external fixator (days).…”

Proximal Interphalangeal Joint Injuries

“…Active/effective range of movement (arc) Complications Bain et al [ 15 ] ORIF or VPA and then monolateral ex-fi x 222 days 65.6° 1 septic arthritis 2 pin track infection Deshmukh et al [ 16 ] Fracture displacement ORIF 2 × residual subluxation Rutland et al [ 11 ] Dynamic ex fi x 16 months 89° 8 pin track infections Waris et al [ 10 ] Dorsal blocking wire 5 years 83° None reported Williams et al [ 24 ] Hemi-hamate autograft 16 months 85° 2 recurrent subluxation Durhan-Smith et al [ 25 ] Volar plate arthroplasty Minimum 6 months 95° 3 dorsal skin necrosis 1 pin track infection Hamer et al [ 26 ] Extension block splint 20.6 months 87° 3 treatment failure requiring surgery Newington et al [ 27 ] …”