Current Concepts in Treatment of Fracture-Dislocations of the Proximal Interphalangeal Joint

Abstract

Background Proximal interphalangeal joint fracture-dislocations are common injuries that require expedient and attentive treatment for the best outcomes. Management can range from protective splinting and early mobilization to complex operations. In this review, the current concepts surrounding the managment of these injuries are reviewed. Methods A literature review was performed of all recent articles pertaining to proximal interphalangeal joint fracture-dislocation, with specific focus on middle phalangeal base fractures. Where appropriate, older articles, or articles on closely related injury types were included for completeness. The methodology and outcomes of each study were analyzed. Results When small avulsion fractures are present, good results are routinely obtained with reduction and early mobilization of stable injuries. Strategies for management of the unstable dorsal fracture-dislocation have evolved over time. To provide early stability, a variety of techniques have evolved, including closed, percutaneous, external, and internal fixation methods. Although each of these techniques can be successful in skilled hands, none have been subjected to rigorous, prospective, comparative trials. Volar dislocations fare less well, with significant loss of motion in many studies. Pilon fractures represent the most complicated injuries, and return of normal motion is not expected. Conclusion The best outcomes can be achieved by (1) establishing enough stability to allow early motion, (2) restoring gliding joint motion rather than non-congruent motion, and (3) restoring the articular surface congruity when possible. Although the majority of literature on this topic consists of expert opinion and retrospective case series, the consensus appears to favor less invasive techniques whenever possible.

Acute Arthrodesis of Interphalangeal Joints of the Hand in Traumatic Injuries

“…Optimal surgical fixation of comminuted intra-articular fractures of the digits with both bone and joint surface comminution is challenging. 2 Though anatomical reduction of the joint with early ROM is ideal, this may not always be possible. In a series by Duteille et al, only 56% of patients achieved anatomical articular restoration.…”

“…1 In fractures associated with adjacent soft tissue injury, inadequate skin cover, significant bone loss, and severe joint surface comminution, achieving a satisfactory result with surgical fixation can be challenging. 2 Arthrodesis is well established as a salvage procedure in the elective setting. 3,4 However, there is a paucity of literature evaluating its usage in acute trauma.…”

Fingerluxationen im PIP-Gelenk – Therapie einer sehr häufigen (Ball)Sportverletzung

“…120°in der sagittalen Ebene (Extensionflexion) ermöglicht. In der axialen und frontalen Ebene sind nur minimale Bewegungsausmaße möglich [6,9]. Die Stabilität des Gelenks wird durch die kongruenten artikulierenden Gelenkflächen erreicht.…”

“…Bei der fraglich instabilen Luxation sind 30 -50 % der Gelenkfläche betroffen, nach Reposition bleibt das Gelenk in einer Flexionsstellung von weniger als 30°stabil. Bei instabilen Luxationen sind hingegen mehr als 50 % der Gelenkfläche betroffen [6,9]. Im Gegensatz dazu wird eine volare Luxation als stabil bezeichnet, wenn weniger als 50 % der Gelenkfläche betroffen sind und das reponierte Gelenk bei vollständiger Extension nicht erneut luxiert.…”

“…Häufig reißt hier die palmare Platte, sodass zunächst eine Ruhigstellung notwendig ist. Diese wiederum geht mit einem höheren Risiko für persistierende Bewegungseinschränkungen einher [9].…”