Factors Affecting the Functional Results of Open Reduction and Internal Fixation for Fracture-Dislocations of the Proximal Interphalangeal Joint

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.

Use of a Multivector Mandibular Distractor for Treatment of Pediatric Proximal Interphalangeal Joint Pilon Fractures: A Case-Based Review

“…They concluded that optimal outcomes were associated with trac tion and that suboptimal results were produced with stat ic fixation and open reduction. 3 Whereas current literature generally agrees that a dynamic component to treatment is optimal for prevention of posthealing PIP joint stiffness, 18 con troversy has remained over the ideal method for treating pilon fractures. 10,19,20 Allison reported on the application of spring loaded dynamic traction with a stainless steel device that permitted AROM and PROM across the joint.…”

Injuries Around the Proximal Interphalangeal Joint

“…Mean PIPJ ROM using various approaches has been reported to be approximately 80 , and there is little difference between the efficacy of these methods. 40 If operative treatment is chosen, the outcomes of the chosen procedure should match or be better than that expected of conservative treatment. Table 1 summarizes the indications of current treatment options.…”

“…Open reduction and internal fixation (ORIF) ideally allows for anatomic reduction of the joint and articular fragments, while restoring stability with the crucial volar lip buttress and allowing early ROM. Reducing the articular surface (for example, a central depressed fragment) may prevent secondary osteoarthrosis 40 but is less crucial. Factors influencing the results after ORIF include patient age, size of palmar fragment, chronic cases, period of immobilization after surgery, and recurrence of subluxation.…”

“…The most significant factor influencing PIPJ joint ROM after surgery is postoperative early motion, with a second factor patient age. 40 Various methods of internal fixation have been described-dorsal and volar plating, 53,54 buttress plating, 40 hook plating, 55 and screw fixation from volar 19,51,56 and dorsal 57 approaches, After internal fixation, splint immobilization, extension block pinning, or an external fixator may be used to augment the fixation. 40 Techniques for fixation of small fragments include K wires, 20,22,58,59 miniscrews, 56,60,61 pull-out sutures with tension banding, 3,17 and a combination of these techniques (Fig.…”

“…64 Foo and colleagues 63 demonstrated that a plate and screw construct showed the greater resistance to displacement and implant failure compared with interfragmentary screws or a buttress plate alone. Flexion contracture due to flexor tendon adhesion after palmar plating can occur 40,53,54 and may necessitate secondary surgery for implant removal and tenolysis.…”