Functional Outcomes Following Pilon Fractures of the Middle Phalanx Managed with the Ligamentotaxor External Fixator

Colegate-Stone, Toby; Marenah, Kebba; Compson, J. P.; Tahmassebi, Ramon; Tavakkolizadeh, Adel

doi:10.1142/s0218810415500252

Cited by 12 publications

(5 citation statements)

References 16 publications

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“…However, as the pain level was very low, these osteoarthritic changes did not appear to be symptomatic. This emphasizes the findings of the previous studies which describe an ongoing articular PIP joint remodeling after the removal of the external fixator and no clear correlation to subsequent osteoarthritic changes [19,24,25]. The limitations of this study are its retrospective design, the short follow-up period, and the relatively small number of patients, in accordance with other studies.…”

Section: Discussionsupporting

confidence: 74%

“…However, there seems to be no clear association between residual articular step offs and the extent of osteoarthritic changes. Several authors described a short-or long-term remodeling capacity of the injured PIP joint [19,24,25]. The present study cohort showed 12 PIP joints anatomically remodeled without any residual intraarticular step off at the time of final follow-up.…”

Section: Discussionmentioning

confidence: 48%

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Clinical and radiological midterm outcome after treatment of pilonoidal fracture dislocations of the proximal interphalangeal joint with a parabolic dynamic external fixator

Kastenberger

Kaiser

Keller

et al. 2019

Arch Orthop Trauma Surg

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Introduction Several methods treating proximal interphalangeal joint (PIP) fracture dislocations have been established providing early joint mobilization. The aim of this study was to evaluate the clinical and radiological outcome of unstable fracture dislocations of the PIP treated with a parabolic dynamic external fixator consisting of two Kirschner (K)-wires. Materials and methods Twenty-one patients who sustained a pilonoidal fracture of the PIP joint and were treated with a dynamic external fixator were evaluated retrospectively. The active range of motion, pain level, DASH score, Buck Gramcko Score, and the patient's satisfaction and acceptance were assessed. X-ray images were evaluated for bone healing, joint alignment, and signs of osteoarthritis. Results Mean PIP joint range of motion was 76°. Patients showed very mild discomfort (mean 0.7), high patient satisfaction (mean 1.9), and a moderate acceptance (mean 2.7). The mean DASH score was 11.6 and the Buck Gramcko score 13. All patients showed bone healing. One patient suffered from a recurrent dislocation, and another a subluxation of the PIP joint while wearing the fixator. Both joints could be corrected by modifying the fixator under image intensifier. Twenty patients (95%) showed a concentric and stable aligned joint. Three patients showed an osteoarthritis stage 0, five stage 1, nine stage 2, three stage 3, and one stage 4 according to the Kellgran-Lawrence Score. Conclusion The use of a parabolic dynamic external fixator constructed from two K-wires restores joint alignment and stability in unstable pilonoidal PIP joint disclocation fractures. It allows immediate PIP joint mobilization to avoid adhesions. Modifications of the radius of the parabolic construct within cases of postoperative malalignment, without anesthesia, can restore joint axis and malalignment. This fixator is a cost-effective alternative, showing a good clinical outcome.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 48%

Clinical and radiological midterm outcome after treatment of pilonoidal fracture dislocations of the proximal interphalangeal joint with a parabolic dynamic external fixator

Kastenberger

Kaiser

Keller

et al. 2019

Arch Orthop Trauma Surg

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“…A total of 48 articles were included in the final review, 5-52 25 of which reported data on dynamic external fixation, 12 on open reduction, 6 on hemi-hamate arthroplasty, 4 on extension block pinning, and 3 on percutaneous fixation. Two studies reported data on more than one group.…”

Section: Resultsmentioning

confidence: 99%

Surgical Management of Proximal Interphalangeal Joint Fracture-Dislocations: A Review of Outcomes

Demino

Yates

Fowler

2019

Hand (New York, N,Y.)

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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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“…The third point concerns the importance of observance to treatment and postoperative rehabilitation to which MacFarlane et al are attached. We do agree, because all the authors who have published on the Ligamentotaxor ® say the same thing and give specific instructions to patients just after release of anaesthesia (Colegate-Stone et al, 2015; Damert et al, 2013; Gillespie et al, 2012; Körting et al, 2009; Pélissier et al, 2015). Table 4 of the article is interesting, but it compared Ligamentotaxor ® with other techniques.…”

mentioning

confidence: 77%

“…As stated by the authors of the recent correspondence, our results compare favourably with other authors who have published using the same device. Colgate-Stone et al (2015) reported a mean proximal interphalangeal joint range of motion of 63° and a Quick-DASH score of 9.1 at final follow-up with 12 patients. Similarly, Damert et al (2013) reported a mean range of motion of 73° and final QuickDASH score of 14.6 points at a mean of 15 months.…”

mentioning

confidence: 99%

Re: 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. 2015, 40: 825–31

Liverneaux

2016

J Hand Surg Eur Vol

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Functional Outcomes Following Pilon Fractures of the Middle Phalanx Managed with the Ligamentotaxor External Fixator

Abstract: The outcomes seen support the use of the Ligamentotaxor in the management of middle phalanx intra-articular fractures. It is simple to apply, potentially avoids the secondary complications of open reduction and gives reproducible results. However judicious patient selection is advised.

Cited by 12 publications

References 16 publications

Clinical and radiological midterm outcome after treatment of pilonoidal fracture dislocations of the proximal interphalangeal joint with a parabolic dynamic external fixator

Clinical and radiological midterm outcome after treatment of pilonoidal fracture dislocations of the proximal interphalangeal joint with a parabolic dynamic external fixator

Surgical Management of Proximal Interphalangeal Joint Fracture-Dislocations: A Review of Outcomes

Re: 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. 2015, 40: 825–31

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