Open Reduction of Proximal Interphalangeal Fracture-Dislocation through a Midlateral Incision Using Absorbable Suture Materials

Abstract

BackgroundFracture-dislocation of the proximal interphalangeal (PIP) joint is a relatively common injury. Various treatments for fracture-dislocation of the PIP joint have been reported. In the present study, we performed open reduction through a midlateral incision using absorbable sutures to reduce the small bone fragments and performed volar plate repair.MethodsWe treated nine patients with fracture-dislocation of the PIP joint with small fractured bone fragments too small for pinning or screw fixation. Patients with volar plate injury were treated with open reduction and volar plate repair at the periosteum of the middle phalangeal bone base by the modified Kessler method using absorbable sutures. All patients were placed in a dorsal aluminum extension block splint, which maintained the PIP joint in approximately 30 degrees of flexion to avoid excessive tension on the sutured volar plate.ResultsAt a mean final follow-up of postoperative 9 months, all patients were evaluated radiographically and had adequate alignment of the PIP joint and reduction of the displaced bone fragments. Range of motion was improved and there were no complications.ConclusionsThis technique is an excellent alternative to the current method of treating patients with fracture-dislocations that include small fragments that are too small for pinning or screw fixation. It is a less invasive surgical method and enables stable reduction and early exercise without noticeable complications.

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

“…Both dorsal, 24 volar, 25 and lateral 26 approaches have been described, using screws between 1.1-2.0 mm in size. Although an early report of two cases by Green et al reported PIPJ arcs of motion of 85° and 105°, 24 other studies have not been as favorable.…”

“…25 Jay Jun Lee et al reported on the use of the lateral approach to fix small fracture fragments with absorbable suture, but on review of this study, it appears most were stable reductions, and might have done just as well without surgery. 26 …”

A novel dynamic distraction external fixator for proximal interphalangeal joint fracture dislocation

“…When fracture-dislocations to the proximal interphalangeal joint (PIPJ) 1,2 are damaged and overstretched and axial load is experienced, this causes loss of hand function and subsequent disability. PIPJ fracture-dislocation often causes many complications, such as ankylosis, joint instability, post-traumatic arthritis, and flexion contracture.…”

Treatment for Acute Proximal Interphalangeal Joint Fractures and Fracture-Dislocations: A Systematic Review of the Literature

“…[53][54][55] Three studies evaluated volar plate arthroplasty: one suture-button, 56 one suture anchor, 57 and one suture repair directly to periosteum. 58 All 37 studies were LOE 4. The MINORS allow assessment of the quality of evidence in comparative and noncomparative nonrandomized trials with 0 being the lowest score and 16 being ideal for noncomparative and 24 for comparative studies.…”