Pitfalls and suggestions for the treatment of open, comminuted fractures of the middle phalanx using custom-made dynamic external fixators: a retrospective case series

Abstract

Background:The proximal interphalangeal joint (PIPJ) is a synovial joint prone to injury encompassing a wide spectrum of severity. In the setting of complicated injuries, dynamic external traction systems are considered to be the optimal treatment modality with numerous different Kirschner-wire configurations combined with rubber bands, springs, pulleys, or hinges being described. However, many of these pose significant technical challenges for the surgeon or are unwieldy to the patient emphasizing the need for simple, easy to construct, and well-tolerated modifications, which are equally effective in reducing the fracture and allowing early motion. Methods:The authors retrospectively analyzed prospectively collected data of 12 patients with open complex PIPJ fracture dislocations treated with a custom-made external fixator based on the one that was originally suggested by Suzuki et al. All patients were men with an average age of 55.1 yr (23 to 81). Injured digits involved four index, five middle, and three ring fingers. Results:The mean follow-up was 54.36 mo, and all patients healed without a second operation and returned to their jobs and preinjury level of activity. The average active range of motion of the PIPJ was 75.16 ± 3.18 degrees, DIPJ was 69.33 ± 14.7 degrees, and MCPJ was 88.75 ± 1.97 degrees. Mean Quick Disabilities of Arm, Shoulder, and Hand (DASH)-Japan Society