Treatment of proximal interphalangeal joint fractures by the pins and rubbers traction system: a follow-up

Abstract

A fracture of the proximal interphalangeal (PIP) joint at the base of the middle phalanx is rare, but is a challenge to treat. Posttraumatic osteoarthritis is a known complication causing impaired hand function and disability. The aim of the present retrospective study was to evaluate characteristics and outcome of complex PIP joint fractures treated by the pins and rubbers traction system (PRTS). Medical records of 42 patients with fractures treated with a PRTS in 1999-2010 were reviewed, and followed-up by questionnaires (QuickDASH, CISS, self-composed questionnaire). Eighteen of the 42 were clinically examined. The fractures were divided into three types of fractures: volar lip, dorsal lip, and pilon fractures. The volar lip fracture was most frequent (26/42; dorsal lip 3/42; pilon 13/42). Most fractures were sport-related (19/42; 45%) and males predominated (M:F ratio = 1.8). All fractures united. Infection occurred in 17/41 (41%) cases. Radiological signs of posttraumatic osteoarthritis were found in 25/41 (61%) patients. In 18/42 patients, where a clinical evaluation was performed, 66% of contralateral total active range of motion (TAM), 93% grip strength, and 100% pinch strength were achieved. The volar lip fracture had the best outcome according to the self-reported QuickDASH and CISS score and regained 77% of contralateral TAM. Fractures of the PIP joint in the middle phalanx can be treated with the PRTS, but reduced mobility, grip strength, infection, and osteoarthritis are seen. The device is well tolerated by the patients, easy to apply, and with ready accessible materials for the surgeon.

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

“…Of these 29 articles that underwent final review and identified fracture type, 26 reported data on dorsal fracture-dislocations, 5 reported data on pilon fracture-dislocations, and 1 on volar fracture-dislocations, with 1 article reporting two fracture types, 10 and 1 article reporting data on all three fracture types. 18…”

“…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.…”

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

“…Postoperative osteoarthritic changes after treatment with external dynamic fixators develop in 12.5-61% of the cases ranging from mild to moderate changes [7,8,23]. In most of the studies, small residual articular step offs are described, which may cause osteoarthritic changes.…”

Sports-related wrist and hand injuries: a review

“…When fractures enter the articular surface of the phalangeal base or condyle, operative fixation should be sought unless less than 1 mm of gap or step-off is present. Fractures can range from simple articular fractures, fixed with K-wires or screws, to comminuted pilon-type fractures which may require a distraction fixator in order to restore articular alignment through ligamentotaxis [ 82 – 84 ].…”