Journal List > J Korean Soc Surg Hand > v.21(1) > 1106544

Shin, Park, and Lee: Clinical Results of Dynamic External Fixation for Proximal Interphalangeal Joint Fracture Dislocation

Abstract

Purpose:

We evaluated clinical outcomes after treating patients with proximal interphalangeal (PIP) joint fracture-dislocation with dynamic external fixator with which early joint motion can be undertaken to prevent joint stiffness effectively and fixate joints firmly.

Methods:

Dynamic external fixators were applied for 20 fracture-dislocation of the PIP joints in 19 patients. The joints involved were 2nd PIP joint in two patients, 3rd PIP joint in three patients, 4th PIP joint in five patients, 5th PIP joint in eight patients. One patient had both 3rd and 4th PIP joint fracture-dislocation. Surgery was performed at least within four weeks. The mean age of the patients was 30.5 years (range, 15-54 years) and the mean follow-up duration was 1.85 years (range, 1-2.3 years) years. All patients were clinically and radiologically assessed on an outpatient basis after being discharged.

Results:

At the final follow-up, the mean range of motion of PIP joints in flexion was 100.1° (flexion range, 88°-110°), the mean extension lag was 3.0° (extension range, 0°-10°), and the mean visual analogue scale score was 0.8. On anterior-posterior and lateral radiographs, congruity of the joint was satisfactory and 1 mm step off was present in three cases.

Conclusion:

We attained satisfactory clinical outcomes on the recovery of joint movement and joint congruity after treating PIP joint fracture-dislocation injury with dynamic external fixator.

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Fig. 1.
Surgical technique of dynamic external fixator. (A) Insertion and flexion of the first K-wire parallel to finger. (B) Insertion second K-wire at head of middle phalanx. (C) Final step of the assembled fixator. (D) Drawing illustrating the lever-assisted reduction of a fracture-dislocation.
jkssh-21-29f1.tif
Fig. 2.
(A) A preoperative anterior-posterior (AP), lateral radiograph of a 36-year-old male patient shows an-intraarticular fracture and subluxation on proximal interphalangeal joint of the 3rd finger and an intra-articular fracture of the 4th finger. (B) Immediate postoperative AP, lateral radiograph of patient. He was applied by an external dynamic device. (C) His devices were removed after 6 weeks. (D) Flexion and extension photographs of the patient.
jkssh-21-29f2.tif
Fig. 3.
(A) A preoperative anterior-posterior (AP), lateral radiograph of a 15-year-old male patient shows an transverse-intra-articular fracture and dislocation on proximal interphalangeal joint of the 5th finger. (B) Immediate postoperative AP, lateral and oblique radiograph of patient. He was applied by an external dynamic device. (C) His devices were removed after 4 weeks. (D) Flexion and extension photographs of the patient.
jkssh-21-29f3.tif
Table 1.
Demographics and summary of results
Pt. Sex/age (yr) Injured finger Side Delay (day) Follow-up (yr) OP time (min) X-ray Fx (%) orientation PIP ROM (°) Pain (VAS) Complications
1 Male/37 Middle Right 2 2 37.5 10% Volar 0-102 1 None
Ring 37.5 40% Volar 0-100 2 Early arthritis
2 Male/15 Little Right 4 2.1 50 20% Dorsal 0-110 0 None
3 Male/36 Ring Right 17 2.2 60 25% Volar 3-90 1 None
4 Male/33 Ring Right 4 2.3 35 10% Volar 10-88 1 None
5 Male /27 Little Left 3 2 40 10% Dorsal 0-100 1 None
6 Male /32 Little Left 2 2 35 40% Volar 3-105 0 None
7 Female/20 Ring Right 3 2.1 40 30% Volar 8-98 0 None
8 Male/37 Index Right 3 1.9 45 50% Volar 3-98 1 None
9 Male/23 Ring Right 4 2 35 35% Volar 10-110 1 None
10 Male/44 Middle Right 6 1.8 50 40% Dorsal 0-105 0 None
11 Female/29 Little Right 2 2.3 40 45% Volar 0-105 1 None
12 Male/31 Little Left 8 2 60 50% Volar 3-100 2 Skin infection
13 Female/26 Index Right 5 1.5 40 60% Dorsal 5-90 0 None
14 Male/21 Little Right 2 1.2 50 25% Volar 0-105 0 None
15 Male/28 Middle Right 6 1 45 50% Volar 0-98 1 None
16 Male/32 Little Right 5 1.2 40 45% Volar 8-110 2 None
17 Female/54 Little Right 13 2.2 55 35% Volar 0-107 0 None
18 Male/34 Ring Left 2 1.7 35 30% Dorsal 3-98 1 None
19 Male/27 Middle Right 3 1.5 40 40% Volar 5-103 1 None

OP, operation; Fx, fracture; PIP ROM, proximal interphalangeal joint range of motion; VAS, visual analogue scale.

Table 2.
Various pin and traction system of dynamic external fixator for PIP joint fracture dislocation
Study Construct PIP ROM Arthritis
Badia et al.17 2 Wires 84 Not reported
Gaul and Rosenberg18 2 Wires 81 Not reported
Hynes and Giddins19 2 Wires 76 Not reported
Syed et al.20 2 Wires 71 1/9
Duteille et al.21 2 Wires, band 86 7/16
Deshmukh et al.22 2 Wires, band 84 1/14
Suzuki et al.23 2 Wires, band 80 Not reported
Ellis et al.24 3 Wires, band 89 5/8
De Smet and Boone25 3 Wires, band 82 0/8
Our series 3 Wires, band 98 1/20

PIP, proximal interphalangeal joint; ROM, range of motion.

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