Clinical Results of Dynamic External Fixation for Proximal Interphalangeal Joint Fracture Dislocation

Eun Ho Shin; Jun Sung Park; Tong Joo Lee

doi:10.12790/jkssh.2016.21.1.29

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

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

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

ORIGINAL ARTICLE

J Korean Soc Surg Hand 2016;21(1):29-37.

Published online: 11 March 2016

DOI: https://doi.org/10.12790/jkssh.2016.21.1.29

Clinical Results of Dynamic External Fixation for Proximal Interphalangeal Joint Fracture Dislocation

Eun Ho Shin, Jun Sung Park, Tong Joo Lee

Department of Orthopedic Surgery, Inha University School of Medicine, Incheon, Korea

Correspondence to: Tong Joo Lee, Department of Orthopaedic Surgery, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 22332, Korea, TEL: +82-32-890-3043, FAX: +82-32-890-3047, E-mail: tjlee@inha.ac.kr

^* This paper was supported by Inha University.

Received 11 November 201521 January 2016 Accepted 31 January 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Finger, Proximal interphalangeal joint, Fracture dislocation, Dynamic external fixator

REFERENCES

1. AladinA. DavisTR. Dorsal fracture-dislocation of the proximal interphalangeal joint: a comparative study of percutaneous Kirschner wire fixation versus open reduction and internal fixation. J Hand Surg Br. 2005; 30:120–8.

2. InanamiH. NinomiyaS. OkutsuI. TaruiT. Dynamic external finger fixator for fracture dislocation of the proximal interphalangeal joint. J Hand Surg Am. 1993; 18:160–4.

3. FreibergA. Management of proximal interphalangeal joint injuries. Can J Plast Surg. 2007; 15:199–203.

4. HamerDW. QuintonDN. Dorsal fracture subluxation of the proximal interphalangeal joints treated by extension block splintage. J Hand Surg Br. 1992; 17:586–90.

5. ViegasSF. Extension block pinning for proximal interphalangeal joint fracture dislocations: preliminary report of a new technique. J Hand Surg Am. 1992; 17:896–901.

6. WilliamsRM. KiefhaberTR. SommerkampTG. SternPJ. Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft. J Hand Surg Am. 2003; 28:856–65.

7. LeeJY. TeohLC. Dorsal fracture dislocations of the proximal interphalangeal joint treated by open reduction and interfragmentary screw fixation: indications, approaches and results. J Hand Surg Br. 2006; 31:138–46.

8. DionysianE. EatonRG. The long-term outcome of volar plate arthroplasty of the proximal interphalangeal joint. J Hand Surg Am. 2000; 25:429–37.

9. AgeeJM. Unstable fracture dislocations of the proximal interphalangeal joint of the fingers: a preliminary report of a new treatment technique. J Hand Surg Am. 1978; 3:386–9.

10. RulandRT. HoganCJ. CannonDL. SladeJF. Use of dynamic distraction external fixation for unstable fracture-dislocations of the proximal interphalangeal joint. J Hand Surg Am. 2008; 33:19–25.

11. HastingsH2nd. ErnstJM. Dynamic external fixation for fractures of the proximal interphalangeal joint. Hand Clin. 1993; 9:659–74.

12. KrakauerJD. SternPJ. Hinged device for fractures involving the proximal interphalangeal joint. Clin Orthop Relat Res. 1996; (327):29–37.

13. SalterRB. The physiologic basis of continuous passive motion for articular cartilage healing and regeneration. Hand Clin. 1994; 10:211–9.

14. SchenckRR. Dynamic traction and early passive movement for fractures of the proximal interphalangeal joint. J Hand Surg Am. 1986; 11:850–8.

15. AgeeJM. Unstable fracture dislocations of the proximal interphalangeal joint: treatment with the force couple splint. Clin Orthop Relat Res. 1987; (214):101–12.

16. DebusG. CourvoisierA. WimseyS. PradelP. MoutetF. Pins and rubber traction system for intra-articular proximal interphalangeal joint fractures revisited. J Hand Surg Eur Vol. 2010; 35:396–401.

17. BadiaA. RianoF. RavikoffJ. KhouriR. Gonzalez-HernandezE. OrbayJL. Dynamic intradigital external fixation for proximal interphalangeal joint fracture dislocations. J Hand Surg Am. 2005; 30:154–60.

18. GaulJSJr. RosenbergSN. Fracture-dislocation of the middle phalanx at the proximal interphalangeal joint: repair with a simple intradigital traction-fixation device. Am J Orthop (Belle Mead NJ). 1998; 27:682–8.

19. HynesMC. GiddinsGE. Dynamic external fixation for pilon fractures of the interphalangeal joints. J Hand Surg Br. 2001; 26:122–4.

20. SyedAA. AgarwalM. BoomeR. Dynamic external fixator for pilon fractures of the proximal interphalangeal joints: a simple fixator for a complex fracture. J Hand Surg Br. 2003; 28:137–41.

21. DuteilleF. PasquierP. LimA. DautelG. Treatment of complex interphalangeal joint fractures with dynamic external traction: a series of 20 cases. Plast Reconstr Surg. 2003; 111:1623–9.

22. DeshmukhSC. KumarD. MathurK. ThomasB. Complex fracture-dislocation of the proximal interphalangeal joint of the hand: results of a modified pins and rubbers traction system. J Bone Joint Surg Br. 2004; 86:406–12.

23. SuzukiY. MatsunagaT. SatoS. YokoiT. The pins and rubbers traction system for treatment of comminuted intraarticular fractures and fracture-dislocations in the hand. J Hand Surg Br. 1994; 19:98–107.

24. EllisSJ. ChengR. ProkopisP. . Treatment of proximal interphalangeal dorsal fracture-dislocation injuries with dynamic external fixation: a pins and rubber band system. J Hand Surg Am. 2007; 32:1242–50.

25. De SmetL. BooneP. Treatment of fracture-dislocation of the proximal interphalangeal joint using the Suzuki external fixator. J Orthop Trauma. 2002; 16:668–71.

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.

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.

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.

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.

TOOLS

Similar articles