Journal List > J Korean Fract Soc > v.32(1) > 1130280

Kim, Lee, Ko, Hwang, Kim, and Jin: Use of a Distraction Dynamic External Fixator in the Treatment of Comminuted Middle Phalanx Base Fractures

Abstract

Purpose

This paper suggests the use of distraction dynamic external fixators (DDEF) for the treatment of proximal middle phalanx fractures.

Materials and Methods

Seven patients, who were diagnosed with comminuted intraarticular fractures at the base of the middle phalanx from February 2014 to November 2016, were enrolled in this study (volar aspect 6 cases, dorsal aspect 1 case). They underwent a closed reduction under a C-arm image intensifier, and DDEF was applied with general anesthesia. Range of motion (ROM) exercise was encouraged after 3 to 5 days postoperatively, and DDEF was removed after 5 weeks. Subluxation, angulation and displacement were evaluated 6 weeks postoperatively.

Results

The patients who were treated with DDEF showed a normal proximal interphalangeal joint ROM (100o), and there was no subluxation or displacement on the X-ray film 6 weeks postoperatively. In addition, there were no signs of infection, such as local heat, redness, and pus-like discharge.

Conclusion

DDEF helps maintain the reduction and reducing forces through the ligamentotaxis. The joint stiffness is reduced, which it makes early return to daily life easier.

References

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Fig. 1.
Close-up X-ray image of the subluxation of proximal interphalangeal joint and suspected injury to the ulnar collateral ligament.
jkfs-32-1f1.tif
Fig. 2.
Close-up X-ray image of distraction dynamic external fixator applied to subluxation of the proximal interphalangeal joint.
jkfs-32-1f2.tif
Fig. 3.
Medical photograph of a patient who applied distraction dynamic external fixator at 3 days after operation.
jkfs-32-1f3.tif
Fig. 4.
Medical photograph of a patient who applied distraction dynamic external fixator. Range of motion exercise was encouraged 3 to 5 days after surgery.
jkfs-32-1f4.tif
Fig. 5.
Medical photograph of a patient applied distraction dynamic external fixator at 5 weeks after operation.
jkfs-32-1f5.tif
Fig. 6.
Medical photograph of a patient applied distraction dynamic external fixator. The external fixator was removed after 5 weeks.
jkfs-32-1f6.tif
Table 1.
Demographics and Summary of the Results
Case No. Sex/Age (yr) Follow-up duration p Type of Fx Site of pin insertion Range of motion (o) Grasping power Complain of discomfort Complication Time of return to daily life (wk)
1 Female/41 11 mo LF MP base Fx MP, PP pin insertion 0–100 5 None None 4
2 Male/23 9 mo RF MP base Fx MP, PP pin insertion 0–100 5 None None 5
3 Male/48 8 wk IF MP base Fx PP head, MP shaft & head insertion 0–100 4 None None 5
4 Male/47 8 wk RF MP base Fx PP head, MP shaft & head insertion 0–100 4 None None 5
5 Male/24 3 mo RF MP base Fx MP, PP pin insertion 0–100 5 None None 4
6 Male/44 5 mo LF MP base Fx PP head, MP shaft & head insertion 0–100 4 None None 5
7 Male/36 3 mo RF MP base Fx PP head, MP shaft & head insertion 0–100 5 None None 5

Fx: fracture, LF: little finger, MP: middle phalanx, RF: ring finger, IF: index finger, PP: proximal phalanx.

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