Use of a Distraction Dynamic External Fixator in the Treatment of Comminuted Middle Phalanx Base Fractures

Sang Woo Kim; Chae Chil Lee; Sang-Hun Ko; Il-Yeong Hwang; Min-Seok Kim; Woo Young Jin

doi:10.12671/jkfs.2019.32.1.1

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

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

Original Article

J Korean Fract Soc 2019;32(1):1-5.

Published online: 10 January 2019

DOI: https://doi.org/10.12671/jkfs.2019.32.1.1

Use of a Distraction Dynamic External Fixator in the Treatment of Comminuted Middle Phalanx Base Fractures

Sang Woo Kim, M.D., Chae Chil Lee, M.D., Sang-Hun Ko, M.D., Il-Yeong Hwang, M.D., Min-Seok Kim, M.D., Woo Young Jin, M.D.

Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

Correspondence to: Chae Chil Lee, M.D. Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, Korea Tel: +82-52-250-7129 Fax: +82-52-235-2823 E-mail: lunarticguy@naver.com

Received 31 August 2017 Revised 30 May 2018 Accepted 28 September 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 (100^o), 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.

Keywords: Proximal phalanx, Phalangeal pilon fracture, Distraction dynamic external fixator, Kirschner wires

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.

Fig. 2.

Close-up X-ray image of distraction dynamic external fixator applied to subluxation of the proximal interphalangeal joint.

Fig. 3.

Medical photograph of a patient who applied distraction dynamic external fixator at 3 days after operation.

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.

Fig. 5.

Medical photograph of a patient applied distraction dynamic external fixator at 5 weeks after operation.

Fig. 6.

Medical photograph of a patient applied distraction dynamic external fixator. The external fixator was removed after 5 weeks.

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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