Dorsal proximal interphalangeal joint fracture-dislocations: evaluation and treatment (original) (raw)
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Current concepts in treatment of fracture-dislocations of the proximal interphalangeal joint
Plastic and reconstructive surgery, 2014
Proximal interphalangeal joint fracture-dislocations are common injuries that require expedient and attentive treatment for the best outcomes. Management can range from protective splinting and early mobilization to complex surgery. In this review, the current concepts surrounding the management of these injuries are reviewed. A literature review was performed of all recent articles pertaining to proximal interphalangeal joint fracture-dislocation, with specific focus on middle phalangeal base fractures. Where appropriate, older articles or articles on closely related injury types were included for completeness. The methodology and outcomes of each study were analyzed. When small avulsion fractures are present, good results are routinely obtained with reduction and early mobilization of stable injuries. Strategies for management of the unstable dorsal fracture-dislocation have evolved over time. To provide early stability, a variety of techniques have evolved, including closed, perc...
The Journal of Hand Surgery, 2010
Purpose A percutaneous, intramedullary fracture reduction technique for treatment of unstable dorsal fracture-dislocation of the proximal interphalangeal (PIP) joint is described and the clinical and radiological results are reported. Methods We conducted a retrospective clinical follow-up of 16 patients with 18 dorsal fracture-dislocations of the PIP joint. After closed joint reduction, we used an extension block K-wire to maintain the joint reduction. Impacted volar articular fragments were reduced percutaneously under fluoroscopy control using a pre-bent K-wire inserted through the intramedullary canal of the middle phalanx. The patients initiated passive range of motion exercises immediately after surgery. After a mean of 3 weeks, we removed the extension block K-wire and allowed free mobilization. We examined 13 patients with 15 injured fingers at a mean 5-year follow-up (range, 1-8 y). Results Radiographic reduction of the joint dislocation was achieved and maintained. The mean articular step-off decreased from 2.1 mm (range, 1.6-3.1 mm) to 0.5 mm (range, 0.0-1.2 mm). At the final follow-up, active PIP motion averaged 83°(range, 65°to 97°) with a mean flexion contracture of 3°(range, 0°to 15°). The mean visual analog scale score for digit pain was 1/10. The mean Disabilities of the Shoulder, Arm, and Hand score of 4/100 indicated little functional impairment. Conclusions Percutaneous, intramedullary reduction of the impacted volar articular fragments associated with unstable, dorsal fracture-dislocation of the PIP joint restores joint congruence and function.
The Journal of hand surgery, 2011
Unstable dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint are complex injuries that are difficult to treat and usually require operative fixation. There are a number of surgical techniques for treating these injuries but none has emerged as superior. The purposes of this study were to describe a simple percutaneous technique to treat unstable dorsal fracture-dislocations of the PIP joint and to report short-term postoperative results. Methods We treated 6 patients with unstable dorsal fracture-dislocations of the PIP joint with the technique of closed reduction, percutaneous fracture reduction, and pinning via a volar approach and also with dorsal block pinning. We collected information on postoperative stability, range of motion at the PIP and distal interphalangeal joints, and radiographic outcomes. We also administered the Disabilities of the Arm, Shoulder, and Hand and visual analog pain scale questionnaires. Results At a mean follow-up of 18 months (range, 6-57 mo), there were no subluxation or dislocation events. The mean range of motion was from 4°of extension to 93°of flexion at the PIP joint and from 1°of extension to 73°of flexion at the distal interphalangeal joint. Radiographic analysis revealed a concentric reduction and union in all cases. The mean Disabilities of the Arm, Shoulder, and Hand score was 8 and the mean visual analog pain score was 1.4 out of 10. There were no minor or major complications. Conclusions This percutaneous technique reliably restored stability to the PIP joint, allowed for concentric reduction of the joint, and produced excellent radiographic and clinical outcomes. The postoperative management course with this technique is critical to the outcome.
Journal of Research in Orthopedic Science, 2022
Background: Previous studies have explored the outcomes of closed reduction and percutaneous pinning in managing dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint, although these studies were limited in scope. Objectives: This study aims to report this technique's clinical and radiographic outcomes in the treatment of PIP joint dorsal fracture-dislocation. Methods: We conducted a retrospective review of twelve patients with unstable dorsal fracturedislocations of the PIP joint that underwent closed reduction and percutaneous pinning. Parameters, including range of motion (ROM), grip strength, pinch strength, and PIP joint pain assessed via a visual analog scale (VAS). The PIP joint function was evaluated using quick disabilities of the arm, shoulder, and hand (Quick-DASH) questionnaire. Results: At a mean follow-up of 18.6 months, the mean PIP ROM was 99±5.3 (range 90-110), representing 90.2% of the contralateral side (P=0.31). The mean flexion contracture and extension lag were 6.7±3.2 º and 6.3±3.1 º , respectively. Patients reported a mean VAS score of 3.3±1.5 and a mean quick disabilities of the arm, shoulder, and hand (Quick-DASH) score of 10.8±6.1 points. The mean pinch strength of the involved hand averaged 80.4% of the contralateral side (P=0.19), and the mean grip strength averaged 92.29% (P=0.28). All patients achieved union with radiographically concentric joints, and no subluxation or dislocation events occurred during follow-up. Although radiographic evidence of arthritic changes was observed in all patients, these changes were clinically asymptomatic. Conclusion: Closed reduction and percutaneous pinning offer a simple, accessible, and minimally invasive technique for managing PIP joint dorsal fracture-dislocations. The observed clinical and radiographic outcomes demonstrate stability and concentricity of the joint, suggesting this technique as a valuable surgical option for such injuries.
Techniques in Hand & Upper Extremity Surgery, 2001
This study assessed the outcome of open reduction and internal fixation of proximal interphalangeal joint fracture-dislocations through a shotgun approach, while keeping hemi-hamate arthroplasty as a backup plan. After using the shotgun approach, fixation was carried out when the anterior fragment was large enough to accept two 1.5 mm screws. Sixty-three fracture-dislocations were treated in 61 patients, of whom 30 underwent internal fixation. Twenty-one of these were assessed in the final study. At a mean follow-up of 29 months, the mean range of joint motion was 80 and 102 for the injured and contralateral hand, respectively. The mean pinch and grip strengths of injured hand were 82% and 83% of contralateral hand, respectively. The mean disabilities of the arm, shoulder and hand score was 5.5. The mean visual analogue pain score was 1.6. Surgery through the versatile shotgun approach allows excellent intra-operative assessment and acceptable outcomes.
Journal of Plastic Surgery and Hand Surgery, 2020
A systematic review was conducted to identify the best management for acute proximal interphalangeal joint fracture-dislocations. A study protocol was designed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Due to limited data in the primary assessment, the hypothesis was tested in a secondary analysis of articles that marginally met the inclusion criteria (i.e. studies that included patients under 18 years of age). A further tertiary analysis was conducted by dividing the studies into closed reduction techniques, open reduction internal fixation and 'other studies' and a narrative synthesis was performed. The study found a higher rate of complications and arthritis in the closed reduction group compared to open reduction internal fixation, suggesting that operative management should be considered for acute PIP joint fracture-dislocations.
Fracture-dislocations of the Proximal Interphalangeal Joint HHS Public Access
Fracture-dislocations of the proximal interphalangeal joint encompass a spectrum of injury severity, ranging from injuries that require little intervention to those that require advanced reconstructive surgery for optimal outcome. Three fracture-dislocation patterns are recognized: dorsal, volar, and pilon. Acceptable outcome is dependent on achieving and maintaining a wellaligned and well-reduced joint, re-establishing normal joint kinematics, and restoring motion. Anatomic articular surface reduction is desirable but not absolutely necessary for a good outcome. Treatment depends on both the type of injury and patient-dependent factors. Optimal outcome for a specific injury is predicated on expedient diagnosis and recognition of injury severity, which enables initiation of appropriate management.
The Journal of Hand Surgery, 2010
We present a case of a man who sustained a closed dorsal fracture-dislocation of his left ring finger proximal interphalangeal joint in a fall. The patient was treated surgically with plate and screw fixation via a volar approach. This method theoretically provides more secure fixation than internal fixation with screws alone, allowing early rehabilitation with active range of motion and potentially better functional outcome.
Hand (New York, N.Y.), 2015
The purpose of this study is to evaluate the outcome of closed reduction and percutaneous Kirschner wire pinning in acute dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint. Eight men and one woman were treated with closed reduction and percutaneous Kirschner wire pinning by one orthopaedic surgeon. The ring finger was injured in six patients, the small finger in two patients and the middle finger in one patient. The mean joint surface involvement was 36 % (range, 26-49 %). The Kirschner wires were removed after an average of 28 days (range, 24-37 days). All patients demonstrated a painless, but fusiform, swollen PIP joint after a mean follow-up of 6.5 months. The average flexion of the PIP joint was 106° (range, 80-110), and the average extension of the PIP joint was 4° short of full extension (range, 10 hyperextension-15 flexion contracture). All patients had a concentrically reduced PIP joint with a healed fracture on radiographs. Two patients had radiograph...
[Fracture dislocation of the proximal interphalangeal joint]
Acta ortopédica mexicana
The proximal interphalangeal (PIP) joint is the most commonly dislocated joint in the body and the hand. We did a review of the literature and report herein our experience treating this condition at the ABC Medical Center from 1991 to 2007. Systematic review of the literature. Retrospective and descriptive study. A total of 13 patients were included between 1991 and 2007. Three of them were managed with ORIF with Kirschner nails, 3 with OR and Kirschner nails blocking extension, 2 with plasty with volar plate interposition, and one with CRIF with a Kirschner nail. Mean follow-up was 4.8 months in 8 patients, the ranges of motion were recorded. The following factors were negatively correlated with the range of motion: age, time elapsed between the injury and the treatment, the combined approaches, and the pins blocking extension. Those treated with interposition arthroplasty had a better range of motion. The fracture dislocation of the PIP joint is a rare pathology with multiple trea...