J Korean Soc Surg Hand.  2016 Mar;21(1):29-37. 10.12790/jkssh.2016.21.1.29.

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

• Shin EH
• Park JS
• Lee TJ

• KMID: 2161161
• DOI: http://doi.org/10.12790/jkssh.2016.21.1.29

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.

Keyword

Finger; Proximal interphalangeal joint; Fracture dislocation; Dynamic external fixator

MeSH Terms

Dislocations*
External Fixators
Fingers
Follow-Up Studies
Humans
Joints*
Outpatients
Range of Motion, Articular

Figure

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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.

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  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.

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