Article

Percutaneous, Intramedullary Fracture Reduction and Extension Block Pinning for Dorsal Proximal Interphalangeal Fracture-Dislocations

Department of Hand Surgery, Helsinki University Central Hospital, Finland.
The Journal of hand surgery (Impact Factor: 1.66). 10/2010; 35(12):2046-52. DOI: 10.1016/j.jhsa.2010.08.004
Source: PubMed

ABSTRACT 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.
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).
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.
Percutaneous, intramedullary reduction of the impacted volar articular fragments associated with unstable, dorsal fracture-dislocation of the PIP joint restores joint congruence and function.
Therapeutic IV.

0 Followers
 · 
143 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Fracture dislocations of the hand are difficult and often unforgiving injuries. Keys to treatment include early recognition, stable concentric reduction, and protected early active range of motion maintaining joint stability. The balance between stability and mobility is difficult to manage; therefore, surgeons need a wide array of treatments to tailor management to the specific fracture pattern. With appropriate treatment, residual stiffness and pain can be minimized. This Current Concepts review aims to provide up-to-date management for proximal interphalangeal, distal interphalangeal, and metacarpophalangeal joint fracture dislocations.
    The Journal of hand surgery 04/2014; 39(4):792–802. DOI:10.1016/j.jhsa.2013.10.001 · 1.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To report our results of open reduction internal fixation with volar mini plate and screw fixation for unstable dorsal fracture dislocations (DFDs) of the proximal interphalangeal (PIP) joint. We performed a retrospective review of 13 consecutive DFDs of the PIP joint treated with volar mini plate and screw fixation, measuring both clinical and radiological outcomes. The age range of our patients was 15 to 56 years (average, 33 y). Six injuries were related to work, 5 to sports, and 2 to motor vehicle accidents. Of the 13 DFDs, 6 were comminuted. Articular involvement ranged from 30% to 70% (average, 44%). The average time to surgery was 7 days (range, 0-23 d). Patients had follow-up of 12 to 60 months (average, 25 mo). Four patients had a postoperative course complicated by plate and screw removal at an average of 4 months later, either as part of a secondary procedure to improve range of motion or owing to patient request. All patients returned to their original occupation. Of the 13 patients, 11 were satisfied with the result, and 12 of 13 had either no or mild pain. All 13 DFDs united in good alignment but 3 showed degenerative changes. Average grip strength was 85% of the unaffected side, and average active PIP joint and distal interphalangeal joint motion arcs were 75° and 65°, respectively. Average Quick Disabilities of Arm, Shoulder, and Hand score was 4 (range, 0-9). All patients had non-tender swelling of the proximal interphalangeal joints but no signs of flexor tenosynovitis or infection. Fixation of unstable PIP joint DFDs via a volar approach is technically feasible with mini plates and screws. This treatment allows early active range of motion and provides good objective and subjective outcomes; however, noteworthy complications occurred in 39% of patients. Therapeutic IV.
    The Journal of hand surgery 01/2012; 37(1):28-33. DOI:10.1016/j.jhsa.2011.08.030 · 1.66 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: 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, percutaneous, external, and internal fixation methods. Although each of these techniques can be successful in skilled hands, none has been subjected to rigorous, prospective, comparative trials. Volar dislocations fare less well, with significant loss of motion in many studies. Pilon fractures represent the most complicated injuries, and return of normal motion is not expected. The best outcomes can be achieved by (1) establishing enough stability to allow early motion, (2) restoring gliding joint motion rather than noncongruent motion, and (3) restoring the articular surface congruity when possible. Although the majority of literature on this topic consists of expert opinion and retrospective case series, the consensus appears to favor less invasive techniques whenever possible.
    Plastic &amp Reconstructive Surgery 12/2014; 134(6):1246-57. DOI:10.1097/PRS.0000000000000854 · 3.33 Impact Factor