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Fingermittelgelenkfrakturen
Abstract
Joint fractures of the fingers often entail operative interventions in contrast to extra-articular fractures. These types of fracture are inclined to dislocate in addition to the actual fracture. The proximal interphalangeal (PIP) joint in particular often shows comminuted fractures due to the long leverage of the finger and a relatively small diameter of the joint. The clinical examination, X-ray diagnostics and if necessary computed tomography allow the classification into stable and unstable fractures. Unstable fractures must be treated by surgical reduction and fixation. A multitude of operative techniques are available for these mostly complicated fractures. The foremost goal is a stable osteosynthesis of the fracture with repositioning of the dislocation, which enables early physiotherapy in order to prevent tendon adhesion and contracture. This article presents the different types of PIP joint fractures, their specific surgical treatment and postoperative treatment regimens.
... Finger proximal interphalangeal joint (PIP) reconstruction after destruction of parts of the joint, additional soft tissue, extensor tendon and ligament injuries, remains challenging [1][2][3][4][5][6][7][8]. Surgical techniques include implant arthroplasty [9][10][11][12][13][14][15][16], arthrodesis [17][18][19][20], non-vascularized bone and joint transfer [21][22][23], and free vascularized joint transfer [24,25]. ...
... Eight patients (89%) rated their operation as excellent, and one as poor. The goal of the PIP reconstruction is to provide a painless, stable and useful joint that allows powerful pinch/ grasp and range of movement [2,5]. Arthrodesis is one of the surgical options but has the major drawback of immobile reconstruction [17]. ...
Introduction
Finger proximal interphalangeal joint (PIP) reconstruction after the destruction of parts of the joint remains challenging. Surgical techniques include implant arthroplasty, arthrodesis, free vascularized joint transfer, and non-vascularized bone and joint transfer. This study analyzes our experience after non-vascularized transfer in terms of range of motion, postoperative rehabilitation, and patient satisfaction.
Materials and methods
Between 2009 and 2014, ten patients underwent non-vascularized partial joint transfer for PIP joint reconstruction. One of them was lost to follow-up. Included patients had osteochondral partial joint transplants of 25–50% of the toes (n = 4) and the hand (n = 5). Range of motion (ROM), grip-, and pinch-strength were measured at the last follow-up control and compared to the healthy side. Patients were asked to score the pain at rest/ on load on a visual scale (VAS: 0 = no pain; 10 = excruciating pain). Satisfaction self-assessment was evaluated by asking the patients to grade their postoperative result as excellent, very good, good or poor.
Results
Mean follow-up period was 4.0 years (range 1.2–7.9 years). Mean PIP joint flexion was 93 ± 26° at the last follow-up control. Mean grip- and pinch-strength of the operated side at the last control were, respectively, 43 ± 18 kg and 8 ± 5 kg, close to the healthy side values (45 ± 15 kg and 9 ± 4 kg). Mean pain at rest/on load measured on a visual scale was, respectively, 0.3 ± 1 and 1.8 ± 2. Eight patients (89%) rated their operation as excellent, and one as poor.
Conclusion
In this study, non-vascularized partial joint transfer provides a mobile and stable PIP joint 4 years after reconstruction. The surgical technique presented herein is complex depending on additional injuries but results in great patient satisfaction.
... Closed reduction can be used, but it is difficult to disimpact and stabilize the depressed segments using this technique [5]. Percutaneous reduction technique using K wire frameworks was introduced to overcome this limitation [12,13]. However, accomplishing reduction without losing control of the small articular fragments is technically difficult; furthermore, handling complex structures such as tendon sheaths, joint capsules, and the volar plate may require advanced proficiency [14]. ...
... Volar, dorsal, or lateral approaches have been used to treat middle phalangeal base articular fractures. Most previously reported volar split fractures were treated using a palmar approach, which offers good visualization of the joint surface and accurate fragment reduction [3,8,9,13]. However, handling of the surrounding volar complex structures is necessary when using a volar approach. ...
Purpose
An articular depressed fragment at the base of the middle phalanx can be an obstacle to congruent reduction and stable fixation. This study assessed the outcomes of a transosseous reduction technique combined with locking plate fixation for the treatment of articular depressed middle phalangeal base fracture.
Methods
Between 2015 and 2017, seven patients (eight fingers) with intraarticular comminuted middle phalangeal base fracture were included in this study. Mean follow-up was 19 months (range 12–30 months). All patients showed depression of the articular fragment on sagittal computed tomography (CT) scan and were treated with a transosseous reduction technique and dorsal locking plate fixation. Radiographic evaluation was performed to ensure restoration of a concentric articular surface postoperatively. Total active range of motion (TAM) of the finger, grip strength, and the quick Disabilities of the Arm, Shoulder and Hand (quick DASH) score were evaluated at the last follow-up. Complications were also assessed.
Results
All fractures obtained bony union with a concentric joint. There was no significant loss of reduction during the follow-up period. The mean active proximal interphalangeal (PIP) joint and distal interphalangeal joint motion arcs at follow-up were 89° and 61°, respectively. Mean TAM of the affected finger and mean grip strength were 94% (range 80–100%) and 94% (range 86–100%) of the contralateral side, respectively. Mean quick DASH score was 2.3 (range 0–9.1). All patients returned to work. No surgery-related complications occurred.
Conclusions
This technique provides satisfactory restoration of articular congruence and enables the early joint mobilization of articular depression-type fractures of the base of the middle phalanx.
Type of study/level of evidence
Therapeutic, level IV.
... Unstable PIP fracture dislocations continue to be a vexing problem for the hand surgeon with no clear "gold standard" treatment and mixed outcomes, with many studies showing some residual joint contracture and progressive degenerative changes despite adequate treatment (1,8). Treatment principles however, are clear-obtain a concentric joint with enough stability to permit a normal gliding arc of motion. ...
Proximal interphalangeal (PIP) fracture-dislocation is a relatively common injury that results from "jamming" a finger. Treatment hinges on the degree of articular surface involvement, which determines stability of the joint. For unstable injuries, a variety of surgical interventions have been described including extension block pinning, open reduction internal fixation, volar plate arthroplasty, static or dynamic external fixation, and hemi-hamate reconstruction. We present the case of an unstable, subacute ring finger PIP dorsal fracture dislocation for which the above options were not possible or desirable to the patient. We performed temporary bridge plate fixation of the joint, based on the success of a similar procedure used to treat comminuted and unstable distal radius fractures. The procedure allowed immediate return to work, which was the patients' primary goal, and resulted in a reasonable short-term outcome, similar to other mentioned procedures. Temporary bridge plate fixation can be considered among treatment choices for PIP fracture dislocation when other, more established options are not possible or desirable.
This review is devoted to the problem of treating patients with intra-articular fracture dislocations affecting the finger proximal interphalangeal joint and their consequences. Although these traumas are quite common among hand injuries, there is currently no single universal approach to their treatment. The review was conducted using literature databases, PubMed and eLibrary. The work highlights the joint anatomy, injury mechanisms, diagnostic methods, classification variations, and treatment methods.
Die Rekonstruktion der palmaren Mittelgliedbasis mit einem „Hemi-Hamatum“-Transplantat ermöglicht die Wiederherstellung der Mittelgelenkstabilität unter Erhalt der Beweglichkeit. Indikationen sind akute und veraltete, palmare Mittelgliedbasisfrakturen mit einer Trümmerzone von über 40 % und dorsaler Subluxationsstellung, ohne Möglichkeit der primären osteosynthetischen Versorgung im Falle der akuten Frakturen. Kontraindikationen sind bereits eingetretene Arthrose am Grundgliedkopf oder im dorsalen Bereich der Mittelgliedbasis. Die palmare Mittelgliedbasis wird hierbei débridiert/reseziert und der Defekt durch ein eingepasstes Transplantat aus der karpometakarpalen Gelenkfläche des Os hamatum ersetzt. Die Osteosynthese erfolgt durch Mini-Schrauben. Eine frühfunktionelle Beübung des Mittelgelenkes wird angestrebt. Hierdurch lässt sich in der Regel eine langfristig gute Beweglichkeit und Stabilität des Mittelgelenkes erreichen.
Objective
Reconstruction of intra-articular impression fractures of the middle phalanx by percutaneous reduction over a small dorsal cortical window. Stabilization by lattice-like arranged K‑wires.
Indications
Impression fractures of the base of the middle phalanx with or without dislocation in the proximal interphalangeal joint.
Contraindications
Fractures extending to the shaft of the middle phalanx.
Surgical technique
By a cortical window at the dorsum of the middle phalanx (through the tendon free triangle) the impression fracture is reduced from the medullary cavity. Reduction is secured and the articular surface is supported by lattice-like arranged K‑wires.
Postoperative management
Thermoplastic splint for the finger for 6 weeks, subsequently K‑wire removal, active range of motion exercises and hand occupational therapy.
Results
In two case series already published, good clinical and radiological results were reported. No complications were detected in either series.
Objective
Anatomical open reduction and internal fixation using screw/plate osteosynthesis.
Indications
Extra-articular fractures with clinically evident malrotation of the finger, comminution fracture and/or loss of length, which cannot be treated non-operatively; fracture instability; intra-articular fracture with step off greater than 1 mm, which cannot be treated percutaneously but openly using plate/screw osteosythesis; failure of conservative treatment.
Contraindications
General operative limitations.
Surgical technique
Dorsal, mediolateral, or palmar approach, temporary reduction using pincers or optional Kirschner wires; screw/plate osteosynthesis for internal fixation.
Postoperative management
Immediate mobilization facilitated by buddy loops for the first 4–6 weeks, prevention of edema using elastic dressing, physiotherapy.
Results
Open reduction and internal fixation using screw/plate osteosynthesis provides good results in combination with immediate mobilization. Nevertheless, adhesion of tendons or capsule tissue with restriction of range of motion is observed.
Kapsel-Band-Läsionen gehören zu den häufigsten Verletzungen an der oberen Extremität. Vor allem Sportler sind einem erhöhten Risiko für diese Verletzungen ausgesetzt. Die klinische Untersuchung ist in Verbindung mit einer standardisierten röntgenologischen Untersuchung die Grundlage einer zielgerichteten Therapie. Mit der Entwicklung hochauflösender Schallköpfe gewinnt die Sonographie als nichtinvasive und dynamische Untersuchungsmethode zunehmend an Bedeutung. Die adäquate Interpretation dieser Befunde ist nur mit umfassenden anatomischen Kenntnissen zu gewährleisten. Oberstes Ziel ist die Wiederherstellung einer Situation, die zügig eine frühfunktionelle Behandlung erlaubt. Nur dadurch kann Stabilität mit freier Beweglichkeit erreicht werden.
Zur Behandlung der Mittelgliedbasisimpressionsfraktur, die immer mit einer dorsalen Subluxation einhergeht, wurden zahlreiche
operative und nichtoperative Verfahren beschrieben. Eine gute Funktion kann nur erreicht werden, wenn eine frühzeitige Diagnose
gestellt werden kann und die Behandlung frühzeitig einsetzt. Wichtigstes Therapieziel sind die Aufhebung oder Beseitigung
der dorsalen Subluxation. Die anatomische Gelenkrekonstruktion ist aufgrund des Zugangsweges sehr schwierig und sollte nur
von sehr erfahrenen Handchirurgen durchgeführt werden. Nach der Operation ist eine frühzeitige Übungsbehandlung notwendig.
Als Operationsverfahren haben sich die „dynamische Traktionsbehandlung“ einerseits und die „offene Gelenkrekonstruktion“ andererseits
durchgesetzt. Die Gesamtbeweglichkeit des Mittelgelenkes liegt nach Ausheilung im Durchschnitt zwischen 75° und 85°. Aber
auch heute noch bleibt diese Verletzung auch für den erfahrenen Handchirurgen eine Herausforderung.
Numerous surgical and non-surgical procedures have been described for the treatment of depression fractures at the base of
the middle phalanx, which are always associated with dorsal subluxation. Good function can only be achieved when an early
diagnosis is made and treatment is initiated promptly. In the latter, elimination of the dorsal subluxation is the most important
goal. Anatomic joint reconstruction is very challenging due to restricted access and should only be performed by very experienced
hand surgeons. Early exercise therapy is necessary following surgery. As far as surgical options are concerned,“dynamic traction”
on the one hand and“open joint reconstruction” on the other represent the established procedures. Once healed, total mobility
of the proximal interphalangeal joint is averagely between 75° und 85°. However, this injury still remains a challenge even
for experienced hand surgeons.
The records of 38 consecutive patients (38 fractures) who underwent treatment for distal unicondylar fractures of the proximal phalanx were reviewed to evaluate fracture characteristics, mechanism of injury, treatment options, and functional outcomes. Four classes of fracture pattern were defined radiographically. Most fractures occurred during ball sports and involved an axial splitting of extended digits, with the condyle closet to the midline of the hand fracturing most commonly. We believed that the fracture occurred as a result of tension loading due to a distraction force from the collateral ligament. All fractures healed. Follow-up examination averaged 3 years. Five of seven nondisplaced fractures treated with splinting and four of ten displaced fractures treated with reduction and single Kirschner wire fixation displaced. Fractures treated with multiple Kirschner wire fixation had the best final joint motion. Class IV fractures with a small palmar coronal fragment had the poorest final motion. A short period of post-operative immobilization did not adversely affect final proximal interphalangeal joint motion. We recommend multiple Kirschner wire or miniscrew fixation of these fractures as the most predictable method of treatment. Final proximal interphalangeal joint motion is not uniformly excellent in patients with these fractures.
Die Behandlungsergebnisse von Mittelgelenkfrakturen sind oftmals nicht befriedigend für den Patienten und den Chirurgen, da vor allem konservative Methoden die Einsteifung des Gelenks nicht verhindern können. Daher wird die frühfunktionelle Therapie mit externen Fixateuren zunehmend favorisiert. Sie kombiniert das Prinzip der Ligamentotaxis mit der Möglichkeit einer frühzeitigen Beübung des Gelenks. Besonders bewährt hat sich das mehrfach modifizierte Pin-Rubber-Traktionssystem (PRTS). Es ist leicht zu handhaben, kostengünstig und wird aufgrund des geringen Gewichts und des begrenzten Größenumfangs vom Patienten gut toleriert. In dieser Übersichtsarbeit werden die Behandlungsoptionen und die klinischen Ergebnisse bei Mittelgelenkfrakturen dargestellt.
Providing stability and reduction of the period of immobilisation of non- or minimally displaced scaphoid fractures using a minimally invasive technique.
Scaphoid fractures of the types A2, B1 and B2 (Herbert's classification) with no or minimal displacement, along with a patient's request for early functional treatment.
Relative contraindications: significant dislocation of the fracture, scaphoid cyst or a too proximal fracture, concomitant fractures of the wrist. Absolute contraindications: pseudoarthrosis, luxation fractures.
Minimally invasive percutaneous screw fixation using a double threaded screw.
Postoperative immobilisation in a plaster cast with a thumb inlay for 1-3 weeks until swelling and pain subside. Followed by active physiotherapeutic exercise, however no pressure on the hand for 6 weeks after surgery.
Seventy patients with a non- or a minimally displaced scaphoid fracture were treated between 2005 and 2011. We used percutaneous screw fixation as the therapy technique. A total of 57 patients (81 %) presented for follow-up. Four patients (5.7 %) had an unhealed fracture 6 months postsurgery confirmed. One patient needed revision surgery because of a screw that was too long. None of the patients had a postsurgical infection, haematoma or a complex regional pain syndrome. Smoking and putting pressure on the hand too early have been identified as possible risk factors for the unhealed fractures.
We aimed to compare results of treatment of oblique-spiral metacarpal and phalangeal fractures with screw only or mini plate plus screw, respectively.
A total of 43 patients who were operated with a diagnosis of displaced, irreducible, unstable, rotational oblique-spiral metacarpal and proximal phalangeal fracture between 2007 and 2010 were included in this study. The mean age of patients with a phalangeal fracture was 33.8 years (range 20-50 years; 4 females, 18 males), and the mean age of patients with a metacarpal fracture was 29.6 years (range 18-45 years; 3 females, 18 males). Mini plate plus screw or screw only was used for internal fixation of these fractures. The patients were followed up for 19.2 ± 5.4 months in the phalangeal fracture group and 20.9 ± 7.3 months in metacarpal fracture group. Of the metacarpal fractures, 14 were oblique and 10 spiral, whereas 14 of the phalangeal fractures were oblique and 8 spiral. The patients were evaluated according to total range of motion of the finger, grasping strength and Q-DASH score.
For patients treated with mini plate plus screw after metacarpal and phalangeal fractures, the time to return to work was significantly shorter in comparison to patients treated with screws only. There was no significant difference between patients with metacarpal fractures treated with mini plate plus screw and patients treated with screw only in terms of total range of motion and Q-DASH results at last on control examination, while results of patients with phalangeal fractures treated with screw only were significantly better. There was no significant difference between these two treatments in phalangeal fractures in terms of grasping strength of the finger in early (1st month) and late (last control examination), whereas patients with metacarpal fractures treated with mini plate plus screw reached higher grasping strength earlier.
Treatment with mini plate plus screw should be avoided in spiral and oblique phalangeal fractures, and fixation should be done with screw only with a short surgical incision and dissection. On the other hand, treatment with mini plate plus screw should be preferred in patients with spiral and oblique metacarpal fractures, especially in those who work in occupations requiring higher physical strength.
Background
Limited range of finger motion is a frequent complication after plate fixation of phalangeal fractures. The purpose of this study was to evaluate the results of plate fixation of extra-articular fractures of the proximal phalanx using current low-profile mini-fragment-systems.
Methods
From 2006 to 2012, 32 patients with 36 extra-articular fractures of the proximal phalanx of the triphalangeal fingers were treated with open reduction and plate fixation (ORPF) using 1.2 and 1.5 mm mini-fragment systems. Patients presenting with open fractures grade 2 and 3 or relevant laceration of adjacent structures were excluded from the study. We retrospectively evaluated the rate of mal-union or non-union after ORPF, the need for revision surgery, for plate removal, and for tenolysis. Data were analyzed for further complications with regard to infections or complex regional pain syndrome (CRPS).
Results
No infections were noted. Five patients developed transient symptoms of CRPS. Six weeks postoperatively, total active finger motion (TAM) averaged 183°, and all 32 patients underwent formal hand therapy. At the latest follow-up or at the time of plate removal, respectively, the mean TAM improved to 213°. Extension lag of proximal interphalangeal joints was found in 67 % of all fractured fingers. Secondary surgery was necessary in 14 of 32 patients (2 corrective osteotomies, 12 plate removals including 7 procedures explicitly because of reduced mobility).
Conclusions
Despite of new implant designs significant problems persist. Adhesions of extensor tendons leading to limited range of finger motion are still the most frequent complications after ORPF of proximal phalangeal fractures, even in absence of significant soft-tissue damage.
Level of evidence
Therapeutic, Retrospective, Level IV.
Die Behandlungsergebnisse von Mittelgelenkfrakturen sind oftmals nicht befriedigend für den Patienten und den Chirurgen, da vor allem konservative Methoden die Einsteifung des Gelenks nicht verhindern können. Daher wird die frühfunktionelle Therapie mit externen Fixateuren zunehmend favorisiert. Sie kombiniert das Prinzip der Ligamentotaxis mit der Möglichkeit einer frühzeitigen Beübung des Gelenks. Besonders bewährt hat sich das mehrfach modifizierte Pin-Rubber-Traktionssystem (PRTS). Es ist leicht zu handhaben, kostengünstig und wird aufgrund des geringen Gewichts und des begrenzten Größenumfangs vom Patienten gut toleriert. In dieser Übersichtsarbeit werden die Behandlungsoptionen und die klinischen Ergebnisse bei Mittelgelenkfrakturen dargestellt.
Injuries of the proximal interphalangeal joint (PIP joint) are common. They are frequently underestimated by patients and initial treating physicians, leading to unfavorable outcomes. Basic treatment includes meticulous clinical and radiological diagnosis as well as anatomical and biomechanical knowledge of the PIP joint.
In avulsions of the collateral ligaments and the palmar plate with or without involvement of bone, nonoperative treatment is preferred. Operative stabilization is reserved for large displaced bony fragments or complex instabilities. In central slip avulsion or rupture, osseous refixation, suture, or reconstruction is common and nonoperative treatment is limited to special situations like minimally displaced avulsions. In basal fractures of the middle phalanx, elimination of joint subluxation and restoration of joint stability are priority. If the fragments are too small for fixation with standard implants, therapeutic alternatives include refixation of the palmar plate, dynamic distraction fixation, percutaneous stuffing, or replacement by a hemihamate autograft. Early motion is initiated regardless of the treatment regime. Undertreatment leads to persistent swelling, instability, and limited range of motion, which are difficult to treat. Contributing factors are unnecessary immobilization, immobilization in more than 20° flexion or transfixation by K-wires. For residual limitations, nonoperative treatment with physiotherapists and splinting is first choice. Operative treatment is reserved for persistent flexion/extension contractures persisting for more than 6 month as well as reconstructions in boutonniere and swan neck deformity and salvage procedures for destroyed joints.
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.
Fractures of the tubular bones of the hand are common and potentially debilitating. The majority of these injuries may be treated without an operation. Surgery, however, offers distinct advantages in properly selected cases. We present a review of hand fracture management, with special attention paid to advances since 2008. The history and mechanisms of these fractures are discussed, as are treatment options and common complications. Early mobilization of the fractured hand is emphasized because soft tissue recovery may be more problematic than that of bone.
The simple, percutaneous placement of a smooth pin into the head of the proximal phalanx creates an extension block, which prevents subluxation of the middle phalanx and allows early active flexion of the proximal interphalangeal joint. Three case reports involving this new treatment are presented along with a detailed description of the technique.
To understand the types of injuries occurring in PIP joints, the anatomical and biomechanical aspects are described. Bony abruptions of the palmar plate of the PIP joint are important indicators of the severity of accompanying capsular and ligamentous injuries and assist in determining specific forms of treatment. A classification of the different injury types is presented. The indication for conservative or operative treatment is based on this classification.
Two patients who sustained posterior and anterior fracture dislocations of the femoral head, respectively, are reported. Each case was treated by open reduction and internal fixation of the fracture fragments. With this operative approach excellent results have been achieved on medium-term followup.
Open reduction of intra-articular fractures of the proximal interphalangeal joints of the fingers requires extensive exposure of the bone. This often leads to disturbance of the delicate mechanics of the joint. The results are, therefore, sometimes not as good as expected. The authors describe a new method of treatment, using the image intensifier with magnification. The fragments are reduced by means of a golf-club shaped instrument, which is inserted into the medullary cavity through a small skin incision and a drill hole in the bone. After reduction, the position is held by a framework of percutaneously introduced thin Kirschner-wires.
A closed method is recommended for the treatment of a common injury of the proximal interphalangeal joint, a fracture of the articular surface of the middle phalanx with dorsal dislocation or subluxation. The method uses extension-block splinting (a forearm gauntlet with a dorsal extension along the finger) which allows early active flexion of the proximal interphalangeal joint but prevents extension beyond a predetermined point at which the joint subluxates on dislocates. The method is described and the results in seventeen patients are presented.
Injuries of the interphalangeal joints are of small size but may be of great importance.The history should be taken with care and all painful, swollen joints caused by injury should be tested for instability and should be radiographed.Stable injuries with fractures showing little displacement should be treated by protected activity.Unstable injuries and widely separated fractures should be operated on. Provided that the necessary facilities and a suitable experienced surgeon are available these operations can often be carried out in an out-patient operating room, using digital block analgesia.
Dorsal fracture dislocations of the proximal interphalangeal joint remain 1 of the most difficult problems in which to obtain an excellent functional outcome. The use of minimally invasive internal fixation techniques improving the biologic healing response and yet providing fracture fragment stabilization has met with greater popularity in recent years. The results of 12 patients treated by the volar cerclage wiring technique are described. At average followup examination of 2.1 years, 11 of 12 patients were noted to have no degenerative joint changes with only 1 patient having evidence of early volar articular surface beaking. Average final active arc of motion at the proximal interphalangeal joint was 89 degrees (range, 72 degrees - 109 degrees). The average degree of extension loss at the proximal interphalangeal joint was 8 degrees (range, 0 degrees - 16 degrees). There were no complications involving implant failure, irritation, or infection. A description of the volar cerclage wire technique is presented. This technique provides the advantage of avoiding fracture fragment stripping, stable restoration of the articular surface, and palmar buttress of the middle phalanx at the proximal interphalangeal joint.
The nature of injury following a PIP fracture dislocation is determined by the direction of force transmission and the position of the joint at the time of impact. Dorsal dislocations with palmar lip fractures are the most frequently encountered and can be classified based on stability. The degree of stability is directly determined by the amount of middle phalangeal palmar lip involvement; the larger the palmar lip fracture, the more unstable the joint becomes. When there is persistent instability or greater than 30 degrees of flexion is required to maintain reduction, treatment must be aimed at reconstituting the cup shaped geometry and buttressing effect of the volar lip of the middle phalanx if stability is to be restored. The use of a hemi-hamate autograft to reconstruct the base of the middle phalanx is a new technique that restores joint congruity and stability while allowing for early motion. This operative technique replaces the damaged palmar lip of the middle phalanx with a size-matched portion of the hamate obtained from its distal dorsal articular surface between the 4th and 5th metacarpals. By restoring both articular congruity and osseous stability the advantage of this procedure is that it allows more immediate rehabilitation with a potential for earlier motion, less stiffness and possibly less post-traumatic arthritis.
Akute und chronische ligamentäre Verletzungen der Fingergelenke und des Daumens (Distorsionen und Luxationen)
- C K Spies
- F Unglaub