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Use of a Multivector Mandibular Distractor for Treatment of Pediatric Proximal Interphalangeal Joint Pilon Fractures: A Case-Based Review
Abstract
Background The difficulties in surgical treatment of pilon fractures of the finger include fragment reconstitution and posthealing stiffness. In adults, external fixation with traction and early active range of motion (AROM)/passive range of motion (PROM) during healing is considered necessary for avoiding joint stiffness and attaining realignment. The authors present a unique approach to pediatric pilon fractures that uses open reduction and multivector external fixation with delayed AROM/PROM. Initial immobilization and significant traction allowed for joint realignment and prevented noncompliance with staged distraction. The authors believe this immobilization leads to a superior outcome because, unlike adults, children tend to avoid stiffness and a larger distraction force allowed for sufficient joint realignment to regain range of motion (ROM).
Methods A right-handed 13-year-old boy sustained a right ring finger fracture and presented 12 days later. Radiographs revealed a comminuted Salter-Harris 4 fracture of the middle phalanx. The patient underwent open reduction and placement of multivector external fixation using a pediatric mandibular distractor/fixator. Significant traction was applied to distract the finger to length.
Results Hardware was removed 6 weeks postoperatively and AROM was initiated after splinting. The patient started PROM 8 weeks postoperatively. Strengthening was initiated 2 weeks later. ROM improved and rehabilitation was continued. The patient exhibited nearly equal grip strength 12 weeks postoperatively. At 14 months follow-up, radiographs showed complete healing and joint realignment. There was no deformity or pain and finger length was restored.
Conclusion Management of pediatric pilon fractures is rarely described and presents unique considerations. Early-stage traction and immobilization using a multivector mandibular fixator/distractor is suitable in a child because noncompliance is avoided and there is a decreased risk for stiffness. Combining early immobilization with subsequent-staged AROM, PROM, and strengthening resulted in no loss of ROM and maintained articular symmetry.
... Even though a few papers in the literature describe percutaneous fixation with K-wires, we were unable to find any literature regarding the use of MEFS in paediatric hand fractures. 20,21 Our ...
Background: Most unstable hand fractures in children are treated by closed methods. If osteosynthesis is required, Kirschner (K)-wires are commonly used, though they carry a risk of injury to the physis. We have been using a mini external fixator system (MEFS) for the treatment of unstable periphyseal fractures of the hand. The aim of this study is to describe the application and report the outcomes of MEFS for the treatment of periphyseal fractures of the hand.
Methods: We retrospectively reviewed all the patients with periphyseal fracture of the hand treated with MEFS from March 2010 to December 2019. Data with regard to age, sex, hand dominance, digit and bone injured, mechanism of injury, medical records and related radiographs were collected. Salter–Harris classification was used to classify epiphyseal fractures and the Al-Qattan classification for categorising neck fractures. Range of motion and residual deformity of the affected fingers were evaluated during follow-up and at 3 months postoperatively.
Results: Fourteen periphyseal unstable fractures were treated using closed reduction and MEFS. Only one patient with a fracture of the neck of the proximal phalanx of the little finger required revision surgery. No patient had pin site infection or pin loosening and the device was well tolerated by all patients. All fractures united and all the patients recovered a full range of motion at final follow-up.
Conclusions: The MEFS is a reasonable alternative for unstable periphyseal fractures with good outcomes and avoids the risk of iatrogenic physeal injury from K-wire fixation.
Level of Evidence: Level IV (Therapeutic)
... For simple, transverse fractures, the open reduction and internal fixation with a plate, as well as intramedullary fixation with k-wires or cannulated screws, can be reliable treatment options [4][5]. For more complex, comminuted fractures, external fixation methods that achieve reduction based on the principle of ligamentotaxis seem to be more efficient [6][7][8]. ...
Severely comminuted fractures of the middle phalanx of the digits are known to be demanding cases for hand surgeons. The restoration of the length and axis of the phalanx, such as the anatomic reduction of the articular surface in case of intra-articular association are basic principles that have to be followed. A simple and cheap device consisting of two Kirschner wires and a nylon suture can work as an external fixation system based on the principle of ligamentotaxis. As a result, the anatomic reduction of the fracture with minimal soft tissue damage and simple surgical equipment is feasible.
Introduction:
Salter-Harris type IV fracture of the proximal phalanx with 90° rotation of the epiphysis is very rare. We report on a case of Salter-Harris type IV fracture of the proximal phalanx of the thumb with rotation of the epiphysis and document the outcome 10 years after surgery.
Presentation of case:
A 5-year old boy presented with Salter-Harris type IV fracture of the thumb with 90° rotation of the epiphysis. Open reduction and K-wire fixation was done. Ten years later, the injured thumb was smaller in width when compared to the contralateral thumb, although there was no length discrepancy. Clinically, there was full range of motion. Radiologically, the physis was still open but there were minor irregularities at the adjacent metaphyseal base and epiphysis. The diaphysis of the injured proximal phalanx had a constricted appearance when compared to the contralateral normal side.
Discussion:
After an extensive literature review, we found one reported case which was similar to our case and had long term assessment. At skeletal maturity, there was complete remodeling and full range of motion of the digit with no shortening. The X-ray showed a constricted diaphysis of the proximal phalanx with an identical appearance to our case.
Conclusion:
We present a rare case of Salter-Harris type IV fracture of the proximal phalanx of the thumb with rotation of the epiphysis. Long term outcome was satisfactory but there was diaphyseal constriction leading to a narrower thumb.
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 well-aligned 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.
Fractures of the proximal interphalangeal joint include a wide spectrum of injuries, from stable avulsion fractures to complex fracture-dislocations. Stability of the joint is paramount in determining the appropriate treatment, which should aim to facilitate early mobilisation and restoration of function.
Health-care costs for hand and forearm injuries in young children are poorly documented. We examined costs in 533 children injured years 1996-2003.
Health-care costs and costs for lost productivity were retrospectively calculated in children from three catchment areas in Sweden. Seven case categories corresponding to alternative prevention strategies were constructed.
Over time, diminishing number of ward days reduced the health-care cost per case. Among children, the cost of lost productivity due to parental leave was 14 percent of total cost. Fingertip injuries had low median costs but high total costs due to their frequency. Complex injuries by machine or rifle had high costs per case, and despite a low number of cases, total cost was high. Type of injury, surgery and physiotherapy sessions were associated with variations in health-care cost. Low age and ethnic background had a significant effect on number of ward days.
The costs per hand injury for children were lower compared to adults due to both lower health-care costs and to the fact that parents had comparatively short periods of absence from work. Frequent simple fingertip injuries and rare complex injuries induce high costs for society. Such costs should be related to costs for prevention of these injuries.
The aim of this study was to review the outcome of the treatment of finger proximal interphalangeal joint dorsal fracture subluxations and pilon fractures with a modified external fixator. We treated 36 patients (36 fingers). We assessed the ranges of motion and patient satisfaction. At final follow-up, 23 patients had no pain; 11 had pain in the cold; and two also had mild pain. None had moderate or severe pain. The mean range of proximal interphalangeal joint motion was 86° (60°-100°). The mean total active range of finger motion was 244° (range 200°-265°). This system is simple, cheap and relatively easily applied. It gives stable fixation that allows early mobilization.
Level of evidence:
IV.
Background:
Intra-articular fractures of the proximal interphalangeal (PIP) joint are commonly treated with dynamic external fixation. Most commonly used is the Suzuki modification of the pins and rubber traction system (PRTS). There are a few other modifications of the PRTS external fixators. We present an alternative pin external fixator that is simple and effective.
Methods:
Under a suitable anesthesia and image intensification a true lateral view of the head of the proximal phalanx is obtained. A K-wire construct holds the affected digit out to length with the fracture reduced and Jurgan pin-balls hold the construct into position. Under image intensification the whole device is checked to ensure the joint and fracture is reduced and the joint is not over distracted. The PIP joint is also checked to ensure good range of motion. The device was checked in clinic at 1 week with radiographs. The wires are removed at 4 weeks followed by intensive hand physiotherapy.
Results:
Over 20 patients with intra-articular fractures of the proximal and middle phalangeal were treated with this technique. In all cases the fracture healed with good joint congruency. All patients achieved good range of motion of the PIP joint but with some restriction of full flexion (mean, 20 degrees). There was no loss of position or pin-site infections. There was good compliance with the treatment.
Discussion:
The main advantages of the technique we describe are: (1) the compact design, making it less cumbersome for the patient compared with other PRTS external fixators; (2) it is straightforward to assemble and the device is easy to adjust in clinic if there is any loss of reduction; (3) the pin-balls prevent sharp ends of the wire protruding causing morbidity to the patient; (4) there is less chance of loss of traction compared with traction devices using rubber bands. It is a dynamic device, which allows mobilization of the joints reducing stiffness.
To clarify the factors affecting functional results of fracture-dislocations of the proximal interphalangeal (PIP) joint treated by open reduction and internal fixation (ORIF), 60 patients, including 38 patients with a dorsal fracture-dislocation and 22 with a pilon fracture, were analysed. The mean ratio of articular surface involvement was 48.5% and a depressed central fragment existed in 75.3% of the cases. ORIF was performed in 47 patients through a lateral approach using Kirschner wires and in 13 through a palmar approach using a plate or screws. The mean flexion, extension and range of motion (ROM) of the PIP joint was 89.5°, 11.5° and 78.0°, respectively. Stepwise regression analysis revealed that a delayed start of active motion exercise after surgery, elderly age and ulnar ray digit were factors affecting functional outcomes. Although ORIF allows accurate restoration of the articular surfaces, an early start of motion exercise is essential for good results.
Background:
The outcomes literature on proximal phalanx fractures in children is sparse. The purpose of this study is to report the complications and outcomes of displaced proximal phalanx fractures after treatment with closed reduction and percutaneous pinning (CRPP).
Methods:
A retrospective chart review identified 105 patients treated with CRPP of displaced proximal phalanx fractures. Specific complications were recorded for all patients. Thirty-one of these patients returned >1 year after surgery for assessment including visual analogue scales (VAS) of pain level, functional ability, and esthetics. Objective measurements included range of motion, grip and pinch strength, and finger deformity. Radiographs were taken to assess deformity.
Results:
Five of the 105 patients (4.8%) had a complication including infection, pin site complication, or malunion. Of the entire group, 36 had stiffness and 31 ultimately underwent hand therapy to regain motion. Subcondylar fractures were associated with a greater likelihood of stiffness. In the 31 patients returning for assessment, the median VAS score was 0 for pain (none), function (full), and esthetics (perfect). Range of motion, grip, and pinch strength were equivalent to the contralateral side. Seven of the 31 patients (22.6%) had a measureable coronal plane deviation averaging 5 degrees (range, 3 to 13 degrees) on radiographs. Deviation was associated with subcondylar fractures and a worse esthetic VAS. Deviation was not associated with worse outcomes overall.
Conclusions:
Pediatric patients with a displaced proximal phalanx fracture treated with CRPP have an initial notable complication rate related to stiffness; subcondylar proximal phalanx fractures are more commonly affected. At >1-year follow-up, patients had full motion, no pain, and were happy with both function and appearance despite minor deformity in some. These complication data may help better inform patients and families before surgical intervention.
Level of evidence:
Level IV-therapeutic.
Hand fractures represent a leading cause of morbidity in children. However, little information exists correlating the mechanisms and environment of injury with outcomes and treatments. We examine the demographics, etiology, anatomic location, mechanism, and management of pediatric hand fractures in our center's hand unit.
We conducted a prospective observational study on all children with acute hand fractures evaluated in the Plastic Surgery Emergency Clinic during a 3-month period in 2010. Data pertaining to demographics, referral patterns, injury pattern, clinical outcomes, and other factors related to hand fractures were then analyzed and interpreted.
Most children were referred by our institution's emergency department. More than 60% were boys, and nearly half were between 10 and 15 years old. The right and left hands were injured at equal rates. Most of the injuries (90%) occurred in the afternoon or evening. More than 85% occurred in urban, rather than rural, environments. Crush injuries were the leading cause in toddlers, whereas sports-related injuries became the major cause of injury in older groups. Proximal phalanges were the most common bone injured, and the fifth digit was the most commonly injured digit. More than 80% of the fractures were managed nonsurgically.
The pattern of pediatric hand fracture in different age groups is highlighted in this article. The observations from this study will hopefully encourage further review with a larger cohort and a focus on preventative measures for pediatric hand fractures.
Unstable, severely comminuted fractures of the base of the proximal phalanx are often difficult to treat. We have been treating pilon-type fractures about the metacarpophalangeal joint using a novel external fixation technique with success. We present 2 examples of comminuted base of proximal phalanx fractures were treated successfully using the distraction external fixation with excellent outcomes. We believe that our technique is easily reproducible, relatively inexpensive, facilitates wound care, and enables early mobilization.
A pilon fracture is an uncommon intraarticular fracture of the proximal interphalangeal (PIP) joint resulting in comminution, central depression, and splay, sagittally and coronally, of the articular surface of the base of the middle phalanx. This study reviews three treatment methods and results in 20 patients. Injury was produced by an axial load and occurred primarily to the ulnar digits. Clinical and radiographic follow-up averaged 25 months. Treatment was divided into three categories: splint (four patients), skeletal traction through the middle phalanx (seven patients), and open reduction with Kirschner pins (nine patients). Anatomic restoration of PIP articular contour was not achieved, regardless of technique. No patient regained full mobility at either interphalangeal joint. Treatment by immobilization is undesirable. Open reduction should be approached cautiously and may result in significant complications. Skeletal traction is safe and gives results that are radiographically and clinically comparable to those achieved with open reduction.
A new concept, continuous passive motion of a synovial joint in vivo, was investigated to determine its biological effect on the healing of full-thickness articular cartilage defects that penetrate the subchondral bone of knee joints of adolescent and adult rabbits. The effect of continuous passive motion was compared with the effects of immobilization and of intermittent active motion. This investigation included assessment of 480 defects in the knees of 120 adolescent rabbits and assessment of 108 defects in the knees of twenty-seven adult rabbits. The continuous passive motion was well tolerated by these animals, whose general well-being was undisturbed. The healing of the defects at weekly intervals up to four weeks was assessed by gross examination and by an analysis of two indices of healing determined by light microscopy: (1) the nature of the reparative tissue, and (2) the degree of metachromasia of the matrix as demonstrated by toluidine-blue staining. At three weeks this assessment revealed that in the adolescent rabbits, healing of the defects by hyaline articular cartilage was present in 8 per cent of forty defects in ten animals whose knees were immobilized, in 9 per cent of forty defects in ten animals whose knees were permitted intermittent active motion, and in 52 per cent of forty defects in ten animals whose knees were managed immediately after operation by continuous passive motion. At three weeks, in the adult animals, healing of the defects by hyaline articular cartilage was present in 3 per cent of thirty-six defects in nine animals whose knees were immobilized, in 5 per cent of thirty-six defects in nine animals whose knees were permitted intermittent active motion, and in 44 per cent of thirty-six defects in nine animals whose knees were managed immediately after operation by continuous passive motion. Thus, the metaplasia of the healing tissue within the defects from undifferentiated mesenchymal tissue to hyaline articular cartilage was not only much more rapid but also much more complete with continuous passive motion than with either immobilization or intermittent active motion.
Unstable intra-articular fracture-dislocations about the proximal interphalangeal joint present a formidable management dilemma. Fourteen patients with comminuted injuries of the proximal interphalangeal joint were treated with dynamic digital traction and followed for an average of 24 months. Dorsal fracture-dislocation and pilon-type injuries made up the majority of cases. Average proximal interphalangeal joint articular surface involvement was 80%. Immediate motion was instituted after traction application. The device was applied in the office with readily available materials. At final follow-up examination, active arc of motion averaged 89 degrees at the proximal interphalangeal joint and 95 degrees for patients sustaining isolated injuries. X-ray films revealed fracture union, joint remodeling, and preservation of joint space. Patient satisfaction was high, with return to previous levels of activity and excellent functional joint restoration. Dynamic digital traction is recommended for unstable proximal interphalangeal joint fractures with comminution, including those associated with subluxation or dislocation.
The authors have developed a new skeletal traction system for comminuted intraarticular fractures and fracture-dislocations in the hand. The system consists of two or three Kirschner wires and rubber bands, and is easy to assemble. It is more compact and comfortable than the banjo splint, and equally effective, and it allows early motion of the affected digits.
A description of the technique is followed by the clinical results of seven cases of severe articular injuries in the hand. At the time of follow-up, the average range of the affected PIP joint motion was about 80° The final active motion of the injured DIP joint ranged from 0 to 40° in flexion and that of the affected thumb (trapezia1 fracture) was not limited. The average follow-up period was 13.1 months.
The treatment of fracture dislocations of the proximal interphalangeal joint often results in pain and stiffness. A small dynamic external finger fixator was designed to maintain the reduced position of the dislocated middle phalanx and allow early active range-of-motion exercise. Four patients with acute unstable fracture dislocations and three with old malunited fracture dislocations of the proximal interphalangeal joint were treated with this apparatus. The average range of the proximal interphalangeal joint motion with this device was 88 degrees. The average follow-up period was 21 months.
Intraarticular fractures of the base of the middle phalanx are difficult to treat, especially if the fragments are comminuted. A spring dynamic traction device is described and the results in the first 14 patients presented. Patient acceptance has been high and the results comparable to other methods of treatment.
We classified fractures of the base of the middle phalanx into five types: 1) single palmar fragment; 2) single dorsal fragment; 3) two main fragments; 4) not involving the articular surface, including epiphyseal separation in children; and 5) all others. Types 1 and 2 were subclassified into avulsion, split and split-depression.
Surgery is recommended for unstable type-1 avulsion fractures, type-2 avulsions which may develop buttonhole deformities, and all fractures which displace articular cartilage surfaces. Long-term follow-up showed that surgical treatment which produced good stability and congruity gave good results. These should be the primary aims of treatment.
Fracture-dislocation of the middle phalanx at the proximal interphalangeal joint is a difficult problem. Open reduction and internal fixation, the panacea for so many unstable fractures, has not been the solution to this injury. During the past three decades, a number of papers have combined old methods with newer concepts, including intradigital traction, "ligamentotaxis," and the beneficial effects of early motion on articular cartilage remodeling. This report describes a simple device, using these new concepts and constructed with available materials, which can be placed on the finger in the office or emergency department, thus avoiding open surgery. Results are compared with other intradigital techniques for treatment of this injury.
Pain, stiffness, instability and degenerative arthritis are common sequelae of complex fracture-dislocations of the proximal interphalangeal (PIP) joint. Operations were carried out to obtain stability, followed by application of a dynamic external fixator in 20 patients with a mean age of 29 years. This provided stability and distraction, and allowed controlled passive movement. Most (70%) of the patients had a chronic lesion and the mean time from injury to surgery was 215 days (3 to 1953). The final mean range of movement was 12 to 86 degrees. Complications included redislocation and septic arthritis, which affected the outcome. Four pin-track infections and two breakages of the hinge did not influence the result. The PIP Compass hinge is a useful adjunct to surgical reconstruction of the injured PIP joint.
Fractures of the proximal interphalangeal joint constitute a broad spectrum of injuries. An understanding of the anatomy, the potential for joint instability, and the treatment options is essential to management of these fractures. Commonly observed fracture patterns involve one or both condyles of the proximal phalanx or the base of the middle phalanx. Fractures of the middle phalanx may involve the palmar lip or the dorsal lip or may be a "pilon" type of injury involving both the palmar and the dorsal lip with extensive intra-articular comminution. Intra-articular injuries may lead to joint subluxation or dislocation and must be identified in a timely manner to limit loss of motion, degenerative changes, and impaired function. These injuries range from those requiring minimal intervention to obtain an excellent outcome to those that are challenging to the most experienced surgeon. The treatment options include extension-block splinting, percutaneous pinning, traction, external fixation, open reduction and internal fixation, and volar-plate arthroplasty. Prompt recognition of the complexity of the injury and appropriate management are essential for an optimal functional outcome.
Eight consecutive pilon fractures of the finger proximal interphalangeal joint and one of the interphalangeal joint of the thumb were treated by closed reduction and application of a new dynamic external fixator. The average range of movement achieved was 12 degrees -88 degrees and there were no serious complications. The technique described offers an effective and simple solution for treatment of pilon fractures of the interphalangeal joint.
To identify the incidence, causes, and details of hand fractures in children.
A retrospective chart review.
Records of children under 16 years of age who had sustained a hand fracture within the last 5 years were collected from the patient population of British Columbia's Children's Hospital. A total of 242 hand fractures in 232 patients were documented. These patients were reviewed for age at time of injury, gender, location of the incident, mechanism of injury, number of radiographs taken, and fracture specifics. Radiographs with obscure details or incomplete folders were excluded.
The patients consisted of 57 (24.6%) females and 175 (75.4%) males, with a mean age of 11.1 +/- 3.3 years. Incidence was low in early childhood but rose sharply after age 9 and peaked at 12 years of age. Sporting activities were the most common cause in both sexes. The fifth metacarpal was the most frequently involved bone (21.1% of total). Nonepiphyseal fractures accounted for 60.2% of the fractures, and the remaining 39.8% were epiphyseal fractures, predominantly Salter-Harris type II (90.4%). Fractures with comminution, severe displacement, intraarticular involvement, and condylar involvement were seen in 12.4%, 12.4%, 20.5%, and 15.1%, respectively. An average of 4.2 radiographs were taken per patient.
Almost all fractures healed in 2 to 3 weeks with excellent functional outcome. Knowledge of epidemiology and etiology of hand fractures can serve as an essential first step in devising strategies to reduce the incidence of these hand injuries. It is hoped that studies such as the present study may serve as a first step in planning measures to reduce the occurrence of hand fractures.
We describe a very cheap, simple and effective dynamic external fixator for treatment of pilon fractures of the proximal interphalangeal joint. At final follow-up, nine such fractures had regained an average range of motion of 79 degrees (range, 65-90 degrees ). There was high patient satisfaction and there were no serious complications.
This study evaluates the use of limited internal fixation and dynamic traction for the treatment of severely displaced digital and thumb pilon fractures.
Six patients were evaluated both clinically and radiographically at an average of 29 months after surgery (range, 18-36 months) for pain, range of motion, and radiographic signs of joint space narrowing and congruence. Surgery involved the placement of a pin for dynamic traction and an assessment of the adequacy of the articular alignment. A limited incision and supplemental K-wires were often used to improve the position of severely displaced fragments or for the repair of the central tendon.
Three patients were pain free, 2 patients experienced pain with prolonged activity, and 1 patient had pain associated with activities of daily living. Average digital arc of motion of the proximal interphalangeal joint was 94 degrees (range, 90 degrees-100 degrees) and thumb interphalangeal motion was 62.5 degrees (range, 60 degrees-65 degrees). The average duration of digital traction was 3.5 weeks. Four patients had greater than 1 mm incongruity of the articular surface immediately after surgery. At final evaluation, all patients had good joint congruency and 2 patients had joint space narrowing but were asymptomatic. There was 1 minor pin tract infection.
Dynamic traction combined with limited internal fixation can be an effective treatment for displaced intra-articular pilon fractures. This technique may allow for earlier removal of traction and simultaneous repair of soft tissue injuries.
Unstable fracture-dislocations of the proximal interphalangeal (PIP) joint remain a difficult management problem, often leading to residual pain, stiffness, and recurrent instability. In a military setting, an easily applied, simple to operate, and inexpensive device becomes an attractive option. The purpose of this clinical investigation was to retrospectively review use of dynamic distraction external fixation (DDEF) for unstable fracture-dislocations and pilon injuries of the PIP joint in an active-duty population.
The fixator is assembled under a local anesthetic from three 1.4-mm (0.045-inch) K-wires and rubber bands. It uses the principles of a lever and ligamentotaxis to assist and maintain reduction. Thirty-four members of the Armed Services, 27 men and 7 women (average age, 30 y), had DDEF for pilon fractures and unstable fracture-dislocations of the PIP joint. A retrospective review of these individuals was conducted. Final range of motion was determined from the clinical records at the final visit.
There were 26 PIP fracture-dislocations (3 chronic, average 6 weeks) and 8 PIP pilon injuries. The average follow-up period was 16 months (range, 6-84 months). The final arc of motion at the PIP joint averaged 88 degrees , and the average distal interphalangeal joint arc of motion was 60 degrees . Eight patients experienced superficial pin-track infections that were easily controlled with oral antibiotics. There were no cases of septic arthritis or osteomyelitis requiring intravenous antibiotics or premature fixator removal. Loss of reduction did not occur. All patients returned to their prior level of activity and duties.
Our results are comparable with other techniques used in the management of unstable PIP joint fracture-dislocations. Easily applied and simple to operate, DDEF is a valuable addition to the hand surgeon's armamentarium. We recommend its use for both primary and adjunctive treatment of acute and chronic unstable PIP joint fracture-dislocations and for primary treatment of PIP pilon injuries.
Therapeutic IV.