External Fixation of PIP Joint Dorsal Fracture-Dislocations

Background: The pins and rubbers traction system is widely used to treat unstable proximal interphalangeal (PIP) joint fracture-dislocations. However, dealing with rubber bands can be difficult due to its elasticity and weakness. The purpose of this study was to report the results of an alternative dynamic external fixator technique for unstable PIP joint injuries. Methods: Thirteen patients with acute unstable PIP joint fracture-dislocation (n = 8), pilon fracture (n = 2), or comminuted shaft fractures of a middle phalanx with or without PIP joint extension (n = 3) were enrolled. The alternative fixator used a plastic syringe to maintain distraction force instead of the commonly used rubber bands. Four patients underwent combined open reduction due to unsatisfactory reduction by closed mean. The fixator was removed when there was radiographic evidence of healing. Results: At 6 months after the operation, the mean active ROM of the injured PIP joint was 89° (range, 70–104°), and the mean Quick-DASH score was 9.78 (range, 0–40.9). The mean NRS of pain before fixator removal was 1 (range, 0–4). One patient had a pin tract infection and underwent debridement and fixator removal at 33 days postoperatively. There was no loss of reduction or implant failure in the study. Conclusions: The results were comparable to other dynamic external fixation techniques used for unstable PIP joint fracture-dislocations. The main advantages of this technique were strength of the system, procedure simplicity, the compact design, and relatively low cost. In addition, this technique can also be used in pilon fractures and comminuted shaft fractures of a middle phalanx with or without PIP joint extension.

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Splinting vs temporary external fixation in the initial treatment of ankle fracture-dislocations

Foot and Ankle Surgery ◽

10.1016/j.fas.2021.03.018 ◽

2021 ◽

Author(s):

Mehmet Ozbey Buyukkuscu ◽

Seckin Basilgan ◽

Ali Mollaomeroglu ◽

Abdulhamit Misir ◽

Hakan Basar

Keyword(s):

External Fixation ◽

Initial Treatment ◽

Ankle Fracture ◽

Fracture Dislocations

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Volar plating versus external fixation for unstable dorsal fracture-dislocations of the proximal interphalangeal joint

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211059300 ◽

2021 ◽

pp. 175319342110593

Author(s):

Atsuhiko Murayama ◽

Kentaro Watanabe ◽

Hideyuki Ota ◽

Shigeru Kurimoto ◽

Hitoshi Hirata

Keyword(s):

External Fixation ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Volar Plating ◽

Distal Interphalangeal Joint ◽

Active Flexion ◽

Plate Group ◽

Fracture Dislocations ◽

Distal Interphalangeal

We retrospectively compared the results of volar plating and dynamic external fixation for acute unstable dorsal fracture-dislocations of the proximal interphalangeal joint with a depressed fragment. We treated 31 patients (31 fingers), 12 with volar buttress plating and 19 with dynamic external fixation. Follow-up averaged 35 and 40 months in the two groups, with a minimal 6-month follow-up. Average active flexion of the proximal interphalangeal joint was 95° after plate fixation and 87° after external fixation, with an active extension lag of –6° and –9°, respectively. Active flexion at the distal interphalangeal joint averaged 67° in the plate group and 58° in the external fixation group, with active extension lags of 0° and –5°, respectively. We conclude that both methods can obtain a good range of motion at the proximal interphalangeal joint. A limitation of the extension of the distal interphalangeal joint occurred with dynamic external fixation but not with volar buttress plating. Level of evidence: IV

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Joint Replacement Arthroplasty: Is It Ever Indicated in PIP Joint Fracture-Dislocations?

PIP Joint Fracture Dislocations ◽

10.1007/978-3-319-28579-5_12 ◽

2016 ◽

pp. 155-170

Author(s):

H. L. Baltzer ◽

Steven L. Moran

Keyword(s):

Joint Replacement ◽

Joint Fracture ◽

Replacement Arthroplasty ◽

Fracture Dislocations ◽

Pip Joint

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Extension-Block Pinning for Unstable Dorsal Proximal Interphalangeal Joint Fracture-Dislocations: A Simple, Percutaneous Technique With Reproducible Outcomes

Hand ◽

10.1177/15589447211066352 ◽

2022 ◽

pp. 155894472110663

Author(s):

Christopher A. Worgul ◽

Andrew B. Stein

Keyword(s):

Range Of Motion ◽

Articular Surface ◽

Kirschner Wire ◽

Proximal Phalanx ◽

Treatment Delay ◽

Joint Fracture ◽

Fracture Dislocations ◽

Pip Joint

Background: Proximal interphalangeal (PIP) joint fracture-dislocations can be technically challenging injuries to treat, and no technique has proven to be superior nor lead to predictably good outcomes. We describe our experience of treating unstable dorsal fracture-dislocations of the PIP joint with extension-block pinning (EBP) at our institution over a 22-year period. Methods: In all, 23 patients with 24 unstable dorsal fracture-dislocations of the PIP joint treated with EBP between January 1998 and October 2020 were identified. All patients underwent closed reduction of the PIP joint and insertion of a Kirschner wire into the proximal phalanx, creating a mechanical block. Range of motion and joint congruity were assessed at final clinic follow-up. Long-term function was assessed via completion of a Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Spearman’s correlation coefficient was utilized to assess if any association existed between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. Results: Mean range of motion at final follow-up was 83.3° and 22 of 24 PIP joints demonstrated a congruent reduction. In all, 15 of the 23 patients completed the QuickDASH questionnaire at a median long-term follow-up of 57.5 months (range: 3-157 months). Average QuickDASH score was 18.8, indicating minimal long-term disability. No statistically significant associations were found between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. Conclusions: EBP offers a simple and innovative method to treat a complex injury of the PIP joint. It is technically straightforward and cheap, and produces excellent functional outcomes with minimal long-term disability.

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Dorsal Fracture Dislocations of the Proximal Interphalangeal Joint Treated by Open Reduction and Interfragmentary Screw Fixation: Indications, Approaches and Results

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2005.09.019 ◽

2006 ◽

Vol 31 (2) ◽

pp. 138-146 ◽

Cited By ~ 55

Author(s):

J. Y. L. LEE ◽

L. C. TEOH

Keyword(s):

Open Reduction ◽

Screw Fixation ◽

Early Mobilization ◽

Proximal Interphalangeal Joint ◽

Patient Comfort ◽

Joint Function ◽

Fracture Dislocations ◽

Pip Joint ◽

Joint Congruity

Many operative and non-operative treatments of dorsal fracture dislocations of the proximal interphalageal (PIP) joint have been described. Return of good joint function requires anatomical reduction of the articular fragments and restoration of joint congruity and a stable functional arc of motion, with the fixation construct stable enough for early mobilization. To prevent recurrent dorsal subluxation, the attachments of the ligamentous palmar restraints and the bony buttress provided by the palmar lip of the middle phalanx base must be restored. Open reduction and internal interfragmentary screw fixation using 1.5 or 1.3 mm screws was employed in 12 fingers in 10 patients with unstable dorsal fracture dislocations of the PIP joints of Schenck grades III and IV. At an average follow-up of 8.7 months, all patients in this series achieved good to excellent results and an average total active interphalangeal motion of 132° (range 105°–165°). Additional benefits over non-operative techniques included improved patient comfort and simplified nursing care and therapy supervision.

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