Dynamic External Fixation for Complex Intraarticular Phalangeal Fractures

2004 ◽  
Vol 29 (1) ◽  
pp. 76-81 ◽  
Author(s):  
D. JOHNSON ◽  
E. TIERNAN ◽  
A. M. RICHARDS ◽  
R. P. COLE
Keyword(s):  
External Fixation ◽  
Joint Stiffness ◽  
Proximal Interphalangeal Joint ◽  
Joint Movement ◽  
Joint Mobilization ◽  
Fracture Dislocations ◽  
Impacted Fracture ◽  
Long Term Follow Up ◽  
Distal Interphalangeal ◽  
Phalangeal Fractures

Intraarticular phalangeal fractures are difficult to treat. The advantages of using dynamic external fixation devices include distraction of impacted fracture fragments and reduction in joint stiffness by allowing early joint mobilization. Previous reports have concentrated on pilon fractures and dorsal fracture dislocations affecting the proximal interphalangeal joint. We report our experience using a dynamic external spring fixator in the management of 15 patients with a variety of fracture patterns affecting the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints. In three cases the device spanned two adjacent joints. Long-term follow-up has shown excellent range of joint movement and no major complications. We consider that this device is an effective tool in the management of a range on complex intraarticular phalangeal fractures.

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

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

SURGICAL TREATMENT OF SEVERE FRACTURE DISLOCATIONS OF THE PROXIMAL INTERPHALANGEAL JOINT

Hand Surgery ◽  
1996 ◽  
Vol 01 (01) ◽  
pp. 31-35 ◽  
Author(s):  
Ueli Büchler
Keyword(s):  
Surgical Treatment ◽  
Internal Fixation ◽  
External Fixation ◽  
Bone Grafting ◽  
Open Reduction ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocations ◽  
Impacted Fracture ◽  
Severe Fracture

A method is presented for open reduction, bone grafting, minimal internal fixation and ancillary dynamic external fixation of unstable impacted fracture-dislocations of the proximal interphalangeal joint of the finger involving more than 40% of the surface of the joint plateau.

Swan-Neck Deformity as a Complication of the Agee Technique

1995 ◽  
Vol 20 (2) ◽  
pp. 255-257 ◽  
Author(s):  
M. L. RAWES ◽  
O. O. A. ONI
Keyword(s):  
Full Range ◽  
Proximal Phalanx ◽  
Joint Stiffness ◽  
Rubber Band ◽  
Proximal Interphalangeal Joint ◽  
Joint Movement ◽  
Fracture Dislocations ◽  
Pip Joint ◽  
Swan Neck Deformity ◽  
Force Couple

Unstable dorsal fracture dislocations of the PIP joint of a finger commonly result in joint stiffness following immobilization or open reduction and internal fixation (Green and Rowland, 1984). The Agee dynamic external fixator, or force couple splint (Agee, 1978Agee, 1987), was introduced in an attempt to avoid this complication and maintains a concentric reduction whilst allowing a full range of joint movement. The splint is constructed from three Kirschner wires and is activated by a single rubber band. A force couple is created across the proximal interphalangeal joint levering the base of the middle phalanx towards the palm whilst simultaneously lifting the distal end of the proximal phalanx dorsally to restore joint reduction. However, this technique is not without complications (Agee, 1987). We report a swan-neck deformity resulting from this treatment.

The S-Quattro in the Management of Acute Intraarticular Phalangeal Fractures of the Hand

2006 ◽  
Vol 31 (1) ◽  
pp. 79-92 ◽  
Author(s):  
W. KHAN ◽  
N. FAHMY
Keyword(s):  
Effective Technique ◽  
Good Tolerance ◽  
Joint Mobilization ◽  
Active Range Of Motion ◽  
Fixation Devices ◽  
Impacted Fracture ◽  
Distal Interphalangeal ◽  
The Mean ◽  
Phalangeal Fractures

Intraarticular phalangeal fractures of the hand are difficult and challenging to manage. Dynamic external fixation devices offer the advantages of allowing distraction of the impacted fracture and early joint mobilization. We present our study of 100 patients with a variety of fractures who were treated with the S-Quattro technique over a 6-year period, with an average follow-up of 10.5 months. The mean active range of motion regained was 92° for proximal interphalangeal joints (81 fractures), 82° for distal interphalangeal joints (10 fractures), 91° for metacarpophalangeal joints (6 fractures) and 80° for interphalangeal joints of the thumb (3 fractures). Only nine patients complained of mild or moderate pain. Postoperative radiographic appearances were satisfactory in all but five out of the 100 patients. This device is a simple and effective technique for the management of these difficult fractures. It offers advantages in terms of versatility, ease of application, good tolerance by patients, few complications and good outcome.

Dynamic intradigital external fixation for proximal interphalangeal joint fracture dislocations

2005 ◽  
Vol 30 (1) ◽  
pp. 154-160 ◽  
Author(s):  
Alejandro Badia ◽  
Felix Riano ◽  
Jessica Ravikoff ◽  
Roger Khouri ◽  
Eduardo Gonzalez-Hernandez ◽  
...  
Keyword(s):  
External Fixation ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Joint Fracture ◽  
Fracture Dislocations

scholarly journals Use of a Multivector Mandibular Distractor for Treatment of Pediatric Proximal Interphalangeal Joint Pilon Fractures: A Case-Based Review

2017 ◽  
Vol 10 (01) ◽  
pp. 006-011
Author(s):  
Rachel Pedreira ◽  
Brian Cho ◽  
Angela Geer ◽  
Ramon DeJesus
Keyword(s):  
Range Of Motion ◽  
External Fixation ◽  
Open Reduction ◽  
Early Stage ◽  
Joint Stiffness ◽  
Ring Finger ◽  
Proximal Interphalangeal Joint ◽  
Complete Healing ◽  
Salter Harris ◽  
Pilon Fractures

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.

scholarly journals Treatment for Acute Proximal Interphalangeal Joint Fractures and Fracture-Dislocations: A Systematic Review of the Literature

2020 ◽  
Vol 12 (S 01) ◽  
pp. S9-S15
Author(s):  
Arianna Gianakos ◽  
John Yingling ◽  
Christian M. Athens ◽  
Andrew E. Barra ◽  
John T. Capo
Keyword(s):  
External Fixation ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Volar Plate ◽  
Fracture Dislocation ◽  
Cochrane Library ◽  
Complication Rates ◽  
Recurrent Pain ◽  
Severity Of Injury ◽  
Fracture Dislocations

AbstractProximal interphalangeal joint (PIPJ) fractures and fracture-dislocations are common hand injuries and recognition of this injury pattern is essential in the management of these fractures. Although a variety of treatment options have been reported in the literature, the optimal treatment remains controversial. MEDLINE, EMBASE, and The Cochrane Library Database were screened for treatment strategies of PIPJ fracture and fracture-dislocation. Demographic data and outcome data were collected and recorded. A total of 37 studies including 471 patients and 480 fingers were reviewed. PIPJ range of motion (ROM) was greatest postoperatively in patients who underwent volar plate arthroplasty at 90.6 degrees. Dynamic external fixation resulted in the lowest PIP joint ROM with an average of 79.7 degrees. Recurrent pain and osteoarthritis were most often reported in extension block pinning at 38.5 and 46.2%, respectively. Open reduction and internal fixation had the highest rate of revision at 19.7%. Overall, the outcomes of PIP fractures and fracture-dislocations are based on the severity of injury, and the necessary treatment required. Closed reduction with percutaneous pinning and volar plate arthroplasty had good clinical and functional outcomes, with the lowest complication rates. Hemi-hamate arthroplasty and dynamic external fixation were utilized in more complex injuries and resulted in the lowest PIPJ ROM. This is a therapeutic, Level III study.

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