scholarly journals Internal Fixation of Displaced Intra-articular Fractures of the Hallux Through a Dorsomedial Approach: A Technical Tip

2017 ◽  
Vol 11 (1) ◽  
pp. 77-81 ◽  
Author(s):  
Danilo Ryuko Cândido Nishikawa ◽  
Fernando Aires Duarte ◽  
Cesar de Cesar Netto ◽  
Augusto César Monteiro ◽  
Rômulo Ballarin Albino ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Interphalangeal Joint ◽  
Rigid Fixation ◽  
Degenerative Arthritis ◽  
Soft Tissue Envelope ◽  
Articular Fractures ◽  
Extensor Hallucis Longus ◽  
Joint Fractures ◽  
Phalangeal Fractures ◽  
Type Of Injury

Phalangeal fractures of the toes represent common injuries of the forefoot. In the hallux, most fractures occur at the distal phalanx and frequently result from a direct crushing type of injury. Intra-articular fractures of the hallux are usually treated nonoperatively, except when the fragments are displaced and the joint is incongruent. Displaced fractures treated nonoperatively can result in degenerative arthritis of the interphalangeal joint, causing pain and range of motion limitation, hindering gait and weightbearing. The aim of this study was to present an option of operative approach in the treatment of displaced interphalangeal joint fractures of the hallux, along the medial border of the extensor hallucis longus tendon. It is our understanding that this approach minimizes injury to the soft tissue envelope, allowing a rigid fixation and early weightbearing and range of motion. Levels of Evidence: Level V: Expert opinion

scholarly journals PO 18133 - Internal fixation of displaced intra-articular fractures of the hallux through a dorsomedial approach

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. S27
Author(s):  
Danilo Ryuko Cândido Nishikawa ◽  
Fernando Aires Duarte ◽  
Augusto César Monteiro ◽  
Bruno Rodrigues de Miranda ◽  
Guilherme Honda Saito ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Range Of Motion ◽  
Clinical Evaluation ◽  
Interphalangeal Joint ◽  
Rigid Fixation ◽  
Aofas Score ◽  
Articular Fractures ◽  
The Mean

Introduction: Intra-articular fractures of the hallux are usually treated nonoperatively, except when the fragments are displaced and the joint is incongruent. Displaced fractures treated nonoperatively can result in degenerative arthritis of the interphalangeal joint, causing pain and range of motion limitation. The aim of this study is to present the results of the surgical treatment of displaced interphalangeal joint (IPJ) fractures of the hallux using a dorsomedial approach. It is our understanding that this approach minimizes injury to the soft tissue envelope without the need to detach or create a tenotomy of the extensor hallucis longus tendon (EHL), allowing rigid fixation and early weight bearing and range of motion. Methods: A retrospective case series was performed of 5 patients with displaced IPJ fractures of the hallux treated with the dorsomedial approach from July 2013 to October 2017. Two patients were male and three female, with a mean age of 37,4 years and a mean follow-up of 36 months. The surgical indication for open reduction and internal fixation through a dorsomedial approach of the IPJ was displaced (>2 mm) bicondylar fractures of the proximal phalanx of the hallux. The incision was performed along the medial border of the EHL tendon without the need to detach or create a tenotomy of this tendon. In the postoperative period, follow-up included clinical evaluation and radiographic exams. All patients were assessed by visual analog scale (VAS) scores for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: All patients presented bone consolidation and returned to their previous activities without limitations. At the final follow-up, the mean VAS score was 0, and the mean AOFAS score was 92,6. Clinical evaluation revealed preservation of approximately 50% of the range of motion of the IPJ compared with the contralateral side. Conclusion: We concluded that a dorsomedial approach should be considered in the surgical management of displaced intra-articular fractures of the hallux. It preserves soft tissue and most of the IPJ motion, preventing postoperative joint pain and stiffness.

scholarly journals The Use of the S-Quattro Dynamic External Fixator for the Treatment of Intra-Articular Phalangeal Fractures: A Review of the Literature

2012 ◽  
Vol 6 (1) ◽  
pp. 54-59 ◽  
Author(s):  
J.S Bhamra ◽  
W.S Khan ◽  
P Pastides
Keyword(s):  
Range Of Motion ◽  
Functional Outcome ◽  
Current Literature ◽  
External Fixator ◽  
Operative Time ◽  
Rigid Fixation ◽  
Review Of The Literature ◽  
Poor Functional Outcome ◽  
Younger Patients ◽  
Phalangeal Fractures

Intra-articular phalangeal fractures are a common injury. If left untreated, these injuries can lead to poor functional outcome with severe dehabilitating consequences, especially in younger patients.The S-Quattro external fixator device (Surgicraft®, UK) can be used to treat such injuries. Its use has been widely documented and has shown many advantages in comparison to other conventional treatments. Advantages include reduced operative time, rigid fixation and early range of motion.We present a review of the current literature and use of the S-Quattro serpentine system in the management of intraarticular phalangeal fractures.

scholarly journals Dorsal Plating for Intra-articular Middle Phalangeal Base Fractures With Volar Instability

Hand ◽  
2018 ◽  
Vol 14 (5) ◽  
pp. 620-625 ◽  
Author(s):  
Travis A. Doering ◽  
Andrew S. Greenberg ◽  
David V. Tuckman
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fixation Method ◽  
Common Mechanism ◽  
Rigid Fixation ◽  
Retrospective Case ◽  
Active Motion ◽  
Dorsal Plating

Background: Intra-articular middle phalangeal base fractures with volar instability are rare injuries with scant literature on optimal management. Our purpose is to describe our method of dorsal plating and report postoperative outcomes. Methods: This study is a retrospective case review of 5 patients with intra-articular middle phalangeal base fractures with volar proximal interphalangeal joint instability, measuring subjective, clinical, and radiographic outcomes. Results: Patient age averaged 38.2 years (range, 23-56 years), and 80% were male. Sporting injuries were the most common mechanism (80%). Time to surgery averaged 7 days, and postoperative follow-up duration averaged 19.6 months (median 8 months). All fractures were intra-articular at the proximal interphalangeal joint with volar instability. There were no complications and no patients required secondary surgery. Grip strength was maintained and range of motion was good, based on the American Society for Surgery of the Hand Total Active Motion score. Average Quick Disability of the Arm, Shoulder and Hand was 0.5 (range, 0-2.3), 100% of patients were satisfied, and average visual analog pain score was 1.2. Patients returned to work at a median of 4 days. There was radiographic union at an average of 6.6 weeks (range, 6-7 weeks) in all fractures. Conclusions: Dorsal plating using a 1.5-mm modular hand plate is a viable option for rigid fixation of intra-articular middle phalangeal base fractures with volar instability. This fixation method allows for early range of motion without complications in this case series. All fractures united, and patients had minimal functional deficits and were able to maintain good range of motion.

Management of difficult intra-articular fractures or fracture dislocations of the proximal interphalangeal joint

2014 ◽  
Vol 40 (1) ◽  
pp. 16-23 ◽  
Author(s):  
E. Liodaki ◽  
S. G. Xing ◽  
P. Mailaender ◽  
F. Stang
Keyword(s):  
Articular Surface ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
External Fixators ◽  
Invasive Treatment ◽  
Articular Fractures ◽  
Joint Fractures ◽  
Fracture Dislocations ◽  
K Wires ◽  
Stable Reconstruction

Intra-articular fractures or fracture dislocations of the proximal interphalangeal joint are difficult clinically because the bone and soft tissue structures are small and intricate. Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand. This article reviews the current methods of treatment, together with the senior author’s experience in treating difficult proximal interphalangeal joint fractures and dislocations. Besides conservative treatments, surgical treatments include open or closed reduction with traditional Osteosynthesis, such as K-wires, screws or plates. Among recent developments are the percutaneous application of thin cannulated compression screws and novel dynamic external fixators. After a preferred minimally invasive treatment with stable reconstruction of the articular surface, sufficient aftercare is necessary to improve surgical outcomes.

Pins and Rubber Traction System for Intra-Articular Proximal Interphalangeal Joint Fractures Revisited

2010 ◽  
Vol 35 (5) ◽  
pp. 396-401 ◽  
Author(s):  
G. Debus ◽  
A. Courvoisier ◽  
S. Wimsey ◽  
P. Pradel ◽  
F. Moutet
Keyword(s):  
Learning Curve ◽  
Simple Procedure ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
System A ◽  
Articular Fractures ◽  
Joint Fractures ◽  
Joint Flexion ◽  
Traction System

The Pins and Rubber Traction System (PRTS) can be used to treat proximal interphalangeal intra-articular fractures. Our experience is that outcomes are not always excellent and that many patients have reduced joint function or residual deformities. The aim of this study was to evaluate the reasons behind the poorer outcomes of some of the patients treated with this system. A retrospective clinical and radiological evaluation was performed on 15 patients after a minimum of 2 years’ follow-up. The mean interphalangeal joint flexion range was 66° (range 0—100) in our series. The review of the literature shows an average active interphalangeal joint flexion of 78° (range 64—95). Reasons for this difference include preoperative delay, technical deficiencies, the learning curve, a lack in postoperative physiotherapy and degenerative changes due to the longer follow-up. Although the Pins and Rubber Traction System seems a simple procedure, a learning curve is necessary to avoid pitfalls.

scholarly journals THE TREATMENT OF EXTRA- AND INTRA-ARTICULAR FRACTURES THE DISTAL HUMERUS

2010 ◽  
Vol 16 (3) ◽  
pp. 96-102
Author(s):  
V. V. Klyuchevsky ◽  
Hassan Ben El Hafi
Keyword(s):  
Soft Tissues ◽  
Functional Results ◽  
Distal Humerus ◽  
Distal Segment ◽  
Rigid Fixation ◽  
Performance Score ◽  
Mayo Elbow Performance Score ◽  
Articular Fractures ◽  
Active Mobilization ◽  
Violent Acts

From 2005 to 2009 we treated 112 patients with fractures of distal segment of the humerus, 83 (74,10%) of them were injured when falling from the height of its own growth, 8 (7,14%) - in an accident, 6 (5,35%) - a fall from a height, 13 (11,6%) - in sports, and two - as a result of violent acts. In 97 (87%) cases the fractures were closed, in 15 (13%) - open. 19 patients were treated conservatively and 93 - operatively. Functional results were evaluated using the Mayo elbow performance score (MEPS) in 78,37% of patients. Results of the conservative method: excellent and good - 46,66%, and in all patients with type A without displacement - in 100%. The fair results - in 33% and the poor in 20% - with type В and C. The results of operative treatment: excellent and good - 90,41%, the fair results - in 9,58%, no poor results. Initial prevent the oedema and bleeding into joints and soft tissues, adequate rigid fixation of fractures with the maximal restoration of the elbow joint congruent without additional immobilization and early active mobilization is essential to prevent the elbow stiffness and achieve a good outcomes.

scholarly journals Surface Replacement Proximal Interphalangeal Joint Arthroplasty: A Case Series

Hand ◽  
2018 ◽  
Vol 14 (5) ◽  
pp. 669-674
Author(s):  
Pieter W. Jordaan ◽  
Duncan McGuire ◽  
Michael W. Solomons
Keyword(s):  
Patient Satisfaction ◽  
Range Of Motion ◽  
Retrospective Review ◽  
Case Series ◽  
Proximal Interphalangeal Joint ◽  
Joint Arthroplasty ◽  
Interphalangeal Joint ◽  
Surface Replacement ◽  
Significant Difference

Background: In 2012, our unit published our experience with a pyrocarbon proximal interphalangeal joint (PIPJ) implant. Due to high subsidence rates, a decision was made to change to a cemented surface replacement proximal interphalangeal joint (SR-PIPJ) implant. The purpose of this study was to assess whether the change to a cemented implant would improve the subsidence rates. Methods: Retrospective review of all patients who had a cemented SR-PIPJ arthroplasty performed from 2011 to 2013 with at least 12 months follow-up. Results: A total of 43 joints were included with an average follow-up of 26.5 months. There was a significant ( P = .02) improvement in arc of motion with an average satisfaction score of 3.3 (satisfied patient). Subsidence was noted in 26% of joints with a significant difference in range of motion ( P = .003) and patient satisfaction ( P = .001) between the group with and without subsidence. Conclusions: The change to a cemented implant resulted in satisfied patients with an improvement in range of motion. The rate of subsidence improved but remains unacceptably high.

Fractures of the Phalanges: Results of Internal Fixation Using 1.5mm and 2mm A. O. Screws

1987 ◽  
Vol 12 (1) ◽  
pp. 28-33
Author(s):  
D. J. FORD ◽  
S. EL-HADIDI ◽  
P. G. LUNN ◽  
F. D. BURKE
Keyword(s):  
Internal Fixation ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Active Movement ◽  
Flexion Deformity ◽  
The Mean ◽  
Condylar Fractures ◽  
Phalangeal Fractures ◽  
Mean Time

Thirty-six patients were treated for 38 phalangeal fractures using 1.5 mm and 2 mm A. O. screws. Plates were not used in the fingers. Oblique fractures of the condyles, shafts or bases of the proximal or middle phalanges were treated by internal fixation because of instability, displacement or rotation. 40% of fractures had associated skin wounds, were comminuted or had damage to the extensor mechanism. The mean duration of post-operative immobilization was 9 days and the mean time off work was 6 weeks. Total active movement in the involved ray was 220 degrees or greater in 24 cases, 180 degrees to 215 degrees in eight cases, and less than 180 degrees in two patients at follow up. The patients were reviewed between three and 54 months after treatment and the mean duration of follow up was 24 months. The most frequent complication was 10 degrees to 30 degrees of flexion deformity of the proximal interphalangeal joint after internal fixation of condylar fractures. Results were satisfactory in 90% of cases.

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