Treatment of acute perilunate dislocation or fracture dislocation using dorsal approach and diamond-shaped Kirschner-wire fixation

ABSTRACTTrapezium fractures and dislocations of the trapezium are both extremely rare injuries whether they occured with or without fractures of the surrounding bones. Specific radiological images can be difficult to help for the diagnosis. CT scan may be necessary for the diagnosis and adequate treatment. We are presenting an unusual case of volar and radial isolated trapezium dislocation concomitant second metacarpal basis fracture in which is treated by using open reduction and Kirschner wire fixation. In our case, isolated dislocation of trapezium was a result of violent and direct trauma. Different techniques have been proposed to achieve a stable fixation and the treatment outcomes. In our case, open reduction, Kirschner wire fixation and intercarpal ligament repair through dorsal approach are recommended for satisfactory outcomes in similiar cases.

Download Full-text

The Treatment of Dorsal Fracture-Dislocation of the Proximal Interphalangeal Joint by Closed Reduction and Kirschner Wire Fixation: A 16-Year Follow Up

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2001.0698 ◽

2001 ◽

Vol 26 (6) ◽

pp. 537-540 ◽

Cited By ~ 44

Author(s):

D. P. NEWINGTON ◽

T. R. C. DAVIS ◽

N. J. BARTON

Keyword(s):

Closed Reduction ◽

Articular Surface ◽

Kirschner Wire ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Fracture Dislocation ◽

Long Term Results ◽

Kirschner Wire Fixation ◽

Wire Fixation

Ten patients who had sustained 11 unstable dorsal fracture-dislocations of finger proximal interphalangeal joints were reviewed at a mean follow-up of 16 years. All had been treated acutely by closed reduction and transarticular Kirschner wire fixation of the proximal interphalangeal joint, without any attempt at reduction of the fracture of the base of the middle phalanx, which probably involved 30–60% of the articular surface. Seven of the ten patients complained of no finger pain or stiffness, and none complained of severe pain. There was a mean fixed flexion deformity of 81 at the proximal interphalangeal joint, which had a mean arc of movement of 851. Although subchondral sclerosis and mild joint space narrowing were observed in some instances, there were no severe degenerative changes. These results confirm that this technique is a reliable treatment method for these injuries, and produces satisfactory long-term results.

Download Full-text

HEMI-HAMATE ARTHROPLASTY VERSUS TRANSARTICULAR KIRSCHNER WIRE FIXATION FOR UNSTABLE DORSAL FRACTURE-DISLOCATION OF THE PROXIMAL INTERPHALANGEAL JOINT IN THE HAND

Hand Surgery ◽

10.1142/s0218810415500161 ◽

2015 ◽

Vol 20 (01) ◽

pp. 115-119 ◽

Cited By ~ 6

Author(s):

R. C. Barksfield ◽

B. Bowden ◽

A. J. Chojnowski

Keyword(s):

Bone Grafting ◽

Kirschner Wire ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Fracture Dislocation ◽

Kirschner Wire Fixation ◽

Wire Fixation ◽

Fracture Dislocations ◽

Fixed Flexion Deformity

Following the introduction of the hemi-hamate arthroplasty (HHA) technique to our unit, we sought to evaluate the early clinical outcomes achieved with this method of fixation and compare these with simple trans-articular Kirschner wire (K-wire) fixation for dorsal fracture dislocations (DFD) of the proximal interphalangeal joint (PIPJ). Ninteen patients underwent fixation of these injuries with either K-wire fixation (12/19) or hemi-hamate bone grafting (7/19) between 2005 and 2011. At a mean follow-up of 14 weeks median arc of movement at the PIPJ was 65° (range 31° to 108°) following HHA and 56° (range 9° to 85°) (p = 0.82) following temporary transarticular K-wire fixation. Median fixed flexion deformity (FFD) was 20° and 15° for hemi-hamate bone grafting and K-wire fixation respectively. Based upon our findings, transarticular K-wire fixation produced equivalent outcomes to HHA for unstable DFD of the PIPJ in the hand.

Download Full-text

Dorsal Fracture–Dislocation of the Proximal Interphalangeal Joint: A Comparative Study of Percutaneous Kirschner Wire Fixation Versus Open Reduction and Internal Fixation

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2004.10.011 ◽

2005 ◽

Vol 30 (2) ◽

pp. 120-128 ◽

Cited By ~ 54

Author(s):

A. ALADIN ◽

T. R. C. DAVIS

Keyword(s):

Internal Fixation ◽

Closed Reduction ◽

Open Reduction ◽

Kirschner Wire ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Fracture Dislocation ◽

Cerclage Wire ◽

Kirschner Wire Fixation ◽

Wire Fixation

Nineteen patients with a dorsal fracture–dislocation of the proximal interphalangeal joint of a finger were treated with either closed reduction and transarticular Kirschner wire fixation (eight cases) or open reduction and internal fixation, using either one or two lag screws (six cases) or a cerclage wire (five cases). At a mean follow-up of 7 (range 6–9) years, most patients reported satisfactory finger function, even though some of the injuries healed with proximal interphalangeal joint incongruency (seven cases) or subluxation (four cases). Those treated by open reduction complained of more “loss of feeling” in the affected finger and those specifically treated by cerclage wire fixation reported more cold intolerance and had a significantly larger fixed flexion deformity (median, 30°: range 18–38°) and a smaller arc of motion (median, 48°: range 45–60°) at the proximal interphalangeal joint, despite having the best radiological outcomes. Closed reduction and transarticular Kirschner wire fixation produced satisfactory results, with none of the eight patients experiencing significant persistent symptoms despite a reduced arc of proximal interphalangeal joint flexion (median=75°; range 60–108°). The results of this relatively simple treatment appear at least as satisfactory as those obtained by the two techniques of open reduction and internal fixation, both of which were technically demanding.

Download Full-text