Abstract
Background
The proximal interphalangeal joint plays a crucial role in the function of the hand. It has been referred to as the anatomical and functional locus of finger function. Its injuries can cause significant loss of hand function and consequent disability. In this study, the functional and radiological results of the management of this fracture using a static external fixator with or without supplementary k wire fixation will be evaluated Patients and methods: From June 2010 to July 2012, there were 19 patients whom suffered from closed comminuted intra-articular proximal interphalangeal fracture injuries. The age of the patients at the time of injury ranged from 20 to 35 years, with a mean of 27 years. All the included patients had closed fractures with displaced articular cartilage surfaces and were treated using a static external fixator with or without supplementary k wire fixation.
Results
The mean follow up period was 18 months with a range from 12 to 24 months. The duration of bone healing till solid union ranged from 4 to 7 weeks, with a mean of 5 weeks. The mean ROM for the PIP at the follow- up evaluation was from 14.5° (range 5° to 25°) to 89.7° of flexion (range 80° to 95°). The mean visual analog pain scale averaged 1.95 ± 0.7. The mean TAM score for all treated fingers was 86.6 ± 5 (range 80–95). At final evaluation, no instability of the PIP was noted and all the cases showed satisfactory clinical and functional results of the affected finger.
Conclusions
Based on the clinical and radiological outcomes of this study at the final follow-up examination, it was found that the use of the static external fixator in the treatment of comminuted intra-articular proximal interphalangeal fracture is an adequate technique.
Similar content being viewed by others
References
Mansha M, Miranda S (2013) Early results of a simple distraction dynamic external fixator in management of comminuted intra-articular fractures of base of middle phalanx. J Hand Microsurg 5(2):63–67
Badia A, Riano F, Ravikoff J, Khouri R, Gonzalez-Hernandez E, Orbay JL (2005) Dynamic intradigital external fixation for proximal interphalangeal joint fracture dislocations. J Hand Surg [Am] 30(1):154–160
Bain GI, Mehta JA, Heptinstall RJ, Bria M (1998) Dynamic external fixation for injuries of the proximal interphalangeal joint. J Bone Joint Surg (Br) 80(6):1014–1019
Seno N, Hashizume H, Inoue H, Imatani J, Morito Y (1997) Fractures of the base of the middle phalanx of the finger classification, management and long-term results. J Bone Joint Surg (Br) 79(5):758–763
Dobyns JH, McElfresh EC (1994) Extension block splinting. Hand Clin 10(2):229–237
Deitch MA, Kiefhaber TR, Comisar BR, Stern PJ (1999) Dorsal fracture dislocations of the proximal interphalangeal joint: surgical complications and long-term results. J Hand Surg [Am] 24(5):914–923
De Smet L, Boone P (2002) Treatment of fracture-dislocation of the proximal interphalangeal joint using the Suzuki external fixator. J Orthop Trauma 16(9):668–671
Deshmukh SC, Kumar D, Mathur K, Thomas B (2004) Complex fracture-dislocation of the proximal interphalangeal joint of the hand. J Bone Joint Surg (Br) 86(3):406–412
Vidal J, Buscayret C, Coones H (1979) Treatment of articular fractures by “ligamentotaxis” with external fixation. In: Brooker E (ed) External fixator current state of art. William and Wilkins, Baltimore, p 75
Ellis SJ, Cheng R, Prokopis P, Chetboun A, Wolfe SW, Athanasian EA et al (2007) Treatment of proximal interphalangeal dorsal fracture-dislocation injuries with dynamic external fixation: a pins and rubber band system. J Hand Surg [Am] 32(8):1242–1250
De Soras X, de Mourgues P, Guinard D, Moutet F (1997) Pins and rubbers traction system. J Hand Surg (Br) 22(6):730–735
Suzuki Y, Matsunaga T, Sato S, Yokoi T (1994) The pins and rubbers traction system for treatment of comminuted intraarticular fractures and fracture-dislocations in the hand. J Hand Surg (Br) 19(1):98–107
Hynes MC, Giddins GE (2001) Dynamic external fixation for pilon fractures of the interphalangeal joints. J Hand Surg (Br) 26(2):122–124
Gaul SJ Jr, Rosenberg SN (1998) Fracture-dislocation of the middle phalanx at the proximal interphalangeal joint: repair with a simple intradigital traction-fixation device. Am J Orthop (Belle Mead NJ) 27(10):682–688
Libberecht K, Lafaire C, Van Hee R (2006) Evaluation and functional assessment of flexor tendon repair in the hand. Acta Chir Belg 106(5):560–565
Debus G, Courvoisier A, Wimsey S, Pradel P, Moutet F (2010) Pins and rubber traction system for intra-articular proximal interphalangeal joint fractures revisited. J Hand Surg Eur Vol 35(5):396–401
Hastings H 2nd, Carroll C 4th (1988) Treatment of closed articular fractures of the metacarpophalangeal and proximal interphalangeal joints. Hand Clin 4(3):503–527
Hastings H 2nd, Ernst JM (1993) Dynamic external fixation for fractures of the proximal interphalangeal joint. Hand Clin 9(4):659–674
Stern PJ, Roman RJ, Kiefhaber TR, McDonough JJ (1991) Pilon fractures of the proximal interphalangeal joint. J Hand Surg [Am] 16(5):844–850
Hamilton SC, Stern PJ, Fassler PR, Kiefhaber TR (2006) Mini-screw fixation for the treatment of proximal interphalangeal joint dorsal fracture-dislocations. J Hand Surg [Am] 31(8):1349–1354
Ruland RT, Hogan CJ, Cannon DL, Slade JF (2008) Use of dynamic distraction external fixation for unstable fracture-dislocations of the proximal interphalangeal joint. J Hand Surg [Am] 33(1):19–25
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shams, A., El-Sayed, M.M.H., Elsawy, M. et al. Treatment of comminuted intra-articular proximal interphalangeal joint fracture using static external fixation with or without supplementary Kirschner wires. Eur Orthop Traumatol 5, 355–361 (2014). https://doi.org/10.1007/s12570-014-0264-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12570-014-0264-0