Abstract
Background
Quantitative 3-dimensional computed tomography (3DCT) analyses can provide a more detailed understanding of fracture morphology. For fracture-dislocation of the proximal interphalangeal joint, the extent of fragmentation of the volar lip of the middle phalanx—a factor that might influence treatment—is not always apparent from radiographs. We hypothesized that there is no correlation between number of fracture fragments and the percentage of articular surface area involved in intra-articular fractures of the base of the middle phalanx using quantitative 3DCT analyses.
Methods
We used 13 computed tomography scans with a slice thickness of 1.25 mm or less to create 3-dimensional models of 15 intra-articular fractures of the base of the middle phalanx in 13 patients. We resized 3-dimensional models of a non-fractured middle phalanx of the same hand to fit the fractured middle phalanx in order to approximate the size and shape of the fractured middle phalanx in its pre-injury state. We created a heatmap to demonstrate the location of the fractured articular surface.
Results
With the number of scans available, we did not find a significant correlation between the percentage of articular surface area involved and the number of fracture fragments. The median percentage of articular surface area involved was 46 % (range, 21–90 %). The heatmap demonstrated that the radio-volar side of the articular surface seems to be more involved than the ulnar-volar side in intra-articular fractures of the base of the middle phalanx.
Conclusion
Quantitative 3DCT analysis of fracture fragments provides useful information that could facilitate surgery and analysis of complex fractures of the base of the middle phalanx.
Level of Evidence: IV, Basic Science Study, Anatomic Study, Imaging.
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Conflict of Interest
Author (DR) has received consultancy fees from Wright Medical and Skeletal Dynamics. Author (DR) has received a speaker honorarium from AO North America and AO International. Author (DR) has received royalties from Wright Medical. Author (DR) owns stock in Illuminos. The other authors declare that they have no conflict of interest.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
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The study was approved by our institutional review board and a waiver of informed consent was obtained.
Ethical Review Committee Statement
A copy of the letter from our ethical committee approving this study is provided.
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Research performed at The Orthopaedic Hand and Upper Extremity Service of the Massachusetts General Hospital & Brigham and Women’s Hospital (Boston, USA)
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Janssen, S.J., ter Meulen, D.P., Hageman, M.G.J.S. et al. Quantitative 3-dimensional CT analyses of fractures of the middle phalanx base. HAND 10, 210–214 (2015). https://doi.org/10.1007/s11552-014-9665-3
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DOI: https://doi.org/10.1007/s11552-014-9665-3