Abstract
Open reduction and internal fixation is an option for treatment of PIP fracture-dislocations. The technique typically involves an open volar approach with placement of one or two 1.1–1.5 mm screws. This allows for restoration of the volar lip of the middle phalanx, which is the bony buttress to dorsal subluxation. The goal of fixation is to achieve a congruent joint and sufficient stability to allow for immediate active range of motion.
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Technical Pearls
If a 1.5 mm screw is used, a 1.1 mm K-wire (0.045 in.) is the same size as the drill bit used to place a 1.5 mm screw in a nonlag fashion. Two 1.1 mm K-wires can be placed in the fragment to stabilize it. One K-wire can be removed and a screw placed into that K-wire hole, while the second K-wire holds the bone stabilized. The second K-wire can then be likewise replaced with a screw. Likewise, if a 1.1 mm screw is used, a 0.7 mm (0.028 in.) K-wire can be used as a “drill.”
Be very careful to avoid additional comminution of the bone. You get one good chance to place the screw. Take your time!
Countersinking the screws can help to minimize the chance of the screws breaking through the cortex.
If the volar plate is left intact, it is difficult to evaluate the joint reduction. If the piece is not comminuted, joint alignment can be approximated by aligning the distal cortical edges of the fracture.
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Lincoski, C. (2016). ORIF with Screw Fixation. In: Adams, J. (eds) PIP Joint Fracture Dislocations. Springer, Cham. https://doi.org/10.1007/978-3-319-28579-5_7
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DOI: https://doi.org/10.1007/978-3-319-28579-5_7
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