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Simplified Kirschner‑wire-based dynamic external fixator for unstable proximal interphalangeal joint fractures

  • Original Article
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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Ligamentotaxis is a well-established treatment modality for treating challenging articular fractures. Many devices have been evolved to apply this principle to complex proximal interphalangeal joint (PIPJ) fractures. Although they gave satisfactory results, these devices were sometimes costly, complex and cumbersome. The aim of this study was to evaluate the short-term functional and radiological outcomes of treating complex intra-articular PIPJ fractures using a simplified, preloaded Kirschner‑wire (K‑wire)-based dynamic external fixator.

Methods

Twenty consecutive patients with intraarticular PIPJ fractures, who fulfilled the study selection criteria, have been treated during 2018 and included in this prospective study after the approval of the responsible institutional ethics committee. Plain radiographs were used for assessing fracture reduction, congruity and healing. The visual analogue sore (VAS) and the Michigan Hand Outcome Questionnaire (MHQ) were used for functional evaluation. PIPJ range of motion (ROM) and hand grip-strength were also assessed.

Results

At the final follow-up, all patients had no residual pain. The average PIPJ-ROM was 76.4 ± 23.51°, and the average grip-strength was 85 ± 13.95% as compared to the healthy side. The mean normalized MHQ score was 83 ± 12.63 points, with 4, 13, and 3 patients had excellent, good, and fair results retrospectively. Complications included pin tract infection (one case), stress fracture related to the applied wires (one case), and flexion contractures (four cases; three of them were symptomatic).

Conclusions

The used fixator technique is simple, reliable, available, reproducible, time-saving and cost-effective for managing complex PIPJ fractures while allowing early joint mobilization, which proven effective in achieving high satisfactory functional results.

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Data availability

The datasets used and analyzed during this study are available from the corresponding author on reasonable request.

References

  1. Haase SC, Chung KC. Current concepts in treatment of fracture-dislocations of the proximal interphalangeal joint. Plast Reconstr Surg. 2014;134(6):1246–57.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Caggiano NM, Harper CM, Rozental TD. Management of proximal interphalangeal joint fracture dislocations. Hand Clin. 2018;34(2):149–65.

    Article  PubMed  Google Scholar 

  3. Demino C, Yates M, Fowler JR. Surgical Management of Proximal Interphalangeal Joint Fracture-Dislocations: A Review of Outcomes. Hand (N Y). 2019 Sep 13:1558944719873152. doi: 10.1177/1558944719873152. [Epub ahead of print].

  4. Kiefhaber TR, Stern PJ. Fracture dislocations of the proximal interphalangeal joint. J Hand Surg Am. 1998;23(3):368–80 (Review).

    Article  CAS  PubMed  Google Scholar 

  5. Stern PJ, Roman RJ, Kiefhaber TR, McDonough JJ. Pilon fractures of the proximal interphalangeal joint. J Hand Surg Am. 1991;16:844–50.

    Article  CAS  PubMed  Google Scholar 

  6. Freiberg A. Management of proximal interphalangeal joint injuries. Can J Plast Surg. 2007;15(4):199–203.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hynes MC, Giddins GE. Dynamic external fixation for pilon fractures of the interphalangeal joints. J Hand Surg Br. 2001;26(2):122–4.

    Article  CAS  PubMed  Google Scholar 

  8. Syed AA, Agarwal M, Boome R. Dynamic external fixator for pilon fractures of the proximal interphalangeal joints: a simple fixator for a complex fracture. J Hand Surg Am. 2003;28B(2):137–41.

    Article  Google Scholar 

  9. Ellis SJ, Cheng R, Prokopis P, et al. Treatment of proximal interphalangeal dorsal fracture-dislocation injuries with dynamic external fixation : a pins and rubber band system. J Hand Surg Am. 2007;32(8):1242–50.

    Article  PubMed  Google Scholar 

  10. Abou Elatta MM, Assal F, Basheer HM, El Morshidy AF, Elglaind SM, Abdalla MA. The use of dynamic external fixation in the treatment of dorsal fracture subluxations and pilon fractures of finger proximal interphalangeal joints. J Hand Surg Am. 2017;42(2):182–7.

    Article  CAS  Google Scholar 

  11. Awad GA, Everton F, Downs M, et al. Outcomes of the use of Ligamentotaxor® for proximal interphalangeal fractures of the hand: North Bristol hand centre experience. Eur J Plast Surg. 2018;41(5):613–6.

    Article  Google Scholar 

  12. Kastenberger T, Kaiser P, Keller M, Schmidle G, Gabl M, Arora R. Clinical and radiological midterm outcome after treatment of pilonoidal fracture dislocations of the proximal interphalangeal joint with a parabolic dynamic external fixator. Arch Orthop Trauma Surg. 2020;140(1):43–50.

    Article  CAS  PubMed  Google Scholar 

  13. Chung KC, Pillsbury MS, Waiters MR, Hayward RA, Arbor A. Reliability and validity testing of the michigan hand outcomes questionnaire. J Hand Surg Am. 1998;23(4):575–87.

    Article  CAS  PubMed  Google Scholar 

  14. Schenck RR. Dynamic traction and early passive movement for fractures of the proximal interphalangeal joint. J Hand Surg Am. 1986;11(6):850–8.

    Article  CAS  PubMed  Google Scholar 

  15. Inanami H, Ninomiya S, Okutsu I, Tarui T, Fujiwara N. Dynamic external finger fixator for fracture dislocation of the proximal interphalangeal. J Hand Surg Am. 1993;18:160–4.

    Article  CAS  PubMed  Google Scholar 

  16. Suzuki Y, Matsunaga T, Sato S, Yokoi T. The pins and rubbers traction system for treatment of comminuted intraarticular fractures and fracture dislocations of the proximal interphalangeal joints of the hand. J Hand Surg Br. 1994;19(1):98–107 (Erratum in: J Hand Surg [Br] 1994 Jun; 19(3):408).

    Article  CAS  PubMed  Google Scholar 

  17. Ruland RT, Hogan CJ, Cannon DL, Slade JF. Use of dynamic distraction external fixation for unstable fracture dislocations of the proximal interphalangeal joint. J Hand Surg Am. 2008;33(1):19–25.

    Article  PubMed  Google Scholar 

  18. Curtis MH, Steve KL, Scott WW. Dynamic external fixation for proximal interphalangeal-fracture dislocation. Oper tech orthop. 2012;22:142–50.

    Article  Google Scholar 

  19. Borgohain B, Borgohain N, Tittal P. Double parabolic Kirschner-wires as dynamic distractor for treatment of unstable intraarticular phalangeal fractures of hand. Indian J Orthop. 2012;46(6):680–4.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Stephanie S, Lawrence EW. Proximal interphalangeal joint fracture-dislocations: external fixation of pip joint dorsal fracture-dislocations: a clinical casebook. Ed: Adams JE., Springer International Publishing, Switzerland; 2016. pp. 57–72.

  21. Theivendran K, Pollock J, Rajaratnam V. Proximal interphalangeal joint fractures of the hand: treatment with an external dynamic traction device. Ann Plast Surg. 2007;58(6):625–9.

    Article  CAS  PubMed  Google Scholar 

  22. Kostoris F, Canton G, Longo E, Romano F, Murena L. Treatment of dorsal fracture-dislocation of the proximal interphalangeal joint using the Ligamentotaxor device: clinical and radiographic preliminary results. Acta Biomed. 2017;88(4S):90–5.

    PubMed  PubMed Central  Google Scholar 

  23. Kodama A, Sunagawa T, Nakashima Y, et al. Joint distraction and early mobilization using a new dynamic external finger fixator for the treatment of fracture-dislocations of the proximal interphalangeal joint. J Orthop Sci. 2018;23(6):959–66.

    Article  PubMed  Google Scholar 

  24. Yang G, McGlinn EP, Chung KC. Management of the stiff finger: evidence and outcomes. Clin Plast Surg. 2014;41(3):501–12.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Grant I, Berger AC. Tham SK Internal fixation of unstable fracture dislocations of the proximal interphalangeal joint. J Hand Surg Br. 2005;30(5):492–8.

    Article  CAS  PubMed  Google Scholar 

  26. Mangelson JJ, Stern P, Abzug JM, Chang J, Osterman AL. Complications following dislocations of the proximal interphalangeal joint. J Bone Joint Surg Am. 2013;95(14):1326–32.

    PubMed  Google Scholar 

  27. Kamnerdnakta S, Huetteman HE, Chung KC. Complications of proximal interphalangeal joint injuries: prevention and treatment. Hand Clin. 2018;34(2):267–88.

    Article  PubMed  PubMed Central  Google Scholar 

  28. De Soras X, De Mourgues P, Guinard D, Moutet F. Pins and rubbers traction system. J Hand Surg. 1997;22B:730–5.

    Article  Google Scholar 

  29. Hastings H 2nd, Ernst JM. Dynamic external fixaton for fractures of the proximal interphalangeal joint. Hand Clin. 1993;9(4):659–74.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopedic and Traumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

    Mostafa Naguib, Mohammed Ramadan, Tarek Ali & Ahmad El-Tantawy

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  1. Mostafa Naguib
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  2. Mohammed Ramadan
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  3. Tarek Ali
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  4. Ahmad El-Tantawy
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Contributions

The authors certify that the submission to this work is original and that they have full power to enter into this agreement. Neither this work nor a similar work has been published or submitted, nor shall it be submitted for publication elsewhere while under consideration by the European Journal of trauma and emergency surgery. All authors have substantially contributed to the design, execution, and analysis of the study. They have reviewed and confirmed the accuracy of the whole manuscript. Authors did not receive any money for this research.

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Correspondence to Mostafa Naguib.

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Conflict of interest

Author 1, Author 2, Author 3 and Author 4 declared that there is no conflict of interest in this study.

Ethics approval and consent to participate

All procedures followed were in accordance with the ethical standards of the responsible local institutional committee on human experimentation and with the Helsinki declaration of 1964 and its later amendments. Informed consents were obtained from all patient before their participation. Every patient was given a code number and his anonymity was preserved (his personal data was omitted). This study has been approved by the ethical research committee of the Faculty of Medicine-Tanta University under the code: 32402.

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Naguib, M., Ramadan, M., Ali, T. et al. Simplified Kirschner‑wire-based dynamic external fixator for unstable proximal interphalangeal joint fractures. Eur J Trauma Emerg Surg 48, 71–79 (2022). https://doi.org/10.1007/s00068-020-01443-9

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  • DOI: https://doi.org/10.1007/s00068-020-01443-9

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