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Adult Phalangeal Base Fractures: Pilons, Avulsions, PIPJ Fracture-Dislocations

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Pediatric and Adult Hand Fractures

Abstract

Traumatic injuries to the phalangeal base and proximal interphalangeal (PIP) joint are incredibly challenging. Common sequelae of PIP joint injuries include stiffness, pain, and loss of function. Expedient diagnosis, appreciation for local anatomy, and appropriate treatment are imperative to optimize patient outcomes. The purpose of this chapter is to review the anatomy, diagnosis, and treatment options in managing phalangeal base and PIP joint injuries.

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References

  1. Karl JW, Olson PR, Rosenwasser MP. The epidemiology of upper extremity fractures in the United States, 2009. J Orthop Trauma. 2015;29(8):e242–4.

    Article  PubMed  Google Scholar 

  2. Ootes D, Lambers KT, Ring DC. The epidemiology of upper extremity injuries presenting to the emergency department in the United States. Hand (N Y). 2012;7(1):18–22.

    Article  PubMed  Google Scholar 

  3. Stanton JS, Dias JJ, Burke FD. Fractures of the tubular bones of the hand. J Hand Surg Eur Vol. 2007;32(6):626–36.

    Article  CAS  PubMed  Google Scholar 

  4. Hoang D, Vu CL, Jackson M, Huang JI. An anatomical study of metacarpal morphology utilizing CT scans: evaluating parameters for antegrade intramedullary compression screw fixation of metacarpal fractures. J Hand Surg Am. 2021;46(2):149.e1–8.

    Article  PubMed  Google Scholar 

  5. Bain GI, Polites N, Higgs BG, Heptinstall RJ, McGrath AM. The functional range of motion of the finger joints. J Hand Surg Eur Vol. 2015;40(4):406–11.

    Article  CAS  PubMed  Google Scholar 

  6. Minami A, An KN, Cooney WP, Linscheid RL, Chao EY. Ligament stability of the metacarpophalangeal joint: a biomechanical study. J Hand Surg Am. 1985;10(2):255–60.

    Article  CAS  PubMed  Google Scholar 

  7. Dy CJ, Tucker SM, Kok PL, Hearns KA, Carlson MG. Anatomy of the radial collateral ligament of the index metacarpophalangeal joint. J Hand Surg Am. 2013;38(1):124–8.

    Article  PubMed  Google Scholar 

  8. Dumont C, Albus G, Kubein-Meesenburg D, Fanghänel J, Stürmer KM, Nägerl H. Morphology of the interphalangeal joint surface and its functional relevance. J Hand Surg Am. 2008;33(1):9–18.

    Article  PubMed  Google Scholar 

  9. Minamikawa Y, Horii E, Amadio PC, Cooney WP, Linscheid RL, An KN. Stability and constraint of the proximal interphalangeal joint. J Hand Surg Am. 1993;18(2):198–204.

    Article  CAS  PubMed  Google Scholar 

  10. Caravaggi P, Shamian B, Uko L, Chen L, Melamed E, Capo JT. In vitro kinematics of the proximal interphalangeal joint in the finger after progressive disruption of the main supporting structures. Hand (N Y). 2015;10(3):425–32.

    Article  PubMed  Google Scholar 

  11. Hogan CJ, Nunley JA. Posttraumatic proximal interphalangeal joint flexion contractures. J Am Acad Orthop Surg. 2006;14(9):524–33.

    Article  PubMed  Google Scholar 

  12. Bogumill GP. A morphologic study of the relationship of collateral ligaments to growth plates in the digits. J Hand Surg Am. 1983;8(1):74–9.

    Article  CAS  PubMed  Google Scholar 

  13. Leibovic SJ, Bowers WH. Anatomy of the proximal interphalangeal joint. Hand Clin. 1994;10(2):169–78.

    Article  CAS  PubMed  Google Scholar 

  14. Nicholson LT, Hill JR, McKnight B, Heckmann N, Stevanovic M, Ghiassi A. Redefining zone ii: anatomy of the flexor digitorum superficialis insertion. Hand (N Y). 2019;14(3):377–80.

    Article  PubMed  Google Scholar 

  15. Clavero JA, Alomar X, Monill JM, et al. MR imaging of ligament and tendon injuries of the fingers. Radiographics. 2002;22(2):237–56.

    Article  PubMed  Google Scholar 

  16. Graham KS, Goitz RJ, Kaufmann RA. Curvatures of the DIP joints of the hand. Hand (N Y). 2014;9(4):522–8.

    Article  PubMed  Google Scholar 

  17. Shrewsbury MM, Johnson RK. Ligaments of the distal interphalangeal joint and the mallet position. J Hand Surg Am. 1980;5(3):214–6.

    Article  CAS  PubMed  Google Scholar 

  18. Craig SM. Anatomy of the joints of the fingers. Hand Clin. 1992;8(4):693–700.

    Article  CAS  PubMed  Google Scholar 

  19. Chepla KJ, Goitz RJ, Fowler JR. Anatomy of the flexor digitorum profundus insertion. J Hand Surg Am. 2015;40(2):240–4.

    Article  PubMed  Google Scholar 

  20. Schweitzer TP, Rayan GM. The terminal tendon of the digital extensor mechanism: part II, kinematic study. J Hand Surg Am. 2004;29(5):903–8.

    Article  PubMed  Google Scholar 

  21. Shum C, Bruno RJ, Ristic S, Rosenwasser MP, Strauch RJ. Examination of the anatomic relationship of the proximal germinal nail matrix to the extensor tendon insertion. J Hand Surg Am. 2000;25(6):1114–7.

    Article  CAS  PubMed  Google Scholar 

  22. Janssen SJ, Ter Meulen DP, Hageman MGJS, Earp BE, Ring D. Quantitative 3-dimensional CT analyses of fractures of the middle phalanx base. Hand (N Y). 2015;10(2):210–4.

    Article  PubMed  Google Scholar 

  23. Chitnis SS, Chitnis SL. Indication for CT following index finger metacarpophalangeal joint dislocation—a case report. Trauma Case Rep. 2018;18:31–6.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wolfe SW, Katz LD. Intra-articular impaction fractures of the phalanges. J Hand Surg Am. 1995;20(2):327–33.

    Article  CAS  PubMed  Google Scholar 

  25. Faccioli N, Foti G, Barillari M, Atzei A, Mucelli RP. Finger fractures imaging: accuracy of cone-beam computed tomography and multislice computed tomography. Skelet Radiol. 2010;39(11):1087–95.

    Article  Google Scholar 

  26. Rubin DA, Kneeland JB, Kitay GS, Naranja RJ. Flexor tendon tears in the hand: use of MR imaging to diagnose degree of injury in a cadaver model. AJR Am J Roentgenol. 1996;166(3):615–20.

    Article  CAS  PubMed  Google Scholar 

  27. Drapé JL, Silbermann-Hoffman O, Houvet P, et al. Complications of flexor tendon repair in the hand: MR imaging assessment. Radiology. 1996;198(1):219–24.

    Article  PubMed  Google Scholar 

  28. Drapé JL, Dubert T, Silbermann O, Thelen P, Thivet A, Benacerraf R. Acute trauma of the extensor hood of the metacarpophalangeal joint: MR imaging evaluation. Radiology. 1994;192(2):469–76.

    Article  PubMed  Google Scholar 

  29. Hinke DH, Erickson SJ, Chamoy L, Timins ME. Ulnar collateral ligament of the thumb: MR findings in cadavers, volunteers, and patients with ligamentous injury (Gamekeeper’s thumb). AJR Am J Roentgenol. 1994;163(6):1431–4.

    Article  CAS  PubMed  Google Scholar 

  30. Read JW, Conolly WB, Lanzetta M, Spielman S, Snodgrass D, Korber JS. Diagnostic ultrasound of the hand and wrist. J Hand Surg Am. 1996;21(6):1004–10.

    Article  CAS  PubMed  Google Scholar 

  31. Allen GM, Drakonaki EE, Tan MLH, Dhillon M, Rajaratnam V. High-resolution ultrasound in the diagnosis of upper limb disorders: a tertiary referral centre experience. Ann Plast Surg. 2008;61(3):259–64.

    Article  CAS  PubMed  Google Scholar 

  32. Bajaj S, Pattamapaspong N, Middleton W, Teefey S. Ultrasound of the hand and wrist. J Hand Surg Am. 2009;34(4):759–60.

    Article  PubMed  Google Scholar 

  33. Lee SA, Kim BH, Kim S-J, Kim JN, Park S-Y, Choi K. Current status of ultrasonography of the finger. Ultrasonography. 2016;35(2):110–23.

    Article  PubMed  Google Scholar 

  34. Champagne N, Eadie L, Regan L, Wilson P. The effectiveness of ultrasound in the detection of fractures in adults with suspected upper or lower limb injury: a systematic review and subgroup meta-analysis. BMC Emerg Med. 2019;19(1):17.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Eaton RG. Joint injuries of the hand. Springfield, IL: Charles C. Thomas; 1971. p. 9–34.

    Google Scholar 

  36. Hastings H, Carroll C. Treatment of closed articular fractures of the metacarpophalangeal and proximal interphalangeal joints. Hand Clin. 1988;4(3):503–27.

    Article  PubMed  Google Scholar 

  37. Krakauer JD, Stern PJ. Hinged device for fractures involving the proximal interphalangeal joint. Clin Orthop Relat Res. 1996;327:29–37.

    Article  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  39. Kang R, Stern PJ. Fracture dislocations of the proximal interphalangeal joint. J Am Soc Surg Hand. 2002;2(2):47–59.

    Article  Google Scholar 

  40. Akagi T, Hashizume H, Inoue H, Ogura T, Nagayama N. Computer simulation analysis of fracture dislocation of the proximal interphalangeal joint using the finite element method. Acta Med Okayama. 1994;48(5):263–70.

    CAS  PubMed  Google Scholar 

  41. Thompson JS, Eaton RG. Volar dislocation of the proximal interphalangeal joint. J Hand Surg. 1977;2:232.

    Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  44. Salter RB. The physiologic basis of continuous passive motion for articular cartilage healing and regeneration. Hand Clin. 1994;10(2):211–9.

    Article  CAS  PubMed  Google Scholar 

  45. Morgan JP, Gordon DA, Klug MS, Perry PE, Barre PS. Dynamic digital traction for unstable comminuted intra-articular fracture-dislocations of the proximal interphalangeal joint. J Hand Surg Am. 1995;20(4):565–73.

    Article  CAS  PubMed  Google Scholar 

  46. Calfee RP, Sommerkamp TG. Fracture-dislocation about the finger joints. J Hand Surg Am. 2009;34(6):1140–7.

    Article  CAS  PubMed  Google Scholar 

  47. Phair IC, Quinton DN, Allen MJ. The conservative management of volar avulsion fractures of the P.I.P. joint. J Hand Surg Br. 1989;14(2):168–70.

    Article  CAS  PubMed  Google Scholar 

  48. Lee S, Jang SJ, Jeon SH. Factors related to failure of conservative treatment in volar plate avulsion fractures of the proximal interphalangeal joint. Clin Orthop Surg. 2020;12(3):379–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Gaine WJ, Beardsmore J, Fahmy N. Early active mobilisation of volar plate avulsion fractures. Injury. 1998;29(8):589–91.

    Article  CAS  PubMed  Google Scholar 

  50. McElfresh EC, Dobyns JH, O’Brien ET. Management of fracture-dislocation of the proximal interphalangeal joints by extension-block splinting. J Bone Joint Surg Am. 1972;54(8):1705–11.

    Article  CAS  PubMed  Google Scholar 

  51. Kuczynski K. The proximal interphalangeal joint. Anatomy and causes of stiffness in the fingers. J Bone Joint Surg Br. 1968;50(3):656–63.

    Article  CAS  PubMed  Google Scholar 

  52. Viegas SF. Extension block pinning for proximal interphalangeal joint fracture dislocations: preliminary report of a new technique. J Hand Surg Am. 1992;17(5):896–901.

    Article  CAS  PubMed  Google Scholar 

  53. Newington DP, Davis TR, Barton NJ. The treatment of dorsal fracture-dislocation of the proximal interphalangeal joint by closed reduction and Kirschner wire fixation: a 16-year follow up. J Hand Surg Br. 2001;26(6):537–40.

    Article  CAS  PubMed  Google Scholar 

  54. Vitale MA, White NJ, Strauch RJ. A percutaneous technique to treat unstable dorsal fracture-dislocations of the proximal interphalangeal joint. J Hand Surg Am. 2011;36(9):1453–9.

    Article  PubMed  Google Scholar 

  55. Aladin A, Davis TRC. Dorsal fracture-dislocation of the proximal interphalangeal joint: a comparative study of percutaneous Kirschner wire fixation versus open reduction and internal fixation. J Hand Surg Br. 2005;30(2):120–8.

    Article  CAS  PubMed  Google Scholar 

  56. Hamilton SC, Stern PJ, Fassler PR, Kiefhaber TR. Mini-screw fixation for the treatment of proximal interphalangeal joint dorsal fracture-dislocations. J Hand Surg Am. 2006;31(8):1349–54.

    Article  PubMed  Google Scholar 

  57. Grant I, Berger AC, Tham SKY. 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 

  58. Yousaf O, Yousaf IS, Giladi AM, Katz RD. Syringe external fixator: an inexpensive static-to-dynamic treatment for comminuted intra-articular phalangeal fractures. Tech Hand Up Extrem Surg. 2020;24(3):126–30.

    Article  PubMed  Google Scholar 

  59. 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 

  60. Kastenberger T, Kaiser P, Keller M, Schmidle G, Gabl M, Arora R. Clinical and radiological midterm outcome after treatment of pilonidal 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 

  61. 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 

  62. Deshmukh SC, Kumar D, Mathur K, Thomas B. Complex fracture-dislocation of the proximal interphalangeal joint of the hand. Results of a modified pins and rubbers traction system. J Bone Joint Surg Br. 2004;86(3):406–12.

    Article  CAS  PubMed  Google Scholar 

  63. Eaton RG, Malerich MM. Volar plate arthroplasty of the proximal interphalangeal joint: a review of ten years’ experience. J Hand Surg Am. 1980;5(3):260–8.

    Article  CAS  PubMed  Google Scholar 

  64. Dionysian E, Eaton RG. The long-term outcome of volar plate arthroplasty of the proximal interphalangeal joint. J Hand Surg Am. 2000;25(3):429–37.

    Article  CAS  PubMed  Google Scholar 

  65. Ozer K. Temporary bridge plate fixation of pilon fractures of the proximal interphalangeal joint. J Hand Surg Am. 2019;44(6):524.e1–6.

    Article  PubMed  Google Scholar 

  66. Selverian S, Jones CM. Case report: bridge plating for unstable pip fracture dislocation. Arch Bone Jt Surg. 2020;8(6):739–43.

    PubMed  PubMed Central  Google Scholar 

  67. Hastings H, Capo J, Steinberg B, Stern P. Hemicondylar hamate replacement arthroplasty for proximal interphalangeal joint fracture/dislocations. Presented at the 54th Annual Meeting of the American Society for Surgery of the Hand; Boston, MA, 2–4 Sept, 199.

    Google Scholar 

  68. Williams RMM, Hastings H, Kiefhaber TR. Pip fracture/dislocation treatment technique: use of a hemi-hamate resurfacing arthroplasty. Tech Hand Up Extrem Surg. 2002;6(4):185–92.

    Article  PubMed  Google Scholar 

  69. Podolsky DJ, Mainprize J, McMillan C, Binhammer P. Suitability of using the hamate for reconstruction of the finger middle phalanx base: an assessment of cartilage thickness. Plast Surg (Oakv). 2019;27(3):211–6.

    Article  PubMed  Google Scholar 

  70. Capo JT, Hastings H, Choung E, Kinchelow T, Rossy W, Steinberg B. Hemicondylar hamate replacement arthroplasty for proximal interphalangeal joint fracture dislocations: an assessment of graft suitability. J Hand Surg Am. 2008;33(5):733–9.

    Article  PubMed  Google Scholar 

  71. Calfee RP, Kiefhaber TR, Sommerkamp TG, Stern PJ. Hemi-hamate arthroplasty provides functional reconstruction of acute and chronic proximal interphalangeal fracture-dislocations. J Hand Surg Am. 2009;34(7):1232–41.

    Article  CAS  PubMed  Google Scholar 

  72. Henry M. Prosthetic hemi-arthroplasty for post-traumatic articular cartilage loss in the proximal interphalangeal joint. Hand (N Y). 2011;6(1):93–7.

    Article  PubMed  Google Scholar 

  73. Criner KT, Ilyas AM. Silicone arthroplasty for chronic proximal interphalangeal joint dislocations. Tech Hand Up Extrem Surg. 2011;15(4):209–14.

    Article  PubMed  Google Scholar 

  74. Jones BF, Stern PJ. Interphalangeal joint arthrodesis. Hand Clin. 1994;10(2):267–75.

    Article  CAS  PubMed  Google Scholar 

  75. Stern PJ, Gates NT, Jones TB. Tension band arthrodesis of small joints in the hand. J Hand Surg Am. 1993;18(2):194–7.

    Article  CAS  PubMed  Google Scholar 

  76. Hussain HM, Roth AL, Sultan AA, Anis HK, Stern PJ. Nonunion and reoperation following proximal interphalangeal joint arthrodesis and associated patient factors. Hand (N Y). 2022;17(3):566–71. Published online 8 Aug 2020.

    Article  PubMed  Google Scholar 

  77. Leibovic SJ, Strickland JW. Arthrodesis of the proximal interphalangeal joint of the finger: comparison of the use of the Herbert screw with other fixation methods. J Hand Surg Am. 1994;19(2):181–8.

    Article  CAS  PubMed  Google Scholar 

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Aziz, K.T., London, D.A., Stern, P.J. (2023). Adult Phalangeal Base Fractures: Pilons, Avulsions, PIPJ Fracture-Dislocations. In: Abzug, J.M., Gaston, R.G., Osterman, A.L., Tosti, R.J. (eds) Pediatric and Adult Hand Fractures. Springer, Cham. https://doi.org/10.1007/978-3-031-32072-9_15

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