gms | German Medical Science

Objectives/Interrogation: Mobilization of proximal interphalangeal joint (PIP) with severe contracture is extremely difficult. We had used the external-fixator, but experienced several complications such as pin site fracture or recurrence of contracture. We modified original technique in order to avoid these complications. Here, we introduce our technique, post-operative management and outcomes.

Methods: Since 2007, we treated 35 fingers with severe flexion contracture of the PIP joint. The patients were divided into 2 groups; the most severe group(12 fingers)showed more than 80° of flexion contracture with long duration (> 3 yrs.), and sever group(23 fingers) showed less contracture with shorter period. Setting of fixator differed depending on each finger condition. At surgery, we only apply the fixator without open soft tissue release.

Post-operative management: 1st stage is a distraction phase; PIP was distracted in its flexed position by using strong elastic bands instead of rigid rod to avoid pin site fracture. 2nd stage is a correction phase to spread the range of movement (ROM); PIP was distracted either in extended or flexed position for more than 4 hours a day including sleeping time, respectively. 3rd stage is a stabilization phase to prevent the recurrence; PIP was stretched in extended or flexed position at maximum. Each stage takes a few weeks duration. At the end of the 2nd stage, we evaluated that the central slip was effective or not. Then we reconstructed the attenuated central slip, if necessary. After removal of fixator, night splint was applied at least 6 M.

Results and Conclusions: An average period of applying fixator was 8 weeks. The follow-up ranged 6 M to 97 M. The median active ROM improved from 4° to 32° in the most severe group and from 16° to 54° in the severe group. Nine fingers needed central slip reconstruction. Pin site infection and fracture were observed 4 and 6 fingers, respectively. Recurrence of the most severe cases after long duration (> 3 yrs.) was frequently observed, thereafter we changed the goal setting and strategy of each patient. We will show the changes of our strategy and methods.

The 1st stage is the most important. The joint distraction is achieved in contracted position up to obtaining 2-5 mm of sufficient joint space. In addition, usages of elastic tools (i.e. rubber bands, coil springs) provide safe and reliable traction and correction force.

Despite very severe contractures with various pathologies, we could improve joint motion with minimum complication.