Article
Preliminary experience with the litos/ dynamic finger distractor for proximal interphalangeal joint fracture dislocations
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Authors
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Hannes Granberg
- Sahlgrenska University Hospital, Department of Hand Surgery, Gothenburg, Sweden
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Allan Ibsen-Sørensen
- Sahlgrenska University Hospital, Department of Hand Surgery, Gothenburg, Sweden
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Peter Axelsson
- Sahlgrenska University Hospital, Department of Hand Surgery, Gothenburg, Sweden
| Published: | February 6, 2020 |
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Outline
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Objectives: We aimed to establish clinical and radiographic outcomes of unstable proximal interphalangeal (PIP) joint fractures treated with the litos/ finger distractor device.
Methods: We retrospectively reviewed notes of 18 consecutive cases of patients with unstable fractures involving the PIP joint. We recorded infections and re-operations. Active range of motion was reviewed at 4-6 weeks and at 8-12 weeks. Joint defects of more than 1mm and incongruity were assessed using plain radiographs.
Results: A total of 10 men and 8 women with an average age of 34.5 (range 17-65) years were included. The average extension lag at 4-6 weeks, before removal of the distractor, was 20° (0-50) with active flexion to 65° (40-90). At 8-12 weeks post operatively was 20° (5-55) and 75° (60-95) respectively. Out of the 18 cases, one required a re-operation due to surgical issue and there were five superficial pin site infections requiring a course of oral antibiotics. Two joint surfaces had a step >1mm and four a defect of >1mm. Two patients had subluxed joints on follow up x-rays following removal of the distractor.
Conclusions: Fractures involving the PIP joints of the fingers are difficult fractures to manage surgically with unpredictable outcomes. These fractures are frequently complicated by dislocation of the joint, which demands distraction to align the joint surfaces yet allowing early motion in order to prevent stiffness. There are multiple methods for addressing this but many are technically demanding. The litos/ finger joint distractor offers an alternative in a ready-made package. This system relies on three K-wires and two spring-loaded adjustable distractors holding the reduction while allowing movement of the PIP joint immediately after the operation (Figure 1 [Fig. 1]).
The litos/finger joint distractor system was relatively easy to use and the post-operative range of motion and the radiographic results were good considering the type of injury. There was a substantial amount of complications but only one required surgical intervention.
