Article
Volar fracture subluxation of PIP joint: A rare injury with a novel technique for treatment
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Authors
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Ahmed Naeem Atiyya
- Ain Shams University, Cairo, Egypt
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Ramy Ahmed Soliman
- Ain Shams University, Cairo, Egypt
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Islam Koriem
- Ain Shams University, Cairo, Egypt
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Hasan Abd El Hamid
- Ain Shams University, Cairo, Egypt
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Mohamed Elbishbishi
- Ain Shams University, Cairo, Egypt
| Published: | February 6, 2020 |
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Outline
Text
Objectives/Interrogation: The volar fracture-dislocations of the proximal phalangeal joint (PIP) of the fingers, the so-called "central slip fractures", are both rare and challenging. They are treated operatively by using either k wires, mini-screws, miniplates, external fixators or anchors. Sometimes open reduction and fixation is technically demanding because of the small size of the fragment or due to its comminuted nature. We introduce a novel technique in treating volar fracture subluxation/dislocation of the PIP joints. We used a 2mm mini-plate as a blocking plate to wedge the central avulsion fragment back to its position till union. We hypothesized that this technique would simplify the surgery and yield favorable functional and radiographic results.
Methods: We present a prospective case series comprised of 8 patients (5 females and 3 males) with volar fracture dislocation/subluxation of the PIP joint. The patients were managed by the index technique within an average of 15.4 days following the injury (range, 1 -27 days). Clinical outcome measurements included assessment of pain (visual analog score) and range of motion. Radiographic outcome measurements included reduction of subluxationl/dislocation, articular congruity, and occurrence of arthritic changes
Results: The length of the follow up averaged 15 months (range, 8-24 months). Union was obtained in all cases in an average of 4.2 weeks (range, 3-5 weeks). The visual analog score was 1.6 (range, 0-3). Postoperative proximal interphalangeal motion averaged 74 degrees (range, 55-90 degrees). Reduction of the subluxation/dislocation was obtained in all cases. There was articular incongruity in one patient. No arthritic changes were noticed during the whole follow up period. Complications included superficial infection of the wound (one case), limited flexion of distal interphalangeal joint (DIP) (3 cases), and mild extension lag of DIP (10-20 degrees) was noticed in 6 patients.
Conclusion: The index technique yields satisfactory outcome at the short term. The technique is simple and straightforward. It can be an addition in treating these challenging cases.
