Article
Open reduction and internal fixation for dorsal fracture dislocation of the proximal interphalangeal joint: a series of 35 cases
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Authors
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Masayoshi Ikeda
- Tokai University School of Medicine, Shona Central Hospital, Isehara, Kanagawa, Japan
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Yuka Kobayashi
- Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Ikuo Saito
- Tokai University School of Medicine, Isehara Kyodo Hospital, Isehara, Kanagawa, Japan
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Ayuko Shimizu
- Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Takayuki Ishii
- Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Daisuke Nakajima
- Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Masahiko Watanabe
- Tokai University School of Medicine, Isehara, Kanagawa, Japan
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: We describe a surgical technique for unstable fracture dislocations of the proximal interphalangeal (PIP) joint using a low-profile mini-plate, review of 35 patients treated by this technique, and discuss the factors affecting patient outcomes.
Methods: After reducing the dorsal subluxation of the PIP joint, the depressed articular surface was reduced and the volar fragment was fixed using a low-profile mini-plate through the volar approach. Postoperative motion exercise was started after a few days.
Active motion of the PIP joint, total active interphalangeal joint motion, and Strickland's scoring scale, and Gaine's outcome assessment were used to evaluate the results. Clinical assessments were considered satisfactory when they were either excellent or good. Analysis of the categorical factors was performed using Fisher's exact test with p-values set at 0.05.
Results and Conclusions: Bony union was obtained in all cases. Twelve patients had persistent postoperative swelling of the PIP joint, which was managed with short-term steroids. Dynamic splints were applied 4 weeks postoperatively for patients with delayed recovery. The articular involvement was averaged 54.6%. Six patients had concomitant injuries. The mean age was 38.1 years (range, 13-82 years). The mean periods from injury to operation was 11.3 days (range, 1-60 days) and postoperative follow-up period averaged 11.5 months (range, 6-24 months). Active motion of the PIP joint averaged 85.5 ° (range, 45°-104°), flexion contracture averaged 10.8° (range, 0°-40°), and total active interphalangeal joint motion averaged 81.0% (range, 41.7%-100%) after surgery. Overall, 22 patients had satisfactory outcomes and 13 had unsatisfactory outcomes. Patient age, the time from injury to surgery, and concomitant injuries, such as an associated mallet injury, were found to be significantly associated with outcomes. Additionally, the control of persistent postoperative swelling was important for joint function.
This technique catches the volar fragment rigidly between the dorsal cortex and the mini-plate, allowing the possibility for early joint motion. Several factors were associated with poor functional results, including older age, delayed surgery, and concomitant injuries. Additionally, the management of early PIP joint swelling improved joint motion.
