Dorsolaterale Dislokation des proximalen Interphalangealgelenkes: Geschlossene Reposition und frühe aktive Mobilisation oder Gipsruhigstellung

Abstract

In this follow-up examination, the outcome of two conservative treatment regimens (immobilisation versus early active motion) were evaluated in 50 patients with dorsolateral dislocation of the proximal interphalangeal joint after a mean follow-up time of 7.9 years. The aim of this study was to prove whether early mobilisation results in better clinical outcome compared to prolonged immobilisation. In group A, 25 patients were treated by static splinting in a cast for four weeks. At follow-up, 21 patients were free of pain, three patients complained of pain following maximum loading and one patient experienced permanent pain. The mean range of motion was 89.4 degrees, the mean lack of extension was 12.7 degrees and the mean joint circumference was 3.4 mm thicker than the uninjured side. Pinch power was reduced to 78 % of the uninjured side. All joints were clinically stable. Degenerative arthritis was seen in five patients. In group B, 25 patients were treated by dorsal block splinting of the interphalangeal joint. The patients were allowed to extend their finger and to perform daily active exercises of the injured joint. At follow-up, eighteen patients were pain free, five experienced pain after maximum loading and two patients complained of permanent pain. The mean range of motion was 96.6 degrees, the mean limitation of extension was 5.3 degrees and the mean joint circumference was 4.1 mm thicker than on the uninjured side. Pinch power was reduced to 85 % of the uninjured side. All joints were clinically stable. Degenerative arthritis was seen in six patients. Early active motion following dorsolateral dislocation of the proximal interphalangeal joint leads to significantly superior results regarding the active range of motion and pinch power.