“Dynamic External Fixation for Proximal Interphalangeal Fracture-Dislocations”

Abstract

Proximal interphalangeal fracture-dislocations and pilon fractures of the middle phalanx represent a conundrum for hand surgeons. Goals of treatment are to: (1) maintain a stable congruent joint, (2) reduce intra-articular step-offs, and (3) prevent stiffness. Because the fragments of the middle phalanx are small, internal fixation is difficult and often impossible. Options other than internal fixation include hemi-hamate arthroplasty, volar plate arthroplasty, extension block pinning, and dynamic external fixation. Techniques for dynamic external fixation of the digit for the treatment of proximal interphalangeal fracture-dislocations and pilon fractures have evolved since first reported in 1946 by Robertson et al. In 1989, Slade et al developed a fixator that uses 3 Kirschner wires and dental rubber bands. Several groups have since published favorable outcomes using this technique. We have used this technique for the past 10 years at our institution and have had similar encouraging results. The present article describes the indications, operative technique, and postoperative protocol used by the authors. A brief review of results and complications are presented, and 2 illustrative case examples are provided.