Functional Outcome of Dynamic Distraction External Fixation of Proximal Interphalangeal Joint Fracture-Dislocation

Abstract

Abstract Introduction: Proximal Interphalangeal (PIP) Joint fracture dislocation commonly observed to involve one or both the condyles of proximal phalanx or base of middle phalanx. Clinical aspects of PIP joint fracture dislocation typically include pain, swelling, and restricted movements over the site of the lesion. Achieving functional and painless range of motion at the PIP joint is a reasonable outcome. The ideal goal for treating these comminuted intra-articular fractures of the PIP joint is to achieve anatomical reduction and stable fixation of the fracture fragments combined with traction followed by early mobilization to prevent joint stiffness. Thereby, the purpose of this study is to evaluate the effectiveness of dynamic external traction systems to allow both reduction of fracture fragments by capsule-ligamentotaxis and early mobilization. Materials and Methods: A total of thirty patients with PIP joint fracture dislocation who were operated with a dynamic external traction system were assessed as a part of the study between the period of December 2019 and July 2021. All the patients included in the study showed a PIP joint fracture dislocation on anteroposterior and lateral radiographs of the 2nd, 3rd, 4th, or 5th phalanx. All patients were operated for PIP joint fracture dislocation with dynamic external traction system under general anesthesia or regional block under fluoroscopy guidance and assessed for functional outcome postoperatively according to Ishida scoring system. Results: According to Ishida scoring system, our study observed 19 (63.33%) cases with excellent outcome, 6 (20%) cases with good, 4 (13.33%) cases with fair, and 1 (3.33%) case with poor outcome compared to a study conducted by Ishida et al., which observed 9 (39.13%) cases with excellent outcome, 6 (26.08%) with good, and 6 (26.08%) with fair outcomes each and 2 (0.08%) cases with poor outcome. Conclusion: In this prospective study, we have concluded that the dynamic distraction external fixation of PIP joint fracture dislocation is a good method for obtaining early rehabilitation of the patient with minimal complications. The technique ensures an anatomic reduction, stable fixation, good union, and early mobilization with good and fast recovery. However, this is a small study and requires a larger sample size for definitive conclusion.