Abstract
The treatment of unstable dorsal fracture dislocations (DFD) of the proximal interphalangeal (PIP) joint is a challenging clinical problem, particularly if the fracture of the palmar base of the middle is highly comminuted, or care is delayed. There is little high-level evidence available to guide the clinician in choosing among the numerous available therapeutic alternatives, although there is general agreement that restoration of the normal gliding motion of the base of the middle phalanx about the head of the proximal phalanx is required for a successful outcome. 1 McAuliffe J.A. Dorsal fracture dislocation of the proximal interphalangeal joint. J Hand Surg. 2008; 33A: 1885-1888 Google Scholar The available literature suggests that modest articular surface irregularity or minor dorsal displacement of the longitudinal axis of the middle phalanx relative to that of the proximal phalanx is generally well-tolerated so long as the base of the middle phalanx does not hinge or pivot on the head of the proximal phalanx. 2 Krakauer J.D. Stern P.J. Hinged device for fractures involving the proximal interphalangeal joint. Clin Orthop Relat Res. 1996; 327: 29-37 Crossref PubMed Scopus (80) Google Scholar , 3 Deitch M.A. Kiefhaber T.R. Comisar B.R. Stern P.J. Dorsal fracture dislocations of the proximal interphalangeal joint: surgical complications and long-term results. J Hand Surg. 1999; 24A: 914-923 Crossref Google Scholar
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