Results of fracture-dislocation of interphalangeal treatment with volar buttressing hook plating techniques

Abstract

IntroductionProximal interphalangeal joint (PIP) is one of the joints exposed to upper limb injury. The dorsal fracture-dislocations of the PIP is a common injury. Treatment of cases with small avulsed bone fragments is challenging. Stable fixation with rapid recovery is important in these patients. HypothesisVolar buttress plating a new technique in treatment of the dorsal proximal interphalangeal joint fracture dislocations but the results of it is unknown. MethodsIn this case series, 21 patients with dorsal fracture-dislocations of the proximal interphalangeal were studied. We used a volar hook plate buttressing technique so that fixation was done by low-profile 2-mm stainless steel hook plate with a 1.5-mm screw. Range of motion movements, power and grip strength were measured after 3 months. At end of follow-up period, functional outcome was determined by the visual analogue scale, Quick Disabilities of the Arm, Shoulder, and Hand. ResultsAfter three-month follow-up a union of fractures occurred in all of the patients. There were no complications, such as infection, digital nerve injuries or flexor tendon rupture. The joints range of motion were stable and had no restrictions. Postoperative range of motion outcome in 19 (90.5%) patients was 85.7±13.2 degree which was not significantly different from opposite side on other hand (p=0.1). In two patients range of motion was 65.5±5.4 degree and painful. Postoperative pain in 19 patients was 2.5±0.8 so that there was no pain in 17(76.2%) patients, three (14.1%) patients had mild pain and two (9.5%) patients had moderate pain (5.4±1.2). Two patients complained of plate irritation of especially at end of proximal intrphalangeal flexion. ConclusionClinical application of hook plate buttressing technique induced stable fixation and rapid recovery. Because of maintaining articular congruity and restoring anatomically, this technique associated with good outcomes. Level of EvidenceIV, Therapeutic study.