Surgical treatment of unstable fracture-dislocations of the proximal interphalangeal joint

Abstract

The purpose of this study was to evaluate the results of surgical treatment of unstable fracture-dislocations of the proximal interphalangeal (PIP) joint. The study included 13 patients (12 males, 1 female; mean age 31 years, range 23 to 48 years) with dorsal fracture-dislocations of the PIP joint. Six patients were treated with open reduction and internal fixation using 1.2-mm titanium screws within the first week of injury. In seven patients with late presentation, time from injury to surgery ranged from 21 to 56 days (mean 37 days). Of these, one was treated with mini screws, four with bone anchors, and two with mini screws and bone anchors. The mean follow-up period was 21.5 months (range 12 to 48 months). Radiographic union was achieved in all the patients. The range of motion of the PIP joint was 73.4 degrees (range 50 degrees -90 degrees ) on the affected side, and 91.9 degrees (range 90 degrees -100 degrees ) on the normal side. Patients presenting early and late had significantly different range of motion of the injured fingers (84.1 degrees and 64.2 degrees , respectively; p<0.05). The mean flexion contracture of the injured fingers was 13 degrees (range 0 degrees -30 degrees ). There was no significant difference with regard to the PIP joint motion between patients treated with mini screws and soft tissue reconstruction. The mean grip strengths were 45.7 kg and 49.3 kg on the affected and normal sides, respectively. Four patients had degenerative signs in the PIP joint and one patient with late-presentation developed subluxation. Four patients complained of limitation of mild degree at work or in daily activities. Treatment of fracture-dislocations of the PIP joint yields successful results with mini screws in early cases or appropriate injuries, and with soft tissue reconstruction with or without mini screws in late-presenting patients or unfavorable injuries.