Tibial Sesamoid Graft as a Treatment for Chronic Unstable Proximal Interphalangeal Joint Fracture Dislocation, a New Surgical Technique

Mansour Oussama,Hellani Ali,Najdi Hassan,Zaarour Yousif,Zreik Houssein,Moussa Mohamad K

doi:10.36959/453/539

Abstract

Abstract Purpose This article reports a new surgical technique applied to treat a patient with chronic comminuted intra-articular volar middle phalanx base fracture of the 3rd finger. This technique uses the tibial sesamoid bone as an osteochondral graft and is characterized bya long-term follow-up. Methods The outcomes of the procedure applied on one patient before 10 years were evaluated clinically and radiographically. Besides that, the disabilities of the arm, shoulder and hand (DASH) scoreand the foot function index (FFI) score were used to grade respectively both his hand and foot. Results The patient had a full range of motion (ROM) 10 years after the surgery. DASH score was 0/100 while FFI was 0/170. Conclusion This technique was easy and cheap. It resulted in good clinical and functional outcomes with no complications 10 years post-operation. Level of Evidence Level IV

Highlights

Phalangeal fractures constitute 59% of all hand fractures
We describe a new surgical technique for the treatment of chronic unstable volar base fracture of the middle phalanx using the tibial sesamoid as an osteochondral graft to reconstruct the impacted volar articular surface of the middle phalangeal base
At week 2, the patient had a range of motion (ROM) of metacarpo-phalangeal joint (MCPJ) of (0°/100°) compared to (0°/100°) preoperatively, aROM of proximal interphalangeal joint (PIPJ) of (0°/100°) compared to (5°/45°) preoperatively, and a ROM of distal interphalangeal joint (DIPJ) of (10°/70°) compared to (0°/70°) preoperatively (Table 1)

Summary

Introduction

Phalangeal fractures constitute 59% of all hand fractures. Amongst which, the middle phalanx represents 14% of fractures and the middle finger is involved in 17% of cases [1]. Proximal interphalangeal joint (PIPJ) fracture dislocation is not an uncommon injury in hand traumatology. These involve 3 basic patterns including dorsal dislocation with volar lip fragment, volar dislocation with dorsal lip fragment and pilon fracture. Volar base fracture with dorsal subluxation of the middle phalanx is the most common type [2]. As a matter of fact, the fracture recently mentioned above is usually caused by longitudinal compression force with the PIPJ in flexion impacting the volar articular surface of middle phalange against dorsal condyle of proximal phalange [2]. The restoration of the articular surface, stable reduction and safe early mobilization are the main goals of any treatment used. Stable injuries could be successfully treated conservatively [3] whereas, in unstable injuries, the treatment is usually surgical [2]

Objectives

Results

Discussion

Conclusion