Fracture-dislocations Of Proximal Interphalangeal Joint Research Articles

A Percutaneous Triple K-Wire Fixation Technique for Nascent Malunion of Proximal Interphalangeal Joint Fracture-Dislocation: A Case Series With an Assessment of Functional Outcome

Fracture-dislocations of the proximal interphalangeal (PIP) joint are difficult to manage. In the case of a 2- to 4-week delay in definitive treatment, a nascent malunion may result. This study aimed to evaluate the effectiveness of the percutaneous triple K-wire technique for treatment of the PIP joint nascent malunion. We treated 13 patients with nascent malunion of PIP joint fracture-dislocations using the percutaneous triple K-wire fixation technique based on the principle of soft callus manipulation to achieve congruity and reduction in the joint. The study included cases where the percentage of articular involvement exceeded 40% and in whom there was a minimum follow-up of 12 months. At the final follow-up, we measured the range of motion at the PIP joint. The Ishida and Ikuta scores were determined. The mean period between injury and surgery was 17.2 days. The average follow-up time was 14.2 months. The mean active arc of motion before surgery in the PIP joint was 15 degrees and that at the final follow-up was 83 degrees. Seven patients achieved excellent outcomes according to the Ishida and Ikuta scores. The final postoperative range of motion at the PIP joint was comparable with that reported in the literature for patients who underwent different procedures. This procedure can be considered a viable alternative to open reduction and plating, hemihamate arthroplasty, and ligamentotaxis with distraction, particularly in the presence of nascent malunion. Therapeutic IV.

Can the result of untreated Proximal Interphalangeal fracture-dislocation be satisfied?

Objectives: The aim of this study is to examine the clinical outcomes of untreated proximal interphalangeal (PIP) fracture-dislocations, a condition known to often result in poor outcomes even if treated appropriately. Methods: A retrocpective analysis was conducted on a 22-year-old male patient presenting with an untreated fracture of the fourth finger of his dominant hand. The patient sustained the injury at the age 16, and while initial X-ray images were unavailable, subsequent imaging revealed features consistent with a proximal interphalangeal joint fracture-dislocation. The patient initially received a finger splint following the trauma but susbsequently discontinued its use and failed to attend follow-up controls. Results: Radiographic evaluation revealed deformity at the base of the middle phalanx, characterized by slight dorsal subluxation and dorsal osteophyte formation. However, physical examination revealed no discernible cosmetic or functional deficits, no signs of joint instability, and the range of motion was found to be complete and painless. Conclusion: Despite the absence of conventional tratment, our patient exhibited notably positive clinical outcomes. However, we emphasize the importance of caution against leaving proximal interphalangeal fracture-dislocations untreated, given the lack of definitive evidence supporting this approach.

Results of an Adjustable Traction Method Using Surgical Gloves and K-Wires for the Treatment of Proximal Interphalangeal Joint Fracture Dislocation

This study aimed to evaluate an adjustable traction method using surgical gloves and Kirschner wires (K-wires) for proximal interphalangeal (PIP) fracture dislocations and examine the association between a reduction pin and range of motion (ROM), and between subluxation immediately after removal and ROM. Patients who underwent this surgical method for PIP joint dislocation fractures between 2003 and 2017 were included. We retrospectively investigated the postoperative results. We defined patients having surgery within 4 weeks after an injury as fresh cases and after 4 weeks as chronic cases. K-wires were inserted at the center of the proximal phalangeal head and the distal part of the middle phalanx to create a frame, and the finger of the surgical glove was used as a traction-force generator. We analyzed the association of ROM with each finger, age, presence of a reduction pin, and subluxation immediately after frame removal. Overall, 37 fingers were included (27 acute and 10 chronic). The mean age of the participants was 40.0 years (range: 13-72 years). The mean follow-up period was 10.5 months (3-47 months). The final active ROM was -4.6°/94.6° (extension/flexion) for acute cases and -27.0°/73.5° for chronic ones. Active ROM was significantly better in patients with a reduction pin than in those without it. Subluxation immediately after frame removal was not associated with postoperative active ROM. Additionally, all PIP joints with subluxation that occurred immediately after frame removal achieved good joint congruity. The results of the adjustable traction method using surgical gloves and K-wires were satisfactory. Postoperative ROM did not decrease because of the additional reduction pin. Subluxation occurring immediately after frame removal did not affect the ROM, ultimately resulting in good joint congruity. Therapeutic IV.

Hemi-hamate arthroplasty for the management of chronic proximal interphalangeal joint fracture dislocations: Analysis of 21 cases in Indian population and review of the literature

BackgroundChronic fracture-dislocations involving the proximal interphalangeal (PIP) joint are challenging cases. We conducted this study to analyze the outcomes following hemi-hamate autograft reconstruction of such injuries and to compare our results with the existing literature. MethodsA retrospective analysis of 21 patients with chronic dorsal PIP fracture-dislocations that were managed with hemi-hamate autograft reconstruction was done. The average articular surface involvement was 64%. The average duration between injury and surgery was 9.4 weeks (range, 6–16). Quick DASH (Disabilities of Shoulder and Hand) scores, VAS (Visual Analog Scale) scores, range of motion of the PIP joints, DIP (distal interphalangeal) joints, and MCP (metacarpophalangeal) joints were measured during serial follow-up visits. ResultsUnion and graft incorporation was seen in all cases. The average Quick DASH score at four weeks post-surgery was 66 and it improved to eight at one year (p-value<0.05). The average VAS score at four weeks post-surgery was 7.66 and it improved to 2.09 at one year (p-value<0.05). The mean flexion of the MCP joint improved from 52.85° at the end of four weeks to 72.38° at one year (p-value<0.05). The average flexion at the PIP joint improved from 10.47° at the end of four weeks to 70.47° at one year (p-value<0.05). The average DIP flexion improved from 38.33° at the end of four weeks to 62.38° at one year (p-value<0.05). The average hand grip strength was 85% of the normal side. ConclusionHemihamate autograft reconstruction is a suitable procedure for the management of chronic PIP joint fracture-dislocations, especially in cases with extensive involvement of the articular surface. Level of evidenceIII.

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

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.

Press-Fit Hemihamate Arthroplasty for the Proximal Interphalangeal Joint.

Background Chronic proximal interphalangeal joint fracture-dislocations with articular malunion are complex injuries. Hemihamate arthroplasty is an established technique for the management of both acute and chronic cases but is associated with several complications. We present the clinical experience of modified press-fit hemihamate arthroplasty. Description of Technique The base of the middle phalanx was exposed from the volar side, and the cartilage defect of the proximal interphalangeal joint (PIPJ) was evaluated in the hyperextended position. A bone hole was created slightly toward the volar side to recreate the curvature of the PIPJ. The hemihamate osteochondral graft was harvested and fixed into the bone hole in a press-fit manner without using a screw. The volar plate and flexor tendon sheath were then reattached. Patients and Methods The study included three patients with chronic dorsal fracture-dislocations of the PIPJ. All patients were treated for >6 weeks after the injury (average 11 weeks). Results The average total arc of motion of the affected joint improved from 38 degrees before surgery to 80 degrees after surgery. Radiographically, bone union and congruity of the joint surface were achieved in all the patients. None of the treated patients complained of resting pain and reported minimal pain during activity (average visual analog scale 0.5; range 0-1.4). Conclusions Press-fit hemihamate arthroplasty is a safe and effective procedure for treating chronic PIPJ fracture-dislocations without the risk of screw protrusion.

Comparison of 3 Dynamic External Fixation Devices for Proximal Interphalangeal Joint Dorsal Fracture-Dislocations in a Cadaver Model

Several improvised dynamic external fixation devices are used for treating unstable dorsal proximal interphalangeal (PIP) joint fracture-dislocations. We compared the effectiveness of 3 constructs for simulated dorsal PIP joint fracture-dislocations in a cadaver model. We tested 30 digits from 10 fresh-frozen, thawed cadaver hands. We aimed to remove the palmar 50% of the base of each digit's middle phalanx (P2), simulating an unstable dorsal PIP joint fracture-dislocation. Each PIP joint was then stabilized via external fixation with either a pins-and-rubber-bands construct, pins-only construct, or tuberculin syringe-pins construct. We allocated 10 digits per fixation group. The finger tendons were secured to a computer-controlled stepper motor-driven linear actuator. Via this mechanism, all PIP joints were taken through 1,400 cycles of flexion-extension. With the PIP joint in neutral extension, we measured the P2 dorsal translation at baseline, after fixator stabilization, and after the motion protocol. The actual mean P2 palmar defect created was 48% of the base. All PIP joints were unstable after creating the defect, with a mean initial P2 dorsal displacement of 3.7 mm. After application of the fixators, all PIP joint dislocations were reduced. The median residual P2 dorsal displacements were 0.0 mm for the pins-rubber bands group, 0.1 mm for the pins-only group, and 0.5 mm for the syringe-pins group. There were no cases of PIP joint redislocation after flexion-extension cycling, and the median dorsal P2 displacements were 0.0 mm for the pins-rubber bands group; 0.0 mm for the pins-only group; and 0.5 mm for the syringe-pins group. All 3 external fixators restored PIP joint stability following simulated dorsal fracture-dislocation, with all reductions maintained after motion testing. The syringe-pins construct had significantly greater median residual P2 dorsal displacement after the initial reduction and motion testing, which is of unclear clinical importance. This study informs surgeon decision-making when considering dynamic external fixator options for dorsal PIP joint fracture-dislocations.

218 Compliance With the British Society for Surgery of the Hand (BSSH) Guidelines on the Management of Open Hand Fractures Audit

Abstract Aim British Society of Surgery of the Hand (BSSH) have defined standards for managing open hand fractures. We intended to ascertain our and referring peripheral units’ adherence with BSSH’s standards of care in managing open hand fractures and determine the associated morbidity. Method We performed a 6-month prospective audit reviewing clinical records of patients referred to our department with open hand fractures, to determine whether: antibiotic prophylaxis had been started, and discontinued at definitive closure; wound washout and closure had been performed within 24 hours of injury; patients had continued rehabilitation with hand therapists. Results 25 patients sustained open hand fractures in this period. All patients, except 1 who declined, received antibiotic prophylaxis. 19 (76%) had a wound washout and closure within 24 hours of injury. Antibiotic prophylaxis was discontinued at time of definitive closure in theatre in 3 (12%) patients. The remaining 21 patients continued antibiotic prophylaxis beyond 72 hours. 3 (12%) patients developed a wound infection, 2 (6%) of these requiring debridement and irrigation in theatre. Both patients had proximal interphalangeal joint fracture dislocations who underwent a wound debridement within 24 hours of injury, 1 of which was secondary to an animal bite. 22 (88%) patients attended their hand therapy appointment. Conclusions The incidence of deep infection requiring subsequent operative debridement remains low in open hand fractures, despite the substandard adherence to BSSH’s recommendations. Educating colleagues will improve the adherence to guidance. The BSSH hand injury triage app fulfils this purpose. We intend to raise awareness and encourage its use.

Hamate vs. capitate grafting for proximal interphalangeal joint fracture-dislocation: an MRI-based study of 35 hands.

We examined the MRI scans of 35 adult hands to assess the feasibility of the hamate and the capitate as potential donor grafts in the management of comminuted intra-articular fractures at the base of the middle phalanges. Essentially neither the hamate nor the capitate were perfect anatomic matches in most digits, but the capitate had the advantage of having more uniform facets, and the capitate facet shapes were similar to those of the little finger. The measurement of angles in the coronal and sagittal plane showed that in some respects the differences between the potential graft and the base of the middle phalanges were smaller for the capitate than for the hamate. Moreover, the sagittal morphology of the capitate made it less prone to joint overstuffing than the hamate. We conclude that the capitate may be considered as a graft donor in selected cases, especially for the little finger.

Extension-Block Pinning for Unstable Dorsal Proximal Interphalangeal Joint Fracture-Dislocations: A Simple, Percutaneous Technique With Reproducible Outcomes.

Proximal interphalangeal (PIP) joint fracture-dislocations can be technically challenging injuries to treat, and no technique has proven to be superior nor lead to predictably good outcomes. We describe our experience of treating unstable dorsal fracture-dislocations of the PIP joint with extension-block pinning (EBP) at our institution over a 22-year period. In all, 23 patients with 24 unstable dorsal fracture-dislocations of the PIP joint treated with EBP between January 1998 and October 2020 were identified. All patients underwent closed reduction of the PIP joint and insertion of a Kirschner wire into the proximal phalanx, creating a mechanical block. Range of motion and joint congruity were assessed at final clinic follow-up. Long-term function was assessed via completion of a Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Spearman's correlation coefficient was utilized to assess if any association existed between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. Mean range of motion at final follow-up was 83.3° and 22 of 24 PIP joints demonstrated a congruent reduction. In all, 15 of the 23 patients completed the QuickDASH questionnaire at a median long-term follow-up of 57.5 months (range: 3-157 months). Average QuickDASH score was 18.8, indicating minimal long-term disability. No statistically significant associations were found between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. EBP offers a simple and innovative method to treat a complex injury of the PIP joint. It is technically straightforward and cheap, and produces excellent functional outcomes with minimal long-term disability.

Morphometric Comparison of Distal Hamate Articular Surface with the Proximal Articular Surface of Middle Phalanges of Index, Middle, Ring and Little Fingers for Hemi-Hamate Arthroplasty

PURPOSE: The study is focused to compare the Distal Hamate articular Surface to the morphology of the base of middle phalanges of Index, Middle, Ring &amp; little fingers. METHODOLOGY: A Observational Paired T study was conducted. Patients with fractures of forearm or hand excluding any fractures in hamate and middle phalanges of Index , Middle, Ring &amp; Little finger of both the upper limbs are subjected to Computed Tomography (CT) of hand and a 3D reconstructed image is obtained. Once the scans are collected, the below parameters will be determined using Radiant software. RESULTS: At the end of this study ,we found that Majority of the patients who underwent CT Scans were noted to be between 31 and 50 years of age. Gender wise, males considered for the study were 24 (52%) and females were 25 (49%). The average hamate axial ridge angle was 69.18 and that of the ring finger middle phalangeal base was 80.23 (P &lt; .05) Out of 50 patients the axial ridge angle of hamate was comparable with ring finger middle phalangeal base. The average distal hamate surface area was 1.04 and that of the middle phalangeal base was 1.00 (P &lt; .05) The distal hamate articular surface area was comparable with the middle finger’s middle phalangeal base. The average sagittal inclination of distal hamate surface was 48.64 and that of the ring finger middle phalangeal base was 49.08 (P &lt; .05) . The sagittal inclination of hamate was comparable with ring finger middle phalangeal base . CONCLUSION: In literature very few radiological studies comparing the hamate and middle phalanx articular surfaces are reported. This study helps us in understanding the digit which is similar to hamate for undergoing Hemi Hamate Arthroplasty and usefulness of pre operative CT scan in further management of chronic proximal interphalangeal joint fracture dislocations. According to the results obtained from our study, we conclude that the Axial ridge angle and sagittal inclination of Middle Phalanx of Ring finger is in close approximation with Hamate . Articular Surface Area of Middle Finger is in close approximation with Hamate distal articular surface area. Keywords: PIPJ- Proximal Interphalangeal Joint, ORIF- Open Reduction, Interal Fixation, CT- Computed Tomography, HHA- Hemi Hamate Arthroplasty

Treatment of Fracture-Dislocations of Proximal Interphalangeal Joint by Applying of Dynamic Mini External Fixator: Clinical and Radiographic Results.

Fracture-dislocations of the proximal interphalangeal joint of fingers are believed to be challenging injuries that usually lead to residual pain and stiffness. To date, several treatment options have been applied. Dynamic traction-external fixation is a safe and easy technique offering good results in many works of literature. The dynamic mini external fixator using K-wires and mini rods provide sufficient dynamic traction and facilitate early mobilization of the injured joint. The present study was conducted to evaluate the results of a dynamic mini external fixator for the treatment of those lesions. In total, 40 patients who suffered from proximal interphalangeal fracture-dislocations were treated at our institution between November 2017 and November 2019. Dynamic mini external fixator device was utilized for their treatment. Clinical and radiographic parameters were evaluated at 2, 4, 6, 12, and 24 weeks after surgery. This study included 30 (75%) males and 10 (25%) females with a mean age of 38.7±9.9 years. In total, 6 (15%) patients had concomitant fractures or fractures in their hands. All the fractures, including 27 (67.5%) dorsal fracture-dislocations and 13 (32.5%) Pilon fractures, were united without the occurrence of any malunion or major residual subluxation. One Pilon fracture needed to be realigned by reassembling the device at the second week of follow-up. Furthermore, 36 (90%) patients achieved full range of joint motion, and 4 (10%) patients had mild loss of motion arc. In addition, 8 (20%) patients developed mild pin site infection treated with oral antibiotics without device removal. Following six months, one (2.5%) patient mentioned minimal residual pain. The dynamic mini external fixator was found to be a safe and applicable technique to manage proximal interphalangeal fracture-dislocations. To obtain significantly accurate results, regular follow-up and accurate device care are of great necessity.

A novel technique for proximal interphalangeal joint fracture-dislocations: the second toe middle phalanx osteochondral graft.

Many different surgical techniques have been used to treat unstable dorsal proximal interphalangeal joint fracture-dislocations. The authors have used the base of the middle phalanx of the second toe base as an alternative autograft to treat this type of injury. This retrospective study assessed the clinical outcomes of this procedure in 11 patients. Range of motion, grip strength, Disability of the Arm, Shoulder and Hand score and donor site morbidity were assessed at regular intervals postoperatively. Nine patients had acute injuries and two had chronic injuries. The mean range of motion in the proximal interphalangeal joint at final review was 65° for patients with acute injuries and 41° for patients with chronic injuries. Other outcomes were satisfactory and there were no complications.Level of evidence: IV.

Anatomy of Distal Articular Surface of Hamate Bone, A Cadaveric Study.

Background: Hemi-hamate arthroplasty is one of the treatment options for dorsal proximal interphalangeal joint fracture dislocation. Many studies reported favorable outcomes. However, some long term studies demonstrated the degenerative change of PIP joint. The articular mismatch of the hemi-hamate autograft might play an important role of this complication. Methods: We studied the anatomy of distal articular surface of the hamate bone in embalmed hamate bones. The anatomy of distal articular surface and dimensions of the hamate bone were measured and recorded. Results: Seventy hamate bones were dissected out from embalmed cadavers and included in this study. The mean angle of the 4th metacarpal articulation was 85.54 degrees (SD = 3.53) and mean angle of the 5th metacarpal articulation was 95.51 degrees (SD = 3.57). The inter-articular ridge was approximately 5 degrees radial inclination. Conclusions: The inter-articular ridge of distal articular surface was approximately 5 degrees radial inclination. In order to minimize the graft mismatch, we recommend making the bone cut with the saw blade tilted to radial side 5 degrees to achieve better alignment of inter-articular ridge of the graft.

A Novel Technique for Dynamic External Fixation of Proximal Interphalangeal Joint Fracture-Dislocations.

Background: The pins and rubbers traction system is widely used to treat unstable proximal interphalangeal (PIP) joint fracture-dislocations. However, dealing with rubber bands can be difficult due to its elasticity and weakness. The purpose of this study was to report the results of an alternative dynamic external fixator technique for unstable PIP joint injuries. Methods: Thirteen patients with acute unstable PIP joint fracture-dislocation (n = 8), pilon fracture (n = 2), or comminuted shaft fractures of a middle phalanx with or without PIP joint extension (n = 3) were enrolled. The alternative fixator used a plastic syringe to maintain distraction force instead of the commonly used rubber bands. Four patients underwent combined open reduction due to unsatisfactory reduction by closed mean. The fixator was removed when there was radiographic evidence of healing. Results: At 6 months after the operation, the mean active ROM of the injured PIP joint was 89° (range, 70-104°), and the mean Quick-DASH score was 9.78 (range, 0-40.9). The mean NRS of pain before fixator removal was 1 (range, 0-4). One patient had a pin tract infection and underwent debridement and fixator removal at 33 days postoperatively. There was no loss of reduction or implant failure in the study. Conclusions: The results were comparable to other dynamic external fixation techniques used for unstable PIP joint fracture-dislocations. The main advantages of this technique were strength of the system, procedure simplicity, the compact design, and relatively low cost. In addition, this technique can also be used in pilon fractures and comminuted shaft fractures of a middle phalanx with or without PIP joint extension.

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

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

Résultats du traitement des fractures-luxation interphalangiennes avec plaque console palmaire munie de crochets

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 interphalangeal 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.

Management of intraarticular proximal interphalangeal joint fracture-dislocations and pilon fractures with the Ligamentotaxor® device.

Fracture-dislocation and pilon injuries of the proximal interphalangeal joints (PIPJ) continue to pose significant management challenges. Stable fracture configurations can be treated with extension block splinting or pinning. Unstable fractures usually require open or closed reduction and fixation either directly/internally onto the fracture using Kirschner wires, cerclage wires, screws or miniplates or indirectly/externally by ligamentotaxis using external fixators which can be dynamic or static. Dynamic external fixators, such as Suzuki's pins and rubber traction system, S-Quattro and Hynes/Giddins frame, appear intuitive as they provide axial distraction, which reduces the fracture whilst obviating the need to open the fracture. They also allow immediate active movement whilst maintaining reduction. The Ligamentotaxor® (Arex, Pallaiseau Cedex, France) is a commercially-available dynamic external fixator which has been used at our institution since 2013. This retrospective study assessed the outcomes (interphalangeal joint active range of movement (AROM), QuickDASH score and complications) in 19 patients [mean age of 48.6 (SD 16.2)] whose proximal interphalangeal joint (PIPJ) fracture-dislocations and/or pilon fractures were treated with the Ligamentotaxor®. Injuries were classified according to Seno i.e. (1) volar lip fracture ± dorsal dislocation (2) dorsal lip fracture ± volar dislocation (3) pilon fracture. There were fifteen (79%) pilon/Seno 3, three (16%) Seno 1 and one (5%) Seno 2 fractures. The mean PIPJ AROM was 70.6° (SD 4.48°) for all Seno classes and 70° (SD 5.6°) for the pilon subgroup. The QuickDASH score averaged to 2.65 (SD 0.88). There were two pin-site infections, three pin-site inflammations, one osteomyelitis and two complex regional pain syndrome diagnoses. One patient required arthroplasty after missing several appointments. These results, considering the predominance of pilon fractures, compare favourably the published Ligamentotaxor® and other dynamic external fixator systems.

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

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.

Functional outcome of hemi-hamate arthroplasty in proximal interphalangeal joint fracture–dislocations

Functional outcome of hemi-hamate arthroplasty in proximal interphalangeal joint fracture–dislocations