Mini-Screw Fixation for the Treatment of Proximal Interphalangeal Joint Dorsal Fracture–Dislocations

doi:10.1016/j.jhsa.2006.07.011

The Journal of Hand Surgery

Volume 31, Issue 8, October 2006, Pages 1349-1354

https://doi.org/10.1016/j.jhsa.2006.07.011 Get rights and content

Purpose

Surgical intervention may be necessary to treat unstable dorsal fracture–dislocations of the proximal interphalangeal (PIP) joint of the hand. One method of stabilization is open reduction and internal fixation (ORIF). The purpose of this study was to assess the outcomes of ORIF for unstable dorsal fracture–dislocations of the PIP joint using mini-screws via a volar approach.

Methods

A retrospective chart review with clinical follow-up evaluation was performed on 9 patients who had ORIF for unstable dorsal fracture–dislocations of the PIP joint. The fracture fragment(s) from the middle phalangeal base were reduced and secured using mini-screws.

Results

A clinical evaluation was performed at an average of 42 months after surgery. The average arc of motion for the involved PIP joint was 70° (range, 55°–90°). The average PIP joint motion in the 2 patients with 1 fracture fragment was 85°, and the average PIP joint motion for the remaining 7 patients was 65°. One joint was subluxated with an intra-articular screw. Nine patients had an average flexion contracture of 14°. Seven patients had no pain, and 2 had pain only with heavy activity.

Conclusions

Open reduction and internal fixation of unstable dorsal PIP joint fracture–dislocations using mini-screws can be considered if the fracture fragment(s) can accommodate the screws. The procedure attempts to restore the concave contour of the middle phalangeal base and permits early protected range of motion. The procedure should be approached cautiously, especially in the presence of comminution. Proximal interphalangeal joint range of motion is usually compromised; 8 of our 9 joints had a residual flexion contracture.

Type of study/level of evidence

Therapeutic IV.

Section snippets

Materials and Methods

Retrospective chart reviews and clinical follow-up evaluations were performed on patients having ORIF with mini-fragment screws for unstable volar lip fractures of the PIP joint of the hand at a hand surgery center from December 1998 to April 2004. Patients were identified as candidates for the study by using diagnosis codes from billing records, and all patients with fractures involving the interphalangeal joints were reviewed. One hundred thirty-one patients were identified who had ORIF

Results

At an average of 42 months after surgery (range, 6–66 mo), the average metacarpophalangeal joint arc of motion was 89° for the involved side (range, 75°–90°) and 87° for the contralateral side (range, 70°–95°) (Table 2). The average arc of motion of the affected PIP joints was 70° (range, 55°–90°) and of the contralateral PIP joints was 91° (range, 85°–95°). The involved PIP joints had an average flexion contracture of 14° (range, 0°–30°). The average arc of motion of the distal interphalangeal

Discussion

The goals of treatment of unstable PIP joint dorsal fracture–dislocations include re-establishing articular congruity and providing a stable and concentric joint, thereby permitting early ROM to minimize the risks of joint stiffness or contracture.¹ A variety of treatment options for fracture–dislocations of the PIP joint have been presented in the literature, including traction,4, 5, 6 external fixation,7, 8, 9, 10, 11 volar plate arthroplasty,¹² hemihamate autograft,³ and ORIF.13, 14, 15, 16,

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Chronic 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.
A 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.
Union 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.
Hemihamate 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.
III.
Emergency metacarpophalangeal arthroplasty with bone grafting for traumatic joint destruction: a report on two cases
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Citation Excerpt :
The bone graft had started to integrate between the 2nd and 3rd months and was fully integrated at 6 months (Fig. 3). There are only a few published reports of surgical management for traumatic MCP joint destruction [1–4], contrary to the proximal interphalangeal joint, which is more likely to be severely damaged [5–9]. The options described in these published studies must be evaluated relative to the local conditions and the patient's background.
Traumatic destruction of the metacarpophalangeal joints with bone defect is a technical challenge for surgeons when maintaining joint mobility is a priority for the patient. An emergency metacarpophalangeal arthroplasty with bone graft has been described in the literature for dorsal defects in the proximal phalanx. We have adapted this technique to allow us to perform this arthroplasty with bone graft in all defects of the proximal phalanx.
Les destructions traumatiques des articulations métacarpo-phalangiennes associées à une perte de substance osseuse (PSO) représentent un défi technique pour le chirurgien qui souhaite conserver la mobilité de cette articulation. Selon le contexte et la demande fonctionnelle du patient, la stratégie chirurgicale peut-être réalisée en un ou deux temps. Les transferts articulaires prélevés sur le pied, les arthroplasties prothétiques, voire même les arthrodèses composent cet arsenal chirurgical. La réalisation d’une arthroplastie en urgence avec greffe osseuse de la phalange proximale (P1) a été décrite dans la littérature pour les PSO dorsales de la base de P1. Nous proposons d’adapter cette technique aux autres PSO de la base de P1.
Management of Finger Joint Dislocation and Fracture-Dislocations in Athletes
2020, Clinics in Sports Medicine
Injuries Around the Proximal Interphalangeal Joint
2019, Clinics in Plastic Surgery
Citation Excerpt :
Various methods of internal fixation have been described—dorsal and volar plating,53,54 buttress plating,40 hook plating,55 and screw fixation from volar19,51,56 and dorsal57 approaches, After internal fixation, splint immobilization, extension block pinning, or an external fixator may be used to augment the fixation.40 Techniques for fixation of small fragments include K wires,20,22,58,59 miniscrews,56,60,61 pull-out sutures with tension banding,3,17 and a combination of these techniques (Fig. 3). The volar approach to the PIPJ commonly is used (Video 1).62
Fracture-dislocation of the proximal interphalangeal joint of the long fingers: Report of an unusual case requiring open surgery
2018, Hand Surgery and Rehabilitation
Dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint of the long fingers are in most cases unstable. They require surgery, whose primary aim is to restore and maintain articular congruency. While numerous techniques exist to treat these injuries, none have been shown to be superior to any of the others in terms of outcomes and complications. The least invasive techniques should be used as much as possible. We report here a rare case of incarceration of the flexor tendons in the PIP fracture which required open surgery.
Les fractures-luxations dorsales de l’articulation interphalangienne proximale (IPP) des doigts longs sont le plus souvent instables. Elles relèvent d’une prise en charge chirurgicale dont l’enjeu principal est le rétablissement et le maintien de la congruence articulaire. Il existe de nombreuses techniques pour traiter ces lésions, aucune n’ayant montré de supériorité par rapport aux autres en termes de résultat et de complication. Les techniques les moins invasives sont à privilégier autant que possible. Nous rapportons ici un cas rare de fracture-luxation dorsale de l’IPP ayant nécessité un abord chirurgical.

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Interphalangeal joint traumaMini-Screw Fixation for the Treatment of Proximal Interphalangeal Joint Dorsal Fracture–Dislocations

Purpose

Methods

Results

Conclusions

Type of study/level of evidence

Section snippets

Materials and Methods

Results

Discussion

J Hand Surg

J Am Soc Surg Hand

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

Hand Clin

J Hand Surg

Interphalangeal joint trauma
Mini-Screw Fixation for the Treatment of Proximal Interphalangeal Joint Dorsal Fracture–Dislocations