Scientific articleStaged External Fixation for Chronic Fracture-Dislocation of the Proximal Interphalangeal Joint: Outcomes of Patients With a Minimum 2-Year Follow-Up
Section snippets
Materials and Methods
Between 2004 and 2008, 6 fingers of 6 patients with subluxation and contracture of the PIP joint associated with chronic fracture-dislocations underwent this surgical protocol. Table 1 shows the patient data. The average patient age was 41 years. The 6 injured digits were the index (1), middle (1), and ring (4) fingers. Of the 6 patients, 3 had received previous medical treatment, which was conservative management with splints that immobilized the PIP joint after closed manipulation at the
Results
Table 2 shows the overall results of our treated cases. The average active range of motion of the PIP joint was 20° before surgery and then improved to 96° after surgery. At follow-up, the range of motion of the PIP joints increased by 76°, and that of the distal interphalangeal joints by 35°. We observed no lateral instability. Although we frequently noted osteoarthritic changes, favorable motion was obtained and pain measured by visual analog score was not a serious problem for any of our
Discussion
Our findings suggest that the described technique results in spontaneous osteochondral remodeling of the injured PIP joint and ongoing clinical improvement for up to 3.5 years. However, we cannot ascertain whether this remodeling was due to fibrocartilage or hyaline cartilage.
McAuliffe9 reviewed dorsal fracture-dislocation of the PIP joint and stated that accurate restoration of the joint surface may not be of major clinical importance. Early motion of the injured joint also may not be
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