Dynamic traction with open reduction internal fixation for fracture-dislocations of the proximal interphalangeal joint

LIU Kun; WU Jing-heng; CHEN Shan-lin; TIAN Wen; Jan van Aaken; Pierre Hoffmeyer; TIAN Guang-lei

doi:10.3969/j.issn.2095-252X.2017.04.005

Abstract：Objective To investigate the outcomes of dynamic traction with open reduction internal fixation ( ORIF ) for treatment of fracture-dislocations of the proximal interphalangealjoint ( PIPJ ). Methods From July 2013 to January 2016, 10 consecutive patients diagnosed with fracture-dislocations of the PIP joint were treated with dynamic traction and ORIF either with K-wires or mini-screws. Among all patients 8 were male and 2 were female. The average age of patients was 32 years. One index finger, 2 long fingers and 7 ring fingers were involved. The average articular area involved was 54%. All fractures were reduced and fixed with 1 - 2 K-wires ( 1.7 mm ) or 2 - 3 mini-screws ( 0.8 mm ) through a volar "shotgun" approach. Autologous bone grafting was performed in 1 patient and allogeneic bone graft in 2. After closure of the incision the dynamic external fixator was applied and was removed at 5 - 6 weeks postoperatively. The clinical and radiological outcomes and satisfaction of the patients were evaluated at the final follow-up. Results All patients had follow-up of 3 to 29 months ( average: 12 months ). No infection, allograft bone rejection, pin loosening or PIPJ instability occurred. Eight fractures united in good alignment and no joint subluxation occurred, 2 patients showed degenerative changes and had a supplementary surgery. Average grip strength was 90% of the unaffected side. The average range of motion ( ROM ) of the PIPJ and distal interphalangeal joint ( DIPJ ) was 97° and 68°, respectively. The average visual analogue scale ( VAS ) pain score was 0.3. The average quick disabilities of the arm, shoulder and hand ( DASH ) was 4 ( range: 0 - 7 ). All patients returned to their original occupation and all were satisfied with the results. Conclusions Dynamic traction with ORIF with K-wires or mini-screws for treatment of fracture-dislocations of the PIP joint can yield good objective and subjective outcomes.