Aim and background: Intra-articular fractures of the proximal interphalangeal (PIP) joint are a difficult entity to treat, commonly leading to stiff and painful fingers. There are multiple techniques described for treatment. We utilize a simple technique consisting of a static traction assembly and early mobilization of the finger to treat this pathology. In this study, we present results obtained with this modality.
Materials and methods: We utilize a malleable aluminum splint for traction against the injured finger. No. 1 polypropylene suture through nail plate of injured finger applies traction to hold joint in reduced position for 2 weeks. At 2 weeks, active-assisted mobilization of the injured finger is begun. Patients were evaluated for the range of motion achieved, radiograph picture, presence of pain, and ability to return to work.
Results: There were 11 cases of intra-articular fractures of the middle phalanx base. The median period of follow-up was 15 months (range 7.5–31 months). The average active flexion possible at the injured joint was 87.7°(range 55–110°). Two patients reported mild pain on terminal flexion without functional limitations. In unstable injuries, suboptimal alignment of fracture was common [9 out of 11]. Despite suboptimal radiographs, patients had a functional, painless range of motion. All patients went back to previous work.
Conclusion: Static traction technique with early mobilization protocol is a safe, relatively simple, and effective technique in the management of intra-articular fractures of the PIP joint. Early mobilization of joint facilitates remodeling of the articular base of the middle phalanx with the recovery of painless motion at the PIP joint despite radiological abnormalities.
Venkataswami R. Surgery of the injured hand–Towards functional restoration. 1st ed., ch. 32. Jaypee Brothers Medical Publishers (P) Ltd.; 2009. pp. 405–408.
Mc Elfresh BC, Dobyns JH, O' Brien BT. Management of fracture- dislocations of the proximal interphalangeal joints by extension block splinting. J Bone Joint Surg 1972;54(8):1705–1711. DOI: 10.2106/00004623-197254080-00010
Viegas SF. Extension block pinning for proximal interphalangeal joint fracture-dislocations: a preliminary report of a new technique. J Hand Surg 1992;17(5):896–901. DOI: 10.1016/0363-5023(92)90464-z
Schenck RR. Dynamic traction and early passive movement for fractures of the proximal interphalangeal joint. J Hand Surg Am 1986;11(6):850–858. DOI: 10.1016/s0363-5023(86)80236-2
Morgan JP, Gordon DA, Klug MS, et al. Dynamic digital traction for unstable comminuted intra-articular fracture-dislocations of the proximal interphalangeal joint. J Hand Surg Am 1995;20(4):565–573. DOI: 10.1016/S0363-5023(05)80268-0
Agee JM. Unstable fracture- dislocations of the proximal interphalangeal joint of the fingers: a preliminary report of a new treatment technique. J Hand Surg Am 1978;3(4):386–389. DOI: 10.1016/s0363-5023(78)80045-8
Slade JF, Baxamusa TH, Wolfe SW. External fixation of proximal interphalangeal joint fracture-dislocations. Atlas Hand Clin 2000;5:1– 29.
Ellis SJ, Cheng R, Prokopis P, et al. Treatment of proximal interphalangeal dorsal fracture-dislocation injuries with dynamic external fixation: a pins and rubber band system. J Hand Surg Am 2007;32(8):1242–1250. DOI: 10.1016/j.jhsa.2007.07.001
Ruland RT, Hogan CJ, Cannon DL, et al. Use of dynamic distraction external fixation for unstable fracture-dislocations of the proximal interphalangeal joint. J Hand Surg Am 2008;33(1):19–25. DOI: 10.1016/j.jhsa.2007.07.018
De Smet L, Boone P. Treatment of fracture - dislocation of the proximal interphalangeal joint using the Suzuki external fixator. J Orthop Trauma 2002;16(9):668–671. DOI: 10.1097/00005131-200210000-00009
Deshmukh SC, Kumar D, Mathur K, et al. Complex fracture-dislocation of the proximal interphalangeal joint of the hand. Results of a modified pins and rubbers traction system. J Bone Joint Surg Br 2004;86(3):406–412. DOI: 10.1302/0301-620x.86b3.14350
Eaton RG, Malerich MM. Volar plate arthroplasty of the proximal interphalangeal joint: a review of ten years’ experience. J Hand Surg 1980;5(3):260–280. DOI: 10.1016/s0363-5023(80)80011-6
Wolfe SW, Katz LD. Intra-articular impaction fractures of the phalanges. J Hand Surg Am 1995;20(2):327–333. DOI: 10.1016/S0363-5023(05)80035–8
Stern PJ, Roman RJ, Kiefhaber TR, et al. Pilon fractures of the proximal interphalangeal joint. J Hand Surg Am 1991;6(5):844–850. DOI: 10.1016/s0363-5023(10)80147-9
Williams RMM, Kiefhaber TR, Sommerkamp TG, et al. Treatment of unstable dorsal proximal interphalangeal joint fracture/dislocations using a hemi-hamate autograft. J Hand Surg Am 2003;28(5):856–865. DOI: 10.1016/s0363-5023(03)00304-6
Merrell G, Slade JF. Green's operative hand surgery. 6th ed., ch. 9, Livingstone, PA: Elsevier Churchill; 2011. p. 294.
Calfee RP, Sommerkamp TG. Fracture dislocations about the finger joints. J Hand Surg Am 2009;34(6):1140–1147. DOI: 10.1016/j.jhsa.2009.04.023
Hamada Y, Hibino N, Tonogai I, et al. Staged external fixation for chronic fracture-dislocation of proximal interphalangeal joint: outcomes of patients with minimum 2-year follow up. J Hand Surg Am 2012;37(3):434–439. DOI: 10.1016/j.jhsa.2011.11.005
Stark RH. Treatment of difficult PIP joint fractures with a mini-external fixation device. Ortho Rev 1993;22(5):609–615.
Waris E, Mattila S, Sillat T, et al. Extension block pinning for unstable proximal interphalangeal joint dorsal fracture dislocations. J Hand Surg Am 2016;41(2):196–202. DOI: 10.1016/j.jhsa.2015.11.007
Badia A, Riano F, Ravikoff J, et al. Dynamic intradigital external fixation for proximal interphalangeal joint fracture dislocations. J Hand Surg Am 2005;30(1):154–160. DOI: 10.1016/j.jhsa.2004.07.019
Newington DP, Davis TR, Barton NJ. The treatment of dorsal fracture-dislocation of the proximal interphalangeal joint by closed reduction and Kirschner wire fixation: a 16-year follow up. J Hand Surg Br 2001;26(6):537–540. DOI: 10.1054/jhsb.2001.0698
Hamilton SC, Stern PJ, Fassler PR, et al. Mini-screw fixation for the treatment of proximal interphalangeal joint dorsal fracture- dislocations. J Hand Surg Am 2006;31(8):1349–1354. DOI: 10.1016/j.jhsa.2006.07.011
Deitch MA, Kiefhaber TR, Comisar BR, et al. Dorsal fracture dislocations of the proximal interphalangeal joint: surgical complications and long-term results. J Hand Surg Am 1999;24(5):914–923. DOI: 10.1053/jhsu.1999.0914
Kang R, Stern PJ. Fracture dislocations of the proximal interphalangeal joint. J Hand Surg Am 2002;2(2):47–59. DOI: 10.1053/jssh. 2002.33317
McAuliffe JA. Dorsal fracture dislocation of the proximal interphalangeal joint. J Hand Surg Am 2008;33(10):1885–1888. DOI: 10.1016/j.jhsa.2008.08.017