A comparative cadaveric biomechanical analysis of the differences between dynamic external traction devices for PIP joint fracture dislocation.

Abstract

Purpose: No study in the literature compares different external distractors for PIPJ injury. We compared a device described by Suzuki et al and another by Hynes & Giddins in non-injured cadaveric fingers. Main outcome measures were articular space and PIPJ flexion resistance.Methods: Thirty-two Thiel embalmed fingers were used. The elastics based model was performed with 3 and 5 elastics per side (3E and 5E); the 2-pin model used no elastics (2P). Articular distraction of each device was measured using x-ray imaging. The force required to flex the PIP joint to 45˚ and 90˚ in each group was measured with a dynamometer.Main findings: The articular distraction was statistically significant for all groups. The difference in articular distraction was significant in the AP view between groups 3E and 2P, and 5E and 2P. Flexion forces were only significant between group 5E and 2P at 90˚ flexion, but resistance was notably higher in group 2P than in groups 3E and 5E. Group 2P was more difficult to engage and often disengaged in flexion compared to groups 3E and 5E.Conclusion: All devices achieved significant articular distraction (>99% in AP) but optimal distraction has not been clinically determined and may depend on each unique fracture, hence a variable distraction device may be optimal. The 3E and 5E models can be adjusted for distraction by adding the sufficient elastics to reduce individual fractures. The increased resistance to PIP flexion found in the 2P model may limit post-op mobilization, but clinical correlation is needed.

Closed Reduction and Percutaneous Pinning for Treatment of Proximal Interphalangeal Joint Pilon Fractures

“…Using mini external fixators and percutaneous Kirschner wire (KW) fixation for treating various types of PIP joint fracture-dislocations is becoming more attractive. 4 These techniques can be the preferred choice of treatment, first, because they are low-profile, flexible, and readily available for emergencies [3][4][5][6][7] and, second, because they allow the patient to move both the reconstructed and adjacent joint while the instrument is used; early passive motion will consequently improve articular cartilage healing and regeneration. [4][5][6][7] Among all types of PIP joint fracture-dislocations, when choosing the best treatment for pilon fracture that involves the entire articular surface and results in comminution, central depression of the articular surface of the base of the middle phalanx is controversial.…”

“…4 These techniques can be the preferred choice of treatment, first, because they are low-profile, flexible, and readily available for emergencies [3][4][5][6][7] and, second, because they allow the patient to move both the reconstructed and adjacent joint while the instrument is used; early passive motion will consequently improve articular cartilage healing and regeneration. [4][5][6][7] Among all types of PIP joint fracture-dislocations, when choosing the best treatment for pilon fracture that involves the entire articular surface and results in comminution, central depression of the articular surface of the base of the middle phalanx is controversial. [8][9][10] There are several surgical techniques suggested for the treatment of pilon fractures, including closed reduction percutaneous pinning, open reduction and internal fixation, and static or dynamic external fixation.…”

“…The decision is made case by case, based on the pattern of fracture, the spectrum of injury, amount of functional disability, the experience of the surgeons, and their access to devices. 5,6 The aim of surgical management is to obtain stable anatomical reduction while allowing for early range of motion (ROM). This study aims to assess both the functional and radiological outcomes of using closed reduction and percutaneous pinning (with or without cement application) for the treatment of PIP pilon fractures.…”

“…Using mini external fixators and percutaneous Kirschner wire (KW) fixation for treating various types of PIP joint fracture-dislocations is becoming more attractive. 4 These techniques can be the preferred choice of treatment, first, because they are low-profile, flexible, and readily available for emergencies 3-7 and, second, because they allow the patient to move both the reconstructed and adjacent joint while the instrument is used; early passive motion will consequently improve articular cartilage healing and regeneration. 4-7…”

“…The decision is made case by case, based on the pattern of fracture, the spectrum of injury, amount of functional disability, the experience of the surgeons, and their access to devices. 5,6…”