Double parabolic Kirschner-wires as dynamic distractor for treatment of unstable intraarticular phalangeal fractures of hand

Abstract

Background:Treatment of complex injuries of interphalangeal joints (IPJs) is difficult. The restoration of joint stability for early joint mobility till fracture union is the key for successful outcome. Although various treatment options like dynamic splinting, external fixator, closed reduction, transarticular Kirschner (K)-wire and ORIF, etc., are available in literature, a universally accepted ideal treatment for complex intraarticular fractures of IPJs is still evolving. Open reduction is difficult because fixation of volar fragment is often impractical and radical procedures like volar plate arthroplasty, arthrodesis or joint replacement, etc., may become mandatory for salvage. We describe percutaneous technique to treat unstable fractures and dorsal fracture–dislocations of the PIP joint and report short-term postoperative results.Materials and Methods:Ten cases of unstable or potentially unstable intraarticular fractures including pilon fractures and fracture-dislocations of IP joints were treated percutaneously by double parabolic K-wire technique (DPK). The device was used as a dynamic distraction, using the principle of ligamentotaxis. The idea was to commence early postoperative continuous active and active-assisted joint motion exercises and to carry on the frame as a definitive treatment for achieving fracture union.Results:In all patients of fracture-dislocation the reduction was satisfactory and early mobility was achieved. Although there is a tendency towards over-distraction, no loss of reduction occurred. Pin tract infection occurred in one with no delayed union or nonunion. The average total range of motion for each involved IP joint was 93.5 degree and the average total active range of motion was 90.8° each at the end of 4 months followup. Excellent to good results were restored in nearly all cases without further interventions.Conclusion:DPK technique may be a cheap and valuable definitive treatment option in the management of unstable or potentially unstable intraarticular fractures of IPJs. The technique gave satisfactory radiological union and functional outcome in our small series. This technique may be worth considering in unstable or potentially unstable intraarticular fractures of IPJs with intact collateral ligaments and when other treatment options are impractical.

Clinical and radiological midterm outcome after treatment of pilonoidal fracture dislocations of the proximal interphalangeal joint with a parabolic dynamic external fixator

“…Numerous reports using external fixators showed a mean range of motion in the PIP joint between 64° and 91° similar to this report with app. 76° [14,[20][21][22]. The patient cohort in this study showed a moderate acceptance of the external fixator, however, a high satisfaction at final follow-up with very mild discomfort (VAS 0.7).…”

Operative treatment of metacarpal and phalangeal fractures with Kirschner wire fixation: A review

“…K-wires are easily removed after 4 to 6 weeks depending on type of fracture, and removal doesn't require hospitalization. 5,7,9,11,12 THE FIRST MC BASE FRACTURES.…”

Comparative study on Kirschner-wire and screw fixation for intra-articular fractures of the proximal phalanx head

“…This type of injury accounts for 0.2% to 3% of patients visiting the emergency unit and 12% to 46% of all hand fractures [1]. Usually, younger patients are injured during sports activities, middle-aged patients are injured in manual labor, and elderly patients are most commonly injured when falling down [2].…”