Fracture-dislocations of the Proximal Interphalangeal Joint

Abstract

Fracture-dislocations of the proximal interphalangeal joint encompass a spectrum of injury severity, ranging from injuries that require little intervention to those that require advanced reconstructive surgery for optimal outcome. Three fracture-dislocation patterns are recognized: dorsal, volar, and pilon. Acceptable outcome is dependent on achieving and maintaining a well-aligned and well-reduced joint, re-establishing normal joint kinematics, and restoring motion. Anatomic articular surface reduction is desirable but not absolutely necessary for a good outcome. Treatment depends on both the type of injury and patient-dependent factors. Optimal outcome for a specific injury is predicated on expedient diagnosis and recognition of injury severity, which enables initiation of appropriate management.

Mid-Term Outcomes of Unstable Complex Proximal Interphalangeal Joint Fracture Management Using the Ligamentotaxor® Device: A Case Series of 33 Cases

“…Fracture dislocations of PIPJ can result in a great loss of ROM with a subsequent disability of hand function. Suboptimal treatment can result in long-term complications such as pain, arthritis, and deformity [13,14]. There is a vast array of treatment options for this injury, including closed reduction, open reduction, percutaneous wire fixation, external fixation, extension block techniques, and hemi-hamate arthroplasty [15].…”

Cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of complex phalangeal fractures: economic simulation

“…The presence of displaced articular fragments, rotational misalignment, abnormal angulation and/or shortening, and soft tissue injury indeed may require a surgical approach [6][7][8][9]. Furthermore, an involvement of more than 25% of the articular surface represents an indication for surgery, in order to align the joint and minimize all that complications negatively influencing patients' quality of life [7][8][9][10][11][12][13]. However, the final decision on the fracture's management is based largely on clinical impairment of hand function, considering comorbidities, compliance, and the need to return to activities or work [6][7][8].…”

Sports-related wrist and hand injuries: a review

“…Athletes close to season completion can be allowed to continue competition as long as their participation is not hindered by the splint [ 96 ]. Rarely do acute injuries require operative treatment unless a displaced bony fragment is identified and requires screw fixation versus excision with repair [ 97 ] after which early rehabilitation can begin [ 97 , 98 ].…”

“…Once a supple deformity is achieved, reconstruction can be attempted with a variety of techniques such as extensor tenolysis and transverse retinacular ligament mobilization or release, terminal extensor tenotomy with lateral band lengthening, and central slip reconstruction [ 102 – 104 ]. Because treatment of a chronic deformity results in much worse outcomes [ 97 , 105 , 106 ], athletes should be strongly encouraged to seek treatment in the acute period.…”