Fractures of the proximal interphalangeal joints of the fingers

Abstract

Fractures of the proximal interphalangeal joint include a wide spectrum of injuries, from stable avulsion fractures to complex fracture-dislocations. Stability of the joint is paramount in determining the appropriate treatment, which should aim to facilitate early mobilisation and restoration of function.

What Middle Phalanx Base Fracture Characteristics are Most Reliable and Useful for Surgical Decision-making?

“…This means that hand surgeons are consistent and likeminded regardless of sex, experience, academic involvement, and practice location when recommending operative treatment, bearing in mind the limited sample size. Our findings that articular step or gap greater than 2 mm, injuries judged unstable, and proximal interphalangeal joint subluxation or dislocation are associated most strongly with the decision for operative treatment, are in line with the indications usually cited [7,13,18,21]. Rsquared values (0.76 to 0.89) and b regression coefficients (0.80 to 0.90) of these three characteristics are high and vary slightly, meaning that these factors drive the decision for operative treatment to a similar degree and fashion.…”

“…We found only fair agreement, indicating variation, regarding specific proposed treatments, which might be a reflection of the lack of high-level evidence and relatively small case series on which surgeons base their decisions [7]. Variation in reported indications for surgical strategies also might influence decision making among hand surgeons when deciding for specific surgical strategies [7,13,18,21]. Creating guidelines by reaching consensus among hand surgeons might reduce variation and improve quality of care [9,14].…”

“…Fracture-dislocations of the proximal interphalangeal joint can be problematic as they can result in stiffness, pain, and secondary osteoarthritis [7,18,21]. Characteristics of the articular fracture of the middle phalanx that are thought to indicate benefit of operative treatment are subluxation of the joint, greater than 2-mm articular stepoff, and more than 40% of articular surface involvement [13,18,21].…”

“…Characteristics of the articular fracture of the middle phalanx that are thought to indicate benefit of operative treatment are subluxation of the joint, greater than 2-mm articular stepoff, and more than 40% of articular surface involvement [13,18,21]. These fracture characteristics also are used in selecting a specific operative treatment with options extending from extension block pinning to hemihamate autograft arthroplasty [13,17,18,21]. However, it is unclear if middle phalanx base fracture characteristics can be assessed with sufficient reliability to be useful for surgical decision making.…”

Proximal Interphalangeal Joint Fracture-Dislocations: Closed Reduction Internal Fixation

“…Introduction PIP joint dorsal fracture-dislocations are injuries that occur most commonly as the result of an axial force to a hyperextended finger , and they represent a wide spectrum of injuries [ 1 ]. Currently no one surgical procedure has proven superiority in achieving the goal of achieving and maintaining a concentric joint reduction in the setting of the unstable PIP fracture-dislocation (those fracture-dislocations in which the volar fragment represents >40 % of the joint surface) [ 3 -6 ].…”