Proximal Interphalangeal Joint Fractures of the Hand

Theivendran, Kanthan; Pollock, Julius; Rajaratnam, Vaikunthan

doi:10.1097/01.sap.0000245132.14908.9d

Cited by 21 publications

(5 citation statements)

References 19 publications

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“…Postoperative osteoarthritic changes after treatment with external dynamic fixators develop in 12.5-61% of the cases ranging from mild to moderate changes [7,8,23]. In most of the studies, small residual articular step offs are described, which may cause osteoarthritic changes.…”

Section: Discussionmentioning

confidence: 99%

“…These systems allow early mobilization, whereas the immobilization of the PIP joint results in stiffness with a reduced range of motion due to periarticular scarring [4]. The use of an external traction fixator is based on reduction through traction of the fracture components and ligamentotaxis within the PIP joint to correct any subluxation of the joint [5][6][7][8][9][10]. Good clinical and radiological results can be expected if anatomical alignment and congruity of the joint can be restored together with sufficient stability for early joint mobilization.…”

Section: Introductionmentioning

confidence: 99%

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

Kastenberger

Kaiser

Keller

et al. 2019

Arch Orthop Trauma Surg

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Introduction Several methods treating proximal interphalangeal joint (PIP) fracture dislocations have been established providing early joint mobilization. The aim of this study was to evaluate the clinical and radiological outcome of unstable fracture dislocations of the PIP treated with a parabolic dynamic external fixator consisting of two Kirschner (K)-wires. Materials and methods Twenty-one patients who sustained a pilonoidal fracture of the PIP joint and were treated with a dynamic external fixator were evaluated retrospectively. The active range of motion, pain level, DASH score, Buck Gramcko Score, and the patient's satisfaction and acceptance were assessed. X-ray images were evaluated for bone healing, joint alignment, and signs of osteoarthritis. Results Mean PIP joint range of motion was 76°. Patients showed very mild discomfort (mean 0.7), high patient satisfaction (mean 1.9), and a moderate acceptance (mean 2.7). The mean DASH score was 11.6 and the Buck Gramcko score 13. All patients showed bone healing. One patient suffered from a recurrent dislocation, and another a subluxation of the PIP joint while wearing the fixator. Both joints could be corrected by modifying the fixator under image intensifier. Twenty patients (95%) showed a concentric and stable aligned joint. Three patients showed an osteoarthritis stage 0, five stage 1, nine stage 2, three stage 3, and one stage 4 according to the Kellgran-Lawrence Score. Conclusion The use of a parabolic dynamic external fixator constructed from two K-wires restores joint alignment and stability in unstable pilonoidal PIP joint disclocation fractures. It allows immediate PIP joint mobilization to avoid adhesions. Modifications of the radius of the parabolic construct within cases of postoperative malalignment, without anesthesia, can restore joint axis and malalignment. This fixator is a cost-effective alternative, showing a good clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Kastenberger

Kaiser

Keller

et al. 2019

Arch Orthop Trauma Surg

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“…33,38-48 Most studies report a mean arc of PIPJ motion between 84-88°, 38,41,46,47 although a significant learning curve is described, and some studies have reported mean arc of motion as low as 66°. 39 Using a modification involving pre-loaded wires without rubber bands, Theivendran et al reported a PIPJ arc of 64° at early follow-up (only 24 weeks); this study reported average Michigan Hand Outcomes Questionnaire (MHQ) scores of 90, which is an outstanding score.…”

Section: Dorsal Fracture-dislocationmentioning

confidence: 99%

“…39 Using a modification involving pre-loaded wires without rubber bands, Theivendran et al reported a PIPJ arc of 64° at early follow-up (only 24 weeks); this study reported average Michigan Hand Outcomes Questionnaire (MHQ) scores of 90, which is an outstanding score. 48 …”

Section: Dorsal Fracture-dislocationmentioning

confidence: 99%

Current Concepts in Treatment of Fracture-Dislocations of the Proximal Interphalangeal Joint

Haase

Chung

2014

Plastic and Reconstructive Surgery

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Background Proximal interphalangeal joint fracture-dislocations are common injuries that require expedient and attentive treatment for the best outcomes. Management can range from protective splinting and early mobilization to complex operations. In this review, the current concepts surrounding the managment of these injuries are reviewed. Methods A literature review was performed of all recent articles pertaining to proximal interphalangeal joint fracture-dislocation, with specific focus on middle phalangeal base fractures. Where appropriate, older articles, or articles on closely related injury types were included for completeness. The methodology and outcomes of each study were analyzed. Results When small avulsion fractures are present, good results are routinely obtained with reduction and early mobilization of stable injuries. Strategies for management of the unstable dorsal fracture-dislocation have evolved over time. To provide early stability, a variety of techniques have evolved, including closed, percutaneous, external, and internal fixation methods. Although each of these techniques can be successful in skilled hands, none have been subjected to rigorous, prospective, comparative trials. Volar dislocations fare less well, with significant loss of motion in many studies. Pilon fractures represent the most complicated injuries, and return of normal motion is not expected. Conclusion The best outcomes can be achieved by (1) establishing enough stability to allow early motion, (2) restoring gliding joint motion rather than non-congruent motion, and (3) restoring the articular surface congruity when possible. Although the majority of literature on this topic consists of expert opinion and retrospective case series, the consensus appears to favor less invasive techniques whenever possible.

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“…(Table 3) Cross-sectional studies represented 43% of publications (25/58). 21,22 (Table 4) Another 43% were prospective studies. Nineteen of the prospective studies utilized a preoperative or baseline time-point.…”

Section: Resultsmentioning

confidence: 99%

The Michigan Hand Outcomes Questionnaire after 15 Years of Field Trial

Shauver

Chung

2013

Plastic and Reconstructive Surgery

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Background The Michigan Hand Outcomes Questionnaire (MHQ) has been used to assess a variety of hand and upper extremity injuries and conditions for nearly 15 years. It has been included in several overviews of upper extremity outcomes measures, but it has not been systematically examined regarding its clinimetric properties during field trials. Methods We conducted a review of the MHQ in the English language literature from 1998 through March 2012. Data from clinical studies were abstracted and compiled. Results The MHQ has been used in 58 clinical studies and its clinimetric properties have been analyzed in an additional 18 publications. The MHQ compares favorably with other hand outcomes instruments in the areas of test-retest reliability, validity, and responsiveness. High internal consistency may indicate redundancy within the items in the MHQ. The strength of the MHQ is its multidimensional construct in measuring patient-rated outcomes in symptom, function, aesthetics, and satisfaction. Conclusions The MHQ has been applied across a variety of conditions affecting the hand and upper limb. Its psychometric properties have been tested through field trials in various clinical settings around the world. Level of Evidence Systematic Review; Level II

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Proximal Interphalangeal Joint Fractures of the Hand

Cited by 21 publications

References 19 publications

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

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

Current Concepts in Treatment of Fracture-Dislocations of the Proximal Interphalangeal Joint

The Michigan Hand Outcomes Questionnaire after 15 Years of Field Trial

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