Volar Plating for Unstable Proximal Interphalangeal Joint Dorsal Fracture-Dislocations

Cheah, Andre Eu-Jin; Tan, David; Chong, Alphonsus K.S.; Chew, Winston Y.C.

doi:10.1016/j.jhsa.2011.08.030

Cited by 26 publications

(33 citation statements)

References 14 publications

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“…Most of the patients (12 of 13) reported no pain or mild pain, but 3 patients required hardware removal to try to improve motion. 30 Analysis of their data shows an average extension lag of 13°; similar deficits were reported by Kang et al when they applied a small hook plate to this fracture. 31 …”

Section: Dorsal Fracture-dislocationsupporting

confidence: 72%

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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Section: Dorsal Fracture-dislocationsupporting

confidence: 72%

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

Haase

Chung

2014

Plastic and Reconstructive Surgery

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“…For unstable dorsal PIP fracture dislocations, the authors chose ORIF for facilitating early ROM exercises. Compared with previous literature, we achieved similar and favourable outcome regardless of the fixation modality [10][11][12][13][14][15][16][17]. However, there was a significant difference in DIP joint flexion as it was inferior in the plate group than in the screw only group; however, this did not affect the clinical outcomes.…”

Section: Discussionsupporting

confidence: 56%

Open Reduction and Internal Fixation for Dorsal Fracture-dislocation of the Proximal Interphalangeal Joint

Lee

Kim

Lee³

et al. 2020

Handchir Mikrochir plast Chir

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Purpose The purpose of this study was to investigate and compare the clinical and radiological results of ORIF with inter-fragment screw or buttress plate fixation of acute PIP joint fracture dorsal dislocation. Patients and Methods Between January 2007 to December 2016, nineteen patients – 14 men and 5 women with an average age of 40.9 (19 to 64) years – were included in this study; 9 patients underwent small sized interfragmentary screw fixation and 10 patients underwent small buttress plating. The average follow-up period was 45.1 (13 to 78) months. Clinical assessment included measurement of range of motion (ROM) of the proximal and distal interphalangeal joint (PIP, DIP), grip and pinch strength, and pain with use of the Visual Analog Scale (VAS). At the postoperative X-ray, articular step off, gap, and degree of dorsal subluxation was measured, and maintenance of the reduction, fracture union, and the presence of degenerative changes were assessed. Results All patients achieved solid unions without instability. The overall average range of motion of PIP joint were from 9° to 85° (10–83° in the screw group, 8–87° in the plate group without significant difference). However, the screw group (average: 53°) presented more flexion in the distal interphalangeal joint than the plate group (average: 34°). Plate fixation can cause limited DIP flexion. Six of the ten patients from the plate group, underwent implant removal and two of these patients required PIP joint arthrolysis due to the PIP flexion contracture of more than 30°. Three of the nine patients in screw group underwent implant removal and two of the three patients required PIP joint arthrolysis. Conclusion Mini plate and screw fixation of acute PIP joint fracture dorsal dislocation can achieve comparable favorable clinical and radiographic outcomes through stable fixation and early range of motion exercise. Screw fixation, if possible, is probably preferable to plate fixation because of better DIP joint ROM and lower incidence of hardware removal. If there is a need for plate fixation the use of a short plate is recommended to avoid joint stiffness.

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“…Average grip strength was 98% of that on the contralateral side. In a recent study of 13 patients with unstable dorsal fracture dislocations treated with ORIF, Cheah et al 33 reported that the mean ROM was 75°, grip strength was 85% of that on the contralateral side, and the DASH score was 4 at an average 2-year follow-up. However, almost one third of patients required hardware removal.…”

Section: Surgical Managementmentioning

confidence: 99%

Fracture-dislocations of the Proximal Interphalangeal Joint

Elfar

Mann

2013

Journal of the American Academy of Orthopaedic Surgeons

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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.

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Volar Plating for Unstable Proximal Interphalangeal Joint Dorsal Fracture-Dislocations

Cited by 26 publications

References 14 publications

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

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

Open Reduction and Internal Fixation for Dorsal Fracture-dislocation of the Proximal Interphalangeal Joint

Fracture-dislocations of the Proximal Interphalangeal Joint

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Volar Plating for Unstable Proximal Interphalangeal Joint Dorsal Fracture-Dislocations

Cited by 26 publications

References 14 publications

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

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

﻿Open Reduction and Internal Fixation for Dorsal Fracture-dislocation of the Proximal Interphalangeal Joint

Fracture-dislocations of the Proximal Interphalangeal Joint

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Open Reduction and Internal Fixation for Dorsal Fracture-dislocation of the Proximal Interphalangeal Joint