Management of a proximal interphalangeal joint fracture dislocation with a compass proximal interphalangeal joint hinge and therapy: a case report.
The purpose of this report is to describe the management of a chronic proximal interphalangeal (PIP) joint fracture dislocation in a 46-year-old computer programmer. Twenty days following injury, a right ring finger volar plate arthroplasty was performed, loose fracture fragments were excised, and a Compass PIP joint hinge was applied. The hinge was locked at 10 degrees to 15 degrees extension and held in this position for 8 days. On postoperative day 8, hand therapy was initiated. Many challenges were encountered. Insurance constraints required the patient to change therapists. The device frame cracked. The patient developed a PIP joint contracture with extensor lag. Despite these obstacles, the patient achieved a successful outcome, returning to normal pain-free use with grip strength at 87% of that of the uninvolved hand. At discharge, active range of motion was 12 degrees/100 degrees at the PIP joint and 0 degrees/40 degrees at the DIP joint. Passive extension was 0 degrees. At 6 months postoperatively, active range of motion was 0 degrees/105 degrees at the PIP joint and 0 degrees/60 degrees at the DIP joint. This case demonstrates the need for closely supervised postoperative therapy that includes good communication between providers, ongoing patient education, and close monitoring of range of motion.
Hamilton Physical Therapy Services, The Philadelphia Hand Center, Southern, New Jersey, USA. greg-gmtg@erols.com
Sheri B
SB
Feldscher
John E
JE
Blank
D002908:Chronic Disease; D016267:External Fixators; D005383:Finger Injuries / Q000628:therapy*; D005592:Fracture Fixation / Q000379:methods; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D004204:Joint Dislocations / Q000628:therapy*; D008297:Male; D008662:Metacarpophalangeal Joint / Q000293:injuries* / Q000601:surgery; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology; D016896:Treatment Outcome