title: Use of dynamic distraction external fixation for unstable fracture-dislocations of the proximal interphalangeal joint.
abstract: OBJECTIVE
  Unstable fracture-dislocations of the proximal interphalangeal (PIP) joint remain a difficult management problem, often leading to residual pain, stiffness, and recurrent instability. In a military setting, an easily applied, simple to operate, and inexpensive device becomes an attractive option. The purpose of this clinical investigation was to retrospectively review use of dynamic distraction external fixation (DDEF) for unstable fracture-dislocations and pilon injuries of the PIP joint in an active-duty population.
  
  
  METHODS
  The fixator is assembled under a local anesthetic from three 1.4-mm (0.045-inch) K-wires and rubber bands. It uses the principles of a lever and ligamentotaxis to assist and maintain reduction. Thirty-four members of the Armed Services, 27 men and 7 women (average age, 30 y), had DDEF for pilon fractures and unstable fracture-dislocations of the PIP joint. A retrospective review of these individuals was conducted. Final range of motion was determined from the clinical records at the final visit.
  
  
  RESULTS
  There were 26 PIP fracture-dislocations (3 chronic, average 6 weeks) and 8 PIP pilon injuries. The average follow-up period was 16 months (range, 6-84 months). The final arc of motion at the PIP joint averaged 88 degrees , and the average distal interphalangeal joint arc of motion was 60 degrees . Eight patients experienced superficial pin-track infections that were easily controlled with oral antibiotics. There were no cases of septic arthritis or osteomyelitis requiring intravenous antibiotics or premature fixator removal. Loss of reduction did not occur. All patients returned to their prior level of activity and duties.
  
  
  CONCLUSIONS
  Our results are comparable with other techniques used in the management of unstable PIP joint fracture-dislocations. Easily applied and simple to operate, DDEF is a valuable addition to the hand surgeon's armamentarium. We recommend its use for both primary and adjunctive treatment of acute and chronic unstable PIP joint fracture-dislocations and for primary treatment of PIP pilon injuries.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Bone and Joint/Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Ruland
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hogan
authors.forename: David L
authors.initials: DL
authors.lastname: Cannon
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Slade
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016267:External Fixators; D005260:Female; D005384:Finger Joint; D050278:Finger Phalanges / Q000293:injuries*; D005592:Fracture Fixation; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000601:surgery*; D008297:Male; D019857:Osteogenesis, Distraction; D012189:Retrospective Studies; D016896:Treatment Outcome