[Long-term follow-up of fracture dislocations and comminuted fractures of the PIP joint treated with Suzuki's pin and rubber traction system].
Fracture dislocations and comminuted fractures of the PIP joint are considered as severe injuries with uncertain outcome. Short-term results of several traction devices in the treatment of PIP joint fractures have been published. But the further course concerning the injured joint surface has not been described yet. From 1995 to 2001 we treated 26 patients who suffered comminuted intraarticular fractures and fracture dislocations with the digital dynamic external fixator from Suzuki. The time of follow-up was 8 years (median) with a range of 5 - 11 years. Due to this rather long period only 13 patients were available for follow-up. The flexion of PIP joint gained a median value of 95 degrees (range: 35 - 100 degrees ), extension loss was 0 degrees (median; range: 0 - 35 degrees ). Range of motion of the PIP joint was 85 degrees (median; range: 0 - 100 degrees ). The evaluation of the X-rays shows an initial anatomic reduction with complete joint congruency in only 20 % of the cases, but over time there was a remodelling of the joint surface in 89 % without obvious signs of degeneration of the joint. We suppose that the surprisingly good long-term results are linked to this extraordinary remodelling. No patient complained about pain using the affected finger without load and only 2 patients experienced mild pain on heavy use. Compared to the 2-years results of another patient group that we published in 2001 the long-term results tend to be slightly better. We conclude that dynamic traction and early motion of intraarticular PIP joint fractures are the treatment of choice, as virtually pain-free and good motion is achieved also in the long-term due to the remarkable remodelling capacity of the joint surface.
Richter
M
M
Abteilung für Hand-, Plastische und Wiederherstellungschirurgie, Malteser Krankenhaus Bonn/Rhein-Sieg, Bonn. dr.martin.richter@gmx.de
Brüser
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P
D000328:Adult; D000368:Aged; D016267:External Fixators; D005383:Finger Injuries / Q000601:surgery*; D005384:Finger Joint / Q000502:physiology; D005500:Follow-Up Studies; D018460:Fractures, Comminuted / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D013997:Time Factors; D014143:Traction / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome