Volar plating for unstable proximal interphalangeal joint dorsal fracture-dislocations.
OBJECTIVE
To report our results of open reduction internal fixation with volar mini plate and screw fixation for unstable dorsal fracture dislocations (DFDs) of the proximal interphalangeal (PIP) joint.


METHODS
We performed a retrospective review of 13 consecutive DFDs of the PIP joint treated with volar mini plate and screw fixation, measuring both clinical and radiological outcomes.


RESULTS
The age range of our patients was 15 to 56 years (average, 33 y). Six injuries were related to work, 5 to sports, and 2 to motor vehicle accidents. Of the 13 DFDs, 6 were comminuted. Articular involvement ranged from 30% to 70% (average, 44%). The average time to surgery was 7 days (range, 0-23 d). Patients had follow-up of 12 to 60 months (average, 25 mo). Four patients had a postoperative course complicated by plate and screw removal at an average of 4 months later, either as part of a secondary procedure to improve range of motion or owing to patient request. All patients returned to their original occupation. Of the 13 patients, 11 were satisfied with the result, and 12 of 13 had either no or mild pain. All 13 DFDs united in good alignment but 3 showed degenerative changes. Average grip strength was 85% of the unaffected side, and average active PIP joint and distal interphalangeal joint motion arcs were 75° and 65°, respectively. Average Quick Disabilities of Arm, Shoulder, and Hand score was 4 (range, 0-9). All patients had non-tender swelling of the proximal interphalangeal joints but no signs of flexor tenosynovitis or infection.


CONCLUSIONS
Fixation of unstable PIP joint DFDs via a volar approach is technically feasible with mini plates and screws. This treatment allows early active range of motion and provides good objective and subjective outcomes; however, noteworthy complications occurred in 39% of patients.


METHODS
Therapeutic IV.
Department of Hand & Reconstructive Microsurgery, National University Hospital, National University Health System, Singapore. andre_ej_cheah@nuhs.edu.sg
Andre E J
AE
Cheah
David M K
DM
Tan
Alphonsus K S
AK
Chong
Winston Y C
WY
Chew
D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D015331:Cohort Studies; D005260:Female; D005383:Finger Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D005384:Finger Joint / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery; D018737:Hand Strength; D006801:Humans; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult