Unstable dorsal proximal interphalangeal joint fracture-dislocations treated with extension-block pinning.
Unstable proximal interphalangeal (PIP) joint fracture-dislocations, which can cause significant disability, can be treated with multiple techniques. Extension-block pinning (EBP) allows for early motion and is less technically demanding than alternative surgical treatments. In the study reported here, 12 patients with unstable dorsal PIP fracture-dislocations were treated with closed reduction of the PIP joint followed by percutaneous insertion of a Kirschner wire (K-wire) into the distal aspect of the proximal phalanx. For these patients, extent of articular surface involvement averaged 43% (range, 25%-75%). Active motion was initiated early after surgery, and the K-wire was removed a mean of 25 days after pinning. Radiographic reduction of joint dislocation was achieved and maintained for 11 of the 12 patients at a mean follow-up of 35.5 months. At follow-up, mean visual analog scale (VAS) score was 0.64 (scale, 0-10). Mean score on the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire was 5.7, suggesting minimal functional impairment. Mean PIP active motion was 84° (range, 50°-110°). Grip strength was equal between operative and contralateral hands. Patient satisfaction most closely correlated with low VAS and QuickDASH scores. One patient developed a malunion, which was treated with corrective osteotomy. EBP is a simple, safe, and reproducible technique for unstable PIP fracture-dislocations. This technique yields outcomes similar to those reported for more complex surgical procedures.
David M
DM
Bear
Matthew T
MT
Weichbrodt
Chris
C
Huang
William C
WC
Hagberg
Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA; Hand and Upper Extremity Center, Wexford, PA. marshallbalk@aol.com.
Marshall L
ML
Balk
D000293:Adolescent; D000328:Adult; D001864:Bone Wires; D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011859:Radiography; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D055815:Young Adult