Percutaneous, intramedullary fracture reduction and extension block pinning for dorsal proximal interphalangeal fracture-dislocations

Abstract

Purpose: A percutaneous, intramedullary fracture reduction technique for treatment of unstable dorsal fracture-dislocation of the proximal interphalangeal (PIP) joint is described and the clinical and radiological results are reported.

Methods: We conducted a retrospective clinical follow-up of 16 patients with 18 dorsal fracture-dislocations of the PIP joint. After closed joint reduction, we used an extension block K-wire to maintain the joint reduction. Impacted volar articular fragments were reduced percutaneously under fluoroscopy control using a pre-bent K-wire inserted through the intramedullary canal of the middle phalanx. The patients initiated passive range of motion exercises immediately after surgery. After a mean of 3 weeks, we removed the extension block K-wire and allowed free mobilization. We examined 13 patients with 15 injured fingers at a mean 5-year follow-up (range, 1-8 y).

Results: Radiographic reduction of the joint dislocation was achieved and maintained. The mean articular step-off decreased from 2.1 mm (range, 1.6-3.1 mm) to 0.5 mm (range, 0.0-1.2 mm). At the final follow-up, active PIP motion averaged 83° (range, 65° to 97°) with a mean flexion contracture of 3° (range, 0° to 15°). The mean visual analog scale score for digit pain was 1/10. The mean Disabilities of the Shoulder, Arm, and Hand score of 4/100 indicated little functional impairment.

Conclusions: Percutaneous, intramedullary reduction of the impacted volar articular fragments associated with unstable, dorsal fracture-dislocation of the PIP joint restores joint congruence and function.

Type of study/level of evidence: Therapeutic IV.