Modified Transosseous Wiring Technique for Neglected Fracture-Dislocation of the Proximal Interphalangeal Joint

Abstract

Background: Fracture-dislocation of the proximal interphalangeal (PIP) joint of the finger is challenging due to the high risk of stiffness. The purpose of this study is to evaluate the clinical and radiological results of a modified transosseous wiring technique for the management of chronic fracture-dislocations of the PIP joint.

Methods: Ten patients (nine men and one woman; mean age, 38.3 years; range, 21 to 69 years) with neglected fracture-dislocation of the PIP joint were included. The mean duration from injury to operation was 14.7 weeks (range, 3 to 66 weeks). The dorsolateral approach and extension block pinning were used to reduce dislocation. After thorough debridement of the scar tissues in the dorsal dead space and the fracture site, the reduction was maintained with transosseous wiring. Radiologic evaluations of bone union and arthritic changes and clinical evaluations (range of motion of the PIP joint and Disabilities of the Arm, Shoulder and Hand [DASH] score) were performed. The mean follow-up period was 12.9 months (range, 12 to 19 months).

Results: All patients demonstrated evidence of radiographic healing within a mean healing time of 6 weeks (range, 4 to 10 weeks); however, one had a widened gap and one had an early arthritic change. The mean range of motion in the PIP joint was 81° (range, 50° to 105°). The mean DASH score was 21.6 (range, 7.5 to 35.8).

Conclusions: For chronic fracture-dislocation of the PIP joint, transosseous wiring with direct curettage and optimal bone purchase can provide satisfying outcome.

Keywords: Bone wires; Extension block; Fracture dislocation; Proximal interphalangeal joint.

Fig. 1. The drawing shows a dorsally dislocated fracture with scar tissue in the dorsal dead space and the malunited site. The scar tissues should be debrided in such cases.

Fig. 2. Intraoperative photograph of a 36-year-old male patient. The fracture site was exposed through the dorsolateral incision. The malunited fracture was osteotomized by using an osteotome. The collateral ligament was intact from the volar fragment of the middle phalanx.

Fig. 3. After osteotomy of the malunited site, a bone tunnel was made in the dorsal fragment by drilling with a Kirschner wire.

Fig. 4. The Kirschner wire was removed, and the inlet was occupied by a wire to pass the bone tunnel.

Fig. 5. The wire that has passed the bone tunnel in the dorsal fragment was tightened and twisted to ensure that it purchased the anterior part of the volar small fragment. The volar plate can be punctured.

Fig. 6. (A) The lateral radiograph of a 21-year-old man who was injured by a direct blow 3 weeks before presentation shows a Schenck type IIIC fracture–dislocation of the third proximal interphalangeal joint. (B) The postoperative radiograph shows a fracture–dislocation that was reduced by transosseous wiring that purchased the volar fragment with an extension blocking Kirschner wire in the proximal phalanx. (C) One year after surgery, the wire was removed. The radiograph shows a normal joint space with bony union.