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. 2022 Jan;17(1):60-67.
doi: 10.1177/1558944719895621. Epub 2020 Jan 23.

Dorsal Subluxation of the Proximal Interphalangeal Joint After Volar Base Fracture of the Middle Phalanx

Kamilcan Oflazoglu  1 , Catherine A de Planque  2 , Thierry G Guitton  3 , Hinne Rakhorst  4 , Neal C Chen  2
Affiliations

Dorsal Subluxation of the Proximal Interphalangeal Joint After Volar Base Fracture of the Middle Phalanx

Kamilcan Oflazoglu et al. Hand (N Y). 2022 Jan.

Abstract

Background: Treatment decisions regarding volar base fractures of the middle phalanx depend on whether the proximal interphalangeal (PIP) joint is reduced. Our aim was to study the agreement among hand surgeons in determining whether the PIP joint fractures are subluxated and to study the factors associated with subluxation of these fractures. Methods: In this retrospective chart review, 413 volar base fractures of the middle phalanx were included. Demographic and injury-related factors were gathered from medical records and radiographs. Using a Web-based survey, interobserver agreement was determined among 105 hand surgeons on the assessment of PIP joint subluxation of a series of 26 cases. Using the cohort of 413 fractures, a threshold for percent articular involvement and relative fracture displacement that corresponds with subluxation of the PIP joint was analyzed. Results: We found moderate to substantial agreement between hand surgeons on subluxation (κ = 0.59, P < .0001) and an overall percent agreement of 85%. Percent articular involvement and relative fracture displacement were independently associated with subluxation of the PIP joint (P < .001). Percent articular involvement of 35% had a specificity of 90% and a negative predicting value (NPV) of 92% for joint subluxation. Relative fracture displacement of 35% had a specificity of 92% and an NPV of 94% for joint subluxation. Conclusions: Surgeons generally agree on whether a PIP joint is subluxated. Percent articular involvement and relative fragment displacement are objective measurements that can help characterize joint stability and assist with decision-making.

Keywords: PIP fracture; PIP joint; dorsal subluxation.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements) or financial remunerations that might pose a conflict of interest in connection with the submitted article.

Figures

Figure 1.
Figure 1.
Articular surface involvement (%) is calculated by dividing the fragment size (A) by the total articular surface (A + B). Fragment displacement (%) is calculated by dividing the fragment displacement (C) by the total articular surface (A + B). Note. In this example, A is 1.56 mm, B is 6.79 mm, and C is 2.29 mm. This results in an articular surface involvement of 19% and fragment displacement of 27%.
See this image and copyright information in PMC

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