Mid-Term Outcomes of Unstable Complex Proximal Interphalangeal Joint Fracture Management Using the Ligamentotaxor® Device: A Case Series of 33 Cases

Abstract

Background and objective Fractures of the proximal interphalangeal joint (PIPJ) of the hand have always been difficult to treat, often leading to less than satisfactory outcomes. The use of dynamic external fixator devices to treat these fractures is well established and it is based on the philosophy of minimal soft tissue injury and early joint mobilization. There has been a wide variety in their designs, surgical technique, and reported outcomes. This study aimed to report the long-term outcome following the use of the Ligamentotaxor® device (Ligamentotaxor1, ArexTM, Palaiseau, France) in treating fractures of the PIPJ of the hand. Methods Between 2009 and 2018, 33 patients treated in our institution with Ligamentotaxor® for fractures of the PIPJ were followed up for a minimum period of 12 months. Radiographs and clinical records were reviewed for clinical and functional outcomes including finger range of motion (ROM), union, Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) score, and any complications. Results A total of 33 patients completed a minimum follow-up of 12 months (mean: 27.5 months). All fractures showed radiological union at a mean of 33 days. Surgery was performed within a mean of 8.9 days and surgical operating time averaged 23.7 minutes. Devices were removed at a mean of 33 days. At the end of the follow-up, the mean range of flexion was 66 degrees and the mean extension lag was six degrees. The mean QuickDASH score was 8.72. Of note, 85% of the patients experienced no limitations in their daily activities, while 35% reported pain on exertion. One patient had a pin tract infection. Four patients had cold intolerance and persistent swelling. Conclusion The results of the use of Ligamentotaxor® in this series are comparable to those of other dynamic external fixator devices reported in the literature. Thanks to its quick and easy surgical technique, the device provides an appealing option for the management of PIPJ fractures.

Keywords: dynamic; fixator; fracture; ligamentotaxis; proximal interphalangeal joint.

Figure 1. Illustration of different types of proximal interphalangeal joint fractures as per Pélissier’s classification

A: extra-articular fractures. B: simple articular fractures. C: pilon fractures. D: fracture involving both ends of the joint. E: palmar lip fractures. F: dorsal lip fractures The fractures are further graded from 1 (one fragment) to 3 (comminuted)

Figure 2. Intraoperative fluoroscopy imaging demonstrating Ligamentotaxor® device installment and fracture reduction

Figure 3. Clinical photographs demonstrating an active range of motion with the device installed during the follow-up visits

Figure 4. Radiographic images at various stages

A: preoperative radiograph demonstrating E2 type fracture of the base of the middle phalanx left ring finger. B: two-week postoperative radiograph demonstrating fracture reduction using the Ligamentotaxor® device. C: six-month postoperative radiograph demonstrating fracture healing and restoration of joint congruency