Neglected Dorsal Proximal Interphalangeal Joint Dislocation Treated by Volar Plate Arthroplasty: A Case Series

Abstract

Chronic unreduced dislocations of the proximal interphalangeal joint are uncommon, and management principles for these injuries have not been defined. The dislocation can be volar or dorsal and closed reduction is rarely successful owing to soft tissue contractures. Treatment options in literature reviews for such rare injuries included open reduction of pip joint with volar plate arthroplasty, extension block pinning, hemi hamate arthroplasty, pip joint arthrodesis, Suzuki dynamic frame fixation, open reduction and repair of capsule and collateral ligaments with suture anchors. Few cases of amputation following treatment were even reported in literature emphasizing the role of meticulous soft tissue handling in such neglected cases of hand. We report six cases of neglected (more than three months old) dorsal dislocation of the PIP joint of the hand, treated with volar plate arthroplasty and extension block pinning. A functional range of motion with a stable joint can be achieved in such injuries with volar plate arthroplasty, as long as the articular cartilage is relatively preserved and bone loss is <30%.

Keywords: chronic pip dislocation; extension block pinning for pip joint dislocation; neglected pip joint dislocation; pip fracture dislocation; volar plate arthroplasty.

Figure 1. Figures A and B showing the pre-operative clinical image of the index finger with neglected PIP dislocation and Figures C and D showing the radiograph of antero-posterior and lateral projections of the index finger showing dislocation of the PIP joint.

PIP: proximal interphalangeal joint

Figure 2. Figure A showing the volar plate interposed in the PIP joint (yellow arrows) after the debridement of fibrous tissue. Figure B showing the bone loss on base of the middle phalanx (yellow arrow) assessed after the debridement of fibrous tissue.

Figure 3. Figure A showing drill holes made through the freshened edges in the area of bone loss as close to the articular cartilage as possible. Figure B showing sutures from the volar plate being passed through the bony tunnel. Figure C showing tightened pull-out sutures over dorsal aspect of the finger over a rubber drain (yellow arrow) and surgical wound closure.

Figure 4. Figure A shows a one-year follow-up radiograph antero-posterior view of the hand focused on the index finger. Figure B shows the lateral view of the index finger showing no subluxation or dislocation.

Figure 5. Figures A and B showing the grip of the hand with flexion of fingers. Figure C showing the mild flexion contracture at the PIP joint of the index finger (11 degrees) at a one-year follow-up.

PIP: proximal interphalangeal joint