Open Reduction and Internal Fixation for Dorsal Fracture-dislocation of the Proximal Interphalangeal Joint

 

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Abstract

Purpose The purpose of this study was to investigate and compare the clinical and radiological results of ORIF with inter-fragment screw or buttress plate fixation of acute PIP joint fracture dorsal dislocation.

Patients and Methods Between January 2007 to December 2016, nineteen patients – 14 men and 5 women with an average age of 40.9 (19 to 64) years – were included in this study; 9 patients underwent small sized interfragmentary screw fixation and 10 patients underwent small buttress plating. The average follow-up period was 45.1 (13 to 78) months. Clinical assessment included measurement of range of motion (ROM) of the proximal and distal interphalangeal joint (PIP, DIP), grip and pinch strength, and pain with use of the Visual Analog Scale (VAS). At the postoperative X-ray, articular step off, gap, and degree of dorsal subluxation was measured, and maintenance of the reduction, fracture union, and the presence of degenerative changes were assessed.

Results All patients achieved solid unions without instability. The overall average range of motion of PIP joint were from 9° to 85° (10–83° in the screw group, 8–87° in the plate group without significant difference). However, the screw group (average: 53°) presented more flexion in the distal interphalangeal joint than the plate group (average: 34°). Plate fixation can cause limited DIP flexion. Six of the ten patients from the plate group, underwent implant removal and two of these patients required PIP joint arthrolysis due to the PIP flexion contracture of more than 30°. Three of the nine patients in screw group underwent implant removal and two of the three patients required PIP joint arthrolysis.

Conclusion Mini plate and screw fixation of acute PIP joint fracture dorsal dislocation can achieve comparable favorable clinical and radiographic outcomes through stable fixation and early range of motion exercise. Screw fixation, if possible, is probably preferable to plate fixation because of better DIP joint ROM and lower incidence of hardware removal. If there is a need for plate fixation the use of a short plate is recommended to avoid joint stiffness.

Zusammenfassung

Ziel In dieser Studie wurden die klinischen und radiologischen Ergebnisse nach Schraubenosteosynthesen mit den Ergebnissen von Plattenosteosynthesen von dorsalen Luxationsfrakturen des Fingermittelgelenkes (PIP-Gelenk) verglichen.

Patienten und Methoden Zwischen Januar 2007 und Dezember 2016 wurden 19 Patienten – 14 Männer und 5 Frauen mit einem durchschnittlichen Alter von 40,9 (19–64) Jahren in die Studie eingeschlossen. Bei 9 Patienten erfolgte eine Schrauben-, bei 10 Patienten eine Plattenosteosynthese. Die Nachuntersuchungszeit betrug im Schnitt 45,1 (13 bis 78) Monate. Die klinische Untersuchung umfasste die Messung des Bewegungsumfangs des Mittel- und Endgelenkes (PIP- und DIP-Gelenk), der Grobgriff- und Spitzgriffkraft sowie der Schmerzen mittels visuellen Analogskala (VAS). Die postoperativen Röntgenbildern wurde bzgl. Frakturheilung, Repositionsverlust, degenerativen Veränderungen und der Größe verbliebener Stufen- und Spaltbildungen ausgewertet.

Ergebnisse Bei allen Patienten kam es zur knöchernen Heilung ohne Zeichen einer Instabilität des PIP-Gelenkes. Die durchschnittliche Beweglichkeit aller PIP-Gelenke betrug 0–9–85°, für die Schraubengruppe 0–10–83°und für die Plattengruppe 0–8–87°, ohne dass ein signifikanter Unterschied bestand. Im DIP-Gelenk wiesen Patienten der Schraubengruppe eine bessere Flexion auf. Bei 6 der 10 Patienten mit Plattenosteosynthese musste die Platte entfernt werden, gleichzeitig erfolgte bei 2 eine Lösung des PIP-Gelenkes aufgrund einer Beugekontraktur von mehr als 30°. Bei 3 der 9 Patienten mit Schraubenosteosynthese erfolgte ebenfalls die Entfernung des Osteosynthesematerials, 2 erhielten zusätzlich eine Lösung des PIP-Gelenkes.

Schlussfolgerung Schrauben- und Plattenosteosynthesen dorsaler Mittelgelenksluxationsfrakturen erzielen vergleichbar gute klinische und radiologische Ergebnisse und erlauben eine Frühmobilisation bei stabiler Situation. Aufgrund der besseren Beweglichkeit im DIP-Gelenk und da weniger häufig das Osteosynthesematerial entfernt werden muss, ist – wenn möglich – die Schraubenosteosynthese zu bevorzugen. Bedarf es einer Plattenosteosynthese, sollte die Platte möglichst kurz sein, um Bewegungseinschränkungen des DIP-Gelenkes zu vermeiden.

Publication History

Received: 03 July 2019

Accepted: 15 November 2019

Article published online:
05 March 2020

© Georg Thieme Verlag KG
Stuttgart · New York

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