The Treatment and Clinical Evaluation of Volar Lip Fracture of Middle Phalangeal Base with Dorsal Dislocation of Proximal Interphalangeal Joint
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Objective:Investigate the Treatment of volar lip fracture of middle phalangeal base with dorsal dislocation of proximal interphalangeal joint and evaluate the treatment effectiveness.Method:During two years 10 patients that confronted volar lip fracture of middle phalangeal base with dorsal dislocation of proximal interphalangeal joint accepted treatment.According to classification of Hasting-subtype,we adopted conservative and operative treatment and rehabilitation after operation.Result:The follow-ups lasted from 3 to 26 months,with a mean period of 11.8 months.On the basis of scoring system of Ishida-Ikuta for evaluation of the results of PIP joint fracture-dislocation,the ratio of excellent-good was 70%.Imaging show good reduction and one-stage union.Short-term complication was few.Conclusion:Treatment effectiveness was satisfactory regardless of the application of conservative or operative treatment for volar lip fracture of middle phalangeal base with dorsal dislocation of proximal interphalangeal joint,the key of therapy is anatomic reduction,and rehabilitation exercises actively postoperation.Keywords:
Interphalangeal Joint
Conservative Treatment
Bony union
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Interphalangeal Joint
Subluxation
Cadaveric spasm
Phalanx
Proximal phalanx
Joint stability
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We report a rare case of open dorsal dislocation of the proximal interphalangeal joint which needed operative reduction. A 39-year-old man injured his right middle finger while playing baseball. There was a laceration on the proximal interphalangeal crease, and the condyles of the proximal phalanx protruded through the wound. The flexor tendons had slipped behind the radial condyle, and made reduction impossible. After the flexor tendons and volar plate were replaced back into their normal position, the reduction was successful. Finally, the patient had full and painless motion of the digit. We review the reported cases of this injury in the relevant literature.
Interphalangeal Joint
Phalanx
Numerical digit
Distal interphalangeal joint
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Objective To investigate therapeutic efficacy of the internal fixation in the closed dislocation of the proximal interphalangeal joint(PIP joint) with the volar basal fracture of the middle phalanx.Methods 20 patients with closed dislocation of the PIP joint with the volar basal fracture of the middle phalanx accepted Kischner wire fixation treatment,splint protection for 3 to 4 weeks and rehabilitation after operation.Results 20 patients all have been followed up after operation over a period of 3 to 6 months,the image evaluation showed the reduced and united of the bone fracture.The active range of motion at the PIP joint was 0~20(18±1)°in extension and 30~90(68±5)°in flexion;the passive range of motion was 5~20(15±2)°in extension and 50~100(78±8)°in flexion.Conclusions The therapeutic efficacy is satisfactory with internal fixation in the treatment to the closed dislocation of the PIP joint with the volar basal fracture of the middle phalanx.
Interphalangeal Joint
Phalanx
Distal interphalangeal joint
Middle finger
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Hook
Plating (geology)
Interphalangeal Joint
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Interphalangeal Joint
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Subluxation
Interphalangeal Joint
Avulsion fracture
Finger joint
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Subluxation
Interphalangeal Joint
Phalanx
Numerical digit
Finger joint
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Citations (27)
The anatomy and histology of the volar plate at the proximal interphalangeal joint and the mechanism of fracture/subluxation of the base of the middle phalanx in closed proximal interphalangeal joint injuries is reviewed. Our current technique of repair for these injuries and its evolution from Eaton’s original procedure is described. The results of 71 cases of volar plate arthroplasty performed over a five-year period for fracture/subluxations of the proximal interphalangeal joints are presented with follow-up ranging from six months to four years. 62 (87%) patients achieved a stable pain-free joint with a range of motion from 5° to 95° within two months. Complications were uncommon and correctable with an overall eventual patient satisfaction rate of 94%.
Interphalangeal Joint
Finger joint
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Citations (51)
Background: Unstable intra-articular proximal interphalangeal (PIP) joint fracture-dislocations present a difficult problem that requires congruous joint reduction and stable internal fixation or distraction. Though fractures with limited articular involvement may be treated successfully with less invasive procedures, fracture-dislocations with a volar shear component may benefit from joint reduction with subchondral support for maintenance of stability. The purpose of this article is to describe a volar transverse plate and screw technique and report the short-term postoperative results. Methods: Seventeen patients with volar shear PIP dorsal fracture-dislocations were treated with transverse plate and screw constructs at an average of 21 days (range, 2-52) after injury. Information on postoperative stability, range of motion at PIP and distal interphalangeal (DIP) joints, and radiographic outcomes and complications were retrospectively collected. Results: At a mean of 7.3 months post-operation (range, 1.5-24), there were no recurrent dislocations and an average PIP arc of 77.4° and DIP arc of 61.5°. Sixteen of 17 patients had radiographically concentric joints, with 1 patient showing slight radiographic dorsal subluxation not apparent clinically. Two of 17 patients (11.8%) had revision surgery for tenolysis and removal of hardware to improve range of motion at 4 and 9 months post-operation. Conclusions: In the setting of PIP dorsal fracture-dislocations with volar shear component >40% of the articular surface, the Seatbelt procedure allows for concentric joint and articular surface reduction with subchondral support for maintenance of stability. This volar transverse plating technique allows for highly functional range of motion without PIP dorsal subluxation clinically in the setting of comminution and delayed presentation.
Subluxation
Interphalangeal Joint
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Dorsal fracture dislocations of the proximal interphalangeal joint remain 1 of the most difficult problems in which to obtain an excellent functional outcome. The use of minimally invasive internal fixation techniques improving the biologic healing response and yet providing fracture fragment stabilization has met with greater popularity in recent years. The results of 12 patients treated by the volar cerclage wiring technique are described. At average followup examination of 2.1 years, 11 of 12 patients were noted to have no degenerative joint changes with only 1 patient having evidence of early volar articular surface beaking. Average final active arc of motion at the proximal interphalangeal joint was 89 ° (range, 72 °-109 °). The average degree of extension loss at the proximal interphalangeal joint was 8 ° (range, 0 °-16 °). There were no complications involving implant failure, irritation, or infection. A description of the volar cerclage wire technique is presented. This technique provides the advantage of avoiding fracture fragment stripping, stable restoration of the articular surface, and palmar buttress of the middle phalanx at the proximal interphalangeal joint.
Interphalangeal Joint
Articular surface
Proximal phalanx
Finger joint
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Citations (78)