Ten patients who had sustained 11 unstable dorsal fracture-dislocations of the finger proximal interphalangeal joints were reviewed at a mean follow-up period of 16 years (range 14 – 21 years). Pre-treatment radiographs were not available, but the authors assumed that 30% to 60% of the palmar articular surface at the base of the middle phalanx was injured in each case. The proximal interphalangeal joint was reduced by closed means and stabilized in 20 degrees to 40 degrees of flexion with one Kirschner wire for 3 weeks. At latest follow-up, 7 of 10 patients complained of no finger pain or stiffness, and none complained of severe pain. The average flexion contracture of the proximal interphalangeal joint measured only 8 degrees with a mean arc of movement of 85 degrees. Radiographs demonstrated no severe degenerative changes withonly mild joint space narrowing in some cases.
The optimal treatment for unstable dorsal fracture-dislocations of the proximal interphalangeal joint remains uncertain. Treatment methods used alone or in combination include open reduction and internal fracture fixation, temporary proximal interphalangeal joint pinning, dynamic traction and extension block splinting. The results of this study suggest that the outcome of closed reduction and percutaneous pinning is similar to that of other techniques. However, the authors have appropriately cautioned that the use of this technique for injuries involving more than 50% of the middle phalanx base may not be successful.
Journal of Hand Surgery