Dynamic intradigital external fixation for proximal interphalangeal joint fracture dislocations

Purpose: Many skeletal traction devices have been described to treat fracture dislocations of the proximal interphalangeal (PIP) joint. Most of these techniques are technically challenging or involve cumbersome frames. We present a design modification that enhances the stability of a simple dynamic fixation system described previously and report our results with this technique.

Methods: A previously described simple dynamic fixator with no rubber bands was applied to 6 patients who sustained fracture dislocations of the PIP joint. The middle finger was involved in 3 patients, the ring finger in 1 patient, and the small finger in 2 patients. The average age of the patients was 27 years (range, 21–42 y). The average involvement of the base of the middle phalanx was 48% (range, 35% to 60%). The average time from the injury to the surgery was 6 days (range, 1–14 d). The average follow-up period was 24 months (range, 7–43 mo). Immediate active flexion extension was allowed and the fixator was removed after 3 to 4 weeks.

Results: The average range of motion of the PIP joint at the final follow-up evaluation was 5° to 89°(range, 0° to 100°). Two patients developed pin track infection that resolved with oral antibiotics. Only one patient complained of mild pain with extreme flexion. Proper reduction and congruency of the joint was noted on final anteroposterior and lateral radiographs.

Conclusions: A simple dynamic fixator for the treatment of unstable PIP joint fracture dislocations was used succesfully in 6 digits to maintain reduction and restore digital range of motion. The addition of modifications to the original technique not only improves the solidity of the construct but also provides satisfactory functional results. Based on our experience we recommend this easy technique to treat fracture dislocations of the PIP joint. (J Hand Surg 2005;30A:154–160. Copyright © 2005 by the American Society for Surgery of the Hand.)

Key words: Proximal interphalangeal joint, fracture dislocation, dynamic fixation.