Extension block pinning for the treatment of a dorsal fracture dislocation of the distal interphalangeal joint: case report

Pins and Rubbers Traction System for Treatment of Intraarticular Fractures of Distal Interphalangeal Joint

Background: The pins and rubber traction system (PRTS) has proven effective in managing intra-articular fractures of the proximal interphalangeal joint. However, there is scant evidence in the literature regarding its efficacy in treating distal interphalangeal joint (DIPJ). This study aims to investigate the outcomes of PRTS in the treatment of comminuted intra-articular fractures of the DIPJ. Methods: We conducted a retrospective review of patients with comminuted intra-articular fractures of the DIPJ treated with PRTS between 2017 and 2021. At the final follow-up, we measured and compared the active range of motion (ROM) in both affected and non-injured contralateral fingers. The subjective evaluation utilised the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and the Visual Analogue Scale (VAS). Results: Ten patients with a mean follow-up of 13.2 months (range: 12-17) were included in the study. Fracture locations included the base of the distal phalanx in two patients, the condyle of the middle phalanx in seven and both in one patient. At the final follow-up, the average VAS score was 0.5 (range: 0-2). The average active motion of the DIPJ was 61° (range: 50°-70°) for the injured side and 76° (range: 75°-80°) for the opposite side. The mean range of DIPJ movement was 80% (range: 68%-87%) of the non-injured side. Extension deficits were observed in five patients, with a median deficit value of 10° (range: 5°-10°). The average Quick-DASH score was 2.9 (range: 0-11.3). Conclusions: The PRTS can be considered as an effective surgical technique in managing comminuted intra-articular fractures of the DIPJ. Level of Evidence: Level IV (Therapeutic).

An adjustable Kirchner wire frame traction method for the treatment of dorsal fracture-dislocation of the distal interphalangeal joint

We applied an adjustable traction method which enables early range of motion exercise for the dorsal fracture-dislocation of the distal interphalangeal joint, and obtained satisfactory results. The reduction of comminuted fragments or depression of the joint is unnecessary using the traction method, because early exercise accelerates the remodelling of the injured soft tissue, followed by the development of joint stability. This traction mechanism is independent of the vector force of the traction applied due to the frame-structure construction. Our method makes it easy to adjust the traction force in millimetre increments of the glove-finger length, and has broad range of traction force. In cases where the dislocation is persistent even after strengthening the traction force, a transverse-transfixing Kirschner wire (K-wire) can be inserted to hold the reduction securely against subluxation.

Fracture-dislocation about the finger joints

Fracture-dislocations in the small joints of the fingers are challenging injuries. The surgeon must choose an appropriate treatment based on fracture pattern, joint stability, and injury chronicity. Fracture-dislocations of the proximal interphalangeal joint are notoriously unforgiving, with potential long-term sequelae of residual pain and stiffness. Similar injuries in the distal interphalangeal joint are more tolerant of fracture displacement and even joint subluxation. Dorsal dislocations of the metacarpophalangeal joint may be associated with shearing fractures of the metacarpal head but are most notable for the volar plate interposition that may block closed reduction.