Dorsal Plating for Intra-articular Middle Phalangeal Base Fractures With Volar Instability

A Review on Volar Fracture-Dislocations of the Proximal Interphalangeal Joint

Volar fracture-dislocations of the proximal interphalangeal joint are rare injuries caused by an axial force on a flexed digit resulting in an avulsion fracture of the dorsal lip of the middle phalanx with volar dislocation of the joint. This volar subtype is analogous to the more common dorsal subtype with a mirror image fracture on the dorsal lip of the middle phalanx. The main significance in this type of injury lies in the disruption of the extensor mechanism at the central slip. The goals of treatment, apart from restoring a congruent and stable joint, is to restore the extensor mechanism to prevent a boutonnière deformity. In this article, we summarise the current literature and discuss the principles for treatment of this uncommon injury. Level of Evidence: Level V (Therapeutic).

The Results of Hook Plate Fixation for Palmar Fracture Dislocation of the Proximal Interphalangeal Joint

PURPOSE

This study aimed to present the clinical outcomes of the dorsal plating technique for palmar fracture dislocations of the proximal interphalangeal (PIP) joint. This plating technique minimizes dissection and interference with the finger extensor mechanism.

METHODS

We treated seven patients (with a mean age of 39.1 years) with dorsal hook plates for palmar fracture dislocations of the PIP joint between April 2018 and August 2022. The little finger was affected in five patients, and ring finger was affected in two. The mean time to surgery was 5.6 days, and the postoperative follow-up period was seven months. On the second postoperative day, all patients were allowed active motion of both the PIP and the distal interphalangeal (DIP) joints. Simultaneously, DIP blocking exercises were started to prevent adhesion of the extensor mechanism.

RESULTS

The mean active flexion and extension of the PIP joint was 105° and -4°, respectively, whereas those of the DIP joint were 65° and 4°. No patient experienced extension lag in the DIP joint. The mean total active motion (TAM) was 273°, and the %TAM was 96%. The grip strength of the affected hand averaged 90% of that of the unaffected hand. The mean numerical rating scale for pain was 0.3 points, and the mean Hand20 score was 5.1 points. No complications were observed; two patients underwent implant removal at their request.

CONCLUSIONS

The present study suggests that this hook plate technique, which minimizes interference with the finger extension mechanism, is an effective surgical procedure that allows patients to tolerate early range of motion exercises and obtain satisfactory clinical outcomes in both the PIP and DIP joints.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic V.

Blocking Plate for Volar Proximal Interphalangeal Joint Fracture Dislocation

PURPOSE

To assess the use of a 2-mm miniplate as a dorsal blocking plate to stabilize the central avulsion fragment in a proximal interphalangeal joint (PIP) volar fracture dislocation.

METHODS

This was a case series comprising 8 patients with volar fracture dislocation of the PIP joint. The average age of the patients was 36 years. The patients were managed by this technique within an average of 11 days following the injury. The clinical outcome measurements included the assessment of pain and range of motion of the PIP and distal interphalangeal joints.

RESULTS

The average follow-up duration was 20 months. The mean visual analog scale pain score was 1.9. The average range of motion of the PIP joint was 82°, whereas the average range of motion of the distal interphalangeal joint was 43°. Reduction of the subluxation was achieved in all cases, with no articular step remaining.

CONCLUSIONS

A dorsal blocking plate is a simple technique, associated with a satisfactory outcome, for volar fracture dislocation injuries of the PIP joint.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic V.

Injuries Around the Proximal Interphalangeal Joint

Proximal interphalangeal joint (PIPJ) injuries are common and challenging to treat, involving a spectrum of conditions ranging from isolated ligamentous injuries to severe fracture dislocations. The main goal of treatment is to achieve a congruent, stable joint, which is key to achieving early range of motion and a favorable outcome. Injuries that do not compromise the stability of the joint may be treated nonsurgically, whereas those that render the joint unstable may be managed with one of many surgical strategies available. This article focuses on the current practices of treatment of injuries around the PIPJ.