Dorsal fracture-dislocation of the proximal interphalangeal joint: a comparative study of percutaneous Kirschner wire fixation versus open reduction and internal fixation

J Hand Surg Br. 2005 May;30(2):120-8. doi: 10.1016/j.jhsb.2004.10.011.

Abstract

Nineteen patients with a dorsal fracture-dislocation of the proximal interphalangeal joint of a finger were treated with either closed reduction and transarticular Kirschner wire fixation (eight cases) or open reduction and internal fixation, using either one or two lag screws (six cases) or a cerclage wire (five cases). At a mean follow-up of 7 (range 6-9) years, most patients reported satisfactory finger function, even though some of the injuries healed with proximal interphalangeal joint incongruency (seven cases) or subluxation (four cases). Those treated by open reduction complained of more "loss of feeling" in the affected finger and those specifically treated by cerclage wire fixation reported more cold intolerance and had a significantly larger fixed flexion deformity (median, 30 degrees : range 18-38 degrees ) and a smaller arc of motion (median, 48 degrees : range 45-60 degrees ) at the proximal interphalangeal joint, despite having the best radiological outcomes. Closed reduction and transarticular Kirschner wire fixation produced satisfactory results, with none of the eight patients experiencing significant persistent symptoms despite a reduced arc of proximal interphalangeal joint flexion (median=75 degrees ; range 60-108 degrees ). The results of this relatively simple treatment appear at least as satisfactory as those obtained by the two techniques of open reduction and internal fixation, both of which were technically demanding.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bone Screws
  • Bone Wires*
  • Cold Temperature / adverse effects
  • Female
  • Finger Injuries / diagnostic imaging
  • Finger Injuries / surgery*
  • Finger Joint / diagnostic imaging
  • Finger Joint / physiopathology
  • Finger Joint / surgery*
  • Follow-Up Studies
  • Fracture Fixation, Internal*
  • Fracture Healing
  • Fractures, Comminuted / diagnostic imaging
  • Fractures, Comminuted / surgery*
  • Humans
  • Joint Dislocations / diagnostic imaging
  • Joint Dislocations / surgery*
  • Male
  • Middle Aged
  • Postoperative Complications
  • Prospective Studies
  • Radiography
  • Range of Motion, Articular / physiology
  • Sensation Disorders / etiology
  • Treatment Outcome