Treatment of proximal interphalangeal dorsal fracture-dislocation injuries with dynamic external fixation: a pins and rubber band system

J Hand Surg Am. 2007 Oct;32(8):1242-50. doi: 10.1016/j.jhsa.2007.07.001.


Purpose: Unstable, dorsal, intra-articular, fracture-dislocations of the proximal interphalangeal (PIP) joint can be difficult to treat and often lead to long-term pain, stiffness, and functional deficit. We present the outcomes of patients sustaining such injuries that were treated by a novel dynamic external fixator. This fixator uses a system of K-wires and rubber bands that maintains a concentrically reduced PIP joint while allowing for early motion.

Methods: Fourteen patients with unstable, dorsal fracture-dislocation injuries of the PIP joint were treated between September 2001 and January 2006. Eight were available for follow-up evaluation at an average of 26 months. We measured PIP range of motion and grip strength, and assessed pain on a visual analog scale. Demographic information about the original injury was recorded. New radiographs were obtained to assess joint congruency and the presence of arthritis or articular step-off deformity.

Results: In the 8 patients available for follow-up evaluation, the average motion of the affected PIP joint was from 1 degrees (range 0 degrees to 5 degrees) to 89 degrees (range 75 degrees to 110 degrees). Grip strength was 92% (range 71% to 110%) of the unaffected hand. The average score on the visual analog pain scale was 0.6 (range 0-1.5). There were few complications. Radiographs at follow-up evaluation showed a concentric reduction in all joints, but with evidence of a small step-off deformity or arthritis in 5 patients.

Conclusions: The dynamic external fixator studied is an effective method of treating unstable, dorsal fracture-dislocation injuries. Outcomes compared favorably with those of other similar devices studied in the literature.

MeSH terms

  • Adult
  • Bone Nails*
  • Equipment Design
  • External Fixators*
  • Female
  • Finger Joint / diagnostic imaging
  • Finger Joint / surgery*
  • Follow-Up Studies
  • Fractures, Bone / surgery*
  • Hand Strength
  • Humans
  • Joint Dislocations / diagnostic imaging
  • Joint Dislocations / surgery*
  • Joint Instability / surgery
  • Male
  • Middle Aged
  • Pain Measurement
  • Radiography
  • Range of Motion, Articular
  • Treatment Outcome