Staged external fixation for chronic fracture-dislocation of the proximal interphalangeal joint: outcomes of patients with a minimum 2-year follow-up.

Abstract

To introduce a new surgical strategy for chronic fracture-dislocations of the proximal interphalangeal (PIP) joint with 2-staged external fixation. We also assessed the results of this method in all of our patients with at least 2 years of follow-up. We used the procedure in 6 cases. For the first step, we applied mini external fixators for 1 week before surgery to apply traction to the PIP joint with sufficient force to stretch the dislocated joint components. The second procedure was surgical release of the PIP joint and an attempt at percutaneous reduction and fixation. This was not possible in 4 cases, and we performed an open reduction and corrective osteotomy. Postoperative early rehabilitation was achieved under controlled movement using an external fixator that allowed PIP joint flexion and extension. At long-term follow-up (mean, 3.5 y), the range of movement of PIP joints had increased by 76°, and that of distal interphalangeal joints by 35°. Osteochondral remodeling likely occurred not only while the joint was protected with the dynamic external fixator during a 12-week period (range, 8-14 wk), but also after removal. Preoperative traction softens the PIP joint, facilitating both surgery and rehabilitation. Postoperative early exercise with controlled movement, while maintaining concentric reduction with the external fixator, may accelerate osteochondral repair of the injured PIP joint.