Abstract
The authors present a series of 11 patients. All of them sustained an unstable dorsal
fracture-dislocation of the proximal interphalangeal joint (PIPJ). These were managed
with open reduction and internal fixation (ORIF) by use of an eight-hole, 1.3-mm oblique-angled
strut plate, cut to shape to produce a four-hole plate, acting as a buttress plate.
The operations were performed by orthopaedic surgeons with a special interest in hand
surgery. Range of motion (ROM) and fixed flexion deformity (FFD) were measured postoperatively.
Outcomes were assessed using the Quick Disabilities of the Arm, Shoulder and Hand
(Quick-DASH) scoring system. Bony union, articular step-off, degenerative changes,
persistent subluxation, or dislocation were confirmed by review of radiographs at
latest follow-up. One patient developed a superficial infection and another developed
complex regional pain syndrome. However, all patients were pain free at final follow-up.
Radiographs at final follow-up confirmed bony union with no step-off, except for one
patient who had a 1-mm step-off of the articular surface. Our attractive and novel
technique of ORIF allows articular congruity to be restored anatomically with early
active mobilization of the affected digit and early return to function.
Keywords
fracture - dislocation - proximal interphalangeal joint - internal fixation - buttress
