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J Hand Microsurg 2020; 12(01): 32-36
DOI: 10.1055/s-0039-1697063
Original Article

Postoperative Dorsal Proximal Interphalangeal Joint Subluxation in Volar Base Middle Phalanx Fractures

Kamilcan Oflazoglu
1   Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
,
Suzanne C. Wilkens
2   Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Hinne Rakhorst
1   Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
,
Kyle R. Eberlin
2   Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
David Ring
3   Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas, United States
,
Neal C. Chen
2   Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Abstract

Introduction This study was designed to assess factors associated with postoperative dorsal proximal interphalangeal (PIP) joint subluxation after operative treatment of volar base middle phalanx fractures. Our second purpose was to study the association between postoperative dorsal subluxation with postoperative arthritis.

Materials and Methods We identified 44 surgically treated volar base PIP joint fractures with available pre- and postoperative radiographs between 2002 and 2015 at two academic medical systems with a median follow-up of 3.5 months. Demographic, injury, radiographic, and treatment data that might be associated with postoperative dorsal subluxation were collected. Three hand surgeons independently assessed subluxation and arthritis on radiographs. Bivariate analysis was performed to analyze our two study purposes.

Results Six of 44 (14%) had postoperative dorsal subluxation after initial surgery. Bivariate analysis showed no factors with statistically significant association with postoperative subluxation, assessed independently by three hand surgeons on radiographs. Fifty per cent of the joints with postoperative arthritis had postoperative subluxation compared with 21% of joints without postoperative subluxation. No significant association was found between postoperative dorsal subluxation with postoperative arthritis.

Conclusion The association of persistent subluxation and early arthrosis in dorsal PIP joint fracture dislocations needs further study. At this time, it is unclear in what ways persistent subluxation or arthrosis affects the rate of reoperation.

Level of Evidence This is a therapeutic level IV study.

Keywords

PIP joint - fracture - postoperative subluxation

Supplementary Apendix



Publication History

Received: 05 May 2019

Accepted after revision: 09 July 2019

Article published online:
02 November 2019

© .

Thieme Medical and Scientific Publishers Private Ltd.
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  • References

  • 1 Hastings II H, Carroll IV C. Treatment of closed articular fractures of the metacarpophalangeal and proximal interphalangeal joints. Hand Clin 1988; 4 (03) 503-527
    CrossrefPubMedGoogle Scholar
  • 2 Kiefhaber TR, Stern PJ. Fracture dislocations of the proximal interphalangeal joint. J Hand Surg Am 1998; 23 (03) 368-380
    CrossrefPubMedGoogle Scholar
  • 3 Deitch MA, Kiefhaber TR, Comisar BR, Stern PJ. Dorsal fracture dislocations of the proximal interphalangeal joint: surgical complications and long-term results. J Hand Surg Am 1999; 24 (05) 914-923
    CrossrefPubMedGoogle Scholar
  • 4 Waris E, Mattila S, Sillat T, Karjalainen T. Extension block pinning for unstable proximal interphalangeal joint dorsal fracture dislocations. J Hand Surg Am 2016; 41 (02) 196-202
    CrossrefPubMedGoogle Scholar
  • 5 Eaton RG, Malerich MM. Volar plate arthroplasty of the proximal interphalangeal joint: a review of ten years’ experience. J Hand Surg Am 1980; 5 (03) 260-268
    CrossrefPubMedGoogle Scholar
  • 6 Moradi A, Braun Y, Oflazoglu K, Meijs T, Ring D, Chen N. Factors associated with subluxation in mallet fracture. J Hand Surg Eur Vol 2017; 42 (02) 176-181
    CrossrefPubMedGoogle Scholar
  • 7 Aladin A, Davis TR. 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; 30 (02) 120-128
    PubMedGoogle Scholar
  • 8 Williams RM, Kiefhaber TR, Sommerkamp TG, Stern PJ. Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft. J Hand Surg Am 2003; 28 (05) 856-865
    CrossrefPubMedGoogle Scholar
  • 9 Lee JY, Teoh LC. Dorsal fracture dislocations of the proximal interphalangeal joint treated by open reduction and interfragmentary screw fixation: indications, approaches and results. J Hand Surg [Br] 2006; 31 (02) 138-146
    CrossrefPubMedGoogle Scholar
  • 10 Ostrum RF. Orthopaedic trauma mythbusters: intra-articular fractures. Instr Course Lect 2013; 62: 29-33
    PubMedGoogle Scholar
  • 11 Bai B, Kummer FJ, Sala DA, Koval KJ, Wolinsky PR. Effect of articular step-off and meniscectomy on joint alignment and contact pressures for fractures of the lateral tibial plateau. J Orthop Trauma 2001; 15 (02) 101-106
    CrossrefPubMedGoogle Scholar
  • 12 Lefkoe TP, Trafton PG, Ehrlich MG. et al. An experimental model of femoral condylar defect leading to osteoarthrosis. J Orthop Trauma 1993; 7 (05) 458-467
    CrossrefPubMedGoogle Scholar
  • 13 Lovász G, Park SH, Ebramzadeh E. et al. Characteristics of degeneration in an unstable knee with a coronal surface step-off. J Bone Joint Surg Br 2001; 83 (03) 428-436
    PubMedGoogle Scholar
  • 14 Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 1996; 78 (11) 1632-1645
    CrossrefPubMedGoogle Scholar
  • 15 Malkani AL, Voor MJ, Rennirt G, Helfet D, Pedersen D, Brown T. Increased peak contact stress after incongruent reduction of transverse acetabular fractures: a cadaveric model. J Trauma 2001; 51 (04) 704-709
    CrossrefPubMedGoogle Scholar
  • 16 Ellis SJ, Cheng R, Prokopis P. et al. Treatment of proximal interphalangeal dorsal fracture-dislocation injuries with dynamic external fixation: a pins and rubber band system. J Hand Surg Am 2007; 32 (08) 1242-1250
    CrossrefPubMedGoogle Scholar