Hamilton Stephen C, Stern Peter J, Fassler Paul R, Kiefhaber Thomas R
Department of Orthopaedic Surgery, University of Cincinnati, OH 45219, USA.
J Hand Surg Am. 2006 Oct;31(8):1349-54. doi: 10.1016/j.jhsa.2006.07.011.
Surgical intervention may be necessary to treat unstable dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint of the hand. One method of stabilization is open reduction and internal fixation (ORIF). The purpose of this study was to assess the outcomes of ORIF for unstable dorsal fracture-dislocations of the PIP joint using mini-screws via a volar approach.
A retrospective chart review with clinical follow-up evaluation was performed on 9 patients who had ORIF for unstable dorsal fracture-dislocations of the PIP joint. The fracture fragment(s) from the middle phalangeal base were reduced and secured using mini-screws.
A clinical evaluation was performed at an average of 42 months after surgery. The average arc of motion for the involved PIP joint was 70 degrees (range, 55 degrees -90 degrees ). The average PIP joint motion in the 2 patients with 1 fracture fragment was 85 degrees , and the average PIP joint motion for the remaining 7 patients was 65 degrees . One joint was subluxated with an intra-articular screw. Nine patients had an average flexion contracture of 14 degrees . Seven patients had no pain, and 2 had pain only with heavy activity.
Open reduction and internal fixation of unstable dorsal PIP joint fracture-dislocations using mini-screws can be considered if the fracture fragment(s) can accommodate the screws. The procedure attempts to restore the concave contour of the middle phalangeal base and permits early protected range of motion. The procedure should be approached cautiously, especially in the presence of comminution. Proximal interphalangeal joint range of motion is usually compromised; 8 of our 9 joints had a residual flexion contracture.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
手部近端指间（PIP）关节不稳定背侧骨折脱位可能需要手术干预。一种稳定方法是切开复位内固定（ORIF）。本研究的目的是评估采用掌侧入路使用微型螺钉对PIP关节不稳定背侧骨折脱位进行ORIF的疗效。
对9例行PIP关节不稳定背侧骨折脱位ORIF的患者进行回顾性病历审查及临床随访评估。使用微型螺钉对中节指骨基底的骨折块进行复位和固定。
术后平均42个月进行临床评估。患侧PIP关节的平均活动弧度为70度（范围为55度至90度）。2例有1个骨折块的患者PIP关节平均活动度为85度，其余7例患者PIP关节平均活动度为65度。1个关节因关节内螺钉出现半脱位。9例患者平均屈曲挛缩14度。7例患者无疼痛，2例仅在剧烈活动时疼痛。
如果骨折块能够容纳螺钉，可以考虑采用微型螺钉对不稳定的PIP关节背侧骨折脱位进行切开复位内固定。该手术试图恢复中节指骨基底的凹面轮廓，并允许早期进行保护性活动范围训练。该手术应谨慎操作，尤其是在存在粉碎性骨折的情况下。近端指间关节活动范围通常会受到影响；我们9个关节中有8个存在残余屈曲挛缩。
研究类型/证据水平：治疗性IV级。
