Borgohain Bhaskar, Borgohain Nitu, Tittal Praveen
Department of Orthopaedics and Trauma, North-Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
Indian J Orthop. 2012 Nov;46(6):680-4. doi: 10.4103/0019-5413.104213.
Treatment of complex injuries of interphalangeal joints (IPJs) is difficult. The restoration of joint stability for early joint mobility till fracture union is the key for successful outcome. Although various treatment options like dynamic splinting, external fixator, closed reduction, transarticular Kirschner (K)-wire and ORIF, etc., are available in literature, a universally accepted ideal treatment for complex intraarticular fractures of IPJs is still evolving. Open reduction is difficult because fixation of volar fragment is often impractical and radical procedures like volar plate arthroplasty, arthrodesis or joint replacement, etc., may become mandatory for salvage. We describe percutaneous technique to treat unstable fractures and dorsal fracture-dislocations of the PIP joint and report short-term postoperative results.
Ten cases of unstable or potentially unstable intraarticular fractures including pilon fractures and fracture-dislocations of IP joints were treated percutaneously by double parabolic K-wire technique (DPK). The device was used as a dynamic distraction, using the principle of ligamentotaxis. The idea was to commence early postoperative continuous active and active-assisted joint motion exercises and to carry on the frame as a definitive treatment for achieving fracture union.
In all patients of fracture-dislocation the reduction was satisfactory and early mobility was achieved. Although there is a tendency towards over-distraction, no loss of reduction occurred. Pin tract infection occurred in one with no delayed union or nonunion. The average total range of motion for each involved IP joint was 93.5 degree and the average total active range of motion was 90.8° each at the end of 4 months followup. Excellent to good results were restored in nearly all cases without further interventions.
DPK technique may be a cheap and valuable definitive treatment option in the management of unstable or potentially unstable intraarticular fractures of IPJs. The technique gave satisfactory radiological union and functional outcome in our small series. This technique may be worth considering in unstable or potentially unstable intraarticular fractures of IPJs with intact collateral ligaments and when other treatment options are impractical.
指间关节（IPJ）复杂损伤的治疗颇具难度。恢复关节稳定性以实现早期关节活动直至骨折愈合是取得成功治疗结果的关键。尽管文献中介绍了多种治疗方法，如动力性夹板固定、外固定器、闭合复位、经关节克氏针（K 针）及切开复位内固定（ORIF）等，但对于 IPJ 复杂关节内骨折，一种普遍认可的理想治疗方法仍在不断发展。切开复位困难，因为掌侧骨折块的固定往往不切实际，而诸如掌板成形术、关节融合术或关节置换术等根治性手术可能成为挽救治疗的必要手段。我们描述了一种经皮技术来治疗近端指间关节（PIP）不稳定骨折及背侧骨折脱位，并报告术后短期结果。
采用双抛物线克氏针技术（DPK）经皮治疗 10 例不稳定或潜在不稳定的关节内骨折，包括 Pilon 骨折和 IP 关节骨折脱位。该装置利用韧带牵引原理作为动力性牵引。其理念是术后早期开始持续主动和主动辅助关节活动锻炼，并保留该外固定架作为实现骨折愈合的确定性治疗方法。
所有骨折脱位患者复位均满意且实现了早期活动。尽管存在过度牵引的趋势，但未发生复位丢失。1 例发生针道感染，无延迟愈合或不愈合情况。随访 4 个月时，每个受累 IP 关节的平均总活动范围为 93.5°，平均总主动活动范围为 90.8°。几乎所有病例均获得了优至良的结果，无需进一步干预。
DPK 技术可能是治疗 IPJ 不稳定或潜在不稳定关节内骨折的一种廉价且有价值的确定性治疗选择。在我们的小样本研究中，该技术取得了令人满意的影像学愈合和功能结果。对于侧副韧带完整且其他治疗方法不切实际的 IPJ 不稳定或潜在不稳定关节内骨折，该技术可能值得考虑。
