Nilsson Jessica A, Rosberg Hans-Eric
Department of Hand Surgery, Skåne University Hospital, Department of Clinical Sciences Malmö - Hand Surgery, Lund University , Malmö , Sweden.
J Plast Surg Hand Surg. 2014 Aug;48(4):259-64. doi: 10.3109/2000656X.2013.870909. Epub 2013 Dec 16.
A fracture of the proximal interphalangeal (PIP) joint at the base of the middle phalanx is rare, but is a challenge to treat. Posttraumatic osteoarthritis is a known complication causing impaired hand function and disability. The aim of the present retrospective study was to evaluate characteristics and outcome of complex PIP joint fractures treated by the pins and rubbers traction system (PRTS). Medical records of 42 patients with fractures treated with a PRTS in 1999-2010 were reviewed, and followed-up by questionnaires (QuickDASH, CISS, self-composed questionnaire). Eighteen of the 42 were clinically examined. The fractures were divided into three types of fractures: volar lip, dorsal lip, and pilon fractures. The volar lip fracture was most frequent (26/42; dorsal lip 3/42; pilon 13/42). Most fractures were sport-related (19/42; 45%) and males predominated (M:F ratio = 1.8). All fractures united. Infection occurred in 17/41 (41%) cases. Radiological signs of posttraumatic osteoarthritis were found in 25/41 (61%) patients. In 18/42 patients, where a clinical evaluation was performed, 66% of contralateral total active range of motion (TAM), 93% grip strength, and 100% pinch strength were achieved. The volar lip fracture had the best outcome according to the self-reported QuickDASH and CISS score and regained 77% of contralateral TAM. Fractures of the PIP joint in the middle phalanx can be treated with the PRTS, but reduced mobility, grip strength, infection, and osteoarthritis are seen. The device is well tolerated by the patients, easy to apply, and with ready accessible materials for the surgeon.
中节指骨近端指间（PIP）关节基底骨折较为罕见，但治疗颇具挑战性。创伤后骨关节炎是一种已知的并发症，可导致手部功能受损和残疾。本回顾性研究的目的是评估采用钢针与橡胶牵引系统（PRTS）治疗的复杂PIP关节骨折的特点及疗效。回顾了1999年至2010年采用PRTS治疗骨折的42例患者的病历，并通过问卷调查（QuickDASH、CISS、自编问卷）进行随访。42例患者中有18例接受了临床检查。骨折分为三种类型：掌侧唇骨折、背侧唇骨折和pilon骨折。掌侧唇骨折最为常见（26/42；背侧唇骨折3/42；pilon骨折13/42）。大多数骨折与运动相关（19/42；45%），男性居多（男:女比例 = 1.8）。所有骨折均愈合。17/41（41%）例发生感染。25/41（61%）例患者出现创伤后骨关节炎的放射学征象。在接受临床评估的18/42例患者中，对侧总主动活动范围（TAM）达到66%，握力达到93%，捏力达到100%。根据自我报告的QuickDASH和CISS评分，掌侧唇骨折预后最佳，对侧TAM恢复了77%。中节指骨PIP关节骨折可用PRTS治疗，但会出现活动度降低、握力下降、感染和骨关节炎等情况。该装置患者耐受性良好，易于应用，且外科医生所需材料易于获取。
