Haase Steven C, Chung Kevin C
Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System.
Plast Reconstr Surg. 2014 Dec;134(6):1246-1257. doi: 10.1097/PRS.0000000000000854.
Proximal interphalangeal joint fracture-dislocations are common injuries that require expedient and attentive treatment for the best outcomes. Management can range from protective splinting and early mobilization to complex surgery. In this review, the current concepts surrounding the management of these injuries are reviewed.
A literature review was performed of all recent articles pertaining to proximal interphalangeal joint fracture-dislocation, with specific focus on middle phalangeal base fractures. Where appropriate, older articles or articles on closely related injury types were included for completeness. The methodology and outcomes of each study were analyzed.
When small avulsion fractures are present, good results are routinely obtained with reduction and early mobilization of stable injuries. Strategies for management of the unstable dorsal fracture-dislocation have evolved over time. To provide early stability, a variety of techniques have evolved, including closed, percutaneous, external, and internal fixation methods. Although each of these techniques can be successful in skilled hands, none has been subjected to rigorous, prospective, comparative trials. Volar dislocations fare less well, with significant loss of motion in many studies. Pilon fractures represent the most complicated injuries, and return of normal motion is not expected.
The best outcomes can be achieved by (1) establishing enough stability to allow early motion, (2) restoring gliding joint motion rather than noncongruent motion, and (3) restoring the articular surface congruity when possible. Although the majority of literature on this topic consists of expert opinion and retrospective case series, the consensus appears to favor less invasive techniques whenever possible.
近端指间关节骨折脱位是常见损伤，需要及时且精心的治疗以获得最佳疗效。治疗方法从保护性夹板固定和早期活动到复杂手术不等。在本综述中，对围绕这些损伤治疗的当前概念进行了回顾。
对所有近期有关近端指间关节骨折脱位的文章进行了文献综述，特别关注中节指骨基底骨折。在适当情况下，纳入了更早期的文章或关于密切相关损伤类型的文章以保证完整性。分析了每项研究的方法和结果。
当存在小的撕脱骨折时，通过对稳定损伤进行复位和早期活动通常可获得良好结果。不稳定背侧骨折脱位的治疗策略随时间不断演变。为提供早期稳定性，已发展出多种技术，包括闭合、经皮、外固定和内固定方法。尽管这些技术在技术熟练者手中均可成功，但均未进行严格的前瞻性对照试验。掌侧脱位的预后较差，在许多研究中活动度明显丧失。Pilon骨折是最复杂的损伤，预期无法恢复正常活动。
通过以下方式可获得最佳疗效：（1）建立足够的稳定性以允许早期活动；（2）恢复关节滑动活动而非不匹配的活动；（3）尽可能恢复关节面的一致性。尽管关于该主题的大多数文献由专家意见和回顾性病例系列组成，但共识似乎是尽可能倾向于采用侵入性较小的技术。
