Kapur Benjamin, Paniker Jayanath, Casaletto John
Wirral University Teaching Hospital NHS Trust, Wirral, Merseyside, United Kingdom.
Tech Hand Up Extrem Surg. 2015 Dec;19(4):163-7. doi: 10.1097/BTH.0000000000000102.
Intra-articular fractures of the proximal interphalangeal (PIP) joint are commonly treated with dynamic external fixation. Most commonly used is the Suzuki modification of the pins and rubber traction system (PRTS). There are a few other modifications of the PRTS external fixators. We present an alternative pin external fixator that is simple and effective.
Under a suitable anesthesia and image intensification a true lateral view of the head of the proximal phalanx is obtained. A K-wire construct holds the affected digit out to length with the fracture reduced and Jurgan pin-balls hold the construct into position. Under image intensification the whole device is checked to ensure the joint and fracture is reduced and the joint is not over distracted. The PIP joint is also checked to ensure good range of motion. The device was checked in clinic at 1 week with radiographs. The wires are removed at 4 weeks followed by intensive hand physiotherapy.
Over 20 patients with intra-articular fractures of the proximal and middle phalangeal were treated with this technique. In all cases the fracture healed with good joint congruency. All patients achieved good range of motion of the PIP joint but with some restriction of full flexion (mean, 20 degrees). There was no loss of position or pin-site infections. There was good compliance with the treatment.
The main advantages of the technique we describe are: (1) the compact design, making it less cumbersome for the patient compared with other PRTS external fixators; (2) it is straightforward to assemble and the device is easy to adjust in clinic if there is any loss of reduction; (3) the pin-balls prevent sharp ends of the wire protruding causing morbidity to the patient; (4) there is less chance of loss of traction compared with traction devices using rubber bands. It is a dynamic device, which allows mobilization of the joints reducing stiffness.
近端指间关节（PIP）的关节内骨折通常采用动力外固定治疗。最常用的是铃木改良的针与橡胶牵引系统（PRTS）。PRTS外固定器还有其他一些改良方法。我们介绍一种简单有效的替代针式外固定器。
在合适的麻醉和影像增强设备辅助下，获取近端指骨头的真实侧位视图。用一根克氏针结构在骨折复位后将患指维持在正常长度，尤尔根针球将该结构固定到位置。在影像增强设备辅助下检查整个装置，确保关节和骨折复位，且关节不过度牵引。还要检查PIP关节，确保其活动范围良好。术后1周时在门诊通过X线片检查该装置情况。4周时拆除钢丝，随后进行强化手部物理治疗护理。
超过20例近端和中节指骨的关节内骨折患者接受了该技术治疗。所有病例骨折均愈合，关节对位良好。所有患者PIP关节均获得良好的活动范围，但完全屈曲有一定受限（平均20度）。未出现位置丢失或针道感染情况。患者对治疗的依从性良好。
我们所描述技术的主要优点有：（1）设计紧凑，与其他PRTS外固定器相比，对患者来说不那么笨重；（2）组装简单，如果出现复位丢失，该装置在门诊易于调整；（3）针球可防止钢丝尖锐端突出对患者造成伤害；（4）与使用橡皮筋的牵引装置相比，牵引丢失的可能性较小。这是一种动力装置，可使关节活动，减少僵硬。
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