Doering Travis A, Greenberg Andrew S, Tuckman David V
Northwell Health, New Hyde Park, NY, USA.
Orthopaedic Associates of Manhasset, Great Neck, NY, USA.
Hand (N Y). 2019 Sep;14(5):620-625. doi: 10.1177/1558944718777868. Epub 2018 May 23.
Intra-articular middle phalangeal base fractures with volar instability are rare injuries with scant literature on optimal management. Our purpose is to describe our method of dorsal plating and report postoperative outcomes. This study is a retrospective case review of 5 patients with intra-articular middle phalangeal base fractures with volar proximal interphalangeal joint instability, measuring subjective, clinical, and radiographic outcomes. Patient age averaged 38.2 years (range, 23-56 years), and 80% were male. Sporting injuries were the most common mechanism (80%). Time to surgery averaged 7 days, and postoperative follow-up duration averaged 19.6 months (median 8 months). All fractures were intra-articular at the proximal interphalangeal joint with volar instability. There were no complications and no patients required secondary surgery. Grip strength was maintained and range of motion was good, based on the American Society for Surgery of the Hand Total Active Motion score. Average Quick Disability of the Arm, Shoulder and Hand was 0.5 (range, 0-2.3), 100% of patients were satisfied, and average visual analog pain score was 1.2. Patients returned to work at a median of 4 days. There was radiographic union at an average of 6.6 weeks (range, 6-7 weeks) in all fractures. Dorsal plating using a 1.5-mm modular hand plate is a viable option for rigid fixation of intra-articular middle phalangeal base fractures with volar instability. This fixation method allows for early range of motion without complications in this case series. All fractures united, and patients had minimal functional deficits and were able to maintain good range of motion.
掌侧不稳定的关节内中节指骨基底骨折是一种罕见损伤，关于其最佳治疗方法的文献较少。我们的目的是描述我们的背侧钢板固定方法并报告术后结果。本研究是一项对5例关节内中节指骨基底骨折伴掌侧近端指间关节不稳定患者的回顾性病例分析，评估主观、临床和影像学结果。患者平均年龄38.2岁（范围23 - 56岁），80%为男性。运动损伤是最常见的致伤机制（80%）。手术平均时间为7天，术后随访时间平均为19.6个月（中位数8个月）。所有骨折均为近端指间关节的关节内骨折且伴有掌侧不稳定。无并发症发生，也无患者需要二次手术。根据美国手外科协会的总主动活动评分，握力得以维持，活动范围良好。手臂、肩部和手部的平均快速残疾评分为0.5（范围0 - 2.3），100%的患者感到满意，平均视觉模拟疼痛评分为1.2。患者平均在4天内恢复工作。所有骨折平均在6.6周（范围6 - 7周）时达到影像学愈合。使用1.5毫米模块化手板进行背侧钢板固定是治疗掌侧不稳定的关节内中节指骨基底骨折的一种可行的坚强固定选择。在本病例系列中，这种固定方法允许早期进行活动且无并发症。所有骨折均愈合，患者功能缺陷最小，能够保持良好的活动范围。
