Department of Orthopaedic Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
Daegu Park's Hospital, Daegu, Korea.
Clin Orthop Surg. 2019 Jun;11(2):220-225. doi: 10.4055/cios.2019.11.2.220. Epub 2019 May 9.
Fracture-dislocation of the proximal interphalangeal (PIP) joint of the finger is challenging due to the high risk of stiffness. The purpose of this study is to evaluate the clinical and radiological results of a modified transosseous wiring technique for the management of chronic fracture-dislocations of the PIP joint.
Ten patients (nine men and one woman; mean age, 38.3 years; range, 21 to 69 years) with neglected fracture-dislocation of the PIP joint were included. The mean duration from injury to operation was 14.7 weeks (range, 3 to 66 weeks). The dorsolateral approach and extension block pinning were used to reduce dislocation. After thorough debridement of the scar tissues in the dorsal dead space and the fracture site, the reduction was maintained with transosseous wiring. Radiologic evaluations of bone union and arthritic changes and clinical evaluations (range of motion of the PIP joint and Disabilities of the Arm, Shoulder and Hand [DASH] score) were performed. The mean follow-up period was 12.9 months (range, 12 to 19 months).
All patients demonstrated evidence of radiographic healing within a mean healing time of 6 weeks (range, 4 to 10 weeks); however, one had a widened gap and one had an early arthritic change. The mean range of motion in the PIP joint was 81° (range, 50° to 105°). The mean DASH score was 21.6 (range, 7.5 to 35.8).
For chronic fracture-dislocation of the PIP joint, transosseous wiring with direct curettage and optimal bone purchase can provide satisfying outcome.
手指近节指间关节（PIP）骨折脱位由于僵硬风险高而具有挑战性。本研究旨在评估改良经骨缝线技术治疗慢性 PIP 关节骨折脱位的临床和影像学结果。
纳入 10 例（9 名男性和 1 名女性；平均年龄 38.3 岁；范围 21 至 69 岁）患有慢性 PIP 关节骨折脱位的患者。从受伤到手术的平均时间为 14.7 周（范围 3 至 66 周）。采用背外侧入路和伸展块固定针来复位脱位。在彻底清除背侧死腔和骨折部位的瘢痕组织后，通过经骨缝线维持复位。进行影像学评估（骨愈合和关节炎变化）和临床评估（PIP 关节活动度和上肢功能障碍评分[DASH]）。平均随访时间为 12.9 个月（范围 12 至 19 个月）。
所有患者均在平均 6 周（范围 4 至 10 周）的时间内显示出影像学愈合证据；然而，1 例存在间隙增宽，1 例存在早期关节炎变化。PIP 关节的平均活动度为 81°（范围 50°至 105°）。平均 DASH 评分为 21.6（范围 7.5 至 35.8）。
对于慢性 PIP 关节骨折脱位，经骨缝线直接刮除和最佳骨质固定可提供满意的结果。
