Singh Talvinder, Jayawardhana Roshenka, Craigen Michael, Rajaratnam Vaikunthan
Department of Trauma and Orthopaedics, Queen Elizabeth Hospital, Birmingham, United Kingdom.
Department of Orthopaedics, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia.
J Hand Microsurg. 2019 Aug;11(2):106-110. doi: 10.1055/s-0038-1677319. Epub 2019 Feb 1.
The authors present a series of 11 patients. All of them sustained an unstable dorsal fracture-dislocation of the proximal interphalangeal joint (PIPJ). These were managed with open reduction and internal fixation (ORIF) by use of an eight-hole, 1.3-mm oblique-angled strut plate, cut to shape to produce a four-hole plate, acting as a buttress plate. The operations were performed by orthopaedic surgeons with a special interest in hand surgery. Range of motion (ROM) and fixed flexion deformity (FFD) were measured postoperatively. Outcomes were assessed using the Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) scoring system. Bony union, articular step-off, degenerative changes, persistent subluxation, or dislocation were confirmed by review of radiographs at latest follow-up. One patient developed a superficial infection and another developed complex regional pain syndrome. However, all patients were pain free at final follow-up. Radiographs at final follow-up confirmed bony union with no step-off, except for one patient who had a 1-mm step-off of the articular surface. Our attractive and novel technique of ORIF allows articular congruity to be restored anatomically with early active mobilization of the affected digit and early return to function.
作者介绍了11例患者。他们均患有近端指间关节（PIPJ）不稳定的背侧骨折脱位。采用八孔、1.3毫米斜角支撑钢板进行切开复位内固定（ORIF）治疗，将其裁剪成四孔钢板作为支撑钢板。手术由对手外科有特殊兴趣的骨科医生进行。术后测量活动范围（ROM）和固定性屈曲畸形（FFD）。使用手臂、肩部和手部快速残疾评定量表（Quick-DASH）评分系统评估结果。通过最新随访时的X线片复查确认骨愈合、关节台阶、退变改变、持续性半脱位或脱位情况。一名患者发生浅表感染，另一名患者出现复杂性区域疼痛综合征。然而，所有患者在最终随访时均无疼痛。最终随访时的X线片证实除一名关节面有1毫米台阶的患者外，其余患者均实现骨愈合且无台阶。我们引人关注且新颖的切开复位内固定技术能够在解剖学上恢复关节一致性，使患指早期积极活动并早日恢复功能。
