Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
Department of Orthopedics and Traumatology, Kantonsspital Baselland, Liestal, Switzerland.
Arch Orthop Trauma Surg. 2020 Jan;140(1):43-50. doi: 10.1007/s00402-019-03275-8. Epub 2019 Sep 5.
Several methods treating proximal interphalangeal joint (PIP) fracture dislocations have been established providing early joint mobilization. The aim of this study was to evaluate the clinical and radiological outcome of unstable fracture dislocations of the PIP treated with a parabolic dynamic external fixator consisting of two Kirschner (K)-wires.
Twenty-one patients who sustained a pilonoidal fracture of the PIP joint and were treated with a dynamic external fixator were evaluated retrospectively. The active range of motion, pain level, DASH score, Buck Gramcko Score, and the patient's satisfaction and acceptance were assessed. X-ray images were evaluated for bone healing, joint alignment, and signs of osteoarthritis.
Mean PIP joint range of motion was 76°. Patients showed very mild discomfort (mean 0.7), high patient satisfaction (mean 1.9), and a moderate acceptance (mean 2.7). The mean DASH score was 11.6 and the Buck Gramcko score 13. All patients showed bone healing. One patient suffered from a recurrent dislocation, and another a subluxation of the PIP joint while wearing the fixator. Both joints could be corrected by modifying the fixator under image intensifier. Twenty patients (95%) showed a concentric and stable aligned joint. Three patients showed an osteoarthritis stage 0, five stage 1, nine stage 2, three stage 3, and one stage 4 according to the Kellgran-Lawrence Score.
The use of a parabolic dynamic external fixator constructed from two K-wires restores joint alignment and stability in unstable pilonoidal PIP joint disclocation fractures. It allows immediate PIP joint mobilization to avoid adhesions. Modifications of the radius of the parabolic construct within cases of postoperative malalignment, without anesthesia, can restore joint axis and malalignment. This fixator is a cost-effective alternative, showing a good clinical outcome.
已经建立了几种治疗近节指间关节（PIP）骨折脱位的方法，这些方法可以提供早期关节活动。本研究的目的是评估使用由两根克氏针（K）组成的抛物线式动力外固定器治疗不稳定的 PIP 关节骨折脱位的临床和放射学结果。
回顾性评估了 21 例因 PIP 关节撕脱骨折而接受动态外固定器治疗的患者。评估了主动关节活动度、疼痛程度、DASH 评分、Buck Gramcko 评分以及患者的满意度和接受度。X 射线图像用于评估骨愈合、关节对线和骨关节炎迹象。
PIP 关节的平均活动度为 76°。患者表现出非常轻微的不适（平均 0.7）、高度的患者满意度（平均 1.9）和中等的接受度（平均 2.7）。平均 DASH 评分为 11.6，Buck Gramcko 评分为 13。所有患者均有骨愈合。1 例患者发生复发性脱位，1 例患者在佩戴固定器时发生 PIP 关节半脱位。在影像增强器下修改固定器可纠正这两个关节。20 例（95%）患者关节对线稳定且同心。根据 Kellgran-Lawrence 评分，3 例患者为 0 期骨关节炎，5 例为 1 期，9 例为 2 期，3 例为 3 期，1 例为 4 期。
使用由两根 K 线构成的抛物线式动力外固定器可恢复不稳定的撕脱性 PIP 关节骨折脱位的关节对线和稳定性。它允许立即进行 PIP 关节活动，以避免粘连。在术后对线不良的情况下，无需麻醉即可修改抛物线结构的半径，可恢复关节轴和对线不良。这种固定器具有成本效益，临床效果良好。
