Amsterdam University Medical Center, VU Medical Center, The Netherlands.
Harvard Medical School, Boston, MA, USA.
Hand (N Y). 2022 Jan;17(1):60-67. doi: 10.1177/1558944719895621. Epub 2020 Jan 23.
Treatment decisions regarding volar base fractures of the middle phalanx depend on whether the proximal interphalangeal (PIP) joint is reduced. Our aim was to study the agreement among hand surgeons in determining whether the PIP joint fractures are subluxated and to study the factors associated with subluxation of these fractures. In this retrospective chart review, 413 volar base fractures of the middle phalanx were included. Demographic and injury-related factors were gathered from medical records and radiographs. Using a Web-based survey, interobserver agreement was determined among 105 hand surgeons on the assessment of PIP joint subluxation of a series of 26 cases. Using the cohort of 413 fractures, a threshold for percent articular involvement and relative fracture displacement that corresponds with subluxation of the PIP joint was analyzed. We found moderate to substantial agreement between hand surgeons on subluxation (κ = 0.59, < .0001) and an overall percent agreement of 85%. Percent articular involvement and relative fracture displacement were independently associated with subluxation of the PIP joint ( < .001). Percent articular involvement of 35% had a specificity of 90% and a negative predicting value (NPV) of 92% for joint subluxation. Relative fracture displacement of 35% had a specificity of 92% and an NPV of 94% for joint subluxation. Surgeons generally agree on whether a PIP joint is subluxated. Percent articular involvement and relative fragment displacement are objective measurements that can help characterize joint stability and assist with decision-making.
治疗掌侧基底中节指骨骨折取决于近节指间关节（PIP）是否复位。我们的目的是研究手外科医生在确定 PIP 关节骨折是否半脱位方面的一致性，并研究与这些骨折半脱位相关的因素。在这项回顾性图表研究中，纳入了 413 例掌侧基底中节指骨骨折。从病历和 X 线片中收集了人口统计学和损伤相关因素。通过基于网络的调查，105 名手外科医生对 26 例病例系列的 PIP 关节半脱位评估进行了观察者间一致性的测定。使用 413 例骨折队列，分析了与 PIP 关节半脱位相对应的关节受累百分比和相对骨折移位的阈值。我们发现手外科医生对半脱位的判断具有中等至较大的一致性（κ=0.59， <.0001），总体一致性为 85%。关节受累百分比和相对骨折移位与 PIP 关节半脱位独立相关（ <.001）。关节受累百分比为 35%时，关节半脱位的特异性为 90%，阴性预测值（NPV）为 92%。相对骨折移位为 35%时，关节半脱位的特异性为 92%，NPV 为 94%。外科医生通常对 PIP 关节是否半脱位达成一致。关节受累百分比和相对骨折移位是客观测量指标，可以帮助确定关节稳定性并协助决策。
