Oflazoglu Kamilcan, Wilkens Suzanne C, Rakhorst Hinne, Eberlin Kyle R, Ring David, Chen Neal C
Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands.
Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States.
J Hand Microsurg. 2020 Apr;12(1):32-36. doi: 10.1055/s-0039-1697063. Epub 2019 Nov 2.
This study was designed to assess factors associated with postoperative dorsal proximal interphalangeal (PIP) joint subluxation after operative treatment of volar base middle phalanx fractures. Our second purpose was to study the association between postoperative dorsal subluxation with postoperative arthritis. We identified 44 surgically treated volar base PIP joint fractures with available pre- and postoperative radiographs between 2002 and 2015 at two academic medical systems with a median follow-up of 3.5 months. Demographic, injury, radiographic, and treatment data that might be associated with postoperative dorsal subluxation were collected. Three hand surgeons independently assessed subluxation and arthritis on radiographs. Bivariate analysis was performed to analyze our two study purposes. Six of 44 (14%) had postoperative dorsal subluxation after initial surgery. Bivariate analysis showed no factors with statistically significant association with postoperative subluxation, assessed independently by three hand surgeons on radiographs. Fifty per cent of the joints with postoperative arthritis had postoperative subluxation compared with 21% of joints without postoperative subluxation. No significant association was found between postoperative dorsal subluxation with postoperative arthritis. The association of persistent subluxation and early arthrosis in dorsal PIP joint fracture dislocations needs further study. At this time, it is unclear in what ways persistent subluxation or arthrosis affects the rate of reoperation. This is a therapeutic level IV study.
本研究旨在评估掌侧中节指骨骨折手术治疗后，与术后近侧指间关节（PIP）背侧半脱位相关的因素。我们的第二个目的是研究术后背侧半脱位与术后关节炎之间的关联。
我们在两个学术医疗系统中，确定了44例在2002年至2015年间接受手术治疗的掌侧PIP关节骨折患者，这些患者有术前和术后的X线片，中位随访时间为3.5个月。收集了可能与术后背侧半脱位相关的人口统计学、损伤、影像学和治疗数据。三位手外科医生独立评估X线片上的半脱位和关节炎情况。进行双变量分析以分析我们的两个研究目的。
44例患者中有6例（14%）在初次手术后出现术后背侧半脱位。双变量分析显示，三位手外科医生在X线片上独立评估时，没有发现与术后半脱位有统计学显著关联的因素。术后有关节炎的关节中，50%出现了术后半脱位，而无术后半脱位的关节中这一比例为21%。未发现术后背侧半脱位与术后关节炎之间存在显著关联。
PIP关节背侧骨折脱位中持续性半脱位与早期关节病之间的关联需要进一步研究。目前尚不清楚持续性半脱位或关节病以何种方式影响再次手术率。
这是一项治疗性IV级研究。
