Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea.
Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea.
Clin Orthop Surg. 2020 Sep;12(3):379-385. doi: 10.4055/cios19149. Epub 2020 Jun 3.
Volar plate avulsion fractures of the proximal interphalangeal (PIP) joint are a common hand injury and have been treated conservatively with favorable results. We assumed that conservative treatment of volar plate avulsion fractures of the PIP joint would be unsuccessful if the fracture fragment, even if small, was much displaced or rotated and that delayed excision of the avulsion fractures would result in good outcomes. We report clinical and radiological outcomes of conservative treatment of volar plate avulsion fractures of the PIP joint and risk factors for failure of conservative treatment.
We retrospectively reviewed the clinical and radiological outcomes of 88 volar plate avulsion fractures (85 patients) treated conservatively at first. In 18 of these fractures, delayed excision of the fracture fragment was required after an average of 75 days of conservative treatment for limited motion or pain of the joint. We compared parameters between failed cases and successful cases after conservative treatment.
Compared to the successful cases, the failed cases had a higher prevalence of joint dislocation at the time of injury and greater pain, larger flexion contracture, and less further flexion after conservative treatment. The shape, comminution, and size of the fracture fragments were not related with the need for operation, but the operative cases had greater displacement and rotation of the fracture fragments than the conservative cases. After fragment excision, postoperative protection of the joint was not necessary, pain was reduced, and the mean range of motion increased.
The presence of joint dislocation and greater displacement and rotation of the fragments may be associated with the failure of conservative treatment of volar plate avulsion fractures. Failed cases after conservative treatment could be resolved by delayed fragment excision with favorable results. Therefore, it might be appropriate to consider conservative treatment at first in almost all volar plate avulsion fractures of stable PIP joints.
近节指间关节（PIP）掌侧板撕脱骨折是一种常见的手部损伤，采用保守治疗可获得良好的效果。我们假设，如果骨折块即使很小，但明显移位或旋转，那么保守治疗 PIP 关节掌侧板撕脱骨折将不成功，如果延迟切除撕脱骨折，也会获得良好的结果。我们报告了保守治疗 PIP 关节掌侧板撕脱骨折的临床和影像学结果，以及保守治疗失败的危险因素。
我们回顾性分析了 85 例 88 处（85 例）保守治疗的 PIP 关节掌侧板撕脱骨折患者的临床和影像学结果。其中 18 例因关节活动受限或疼痛，在保守治疗平均 75 天后需要延迟切除骨折块。我们比较了保守治疗后失败和成功病例的参数。
与成功病例相比，失败病例在受伤时关节脱位的发生率更高，疼痛更剧烈，屈曲挛缩更大，保守治疗后进一步屈曲的程度更小。骨折块的形状、粉碎程度和大小与是否需要手术无关，但手术病例的骨折块移位和旋转程度大于保守病例。切除骨折块后，关节无需术后保护，疼痛减轻，平均活动度增加。
关节脱位和骨折块更大的移位和旋转可能与 PIP 关节掌侧板撕脱骨折保守治疗失败有关。经保守治疗失败的病例可通过延迟切除骨折块获得良好的效果。因此，对于稳定的 PIP 关节掌侧板撕脱骨折，几乎所有病例都可以先考虑保守治疗。
