Nishimura Ken, Kobayashi Koichi, Fukasawa Katsuyasu, Masuyama Naoko
Department of Orthopaedic Surgery, Kanto Rosai Hospital, Kanagawa, Japan.
J Hand Surg Glob Online. 2023 Oct 28;6(1):68-73. doi: 10.1016/j.jhsg.2023.09.005. eCollection 2024 Jan.
This study aimed to evaluate an adjustable traction method using surgical gloves and Kirschner wires (K-wires) for proximal interphalangeal (PIP) fracture dislocations and examine the association between a reduction pin and range of motion (ROM), and between subluxation immediately after removal and ROM.
Patients who underwent this surgical method for PIP joint dislocation fractures between 2003 and 2017 were included. We retrospectively investigated the postoperative results. We defined patients having surgery within 4 weeks after an injury as fresh cases and after 4 weeks as chronic cases. K-wires were inserted at the center of the proximal phalangeal head and the distal part of the middle phalanx to create a frame, and the finger of the surgical glove was used as a traction-force generator. We analyzed the association of ROM with each finger, age, presence of a reduction pin, and subluxation immediately after frame removal.
Overall, 37 fingers were included (27 acute and 10 chronic). The mean age of the participants was 40.0 years (range: 13-72 years). The mean follow-up period was 10.5 months (3-47 months). The final active ROM was -4.6°/94.6° (extension/flexion) for acute cases and -27.0°/73.5° for chronic ones. Active ROM was significantly better in patients with a reduction pin than in those without it. Subluxation immediately after frame removal was not associated with postoperative active ROM. Additionally, all PIP joints with subluxation that occurred immediately after frame removal achieved good joint congruity.
The results of the adjustable traction method using surgical gloves and K-wires were satisfactory. Postoperative ROM did not decrease because of the additional reduction pin. Subluxation occurring immediately after frame removal did not affect the ROM, ultimately resulting in good joint congruity.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究旨在评估一种使用手术手套和克氏针（K 针）的可调节牵引方法治疗近端指间关节（PIP）骨折脱位，并探讨复位针与活动度（ROM）之间以及去除固定架后即刻半脱位与 ROM 之间的关联。
纳入 2003 年至 2017 年间接受该手术方法治疗 PIP 关节脱位骨折的患者。我们回顾性研究术后结果。将伤后 4 周内接受手术的患者定义为新鲜病例，伤后 4 周后接受手术的患者定义为慢性病例。在近节指骨头中心和中节指骨远端插入 K 针以形成一个框架，手术手套的手指用作牵引力发生器。我们分析了 ROM 与每个手指、年龄、复位针的存在以及去除固定架后即刻半脱位之间的关联。
总共纳入 37 个手指（27 个急性和 10 个慢性）。参与者的平均年龄为 40.0 岁（范围：13 - 72 岁）。平均随访期为 10.5 个月（3 - 47 个月）。急性病例的最终主动 ROM 为 -4.6°/94.6°（伸展/屈曲），慢性病例为 -27.0°/73.5°。有复位针的患者的主动 ROM 明显优于没有复位针的患者。去除固定架后即刻半脱位与术后主动 ROM 无关。此外，所有去除固定架后即刻出现半脱位的 PIP 关节均实现了良好的关节对合。
使用手术手套和 K 针的可调节牵引方法的结果令人满意。术后 ROM 并未因额外的复位针而降低。去除固定架后即刻出现的半脱位并未影响 ROM，最终导致良好的关节对合。
研究类型/证据水平：治疗性四级。
